Study design: Construction of an international walking scale by a modi®ed Delphi technique. Objective: The purpose of the study was to develop a more precise walking scale for use in clinical trials of subjects with spinal cord injury (SCI) and to determine its validity and reliability. Setting: Eight SCI centers in Australia, Brazil, Canada (2), Korea, Italy, the UK and the US. Methods: Original items were constructed by experts at two SCI centers (Italy and the US) and blindly ranked in an hierarchical order (pilot data). These items were compared to the Functional Independence Measure (FIM) for concurrent validity. Subsequent independent blind rank ordering of items was completed at all eight centers (24 individuals and eight teams). Final consensus on rank ordering was reached during an international meeting (face validation). A videotape comprised of 40 clips of patients walking was forwarded to all eight centers and inter-rater reliability data collected. Results: Kendall coecient of concordance for the pilot data was signi®cant (W=0.843, P50.001) indicating agreement among the experts in rank ordering of original items. FIM comparison (Spearman's rank correlation coecient=0.765, P50.001) showed a theoretical relationship, however a practical dierence in what is measured by each scale. Kendall coecient of concordance for the international blind hierarchical ranking showed signi®cance (W=0.860, P50.001) indicating agreement in rank ordering across all eight centers. Group consensus meeting resulted in a 19 item hierarchical rank ordered`Walking Index for Spinal Cord Injury (WISCI)'. Inter-rater reliability scoring of the 40 video clips showed 100% agreement. Conclusions: This is the ®rst time a walking scale for SCI of this complexity has been developed and judged by an international group of experts. The WISCI showed good validity and reliability, but needs to be assessed in clinical settings for responsiveness. Spinal Cord (2000) 38, 234 ± 243

Study Design: A prospective descriptive study of the course of recovery of re¯exes following acute spinal cord injury (SCI). Objectives: The purpose of the study was to observe the pattern of re¯ex recovery following acute SCI in order to determine the prognostic signi®cance of re¯exes for ambulation and their relationship to spinal shock. Setting: A regional spinal cord injury center in Philadelphia, Pennsylvania, USA. Methods: Fifty subjects admitted consecutively over a 9 month period and on the day of injury were observed for the following re¯exes; bulbo-cavernosis (BC), delayed plantar response (DPR), cremasteric (CRM), ankle jerk (AJ), knee jerk (KJ), and normal plantar response for 5 ± 7 days a week and 6 ± 8 weeks duration. The 50 subjects were assessed for ambulation of 200 feet at time of discharge. MRI studies were reviewed on 13/28 complete (ASIA A) injuries. Results: Thirty-®ve subjects (28 ASIA A, 4 ASIA B, 3 ASIA C) had a DPR of 2 days or longer duration and these subjects were not ambulatory. The fourteen subjects (12 ASIA D and 2 ASIA C), who were ambulatory, either had no DPR (11/14) or had a DPR of only 1 days duration (3/14). One subject (ASIA B) was not ambulatory and had a DRP of 1 days duration. The DPR was the ®rst re¯ex to recover most often, followed by the BC, CRM in the ®rst few days and later followed by the deep tendon re¯exes (AJ & KJ) by 1 ± 2 weeks respectively. Less than 8% of subjects had no re¯exes on the day of injury and the re¯exes did not follow a caudal-rostral pattern of recovery. Conclusions: Prognosis for ambulation based on re¯exes early after SCI should not be linked to current descriptions of spinal shock. In fact, the view of spinal shock, based on the absence of re¯exes and the recovery of re¯exes in a caudal to rostral sequence, is of limited clinical utility and should be discarded. The evolution of re¯exes over several days following injury may be more relevant to prognosis than the use of the term spinal shock and the presence or absence of re¯exes on the day of injury.

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A HC(NH 2 ) 2 PbI 3 solar cell of perovskite structure based on TiO 2 nanohelices has been developed. Wellaligned helical TiO 2 arrays of different pitch (p) and radius (r), helix-1 (p/2 ¼ 118 nm, r ¼ 42 nm), helix-2 (p/2 ¼ 353 nm, r ¼ 88 nm) and helix-3 (p/2 ¼ 468 nm, r ¼ 122 nm), were grown on fluorine-doped tin oxide (FTO) glass by oblique-angle electron beam evaporation. HC(NH 2 ) 2 PbI 3 perovskite was deposited on the TiO 2 nanohelices by a two-step dipping method. Helix-1 showed higher short-circuit current density (J SC ), whereas helix-3 exhibited slightly higher open-circuit voltage (V OC ). HC(NH 2 ) 2 PbI 3 perovskite combined with helix-1 demonstrated an average power conversion efficiency of 12.03 AE 0.07% due to its higher J SC compared to helix-2 and helix-3. The higher J SC of helix-1 could be attributed to its greater light scattering efficiency and higher absorbed photon-to-current conversion efficiency. In addition, despite having the longest pathway structure, helix-1 showed rapid electron diffusion, attributed to its higher charge injection efficiency due to the larger contact area between perovskite and TiO 2 . We have established that fine tuning of the interface between perovskite and the electron-injecting oxide is a crucial factor in achieving a perovskite solar cell of high performance.

The present clinical investigation was to ascertain whether the effects of WALKBOT-assisted locomotor training (WLT) on balance, gait, and motor recovery were superior or similar to the conventional locomotor training (CLT) in patients with hemiparetic stroke. Thirty individuals with hemiparetic stroke were randomly assigned to either WLT or CLT. WLT emphasized on a progressive, conventional locomotor retraining practice (40 min) combined with the WALKBOT-assisted, haptic guidance and random variable locomotor training (40 min) whereas CLT involved conventional physical therapy alone (80 min). Both intervention dosages were standardized and provided for 80 min, five days/week for four weeks. Clinical outcomes included function ambulation category (FAC), Berg balance scale (BBS), Korean modified Barthel index (K-MBI), modified Ashworth scale (MAS), and EuroQol-5 dimension (EQ-5D) before and after the four-week program as well as at follow-up four weeks after the intervention. Two-way repeated measure ANOVA showed significant interaction effect (time × group) for FAC (p=0.02), BBS (p=0.03) , and K-MBI (p=0.00) across the pre-training, post-training, and follow-up tests, indicating that WLT was more beneficial for balance, gait and daily activity function than CLT alone. However, no significant difference in other variables was observed. This is the first clinical trial that highlights the superior, augmented effects of the WALKBOT-assisted locomotor training on balance, gait and motor recovery when compared to the conventional locomotor training alone in patients with hemiparetic stroke.

ObjectiveTo evaluate the effectiveness of constraint-induced movement therapy (CIMT) and combined mirror therapy for inpatient rehabilitation of the patients with subacute stroke.MethodsTwenty-six patients with subacute stroke were enrolled and randomly divided into three groups: CIMT combined with mirror therapy group, CIMT only group, and control group. Two weeks of CIMT for 6 hours a day with or without mirror therapy for 30 minutes a day were performed under supervision. All groups received conventional occupational therapy for 40 minutes a day for the same period. The CIMT only group and control group also received additional self-exercise to substitute for mirror therapy. The box and block test, 9-hole Pegboard test, grip strength, Brunnstrom stage, Wolf motor function test, Fugl-Meyer assessment, and the Korean version of Modified Barthel Index were performed prior to and two weeks after the treatment.ResultsAfter two weeks of treatment, the CIMT groups with and without mirror therapy showed higher improvement (p<0.05) than the control group, in most of functional assessments for hemiplegic upper extremity. The CIMT combined with mirror therapy group showed higher improvement than CIMT only group in box and block test, 9-hole Pegboard test, and grip strength, which represent fine motor functions of the upper extremity.ConclusionThe short-term CIMT combined with mirror therapy group showed more improvement compared to CIMT only group and control group, in the fine motor functions of hemiplegic upper extremity for the patients with subacute stroke.

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BackgroundTo observe brain activation induced by functional electrical stimulation, voluntary contraction, and the combination of both using functional magnetic resonance imaging (fMRI).MethodsNineteen healthy young men were enrolled in the study. We employed a typical block design that consisted of three sessions: voluntary contraction only, functional electrical stimulation (FES)-induced wrist extension, and finally simultaneous voluntary and FES-induced movement. MRI acquisition was performed on a 3.0 T MR system. To investigate activation in each session, one-sample t-tests were performed after correcting for false discovery rate (FDR; p < 0.05). To compare FES-induced movement and combined contraction, a two-sample t-test was performed using a contrast map (p < 0.01).ResultsIn the voluntary contraction alone condition, brain activation was observed in the contralateral primary motor cortex (MI), thalamus, bilateral supplementary motor area (SMA), primary sensory cortex (SI), secondary somatosensory motor cortex (SII), caudate, and cerebellum (mainly ipsilateral). During FES-induced wrist movement, brain activation was observed in the contralateral MI, SI, SMA, thalamus, ipsilateral SII, and cerebellum. During FES-induced movement combined with voluntary contraction, brain activation was found in the contralateral MI, anterior cingulate cortex (ACC), SMA, ipsilateral cerebellum, bilateral SII, and SI.The activated brain regions (number of voxels) of the MI, SI, cerebellum, and SMA were largest during voluntary contraction alone and smallest during FES alone. SII-activated brain regions were largest during voluntary contraction combined with FES and smallest during FES contraction alone. The brain activation extent (maximum t score) of the MI, SI, and SII was largest during voluntary contraction alone and smallest during FES alone. The brain activation extent of the cerebellum and SMA during voluntary contraction alone was similar during FES combined with voluntary contraction; however, cerebellum and SMA activation during FES movement alone was smaller than that of voluntary contraction alone or voluntary contraction combined with FES. Between FES movement alone and combined contraction, activated regions and extent due to combined contraction was significantly higher than that of FES movement alone in the ipsilateral cerebellum and the contralateral MI and SI.ConclusionsVoluntary contraction combined with FES may be more effective for brain activation than FES-only movements for rehabilitation therapy. In addition, voluntary effort is the most important factor in the therapeutic process.