NeuroRehabilitation - Volume 33, issue 1

Authors: Forrester, Larry W. | Roy, Anindo | Goodman, Ronald N. | Rietschel, Jeremy | Barton, Joseph E. | Krebs, Hermano Igo | Macko, Richard F.

Article Type: Research Article

Abstract: Background: Advances in our understanding of neuroplasticity and motor learning post-stroke are now being leveraged with the use of robotics technology to enhance physical rehabilitation strategies. Major advances have been made with upper extremity robotics, which have been tested for efficacy in multi-site trials across the subacute and chronic phases of stroke. In contrast, use of lower extremity robotics to promote locomotor re-learning has been more recent and presents unique challenges by virtue of the complex multi-segmental mechanics of gait. Objectives: Here we review a programmatic effort to develop and apply the concept of joint-specific modular robotics to …the paretic ankle as a means to improve underlying impairments in distal motor control that may have a significant impact on gait biomechanics and balance. Methods: An impedance controlled ankle robot module (anklebot) is described as a platform to test the idea that a modular approach can be used to modify training and measure the time profile of treatment response. Results: Pilot studies using seated visuomotor anklebot training with chronic patients are reviewed, along with results from initial efforts to evaluate the anklebot's utility as a clinical tool for assessing intrinsic ankle stiffness. The review includes a brief discussion of future directions for using the seated anklebot training in the earliest phases of sub-acute therapy, and to incorporate neurophysiological measures of cerebro-cortical activity as a means to reveal underlying mechanistic processes of motor learning and brain plasticity associated with robotic training. Conclusions: Finally we conclude with an initial control systems strategy for utilizing the anklebot as a gait training tool that includes integrating an Internal Model-based adaptive controller to both accommodate individual deficit severities and adapt to changes in patient performance. Show more

Keywords: Stroke, rehabilitation robotics, hemiparetic gait, lower extremity robotics, motor learning

DOI: 10.3233/NRE-130931

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 85-97, 2013

Authors: Tanabe, Shigeo | Hirano, Satoshi | Saitoh, Eiichi

Article Type: Research Article

Abstract: Background: Due to physical and psychosocial issues associated with long-term sitting in a wheelchair, devising new ways to facilitate upright mobility is a key issue in rehabilitation medicine. Wearable Power-Assist Locomotor (WPAL) is a motorized orthosis and is developed for providing independent and comfortable walking for paraplegic patients. Methods: The WPAL consists of a wearable robotic orthosis and custom walker. To facilitate alternate usage with a wheelchair, the wearable robotic orthosis is based on a medial system with motors located at the bilateral hip, knee and ankle joints to reduce the increase in heart rate during gait. The …gait parameters include stride length, toe clearance height, swing time, double support time, etc. (gait speed: up to 1.3 km/h). Independent gait with the walker can be learned through a five-stage gait exercise sequence. The first two stages are stepping and gait exercises with parallel bars. The third stage is gait exercise on treadmill. The subsequent two stages are gait exercise with walker. Results: Seven motor-complete paraplegic patients (spinal cord functional levels: T6-T12) participated. Through a series of exercises, all users achieved independent gait on a level floor (Functional Ambulation Categories: 4). The mean duration and distance of consecutively walking were 14.1 ± 11.4 minutes and 165.6 ± 202.6 m, respectively. The most competent user was able to walk continuously for as long as 40 minutes and 640 m whereas only for 6 minutes and 107 m with a conventional orthosis. Conclusions: These results suggest that WPAL might be useful device for supporting upright walking in persons with paraplegia. Show more

Keywords: Spinal cord injury, gait rehabilitation, rehabilitation robotics, motorized orthosis

DOI: 10.3233/NRE-130932

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 99-106, 2013

Authors: Brichetto, Giampaolo | Rinaldi, Sara | Spallarossa, Patricio | Battaglia, Mario Alberto | Lopes de Carvalho, Maria Laura

Article Type: Research Article

Abstract: Objective: Evaluate the efficacy of outcome measures routinely used in a physical therapy service for Multiple Sclerosis (MS). Design: We performed a retrospective review of 500 medical records of MS patients from the outpatients service of AISM Rehabilitation Centre, Genova, Italy. Patients: All records of outpatients followed by AISM Rehabilitation Centre who underwent physical therapy from 2006 to 2008 were evaluated. Methods: Modified Fatigue Impact Scale (MFIS) and Ambulation Index (AI) were reviewed for all records at the begin and at the end of the rehabilitation treatment. Results: The number of assessments …recorded was 295 in 209 patients. Out of the 209 patients, 133 were female and 76 were male. The mean age was 51.6 ± 11.68 years, the mean Expanded Disability Status Scale (EDSS) score was 4.98 ± 1.79, and 185 patients were ambulatory. In nonambulatory patients neither scale showed a significant increase. In ambulatory patients (275 assessments) significant changes were observed in AI, MFIS total score and subscores. Conclusion: Physical therapy has a positive impact on fatigue, and the MFIS seems to be a good outcome measure in ambulatory patients. The AI and MFIS seem to be not indicated for use in non-ambulatory patients. Show more

Keywords: Multiple sclerosis, rehabilitation, outcome, ambulation index, fatigue

DOI: 10.3233/NRE-130933

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 107-112, 2013

Authors: Kholod, Hajuj | Jamil, Andrawes | Katz-Leurer, Michal

Article Type: Research Article

Abstract: Aims: To measure heart rate (HR) and heart rate variability (HRV) at rest, during and after walking among children with cerebral palsy (CP) as compared to age matched typically developed (TD) controls. The second aim was to describe the association between HRV and motor performance in children with CP. Methods: Twenty six children with CP (age 8–14 years) and sixteen TD children matched for age assessed during rest, walking and after walking. HR and HRV parameters include: time domain parameters: standard deviation of the R-R interval (SDNN), square root of the mean squared differences of successive R-R differences …(RMSSD). Results: Children with CP demonstrated higher mean HR values at rest; 98.4 ± 13.9 bpm vs 83.0 ± 11.5 bpm in controls, (p < 0.05) and significantly lower time domain measures of HRV; RMSSD was 52.0 ± 19.1 ms and 87.0 ± 39.8 ms respectively (p < 0.05). Significant interaction effects were noted for HR and time domain HRV parameters. HR increased and SDNN and RMSSD decreased when children change their activity level from rest to walking and HR decreased and SDNN and RMSSD increased again after walking for TD children but not for children with CP (p < 0.05). No association was noted between HRV and motor performance in children with CP. Interpretation: The findings of this study suggest that among children with CP, the cardiac autonomic mechanism is less efficient at rest and less adaptive to exercise and activity as compared to TD children. Show more

Keywords: Cerebral palsy, heart rate variability, motor performance, walking

DOI: 10.3233/NRE-130934

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 113-119, 2013

Authors: Barman, Apurba | Bhide, Rohit | Viswanathan, Anand | George, Jacob | Thomas, Raji | Tharion, George

Article Type: Research Article

Abstract: Background: Gorham's disease of the spine is very rare and usually associated with poor prognosis. Till date very few cases have been reported in the literature. It is characterized by osseous invasion by angiomatous vascular mass without skip areas, eventually causing lysis of affected bone. Morbidity and mortality are high in those with spinal and/or visceral involvement. Neurological complications increase the mortality to 33% whereas with chylothorax, mortality increases to more than 50%. Objectives: To describe the clinical course and the challenges in planning and implementing effective rehabilitation services for management of patients with Gorham's disease of the …spine. Methods: We report two patients with Gorham's disease who had neurological deficits secondary to spinal cord involvement, and their rehabilitation perspectives. Results: Both patients achieved satisfactory ambulation and functional outcomes. Conclusion: Multiple revision surgeries may be required to ensure spinal stability. When working with these patients, one must remain vigilant about spinal stability as well as about possible serious pulmonary complications, and be prepared to make appropriate management decisions when necessary. Show more

Keywords: Gorham's disease, spinal cord, rehabilitation

DOI: 10.3233/NRE-130935

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 121-126, 2013

Authors: Brogårdh, Christina | Flansbjer, Ulla-Britt | Espelund, Christina | Lexell, Jan

Article Type: Research Article

Abstract: Background: Muscle weakness in the lower limbs and impeded gait performance are common in persons with late effects of polio. Objective: To assess self-reported walking ability in persons with late effects of polio and determine the relationship with objectively assessed gait performance. Methods: One-hundred and twenty-two individuals with prior polio (65 women and 57 men, mean age 65 [SD ± 9] years) participated in the study. The main outcome measures were: Walk-12 (Swedish version) to assess self-reported walking ability, and Timed “Up & Go”, Comfortable Gait Speed, Fast Gait Speed and 6-Minute Walk Tests to assess …gait performance objectively. Results: More than 50% of the participants reported limitations (moderately or quite a bit) related to standing or walking, climbing stairs, walking speed and distance, concentration and effort, and gait quality aspects. Half of the participants reported no need to use support when walking indoors or outdoors, but 58% reported that their ability to run was extremely limited. Significant correlations (P < 0.01) were found between the Walk-12 and the four gait performance tests (rho −0.66 to 0.63). Conclusion: The strength of the relationship implies that Walk-12 reflects broader dimensions than the objective gait performance tests and can be a complement when the walking ability in persons with late effects of polio is evaluated. Show more

Keywords: Outcome assessment (Health Care), rehabilitation, self-report, post-polio myelitis, walking

DOI: 10.3233/NRE-130936

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 127-132, 2013

Authors: Thrasher, Timothy Adam | Ward, John Stanley | Fisher, Stanley

Article Type: Research Article

Abstract: Objectives: To describe adaptations in power output, quadriceps muscle strength, and fatigability that occur during a 13-week regimen of Functional Electrical Stimulation Leg Cycle Ergometry (FES-LCE) in Spinal Cord Injury (SCI). To identify differences in outcomes between individuals with complete and incomplete motor impairment. Design: Observational and longitudinal. SETTING: Rehabilitation and biomechanics research laboratory. Participants: Eleven (N = 11) individuals with SCI and no previous FES-LCE experience. Intervention: 40 sessions of FES-LCE at a rate of three sessions per week. Continuous exercise was performed at a pedal cadence of 45 RPM against a constant …resistance for up to 60 minutes. Outcome measures: Mean power output was recorded for each session. Before and after the training regimen, each subject performed a fatigue test in which electrically stimulated knee extension torque and Fatigue Index were measured. Results: Participants demonstrated significant increases in mean power output (9.0 to 20.3 W; p < 0.001), peak isometric knee extension torque (3.8 to 16.9 Nm; p = 0.006) and sustainable isometric knee extension torque (4.9 to 14.4 Nm; p = 0.001) after FES-LCE training (95% confidence intervals). Participants with incomplete motor impairment demonstrated a decrease in Fatigue Index (p = 0.021), and improved mean power output more than those with complete motor impairment (p = 0.037). Conclusions: Significant improvements in muscle conditioning and exercise performance are possible following the 13-week regimen of FES-LCE described in this article. Individuals with incomplete motor impairment experience greater improvements in mean power output than individuals with complete motor impairment. Show more

Keywords: Exercise, paraplegia, tetraplegia, cycling

DOI: 10.3233/NRE-130937

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 133-138, 2013

Authors: Hansen, Dominique | Wens, Inez | Dendale, Paul | Eijnde, Bert O.

Article Type: Research Article

Abstract: Objective: To explore the etiology of exercise intolerance in patients with MS, it is analyzed whether a disturbed cardiac autonomic control could be observed during exercise testing in patients with MS, and is related to exercise tolerance. Patients and method: From 26 MS patients and 15 healthy subjects, exercise-onset (first 20 and 60 seconds) and –offset (1-minute recovery) HR change was determined during a 6-minute constant-load exercise bout on bike. Blood lactate, HR, oxygen uptake, expiratory volume and perceived exertion were assessed during exercise, and compared between groups. In 15 MS patients, a 6-min walking test was executed. …Result: Twenty-second exercise-onset HR increase was significantly smaller in MS patients (14 ± 7 bts/min) vs. healthy subjects (20 ± 8 bts/min, p < 0.05), and independently related to MS and age in total group (p < 0.05). Sixty-second exercise-onset and –offset HR changes were not different between groups, nor independently related to MS presence (p > 0.05). A significant correlation was found between 20-second exercise-onset HR increase and walking capacity in MS patients (r = 0.64, p < 0.01). Conclusion: In MS patients, the early increase in heart rate during endurance exercise is significantly slowed, indicating a disturbed cardiac autonomic control, and is related to exercise tolerance. Show more

Keywords: Multiple sclerosis, endurance exercise, exercise testing, heart rate, autonomic control

DOI: 10.3233/NRE-130938

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 139-146, 2013

Authors: Govil, Kanika | Noohu, Majumi M.

Article Type: Research Article

Abstract: Study design: A Pretest –Posttest Experimental Design. Objectives: Patients with incomplete spinal cord injury (ISCI) retain or regain the ability to walk, but due to limitations in gait parameters, walking may not be the practical method of mobility in the community. Specific muscle training plays an important role in gait training. The purpose of this study was to determine the effect of EMG Biofeedback training of gluteus maximus muscle on gait parameters in ISCI patients. Setting: Indian Spinal Injury Center, New Delhi, India. Subjects: 30 incomplete spinal cord injured (ISCI) patients were included and …randomly assigned to two groups. Group 1 received EMG Biofeedback (EMG BF), Traditional Rehabilitation and Gait Training. Group 2 received Traditional Rehabilitation and Gait Training. Methods: Gait parameters were measured prior to the intervention for all 30 ISCI patients. EMG Biofeedback was given specifically over gluteus maximus muscle along with traditional rehabilitation and gait training to Group 1 for 5 days/week for 4 weeks. Group 2 received traditional rehabilitation and gait training for 5 days/week for 4 weeks. The results were interpreted on the basis of: EMG amplitude, step length, walking velocity and cadence. Results: Results showed significant difference between two groups for EMG amplitude (t = 6.06, p = 0.001), walking velocity (t = 2.12, p = 0.043), cadence (t = 1.96, p = 0.05). Step length did not show any significant difference (t = 0.66, p = 0.512). Conclusion: The study concluded that EMG BF when given specifically over gluteus maximus resulted in improvement of EMG amplitude and various gait parameters (walking velocity, cadence). Show more

Keywords: Incomplete spinal cord injury, EMG biofeedback, gluteus maximus, gait velocity, cadence, step length

DOI: 10.3233/NRE-130939

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 147-152, 2013

Authors: Akbari, Shadi | Lyden, Patrick D. | Kamali, Mohammad | Akbarfahimi, Malahat

Article Type: Research Article

Abstract: Objectives: We investigated the hypothesis that ADL tests dependent on cortical functions could be used to assess outcome in stroke patients. Materials and method: 27 right-handed stroke patients were evaluated on National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), Instrumental Activities of Daily Living (IADL) Scale and thinking process items of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA). Results: Correlations between thinking process subtests of LOTCA and different items of NIHSS such as consciousness, arm movement, aphasia, ataxia and inattention was significant. Spearman correlation of thinking process and BI tasks showed no relationship, although Structured …Riska of thinking process evaluation was correlated to both self-care and mobility areas of the BI. Thinking process was strongly related to IADL total score (p = 0.004). The total NIHSS correlated significantly with BI and IADL total scores. Conclusion: Higher-order functions, such as categorization, sorting and reasoning, are related to IADL performance which depends on complicated cognitive abilities. In contrast, the BI depends heavily on motoric function, and does not correlate with higher-order functions. Further confirmation is needed, but our data suggest that commonly used IADL tests could serve to as valid, reliable tests of cognitive impairment and recovery in stroke victims. Show more

Keywords: Stroke, mild cognitive impairment, rehabilitation, cerebrovascular disease

DOI: 10.3233/NRE-130940

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 153-160, 2013

Authors: Gorgey, Ashraf S. | Cho, Gilbert M. | Dolbow, David R. | Gater, David R.

Article Type: Research Article

Abstract: Objectives: To investigate the effects of regional thigh composition that result in different responses to current amplitude among individuals with spinal cord injury (SCI) during applications of surface neuromuscular electrical stimulation (NMES) to evoke dynamic leg extension. Design: Cross-sectional. Settings: Academic Settings. Methods: Five males with chronic motor complete SCI completed 3 visits of NMES to determine the current amplitude required to evoke full knee extension. The participants underwent magnetic resonance imaging of both thighs to measure skeletal muscle cross-sectional area (CSA), thigh subcutaneous adipose tissue (SAT) and intramuscular fat (IMF). Applicants were classified …into high (n = 3) and low-responders (n = 2) based on the determined current amplitude. Results: The low-responders required 48–59% greater current amplitude to complete the same task as the high-responders. Low-responders had greater thigh SAT CSA (51–56%) than the high-responders with SCI. After adjusting to whole thigh CSA, IMF CSA was significantly greater in the low- responders; whereas skeletal muscle CSA was lower compared to the high-responders. Conclusion: The findings suggest that thigh SAT and IMF act as insulation against propagation of current during surface NMES applications in individuals with SCI. Show more

Keywords: Spinal cord injury, electrical stimulation, magnetic resonance imaging, subcutaneous adipose tissue, intramuscular fat

DOI: 10.3233/NRE-130941

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 161-170, 2013

Authors: Suzuki, Toshiaki | Bunno, Yoshibumi | Onigata, Chieko | Tani, Makiko | Uragami, Sayuri

Article Type: Research Article

Abstract: Background: It is unclear whether mental simulation without actual muscle contraction associated with actual motion can increase the excitability of the spinal neural function. Objective: To determine the best method for mental simulation without actual muscle contraction, we analyzed the F-wave of thenar muscles after stimulating the median nerve by motor imagery whilst holding the sensor of a pinch meter between the thumb and index finger and without holding the sensor. Methods: Healthy volunteers (n = 11; mean age, 34 years) participated in this study after providing informed consent. We examined the F-wave of the left …thenar muscles after stimulating the left median nerve at the wrist at rest and under holding and motor imagery conditions. For the motor imagery condition, the subjects were asked to establish 50% maximal voluntary contraction (MVC) of isometric contraction while holding the sensor between the thumb and index finger (motor imagery with the sensor condition) and without holding the sensor on another day (motor imagery without the sensor condition). Results: The persistence and amplitude ratio of F/M during motor imagery with or without the sensor was better than that during relaxation. In particular, this ratio was significantly higher under the with sensor condition than under the without sensor condition. Conclusion: Movement preparation for a motor imagery task involving 50% MVC isometric contraction of the opponens pollicis is important. Show more

Keywords: Motor imagery, F-wave, movement preparation

DOI: 10.3233/NRE-130942

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 171-176, 2013

Authors: Lee, Na Kyung | Kwon, Jung Won | Son, Sung Min | Kang, Kyung Woo | Kim, Kyoung | Hyun-Nam, Seok

Article Type: Research Article

Abstract: Objective: The major contributors to physical disability after stroke are the negative impairments related to loss of functional ability and muscle strength. The aim of this study was to examine the effects of close kinetic chain (CKC) exercise and open kinetic chain (OKC) exercise on muscle activation of the paretic lower limb and balance in chronic stroke subjects. Methods: Thirty-three patients with chronic stroke of over 6 months were enrolled. They were randomly allocated to three groups: CKC exercise group (n = 11), OKC exercise group (n = 11), and control group (n = 11). CKC and OKC …exercise groups were trained 5 times per week for 6 weeks. The control group maintained routine activities and did not participate in any regular exercise program. All subjects were measured on muscle activation of the paretic lower limb and balance. Results: Muscle activation of rectus femoris (RF) and biceps femoris (BF) was significantly increased in both CKC exercise and OKC exercise groups, compared to the control group. However, muscle activation of gastrocnemius (GC) and tibialis anterior (TA) was significantly increased in only the CKC exercise group. Antero-posterior (A-P) andmedio-lateral (M-L) sway velocities (both with EO and EC) were decreased with the application of CKC exercise. Conclusion: These findings indicate that the CKC exercise can improve lower limb muscle strength, and balance in chronic stroke, and it may carry over into an improvement in functional performance. Show more

Keywords: Close and open kinetic chain exercise, progressive resistance training, stroke

DOI: 10.3233/NRE-130943

Citation: NeuroRehabilitation, vol. 33, no. 1, pp. 177-183, 2013