We studied the changes of vertical contact forces, lower limb kinematics, and electromyographic activity (EMG) at different speeds and gravitational loads. To this end healthy subjects were asked to walk on a motorized treadmill while the percentage of body weight unloaded (body weight support, BWS) was modified in steps by means of a well-characterized unloading system. BWS was set at 0, 35, 50, 75, 95, or 100% of body weight. Walking speed was 0.7, 1.1, 2, 3, or 5 km/h. We found that changing BWS between 0 and 95% resulted in drastic changes of kinetic parameters but in limited changes of the kinematic coordination. In particular, the peak vertical contact forces decreased proportionally to BWS; at 95%-BWS they were 20-fold smaller than at 0% and were applied at the forefoot only. Also, there were considerable changes of the amplitude of EMG activity of all tested lower limb muscles and a complex re-organization of the pattern of activity of thigh muscles. By contrast, the corresponding variation of the parameters that describe shape and variability of the foot path was very limited, always <30% of the corresponding values at 0 BWS. Moreover, the planar co-variation of the elevation angles was obeyed at all speed and BWS values. Minimum variance of limb trajectory occurred at 3 km/h. At 100% BWS, subjects stepped in the air, their feet oscillating back and forth just above but never contacting the treadmill. In this case, step-to-step variability of foot path was much greater than at all other BWS levels but was restored to lower values when minimal surrogate contact forces were provided during the "stance" phase. The results did not depend on the specific instruction given to the subject. Therefore we conclude that minimal contact forces are sufficient for accurate foot trajectory control.

Eleven experimental saccular aneurysms were created on the common carotid artery of swine. Between 3 and 15 days after creation of these aneurysms, they were thrombosed via an endovascular approach, using a very soft detachable platinum coil delivered through a microcatheter positioned within the aneurysm. This detachable platinum coil was soldered to a stainless steel delivery guidewire. Intra-aneurysmal thrombosis was then initiated by applying a low positive direct electric current to the delivery guidewire. Thrombosis occurred because of the attraction of negatively charged white blood cells, red blood cells, platelets, and fibrinogen to the positively charged platinum coil positioned within the aneurysm. The passage of electric current detached the platinum coil within the clotted aneurysm in 4 to 12 minutes. This detachment was elicited by electrolysis of the stainless steel wire nearest to the thrombus-covered platinum coil. Control angiograms obtained 2 to 6 months postembolization confirmed permanent aneurysm occlusion as well as patency of the parent artery in all cases. No angiographic manifestation of untoward distal embolization was noted. Due to the encouraging results of this research, this technique has been applied in selected clinical cases which are described in Part 2 of this study.

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Objective-To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.Methods-Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain.Results-After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P < .00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P < .003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P = .01).Address correspondence to Mary Stuart, ScD, Health Administration and Policy Program, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250. stuart@umbc.edu. Drs Stuart and Benvenuti contributed to this work equally.For reprints and permission queries, please visit SAGE's Web site at http://www.sagepub.com/journalsPermissions.nav. NIH Public Access Author ManuscriptNeurorehabil Neural Repair. Author manuscript; available in PMC 2011 January 20. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusion-APA-stroke appears to be safe, feasible, and efficacious in a community setting. KeywordsStroke; Exercise; Community; Rehabilitation Stroke is one of the leading causes of death and long-term disability. 1 The Framingham study found that at 6 months following a stroke (ie, after the period of natural recovery 2 ) 50% of stroke survivors aged 65 years or older had some hemiparesis and 30% were unable to walk without assistance. 3 Due in part to the sedentary lifestyle associated with these limitations, the stroke survivor is at increased risk of diabetes, glucose intolerance, heart disease, subsequent stroke death, and depression. 4,5 There is substantial evidence supporting a protective role for exercise in the prevention of stroke. 1 For stroke survivors, increasing evidence also links exercise to improved cardiovascular health, with decreased ris...

What are the building blocks with which the human spinal cord constructs the motor patterns of locomotion? In principle, they could correspond to each individual activity pattern in dozens of different muscles. Alternatively, there could exist a small set of constituent temporal components that are common to all activation patterns and reflect global kinematic goals. To address this issue, we studied patients with spinal injury trained to step on a treadmill with body weight support. Patients learned to produce foot kinematics similar to that of healthy subjects but with activity patterns of individual muscles generally different from the control group. Hidden in the muscle patterns, we found a basic set of five temporal components, whose flexible combination accounted for the wide range of muscle patterns recorded in both controls and patients. Furthermore, two of the components were systematically related to foot kinematics across different stepping speeds and loading conditions. We suggest that the components are related to control signals output by spinal pattern generators, normally under the influence of descending and afferent inputs.