NeuroRehabilitation - Volume 33, issue 2

Authors: Saxton, Melissa E. | Younan, Shameran Slewa | Lah, Suncica

Article Type: Research Article

Abstract: Objective: This theoretically driven study aimed to determine contribution of emotional perception impairments to social behaviour following traumatic brain injury (TBI). Methods: Adults with severe TBI (n = 24) participated. Emotion perception predictors included: (i) appraisal: Montreal Set of Facial Displays of Emotion, The Adapted Story Task, (ii) affective state: Depression, Anxiety and Stress Scale (DASS-21), Interpersonal Reactivity Index (IRI) and (iii) regulation: Delis Kaplan Executive Function System - Colour Word Interference and Word Fluency. Social behavioural outcomes were (i) interpersonal: Key Behaviors Change Inventory (KBCI) - Interpersonal Difficulties and (ii) communication: KBCI - Communication Problems. …Results: Social behaviours correlated with affective state, but not appraisal or regulation. Simultaneous regression analyses revealed significant independent contributions of affective state: (i) the IRI Perspective Taking to the KBCI Interpersonal Difficulties and (ii) the DASS-21 (composite) and IRI Perspective Taking to the KBCI Communication Problems. The models explained 52% and 72% of the variance of the KBCI Interpersonal Difficulties and Communication Problems respectively. Conclusions: This study provides evidence that impairments in certain aspects of emotion perception: affective state [empathy (perspective taking) and mood], but not appraisal and regulation, contribute to social behaviour difficulties in patients with severe TBI, which has important implications for rehabilitation. Show more

Keywords: Brain injuries, emotions, social behaviour, rehabilitation

DOI: 10.3233/NRE-130954

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 263-271, 2013

Authors: Stevens, Lillian F. | Perrin, Paul B. | Hubbard, Rebecca | Díaz Sosa, Dulce María | Espinosa Jove, Irma Guadalupe | Arango-Lasprilla, Juan Carlos

Article Type: Research Article

Abstract: Purpose: To examine differences in ratings of family dynamics between individuals with traumatic brain injury (TBI) and their family caregivers in Mexico, as well as differences in the prediction of caregiver and patient mental health outcomes from those ratings. Method: Forty-two patient-caregiver dyads (n = 84) from the National Institute of Rehabilitation in México City participated in a comprehensive evaluation of their family dynamics and mental health. Results: Patients' and caregivers' ratings of family dynamics were significantly correlated and did not differ across five of six types of family dynamics, but caregivers rated their family's level …of empathy higher than patients, p < 0.001. Additionally, all patient and caregiver ratings of family dynamics were significantly correlated. Patients', caregivers', and combined (using structural equation modeling latent constructs) ratings of family dynamics robustly predicted four times as many caregiver mental health outcomes as patient mental health outcomes. Conclusions: Family dynamics influence both TBI patient and caregiver mental health but much more so in caregivers. Research on families of individuals with TBI in Mexico should incorporate both patient and caregiver perspectives to more comprehensively depict the environment in which TBI rehabilitation occurs. Show more

Keywords: TBI, caregivers, family functioning, mental health outcomes

DOI: 10.3233/NRE-130955

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 273-283, 2013

Authors: Salhofer-Polanyi, Sabine | Windt, Judith | Sumper, Harald | Grill, Hermine | Essmeister, Maria | Diermayr, Gudrun | Zebenholzer, Karin | Leutmezer, Fritz | Zulehner, Gudrun | Vass, Karl | Asenbaum-Nan, Susanne

Article Type: Research Article

Abstract: Background: Rehabilitation is often recommended to MS-patients but data on its efficacy is limited. Objective: To evaluate the benefit of inpatient multidisciplinary rehabilitation. Methods: A rater-blinded, randomized, waiting list controlled exploratory study. 19 participants completed the study with ten allocated to the intervention and nine to the waiting list group. Assessment of outcome-parameters was done at baseline and after 3 months. Time Walking Tests (TWTs) and 9 Hole Peg Test were used to objectively assess the level of activity, Functional-Assessment-in-MS and MS-Self Efficacy-Scale to assess participation and quality of life and Expanded Disability Status Scale (EDSS) …to assess bodily function. Additionally Rivermead Mobility Index, Berg Balance Scale, Tinetti-Test, MS-Functional Composite and a rater-blinded evaluation of a video-analysis on walking performance was done. Results: Mean change scores of Timed 50 meter Walk (p = 0.014), walking speed (p = 0.034), 2- (p = 0.204) and 6-Minute Walk (p = 0.027) indicated an improvement favoring inpatient multidisciplinary rehabilitation. We could not demonstrate a benefit for upper limb function and some improvement was seen in other outcome-parameters without reaching statistical significance. EDSS remained unchanged. Conclusion: Inpatient multidisciplinary rehabilitation is effective in MS patients with positive impact on the level of activity as measured by TWTs covering both short and long distance ambulation. Show more

Keywords: Multiple sclerosis, inpatient, rehabilitation, level of activity, 6-Minute walk, 2-Minute walk

DOI: 10.3233/NRE-130956

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 285-292, 2013

Authors: Citaker, Seyit | Guclu-Gunduz, Arzu | Yazici, Gokhan | Bayraktar, Deniz | Nazliel, Bijen | Irkec, Ceyla

Article Type: Research Article

Abstract: Background: Muscle strength and standing balance decrease in patients with Multiple Sclerosis (MS). Objective: The aim of the present study was to investigate the relationship between the lower extremity isometric muscle strength and standing balance in patients with MS. Methods: Forty-seven patients with MS and 10 healthy volunteers were included. Neurological disability level was assessed using Expanded Disability Status Scale (EDSS). Isometric strength of seven lower extremity muscles (hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor) was assessed using hand-held dynamometer. Duration of static one-leg standing balance was measured using digital chronometer. Results: Hip …flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength, and duration of one-leg standing balance were decreased in patients with MS when compared with controls (p < 0.05). All assessed lower extremity isometric muscle strength and EDSS level was related duration of one-leg standing balance in patients with MS. All assessed lower extremity isometric muscle strength (except ankle dorsal flexor) was related with EDSS. Conclusions: Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength decreases in ambulatory MS patients. Lower extremity muscle weakness and neurological disability level are related with imbalance in MS population. Hip and knee region muscles weakness increases the neurological disability level. For the better balance and decrease neurological disability level whole lower extremity muscle strengthening should be included in rehabilitation programs. Show more

Keywords: Muscle strength, balance, multiple sclerosis, EDSS

DOI: 10.3233/NRE-130958

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 293-298, 2013

Authors: Frazzitta, Giuseppe | Abbruzzese, Giovanni | Bertotti, Gabriella | Boveri, Natalia | Pezzoli, Gianni | Maestri, Roberto

Article Type: Research Article

Abstract: Goal and objectives: Parkinsonian patients can be classified in two main subgroups: tremor dominant and akinetic-rigid. The aim of this study was to evaluate whether intensive rehabilitation treatment has the same efficacy in the two subtypes. Material and methods: Patients were classified according to tremor: 65 patients with absence of tremor in “on” and “off” state were assigned to Group_1 and 65 patients with tremor were assigned to Group_2. All patients underwent a 4-week intensive multidisciplinary rehabilitation treatment. The primary outcome measures were: the Unified Parkinson's Disease Rating Scale (UPDRS) II, III, UPDRS akinetic-rigid score and UPDRS tremor …score. The secondary outcome measures were: the Berg Balance Scale, 6-minute walking test, self-assessment Parkinson's Disease Disability Scale, Abnormal Involuntary Movement Scale, Freezing of Gait Questionnaire. Results: Patients in Group_1 tended to be more affected than patients in Group_2 by dyskinesias (45% vs 29% p = 0.069) and freezing (46% vs 29%, p = 0.046). Levodopa-equivalent dosages were higher in Group_1 (802 vs 670 mg/day, p = 0.008). Considering the effect of rehabilitation, an homogeneous improvement was observed in all variables in both groups of patients (p < 0.0001). Conclusion: Intensive rehabilitation treatment is effective in improving motor performance in both groups. The anatomical and biochemical differences existing between the two subgroups appear to not determine different clinical outcomes. Show more

Keywords: Parkinson's disease, akinetic-rigid, tremor, rehabilitation

DOI: 10.3233/NRE-130959

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 299-303, 2013

Authors: Stegemöller, Elizabeth L. | Vallabhajosula, Srikant | Haq, Ihtsham | Hwynn, Nelson | Hass, Chris J. | Okun, Michael S.

Article Type: Research Article

Abstract: Background: High frequency stimulation (HFS) of the subthalamic nucleus is one of the most effective treatments for advanced Parkinson's disease (PD). HFS has provided beneficial improvements in the cardinal features of PD, but has not been proven as effective for addressing the axial predominant levodopa resistant symptoms, such as speech disturbances, gait disturbances, and postural instability. Recent studies have suggested that changes in stimulation parameters may influence differing PD symptoms. Objective: The purpose of this study was to compare the effects of low frequency stimulation (LFS) versus HFS on the Unified Parkinson's Disease Rating Scale (UPDRS), gait, balance, …and verbal fluency. Methods: Eight tremor dominant and nine non-tremor dominant participants with bilateral deep brain stimulation of the subthalamic nucleus were tested off stimulation, during LFS, and during HFS. Results: Results revealed that HFS significantly reduced UPDRS tremor score in the tremor dominant group; however no differences emerged within the non-tremor dominant group. No differences between groups or stimulation conditions were found for gait, balance, and verbal fluency measures. Conclusion: These results may suggest that HFS is better than LFS for reducing tremor in tremor dominant patients. However, patients with mild or no tremor show no acute differences in benefit from LFS as compared to HFS. Show more

Keywords: Low frequency stimulation, Parkinson's disease, gait, balance, speech

DOI: 10.3233/NRE-130960

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 305-312, 2013

Authors: Corbett, Duane B. | Peer, Kimberly S. | Ridgel, Angela L.

Article Type: Research Article

Abstract: Background: Parkinson's disease (PD) is a neurological disorder which often results in joint rigidity, bradykinesia and decreased range of motion (ROM). Segmental biomechanical muscle stimulation (BMS) can increase ROM in healthy young adults. However, acute effects on ROM in PD have not been examined. Objective: To examine whether BMS and active-assisted cycling (AAC) of the legs results in acute changes in ROM in PD. Methods: Seventeen individuals with PD completed four sessions. Subjects first came to the lab ‘on’ PD medications and completed baseline assessments. During session 2, subjects were ‘off’ PD medications and watched a …video describing the interventions. In the 3rd and 4th visits, subjects were ‘off’ medications and the order of AAC or BMS was counterbalanced. Shoulder and hip ROM was measured prior to and immediately after each intervention and hip kinematics were examined during over-ground walking. Results: There was a significant improvement in hip and shoulder ROM after BMS and AAC. Hip velocity during over-ground walking improved after BMS but not after AAC. Conclusions: Single bouts of BMS and AAC have a positive effect on ROM and hip velocity during over-ground walking. This suggests that BMS and AAC may be altering central motor control processes. Show more

Keywords: Segmental vibration, range of motion, flexibility, exercise

DOI: 10.3233/NRE-130961

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 313-322, 2013

Authors: Paker, Nurdan | Bugdayci, Derya | Goksenoglu, Goksen | Sen, Aysu | Kesiktas, Nur

Article Type: Research Article

Abstract: Background: Decreased mobility and walking capacity occur frequently in Parkinson's disease (PD). Robotic treadmill training is a novel method to improve the walking capacity in rehabilitation. Objectives: The primary aim of this study was to investigate the effects of robotic treadmill training on functional mobility and walking capacity in PD. Secondly, we aimed to assess the effects of the robotic treadmill training the motor symptoms and quality of life in patients with PD. Methods: Seventy patients with idiopathic Parkinson's disease who admitted to the outpatient clinic of the rehabilitation hospital were screened and 12 ambulatory volenteers …who met the study criteria were included in this study. Patients were evaluated by Hoehn Yahr (HY) scale clinically. Two sessions robotic treadmill training per week during 5 weeks was planned for every patient. Patients were evaluated by the Timed Up and Go (TUG) test, 10 meter walking test (10 MWT), Unified Parkinson's Disease Rating Scale (UPDRS) motor section and Parkinson's Disease Questionnaire-39 (PDQ-39) at the baseline, at the 5 and 12 weeks. Cognitive and emotional states of the patients were assessed by Mini Mental State Examination (MMSE) test and Hospital Anxiety and Depression Scale (HADS) at the baseline. All patients were under medical treatment for the PD in this study and drug treatment was not changed during the study. Results: Ten patients completed the study. The mean age was 65.6 ± 6.6 years. Five patients (50%) were women. Disease severity was between the HY stage 1–3. Two patients did not continue the robotic treadmill training after 7 sessions. They also did not want to come for control visits. TUG test, 10 MWT and UPDRS motor subscale scores showed statistically significant improvement after robotic treadmill training (p = 0.02, p = 0.001, p = 0.016). PDQ-39 scores improved significantly after robotic treadmill training (p = 0.03), however, the scores turned back to the baseline level at the 12. week control. Conclusion: As a result of this preliminary study, robotic treadmill training was useful to improve the functional mobility, walking capacity and motor symptoms in mild to moderate PD. Robotic treadmill training provided a transient improvement in the quality of life during the treatment. Show more

Keywords: Parkinson's disease, robotic treadmill training, Timed Up and Go test, 10 meter walk test, functional status, quality of life

DOI: 10.3233/NRE-130962

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 323-328, 2013

Authors: Reitz, André

Article Type: Research Article

Abstract: Background: Critical illness polyneuropathy is a frequent complication of critical illness in intensive care units. Reports on autonomic systems like lower urinary tract and bowel functions in patients with CIP are not available in medical literature. Objective: This study performed during primary rehabilitation of patients with critical illness polyneuropathy explores if sensory and motor pathways controlling the lower urinary tract function are affected from the disease. Methods: Neurourological examinations, urodynamics, electromyography and lower urinary tract imaging were performed in 28 patients with critical illness polyneuropathy. Discussion: Sacral sensation was impaired in 1 patient (4%). …Sacral reflexes were absent in 8 patients (30%). Anal sphincter resting tone was reduced in 3 (12%), anal sphincter voluntary contraction was absent or reduced in 8 patients (30%). Urodynamic findings were detrusor overactivity and detrusor overactivity incontinence in 9 (37.5%), incomplete voiding in 8 (30%), abnormal sphincter activity in 4 (16%), abnormal bladder sensation in 4 (16%) and detrusor acontractility in 2 patients (8.3%). Morphological abnormalities of the lower urinary tract had 10 patients (41.6%). Conclusion: Sensory and motor pathways controlling the lower urinary tract might be affected from CIP. During urodynamics dysfunctions of the storage as well as the voiding phase were found. Morphological lower urinary tract abnormalities were common. Show more

Keywords: Critical illness polyneuropathy, urinary bladder, neurogenic, detrusor overactivity, urinary incontinence, urinary retention

DOI: 10.3233/NRE-130963

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 329-336, 2013

Authors: Paker, Nurdan | Bugdayci, Derya | Midik, Melike | Celik, Berna | Kesiktas, Nur

Article Type: Research Article

Abstract: Background: Emotional problems are common in spinal cord injury (SCI). Self report questionnaires are easy and useful for screening the emotional status in clinical practice. Objectives: The aim of this study was to assess the reliability of the Turkish version of the Hospital Anxiety and Depression Scale (HADS) as well as to investigate the frequency of anxiety and depression in a group with SCI admitted to the outpatient clinic of a rehabilitation hospital. Methods: One hundred seventy-five persons with traumatic SCI were included in this study. The American Spinal Injury Association Impairment Scale, Functional Independence Measure …(FIM) and HADS were used for assessments. Results: The mean age of the participants was 35 ± 13 years, and the mean time elapsed since injury was 13 ± 29 months. The mean motor FIM score was 41 ± 21. The Cronbach's alpha coefficient was 0.90 and 0.77 for the anxiety and depression subscales of the HADS, respectively. Forty percent of the participants had anxiety and 28% had depression. Anxiety was positively correlated with time since injury (r = 0.2). Depression was negatively correlated with the education level (r = 0.25), and positively correlated with age (r = 0.17). There was a positive correlation with completeness and anxiety and depression (r = 0.49, r = 0.55). Conclusion: The Turkish version of the HADS is a reliable psychological screening test for anxiety and depression in people with SCI. Rehabilitation team should gather maximum information about the emotional status of the person with SCI, and plan the appropriate treatment for anxiety and depression. Show more

Keywords: Anxiety, depression, hospital anxiety and depression scale, reliability, spinal cord injury

DOI: 10.3233/NRE-130964

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 337-341, 2013

Authors: Block, Cady | Cianfrini, Leanne

Article Type: Research Article

Abstract: Background: The pervasive disease of chronic pain is a common challenge for the clinical rehabilitation professional. Concurrent with physical and emotional symptoms, pain-related cognitive impairment has been reported. Although opioid analgesics are frequently prescribed, concern exists that opioids possess adverse cognitive effects of their own. Objectives: To review the neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population, and to provide recommendations for clinical practice and future research. Methods: This non-systematic review sought to provide a comprehensive synthesis of relevant neurobiology, …neuroimaging, neuropsychological, and rehabilitation research literatures. We included citations from seminal and current texts as well as relevant original and review articles from 1980–2012 in PubMed and PubMedCentral online research databases. Discussion and summary/conclusions: To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations. Show more

Keywords: Pain, chronic, analgesics, opioid, cognition, neuropsychology, automobile driving

DOI: 10.3233/NRE-130965

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 343-366, 2013