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Background and Purpose-The purpose of this study was to compare treadmill and electromechanical gait trainer therapy in subacute, nonambulatory stroke survivors. The gait trainer was designed to provide nonambulatory subjects the repetitive practice of a gait-like movement without overexerting therapists. Methods-This was a randomized, controlled study with a crossover design following an A-B-A versus a B-A-B pattern.A consisted of 2 weeks of gait trainer therapy, and B consisted of 2 weeks of treadmill therapy. Thirty nonambulatory hemiparetic patients, 4 to 12 weeks after stroke, were randomly assigned to 1 of the 2 groups receiving locomotor therapy every workday for 15 to 20 minutes for 6 weeks. Weekly gait ability (functional ambulation category [FAC]), gait velocity, and the required physical assistance during both kinds of locomotor therapy were the primary outcome measures, and other motor functions (Rivermead motor assessment score) and ankle spasticity (modified Ashworth score) were the secondary outcome measures. Follow-up occurred 6 months later. Results-The groups did not differ at study onset with respect to the clinical characteristics and effector variables. During treatment, the FAC, gait velocity, and Rivermead scores improved in both groups, and ankle spasticity did not change. Median FAC level was 4 (3 to 4) in group A compared with 3 (2 to 3) in group B at the end of treatment (Pϭ0.018), but the difference at 6-month follow up was not significant. The therapeutic effort was less on the gait trainer, with 1 instead of 2 therapists assisting the patient at study onset. All but seven patients preferred the gait trainer. Conclusions-The newly developed gait trainer was at least as effective as treadmill therapy with partial body weight support while requiring less input from the therapist. Further studies are warranted.

The placebo-controlled trial favours the concept that electrical stimulation enhances the effectiveness of BtxA in the treatment of chronic upper limb flexor spasticity after stroke.

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The Periadriatic fault system (PFS) is an array of late orogenic faults (35-15 Ma) in the retro-wedge of the Alpine orogen that accommodated dextral transpression during oblique indentation by the southern Alpine crust. Decoupling along the leading edges of the southern Alpine indenter occurred where inherited lithological and rheological contrasts were accentuated by lateral thermal gradients during emplacement of the warm orogenic retro-wedge next to the cold indenter. In contrast, decoupling within the core and retro-wedge of the orogen occurred in a network of folds and mylonitic faults. In the Eastern Alps, this network comprises conjugate sets of upright, constrictional folds, strike-slip faults and low-angle normal faults that accommodated nearly coaxial NNE-SSW shortening and E-W extensional exhumation of the Tauern thermal dome. The dextral shear component of oblique convergence was taken up by a discrete, brittle fault parallel to the indenter surface. In the Central and Western Alps, a steep mylonitic backthrust, upright folds, and low-angle normal faults effected transpressional exhumation of the Lepontine thermal dome. Mylonitic thrusting and dextral strike-slip shearing along the steep indenter surface are transitional along strike to low-angle normal faults that accommodated extension at the western termination of the PFS. The areal distribution of poles to mylonitic foliation and stretching lineation of these networked structures is related to the local shape and orientation of the southern Alpine indenter surface, supporting the interpretation of this surface as the macroscopic shearing plane for all mylonitic segments of the PFS. We propose that mylonitic faults nucleate as viscous instabilities induced by cooling, or more often, by folding and progressive rotation of pre-existing foliations into orientations that are optimal for simple shearing parallel to the eigenvectors of flow. The mechanical anisotropy of the viscous continental crust makes it a preferred site of decoupling and weakening. Networking of folds and mylonitic fault zones allow the viscous crust to maintain strain compatibility between the stronger brittle crust and upper mantle, while transmitting plate forces through the lithosphere. Decoupling within the continental lithosphere is therefore governed by the symmetry and kinematics of strain partitioning at, and below, the brittle-to-viscous transition.