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’’WWW: Writing, Wikipedia, and Wizardry in Scientific Communication’’’ is a course in the Biokinesiology and Physical Therapy PhD program at the University of Southern California. The goal of the course is to introduce students to fundamentals of scientific writing, in the practical context of developing scientific content for Wikipedia that enhances consolidation and accessibility of important results in the field of Kinesiology

=Introduction= Gait recovery after stroke is always a tough problem for both the patients and physical therapists. Because of the impaired function on the paretic sides, patients who suffer from hemiplegia tend to develop different kinds of compensations in order to be able to walk. However, the result of a long time adaptive compensations can be pernicious. In the chronic stage, a majority of patients may develop some stubborn abnormal gait patterns such as the decreasing walking speed, asymmetrical temporal parameters, exaggerated frontal plane kinematics, impairment of loading ability on their paretic side, and abnormal muscle activation patterns, which greatly influence the quality of life. A new gait training method with wearable robotic orthosis, which encourages the active involvement of the patient, has been invented recently. However, little was reported about their biomechanical training effect on the gait pattern. Thus, in this case study, we try to test the biomechanical training effect with a new wearable robotic leg using both kinematic and kinetic parameters.

Subject characteristics
One subject (60 years old) with chronic right hemiplegic cortical stroke was recruited. Before the patient was recruited in our study, he has received conservative treatment for 291days. And the patient was able to walk more than 10m independently without a walking aid when he was first examined in our study. Medical history includes multi- infraction of the corona radiate, slight encepahalatrophy, and third degree of hypertension. The patient didn’t have any cognitive deficits, aphasia or other neuropathology that interfere with the understanding of our training protocol. Before our training protocol, the patient has three days to acquire the basic techniques of the machine. During this preparation period, our physical therapists taught the patient the basic construction and working mode of the machine and let the patient walk with the machine independently to get familiar with the orthosis.

Magnetic resonance imaging
All images were acquired on the same General Electric 1.5-T Signa scanner (Waukesha, WI), which was located at the NIH clinical center in Bethesda, Maryland. The following parameters were utilized for both patients (scanned between 2001 and 2011) and healthy volunteers (scanned between 1992 and 2011). A sagittal T1-weighted spin-echo sequence was acquired with 5 mm thickness and 1.5 mm gap (FOV = 300 mm, acquisition matrix 256 × 128, TR = 400 ms, TE = 14 ms). A 3-dimensional spoiled-gradient recalled-echo sequence in the steady-state sequence, designed to optimize discrimination between gray matter, white matter, and cerebrospinal fluid (CSF), was used to acquire 124 contiguous 1.5-mm-thick slices in the axial plane (TE = 5 ms; TR = 24 ms; flip angle: 45°; acquisition matrix = 256 × 192; number of excitations: 1; field of view: 240 mm; acquisition time: 9 min, 52 s). A dual-echo fast-spin-echo imaging sequence (generating proton-density weighted and T2-weighted images) was acquired to complete the clinical evaluation (effective thickness is 7.25 mm (6 mm plus 1.25 mm gap); effective TE = 11.88 and 83.16 ms; TR = 2400 ms; FOV = 240 mm; acquisition matrix = 256 ×  192).

Results
Our result shows a change of the step length symmetry ratio, an increase of the plantarflexor moment and a decrease of the hip flexor moment for the patient after three weeks training. Besides, the exaggerated pelvic obliquity alleviated after training. And the patient also performed better on Berg Balance scale test after training.

Conclusions
Training with the wearable robotic improves our patient’s gait pattern by a probable motor relearning effect. Large sample size randomized clinical trials are necessary. =Writing Assignment=

Assignment 1: Self-introduction
My background is Rehabilitation Science and I just got my Bachelor of Science degree from Sun Yat-sen University in China this summer. My research interests are motor control development and clinical practice of lower limb robotic technology on stroke rehabilitation. As for my goals for this course, I think I want to improve my thesis writing skills and scientific communication abilities by taking this class.

Topic
Body Weight Support Treadmill Training (BWSTT) for gait recovery

Pages of interest
treadmill, gait training, central pattern generator, neuroplasticity, spinal cord injury, stroke, LOPES exoskeleton, randomized controlled trial

Content
The idea of body weight support treadmill gait training (BWSTT)started from early animal experiment. It was found that after spinal cord transection, adult cats and rats  were able to improve their locomotor capability with sensory stimulation by body weight support treadmill training. After that, some scientists use the theory of peripheral sensory stimulation on central pattern generator (CPG) to explain this phenomenon. Besides the evidence of CPG, the neural adaptive change was also found to support BWSTT in term of the principle of neuroplasticity. Based on the support of those theories, body weight support treadmill training was gradually applied on clinical gait training practice for stroke and spinal cord injury (SCI) patients. During clinical practice, besides the traditional animal experiment equipment, LOPES exoskeleton was also used for facilitation with treadmill training. However, even though preliminary pilot studies on stroke and SCI patients have shown great training effect of BWSTT, some recent randomized controlled trial didn’t show any superior training effect of BWSTT when compared with the traditional overground gait training method on both stroke and SCI patients. Thus, in the future study, more RCTs need to be designed to evaluate the effectiveness of body weight support treadmill training and its combination with LOPES exoskeleton.

Writing Assignment 3
First of all, I searched in web of science with the topic body weight support treadmill training and I got 518 results which are related to the topic. Then I sorted out the results by the publication years and saved the analysis data to my computer. Then I make a graph of the analysis data with Microsoft Exel and I found that from a chronological view, both the number of papers that were published per year and the citations of the papers per year in the field of body weight support treadmill training were increasing and it might suggest that the scientists’ interests of research in body weight support treadmill training increased these years.

Next, I sorted out the previous 518 results with research areas. From the result, I found the top 3 research areas that are related to this topic are Rehabilitation, Neurosciences neurology and sport sciences. Then I refined the original 518 results by single year from 2009 to 2013 and sorted out each results by research areas. From the analysis result, I found that the top 3 research areas that are related to BWSTT never changed from 2009 to 2013.

Finally, I went to the previous page and refined the original 518 results with research area in rehabilitation. In this way, I got 296 papers. Then I sorted out these 296 papers with research area again. By doing this, I found that although all these 296 papers belong to rehabilitation research field according to the classification first time by web of science, 34.80% of them still belong to the field of neurosciences and neurology and 25% of them still belong to the field of sport sciences. Thus, it might suggest that BWSTT is a multi-disciplinary topic with a lot of cooperations among different field of study.

Topic Proposal
For the writing part, on the one hand, I’m going to add some information under the subsection---Neuroplasticity. Specifically, I want to talk about the neurophysiological change of the stroke patients after Locomotor Experience Applies Post-Stroke (LEAPS) training and its correlation with the walking performance change after this training. In detail, body weight support treadmill training and over ground walking training might be used as two examples of LEAPS training in this subsection and the neurophysiological change of the patients in this subsection is based on the findings of current fMRI studies of the LEAPS training. On the other hand, I also want to write something about the 3D gait analysis system, such as ‘VICON’, under the subsection---Capturing and Analyzing Human Movement.

As for the graphical content, I’m thinking about creating an animated gif showing a gait cycle of one stroke patient. Because we always see the gait cycle pattern of the healthy people on the website, however, it’s also necessary for us to analyze the gait pattern of the patients in the lab in order to identify their gait abnormities.

Assignment 6
See Sporozc Assignment #6

Affiliated Clinics

 * USC Verdugo Hills Hospital---Clinic website
 * Children's Hospital Los Angeles---Clinic website
 * Rancho Los Amigos National Rehabilitation Center---Clinic website
 * Keck Hospital of USC---Clinic website
 * LAC+USC Medical Center ---Clinic webstie
 * USC PT Associates---HSC---Clinic webstie
 * USC PT Associates---UPC---Clinic webstie

Principle
Neuroplasticity

Neuroplasticity is a mechanism and a process that our brain learns new skills and behaviors via experiences. The brain encodes new experiences by remodeling the neural responses to enable behavior changes. This process can happen in a healthy brain as well as a damaged brain while re-learning lost functions through compensation or rehabilitative training.

Kleim and Jones (2008) reviewed ten principles of experience-dependent neuroplasticity and emphasized the implications for rehabilitation. The principles, including “use it or lose it”, “use it and improve it”, and “specificity”, addressed the importance of repetitive and intensive trainings to induce neuroplasticity in order to optimize patients' functional outcomes. Other previous studies have also supported the possibility of neuroplasticity and brain reorganization induced by intensive trainings, such as constraint-induced movement therapy, which can improve individuals' functional ability.

Assignment 8
Neuroplasticity is also related to the mechanism by which the damaged brain relearns lost behavior in response to rehabilitation.

A lot of studies showed that behavioral experience could enhance the behavioral performance and optimize the restorative brain plasticity after brain damage. Followings are three fields of these studies:

Constraint induced movement therapy (CIMT) involves the intensive training of the stroke affected limb coupled with the restricted use of the unaffected limb. The Extremity Constraint Induced Therapy Evaluation (EXCITE) trial showed significant improvements in paretic arm motor ability and daily use after CIMT. In addition, it’s found that CIMT intervention was associated with the cortical reorganization.

Body weight support treadmill training (BWSTT) is a new type of locomotion training methods. It provides the patients with an overhead harness, which allows them to do considerable stepping practices. It’s also shown to cause neural adaptive change and functional improvement in patients with a history of stroke.

Mirror therapy was originally used as one treatment for the management of chronic pain such as phantom pain. Recently, it’s also used as a training method for the patients with a history of stroke. A mirror is used during the training procedure to provide the patients with visual feedback. Clinical trails showed significant training effects of mirror therapy to enhance motor recovery and functioning after stroke.

Thus, previous studies strongly support the use of rehabilitative training as a tool to improve brain reorganization and functional outcome.