Objective: The aim of this study was to clarify the effect of ankle foot orthosis (AFO) on the reproducibility of kinematic data and spatiotemporal patterns of muscle synergy in a stroke patient with occasional toe-catching.

Method: The case was a woman in her 70s who had hemiplegic stroke. Walking with comfortable speed was performed in two conditions with and without wearing AFO, surface electromyography was used to collect muscle activity from paretic lower limb muscles during 10 gait cycles. Non-negative matrix factorization was used to extract muscle synergies and their spatiotemporal patterns were compared between both conditions with and without AFO. To compare the reproducibility of the spatiotemporal pattern of muscle synergy and the time series changes in lower limb joint angles between the two conditions, cross-correlation analysis and cosine similarity were calculated based on the date on the obtained from 10 gait cycles.

Results: Two types of muscle synergies were extracted in both conditions, which were activated during stance and swing phases. The similarity of the spatiotemporal patterns between the both conditions was high(>0.990) for the two types of muscle synergies. The cross-correlation values between the lower limb joint angle and the temporal pattern of muscle synergy activated during the swing phase were significantly lower in the without AFO condition. Furthermore, the cosine similarity in this muscle synergy was significantly lower in the without AFO condition.

Conclusion: We suggest that AFO may have contributed to improved reproducibility of lower limb joint movements through improved reproducibility of the spatiotemporal pattern of muscle synergy.

Objective: This case report describes the improvement in balance function and dizziness in a patient with right thalamic hemorrhage following vestibular rehabilitation, including balance exercises.

Patient: A 70-year-old male with a right thalamic hemorrhage exhibited mild motor paralysis and decreased somatosensation. Despite these mild impairments, the patient experienced unsteadiness when standing and turning while walking, necessitating constant supervision for activities of daily living (ADL).

Methods: Vestibular rehabilitation including balance exercises were conducted for a month.

Results: One month after the vestibular rehabilitation, the participant’s performance on the Subjective Visual Vertical, Head Impulse Test, Mini-Balance Evaluation Test, 10 m walking speed and Timed Up and Go Test improved. Further, the dizziness resolved. All parameters of the modified Clinical Test of Sensory Interaction and Balance using a force platform improved when eyes remained closed. He could independently walk during his ADL.

Conclusion: Vestibular rehabilitation for a patient with right thalamic hemorrhage and decreased vestibular function may improve his balance function.

Background: This case study investigated the temporal relationship between improvements in pusher behavior (PB) and the progression of subjective postural vertical (SPV) in a participant with stroke.

Methods: We assessed a participant with severe PB following thalamic hemorrhage, conducting weekly assessments from one-month post-onset until PB resolution. Outcome measures included the Scale for Contraversive Pushing (SCP), Burke Lateropulsion Scale (BLS), lower extremity motor function of Fugl-Meyer Assessment (FMA-LE), lower extremity somatosensory function, and SPV. Cross-correlation analyses were performed to explore these variables' relationships and temporal sequences.

Results: PB resolved approximately five months post-onset. Significant positive correlations were observed between improvements in SCP and BLS. In contrast, significant negative correlations were found between SCP and FMA-LE and between BLS and FMA-LE. These changes occurred synchronously. However, neither SCP nor BLS improvements showed significant correlations with SPV changes. Somatosensory deficits persisted despite the resolution of PB.

Conclusion: This case demonstrated that PB improvement occurred independently of SPV changes, suggesting that the mechanisms of PB recovery may be more complex than previously hypothesized.

Patient-reported outcomes (PROs), one of the Clinical Outcome Assessments (COAs) used in clinical research, allow the patient voice to be used as an outcome in routine care and clinical trials. Patient-reported outcomes (PROs), one of the Assessments in rehabilitation medicine, it is sometimes challenging to set goals and determine the effectiveness of conventional outcome assessments consisting of standardized items, which take into account "meaningful goal" and "meaningful change" based on individual patients' lifestyles and desires. The Goal Attainment Scale (GAS), one of the PROs, allows patients to freely select priority issues as evaluation items in the individual patient and quantify goal attainment. On the other hand, the high degree of freedom in the evaluation criteria (goal attainment) set by patients, families, and healthcare providers affects the scale's characteristics (validity, reliability, and responsiveness), and the lack of uniformity in its use makes the GAS challenging to use in clinical practice. This paper provides a practical guide to using standardized GAS by presenting procedures for goal setting and effectiveness assessment in GAS and a case study of their use in ataxia.