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Karen L. Perell, Robert J. Gregor and A.M. Erika Scremin

Biomechanical analysis of the generalized muscle moment and power patterns involved in cycling provides information regarding coordination within each limb. The purpose of this study was to compare individual joint kinetics, bilaterally, in subjects who had experienced cerebrovascular accidents (CVAs). Two-dimensional cinematography and force pedal data in a linked-segment model were used to study 8 ambulatory subjects while they rode a recumbent bicycle. The involved lower limb was defined as the lower limb with the greatest deficits, whereas the contralateral lower limb was defined as the lower limb opposite the involved lower limb and ipsilateral to the lesion site. The contralateral lower limbs of subjects with CVAs demonstrated patterns similar to those reported for nondisabled cyclists on an upright bicycle except for a bimodal hip power generation pattern that was possibly due to compensation for a lack of involved lower limb power generation. There were two critical findings of this study: Single-joint power generation patterns during the power phase indicated that either the hip or the knee, but not both joints, generated power in the involved lower limb, and asymmetrical differences between lower limbs appeared significant at the ankle alone.

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Karen L. Perell, Robert J. Gregor and A.M. Erika Scremin

The purpose of this sludy was to compare individual pedal reaclion force components following bicycle training with and without effective force feedback in subjects with unilateral cerebrovascular accident (CVA). Eight ambulatory subjects with CVA were studied on a recumbent bicycle equipped with custom-built pedals, which measure normal and tangential components of the load applied to the pedal surface. Comparisons of normal and tangential pedal reaction forces were made following 1 month of bicycle training (3 times/week for 4 weeks) during retention tests performed without feedback. The ratios of involved to contralateral (I/C ratios) force parameters were used to assess symmetry. Subjects were randomly assigned to 2 groups: (a) a feedback group that received visual/verbal feedback regarding effective force patterns, bilaterally, after each trial; and (b) a no-feedback group dial received no feedback. Two critical results were found: (a) tangential pedal forces were significantly more posteriorly directed bilaterally following training across all subjects, but the change was greater for the no-feedback group relative to the feedback group, and (b) effective force feedback training did not demonstrate improvements in the I/C ratios above that of the control group. A more posteriorly applied tangential pedal force may represent increased dorsiflexion and may suggest that bicycle training facilitated ankle control. The cyclical nature of cycling, however, may allow for natural patterns to develop without feedback or may require less frequent use of feedback based on retention test performance.

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Karen L. Perell, Robert J. Gregor and A.M. Erika Scremin

The purpose of this study was to determine the effect of bicycle exercise on knee-muscle strength and gait speed in 8 male participants with cerebrovascular accident (CVA). Isokinetic knee-extensor and -flexor strength were measured in both concentric- and eccentric-contraction modes. Fifty-foot walking tests were used for gait speed. After only 4 weeks of stationary recumbent cycling (12 sessions), participants improved eccentric muscle strength of the knee extensors, bilaterally. Walking-speed improvements approached but did not achieve significance with training. Improvement in concentric muscle strength of the knee extensors was observed in the involved limb, although most participants demonstrated a nonsignificant increase in muscle strength in the contralateral limb, as well. No improvements were demonstrated in the knee-flexor muscles. Thus, bicycle exercise serves to improve knee-extensor strength. In addition, these strength improvements might have implications for better control of walking in terms of bilateral improvement of eccentric muscle strength.

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Etem Curuk, Yunju Lee and Alexander S. Aruin

The authors investigated anticipatory postural adjustments in persons with unilateral stroke using external perturbations. Nine individuals with stroke and five control subjects participated. The electromyographic activity of 16 leg and trunk muscles was recorded. The onsets of muscle activity during the anticipatory phase of postural control were analyzed. The individuals with stroke did not show an anticipatory activation of leg and trunk muscles on the affected side; instead, the muscle onsets were seen after the perturbation, during the balance restoration phase. However, an anticipatory activation of muscles on the unaffected side was seen in individuals with stroke, and it was observed earlier compared with healthy controls (p < .05). The individuals with stroke showed a distal to proximal order of anticipatory activation of muscles on the unaffected side. The outcome of the study provides a basis for future investigations regarding ways of improving balance control in people with stroke.

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Kevin McQuade, Michelle L. Harris-Love and Jill Whitall

The purpose of this study was to determine whether the phenomenon of bilateral deficit in muscular force production observed in healthy subjects and mildly impaired stroke patients also exists in patients with more chronic and greater levels of stroke impairment. Ten patients with chronic hemiparesis resulting from stroke performed unilateral and bilateral maximal voluntary isometric contractions of the elbow flexors. When the total force produced by both arms was compared, 12% less force was produced in the bilateral compared with unilateral condition (p = 0.01). However, studying the effect of task conditions on each arm separately revealed a significant decline in nonparetic (p = 0.01) but not paretic elbow flexor force in the bilateral compared with unilateral condition. Results suggest that a significant bilateral force deficit exists in the nonparetic but not the paretic arm in individuals with chronic stroke. Bilateral task conditions do not seem to benefit or impair paretic arm maximal isometric force production in individuals with moderate-severity chronic stroke.

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Hsieh-ching Chen, Keh-chung Lin, Chia-ling Chen and Ching-yi Wu

This study evaluated the effect of context on the reaching performance of the unaffected arm and postural control while standing in patients with right cerebral vascular accidents (RCVA) and in healthy adults. Fifteen subjects with RCVA and sixteen healthy subjects performed tasks with the right hand under two conditions while standing. One condition involved moving coins forward on a table as far as possible (concrete task) and the other reaching forward without a target (abstract task). Forward reaching distance, forward displacement and lateral shift of center of pressure (CoP), and weight distribution were the dependent variables. The RCVA and control groups achieved significantly greater reaching distances in the concrete task than in the abstract one. The RCVA group showed significantly less lateral shift of the CoP and placed more weight on the affected leg in the concrete than the abstract task, whereas the control group made a greater lateral shift in the concrete task and had a similar mean ratio of weight distribution during both tasks. The results demonstrate that a functional application of task targets may favorably modulate both reaching and posture performance and exert various positive affects on postural control. Such applications may have a place in the therapeutic recovery efforts for patients afflicted with stroke.

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Esther Casas, Arturo Justes and Carlos Calvo

joint and in all possible positions it can adopt. In rehabilitation of severe CNS pathological conditions, such as cerebral palsy or cerebrovascular accidents, different reflex methods (Vöjta 1 and Brunkow 2 methods) have been used to facilitate muscle activity. These methods achieve coordinated

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Flávia Cavalcante Monteiro Melo, Kátia Kamila Félix de Lima, Ana Paula Knackfuss Freitas Silveira, Kesley Pablo Morais de Azevedo, Isis Kelly dos Santos, Humberto Jefferson de Medeiros, José Carlos Leitão and Maria Irany Knackfuss

victims of cerebrovascular accident; (3) training to improve gait and functional electrical stimulation; and (4) studies with animals. Data Extraction Two independent evaluators extracted from each article data on study characteristics (publishing year, country of origin, and study design), of the

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Brice T. Cleland and Sheila Schindler-Ivens

subjects with unilateral cerebrovascular accidents . Journal of Applied Biomechanics , 14 , 158 – 179 . doi:10.1123/jab.14.2.158 10.1123/jab.14.2.158 Power , M.L. , & Schulkin , J. ( 2008 ). Sex differences in fat storage, fat metabolism, and the health risks from obesity: Possible evolutionary