Aim  To compare the effects of a supported speed treadmill training exercise program (SSTTEP) with exercise on spasticity, strength, motor control, gait spatiotemporal parameters, gross motor skills, and physical function. Method  Twenty‐six children (14 males, 12 females; mean age 9y 6mo, SD 2y 2mo) with spastic cerebral palsy (CP; diplegia, n=12; triplegia, n=2; quadriplegia n=12; Gross Motor Function Classification System levels II–IV) were randomly assigned to the SSTTEP or exercise (strengthening) group. After a twice daily, 2‐week induction, children continued the intervention at home 5 days a week for 10 weeks. Data collected at baseline, after 12‐weeks’ intervention, and 4 weeks after the intervention stopped included spasticity, motor control, and strength; gait spatiotemporal parameters; Gross Motor Function Measure (GMFM); and Pediatric Outcomes Data Collection Instrument (PODCI). Results  Gait speed, cadence, and PODCI global scores improved, with no difference between groups. No significant changes were seen in spasticity, strength, motor control, GMFM scores, or PODCI transfers and mobility. Post‐hoc testing showed that gains in gait speed and PODCI global scores were maintained in the SSTTEP group after withdrawal of the intervention. Interpretation  Although our hypothesis that the SSTTEP group would have better outcomes was not supported, results are encouraging as children in both groups showed changes in function and gait. Only the SSTTEP group maintained gains after withdrawal of intervention.

Rotator cuff tendinopathy (RCT) is one of the most common causes of shoulder pain and dysfunction 5,26,48,73,74 and has been associated with symptoms of shoulder impingement. 15 While TSM may be beneficial in reducing shoulder pain and dysfunction, the mechanisms by which the manipulation might induce these changes are not well understood. Bialosky et al 3 suggested that the introduction of a manipulative force results in biomechanical as well as neurophysiologic responses. Biomechanical re-T T STUDY DESIGN: Controlled laboratory study. T T OBJECTIVES:To assess scapular kinematics and electromyographic signal amplitude of the shoulder musculature, before and after thoracic spine manipulation (TSM) in subjects with rotator cuff tendinopathy (RCT). Changes in range of motion, pain, and function were also assessed. T T BACKGROUND:There are various treatment techniques for RCT. Recent studies suggest that TSM may be a useful component in the management of pain and dysfunction associated with RCT. T T METHODS:Thirty subjects between 18 and 45 years of age, who showed signs of RCT, participated in this study. Changes in scapular kinematics and muscle activity, as well as changes in shoulder pain and function, were assessed pre-TSM and post-TSM using paired t tests and repeated-measures analyses of variance. T T RESULTS:TSM did not lead to changes in range of motion or scapular kinematics, with the exception of a small decrease in scapular upward rotation (P = .05). The only change in muscle activity was a small but significant increase in middle trapezius activity (P = .03). After TSM, subjects demonstrated decreased pain during performance of the Jobe empty-can (mean  SD change, 2.6  1.1), Neer (2.6  1.3), and Hawkins-Kennedy (2.8  1.3) tests (all, P<.001). Subjects also reported decreased pain with shoulder flexion (mean  SD change, 2.0  1.5; P<.001) and improved shoulder function (force production, 2.5  1.4 kg; Penn Shoulder Score, 7.7  9.4; sports/performing arts module of the Disabilities of the Arm, Shoulder and Hand questionnaire, 16.4  13.2) (all, P<.001). T T CONCLUSION: Immediate improvements inshoulder pain and function post-TSM are not likely explained by alterations in scapular kinematics or shoulder muscle activity. For people with pain associated with RCT, TSM may be an effective component of their treatment plan to improve pain and function. However, further randomized controlled studies are necessary to better validate this treatment approach. T T LEVEL OF EVIDENCE:Therapy, level 4.

An adaptive neuro-fuzzy inference system (ANFIS) with a supervisory control system (SCS) was used to predict the occurrence of gait events using the electromyographic (EMG) activity of lower extremity muscles in the child with cerebral palsy (CP). This is anticipated to form the basis of a control algorithm for the application of electrical stimulation (ES) to leg or ankle muscles in an attempt to improve walking ability. Either surface or percutaneous intramuscular electrodes were used to record the muscle activity from the quadriceps muscles, with concurrent recording of the gait cycle performed using a VICON motion analysis system for validation of the ANFIS with SCS. Using one EMG signal and its derivative from each leg as its inputs, the ANFIS with SCS was able to predict all gait events in seven out of the eight children, with an average absolute time differential between the VICON recording and the ANFIS prediction of less than 30 ms. Overall accuracy in predicting gait events ranged from 98.6% to 95.3% (root mean-squared error between 0.7 and 1.5). Application of the ANFIS with the SCS to the prediction of gait events using EMG data collected two months after the initial data demonstrated comparable results, with no significant differences between gait event detection times. The accuracy rate and robustness of the ANFIS with SCS with two EMG signals suggests its applicability to ES control.

Cortical signals might provide a potential means of interfacing with a neuroprosthesis. Guidelines regarding the necessary control features in terms of both performance characteristics and user requirements are presented, and their implications for the design of a first generation cortical control interface for a neuroprosthesis are discussed.