BackgroundRehabilitation robots can provide intensive physical training after stroke. However, variations of the rehabilitation effects in translation from well-controlled research studies to clinical services have not been well evaluated yet. This study aims to compare the rehabilitation effects of the upper limb training by an electromyography (EMG)-driven robotic hand achieved in a well-controlled research environment and in a practical clinical service.MethodsIt was a non-randomized controlled trial, and thirty-two participants with chronic stroke were recruited either in the clinical service (n = 16, clinic group), or in the research setting (n = 16, lab group). Each participant received 20-session EMG-driven robotic hand assisted upper limb training. The training frequency (4 sessions/week) and the pace in a session were fixed for the lab group, while they were flexible (1–3 sessions/week) and adaptive for the clinic group. The training effects were evaluated before and after the treatment with clinical scores of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS).ResultsSignificant improvements in the FMA full score, shoulder/elbow and wrist/hand (P < 0.001), ARAT (P < 0.001), and MAS elbow (P < 0.05) were observed after the training for both groups. Significant improvements in the FIM (P < 0.05), MAS wrist (P < 0.001) and MAS hand (P < 0.05) were only obtained after the training in the clinic group. Compared with the lab group, higher FIM improvement in the clinic group was observed (P < 0.05).ConclusionsThe functional improvements after the robotic hand training in the clinical service were comparable to the effectiveness achieved in the research setting, through flexible training schedules even with a lower training frequency every week. Higher independence in the daily living and a more effective release in muscle tones were achieved in the clinic group than the lab group.

injury (i.e., knee injury occurred in the past 12 months that was severe enough to limit the ability to walk for at least two days). Since the temporal sequence between KEs and SBCs was unclear, we also performed additional analyses adjusting for each other in the multivariable regression model. Subjects who had a TKR or had missing values for variables of interest in either knee were excluded. Results: We included 888 subjects with knees discordant for pain at rest and 253 with knees discordant for pain exacerbation with walking measured by NRS. For pain in bed, pain with sitting/lying down and pain with walking assessed using WOMAC pain sub-scales, 688, 780 and 1239 subjects were identified as having discordant knees, respectively. Approximately 60% of participants included in the analyses were women, the mean age ranged between 62.1 and 63.4 years, and mean BMI was from 29.1 to 29.6 kg/m 2 . When knee pain at rest and pain exacerbation with walking were measured by NRS in the walking test, the adjusted odds ratios (OR) for the association of KEs with pain at rest and pain exacerbation with walking were 1.8 (95% confidence interval (CI): 1.3-2.5) and 3.7 (1.8-7.8), respectively. The corresponding ORs for SBCs were 1.1 (0.7-1.7) and 2.1 (1.1-4.3), respectively (Table 1). Similar differential associations of KEs and SBCs with pain at rest and pain with walking assessed by WOMAC pain sub-scales were also observed ( Table 2). When we further adjusted for SBCs in the multivariable regression model for KEs, or vice versa, the results did not change significantly. Conclusions: Both knee effusions and subchondral bone cysts contributed to pain with walking, whereas only knee effusions were associated with pain at rest.

Purpose: Quadriceps is affected in individuals with knee osteoarthritis (KOA) with significant morphology change and dysfunction. The alignment of knee joint could influence properties of quadriceps muscle. Except for strength, feature of quadriceps muscle properties is yet to be investigated in these patients, including muscle passive tension. Knowing the underlying relationship between quadriceps passive tension and malalignment could be important to provide potential treatment strategy targeting on quadriceps dysfunction in KOA. We assumed that knee alignment changed the passive tension of different superficial heads of quadriceps. Methods: KOA patients were recruited from a local hospital from Mar 2017 to Aug 2018. The diagnosis was made by experienced orthopedic doctor through clinical examination and radiography. Patients were included if they have KL grade between 1 and 3, severer OA in the medial tibiofemoral compartment, and knee pain during walking in most of days in the past month. Knee alignment was measured by the EOS bi-planar x-ray imaging system (EOS imaging, Paris, France) in standing position. Knee varus angle, tibiofemoral rotation and tibial torsion were estimated with sterEOS 1.6 software. Supersonic shearwave elastograph (Supersonic Imaging, Aix-en-Provence, France) was used to measure passive muscle tension of superficial heads of quadriceps femoris, including vastus lateralis (VL), rectus femoris (RF) and vastus medialis (VMO). During ultrasound measurement, patients kept relaxed in supine position with knee flexion to 60 degree. SPSS 34.0 was used to make regression curve estimation. Results: 61 patients were eligible for analysis (age: 62.48 ± 5.80 years; gender: female 46/ male 15; BMI: 26.11 ± 3.72 kg/m 2 ), among whom 7 were KL grade 1, 32 were KL grade 2 and 22 were KL grade 3. The result showed that knee varus/valgus alignment was not a significant predictor to either passive tension of VL or RF, while it was significant to that of VMO. It suggested that a good fit of an exponential regression model could be revealed relationship between knee varus angle and VMO passive tension (R 2 ¼0.07, F¼4.04, p<0.05). No significant result could be found between tibiofemoral rotation, tibial torsion and quadriceps passive tension. Conclusions: Our assumption that knee alignment affected passive tension of quadriceps was partly supported. Knee alignment in the frontal plane was strong predictor to passive tension of VMO. The fit of exponential pattern agreed with classical estimation of passive lengthtension curve of skeletal muscles. It indicated that knee varus alignment could influence passive tension of VMO possibly by changing the initial length of the muscle. VMO was the primary dynamic stabilizer of knee joint. Any alteration of muscle property could affect the function of this muscle head. Interpretation of the result should be carefully since the effect seemed minimal. Further study could investigate the relationship between passive tension and knee joint function to explore the therape...

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