NeuroRehabilitation - Volume 33, issue 4

Authors: Lee, Dong-Kyu | Kang, Min-Hyeok | Kim, Ji-Won | Kim, Yang-Gon | Park, Ji-Hyuk | Oh, Jae-Seop

Article Type: Research Article

Abstract: Background: Abdominal strengthening exercises are important for stroke patients; however, there is a lack of research on therapeutic exercises for increasing abdominal muscle activity in stroke patients. Objective: We investigated the effects of non-paretic arm exercises using a tubing band on abdominal muscle activity in stroke patients. Methods: In total, 18 hemiplegic subjects (13 males, 5 females) were recruited. All subjects performed non-paretic arm exercises involving three different shoulder movements (extension, flexion, and horizontal abduction) using an elastic tubing band. Surface electromyography (EMG) signals were recorded from the rectus abdominis (RA), external oblique (EO), and internal …oblique (IO) muscles bilaterally during non-paretic arm exercises. Results: EMG activities of abdominal muscles during non-paretic arm extension and horizontal abduction were increased significantly versus shoulder flexion when subjects performed the arm exercise in a seated position. Muscle activity of the EO was significantly greater in the paretic than the non-paretic side during non-paretic arm extension and horizontal abduction. Conclusions: We suggest that non-paretic arm extension and horizontal abduction exercises using an elastic tubing band may be effective in increasing abdominal muscle activity. Show more

Keywords: Elastic tubing band, non-paretic arm exercise, resistance direction, abdominal muscle

DOI: 10.3233/NRE-131003

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 605-610, 2013

Authors: Lisa, Lisa Pernet | Jughters, Anke | Kerckhofs, Eric

Article Type: Research Article

Abstract: Background: Patients suffering from unilateral neglect syndrome (UNS) are not able to respond to stimuli administered to the side of the body opposite to the lesion. UNS is most commonly seen after right-hemisphere lesions. Patients with UNS experience more problems with activities of daily living and recovery after stroke is delayed. Objective: To investigate which treatment modalities can alleviate the symptoms of UNS after stroke and to determine their effectiveness. Methods: Databases PubMed, Web of knowledge and PEDro have been searched. Quality assessment was conducted using the 9-item Delphi list. Data extraction was performed by the …first author. Effect sizes have been calculated using Cohen's d. Results: 15 RCT's have been included. Most studies used add-on therapies. Almost all studies found improvements in both groups, but only 7 trials showed statistically significant between group differences in favor of the experimental group. Large effect sizes were found in only four studies. Conclusions: All the interventions discussed in this review can reduce the symptoms of UNS. However, TENS, optokinetic stimulation, somatosensory electrostimulation, mirror therapy and virtual reality training seem to be the most effective treatment methods (d > 0,80). Future research should focus on producing studies of higher methodological quality with larger sample sizes. Show more

Keywords: Stroke, unilateral neglect, treatment, effect size, review

DOI: 10.3233/NRE-130986

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 611-620, 2013

Authors: Colombo, R. | Sterpi, I. | Mazzone, A. | Delconte, C. | Pisano, F.

Article Type: Research Article

Abstract: Background: Robotic neurorehabilitation, thanks to high dosage/intensity training protocols, has the potential for a greater impact on impairment. Objective: We aimed to analyze how time since the acute event may influence the motor recovery process during robot-assisted rehabilitation of the upper limb. Methods: A total of 41 patients after stroke were enrolled: 20 in subacute phase, i.e. ≤ 6 months elapsed since their unilateral cerebrovascular accident (CVA), and 21 at chronic stage, i.e. > 6 months since CVA. All subjects underwent 30 minutes of robot-aided rehabilitation twice a day, 5 days a week for at least …three weeks of training. Patients were evaluated at the start and end of treatment using the Fugl-Meyer and Modified Ashworth clinical scales and by a set of robot measured kinematic parameters. The time interval from stroke was considered as a grouping factor to analyze its impact on time course of recovery. Results: After training both groups significantly improved their impairment (F = 44.25, p < 0.001) but sub-acute patients showed a greater improvement on the Fugl-Meyer scale than chronic patients. The time course of recovery of the kinematic variables showed higher time constants of motor improvement in the sub-acute than chronic group, but they were one order lower than spontaneous recovery time constants. Conclusions: Spontaneous recovery seems to have a limited impact on the improvement of sub-acute patients, most of their changes being likely due to re-learning during rehabilitation. In addition, a longer recovery time was required to maximize outcome in sub-acute than in chronic patients. Show more

Keywords: Robotic therapy, motor recovery, stroke, spontaneous recovery, neurorehabilitation

DOI: 10.3233/NRE-131002

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 621-629, 2013

Authors: Guillén-Solà, Anna | Marco, Ester | Martínez-Orfila, Joan | Donaire Mejías, M. Fernanda | Depolo Passalacqua, Marina | Duarte, Esther | Escalada, Ferran

Article Type: Research Article

Abstract: Background: Swallowing disorders affect up to 35–85% of patients with stroke. Dysphagia complications can lead to malnutrition, dehydration, bronchoaspirative pneumonia and death, and have impact on health care costs. Objective: To evaluate the clinical screening capacity of the Volume Viscosity Swallow Test (V-VST) for oropharyngeal dysphagia and aspiration in a homogeneous stroke patient sample. Methods: Cohort study of 52 stroke patients in a subacute phase. Piecemeal deglutition and oropharyngeal residue were considered signs of impaired efficacy and cough, fall in oxygen saturation and voice changes, signs of impaired safety. Sensitivity, specificity, positive and negative predictive values, …accuracy and likelihood ratios were calculated for V-VST results and compared with those of videofluoroscopy (VFS), the gold standard for studies on swallowing disorders. Results: The V-VST is a highly sensitive and specific test to detect aspiration with sensitivity of 88.2% and specificity of 71.4%; negative predictive value was 92.6%; accuracy index was 0.74. Sensitivity and specificity for penetration were 34.3% and 70.6%, respectively; accuracy was 32%. Conclusions: The V-VST is low in cost, easy to use and very sensitive, meeting the requirements of oropharyngeal dysphagia and aspiration screening test in subacute stroke patients. Show more

Keywords: Stroke, oropharyngeal dysphagia, volume viscosity swallow test, pulse oximetry, screening, sensitivity, specificity

DOI: 10.3233/NRE-130997

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 631-638, 2013

Authors: Aguirrezabal, Aizpea | Duarte, Esther | Rueda, Nohora | Cervantes, Cristina | Marco, Ester | Escalada, Ferran

Article Type: Research Article

Abstract: Background: Active information and training improves patient and carer knowledge of stroke and aspects of patient satisfaction, as well as reduces patient depression. Objective: To evaluate the effect of a post-stroke information and carer training intervention provided in the rehabilitation hospital setting on patient and carers' satisfaction. Methods: Nonrandomized, controlled trial with 241 patients consecutively admitted in a post-stroke rehabilitation unit and their carers. The first 140 underwent a standard rehabilitation program (control group) and the 131 following attended an additional class (intervention group). Satisfaction was assessed with the Satisfaction Pound Scale administered by telephone 6 …months after stroke in 74 patients and 85 carers from the control group and in 76 patients and 73 carers from the intervention group. Results: Over 80% of patients in both groups were satisfied with information, care and therapy during hospitalization. The amount of therapy and support at discharge were the issues that arouse greater dissatisfaction. Patient and carers' satisfaction with information, support and accessibility to rehabilitation team after hospital discharge improved after the intervention (p < 0.001). Conclusions: Systematic active information, training and community support provision for stroke patients and carers improves satisfaction with stroke rehabilitation programs and support received after hospital discharge. Show more

Keywords: Stroke, patient satisfaction, social support, carer, rehabilitation

DOI: 10.3233/NRE-130989

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 639-647, 2013

Authors: Müller, Thomas | Saft, Carsten | Andrich, Jürgen | Harati, Ali

Article Type: Research Article

Abstract: Background: Assessment of impaired motor behaviour serves as tool for diagnosis and for evaluation of progression of chronic neurodegeneration. Methods: We measured performance of rapid alternating movements, simple and complex motion series with instruments in scored, drug naïve patients with Huntington's disease and controls. Objectives: To compare device outcomes with the ones of controls and to correlate them with each other and with the disease symptoms. Results: Patients showed lower peak velocities and longer intervals for performance of rapid alternating movements than the controls. On the right dominant side, a correlation was found between …intervals needed for standardised alternating movement performance and the simple motion task outcomes in the patients. No relations to the rated disease symptoms appeared. Conclusion: Execution of alternating movements is disturbed in Huntington's disease. Performance of the simple motion task and realisation of alternating motions shares a need for low cognitive efforts. Both ask for a more automated motion execution. Therefore they were related to each other to a certain extent. Execution of complex movement series asks for higher cognitive load, as it demands aiming and planning of movement series with visual input. This motion pattern does not resemble to the realisation of rapid alternating movements. Show more

Keywords: Velocity, pronation, supination, Huntington's disease

DOI: 10.3233/NRE-130992

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 649-655, 2013

Authors: IJspeert, Jos | Janssen, Renske M.J. | Murgia, Alessio | Pisters, Martijn F. | Cup, Edith H.C. | Groothuis, Jan T. | van Alfen, Nens

Article Type: Research Article

Abstract: Background: Neuralgic Amyotrophy (NA) is characterized by neuropathic pain, subsequent patchy paresis and possible sensory loss in the upper extremity. Many patients experience difficulties in performing activities of daily life and are unable to resume work. We developed a combined physical- and occupational therapy program for patients recovering from NA. Objective: Evaluation of the effectiveness of a multidisciplinary intervention program for patients with subacute NA. Methods: We performed a within subject proof-of-principle pilot study in eight patients with subacute NA. Patients followed 8 hours of physical and 8 hours of occupational therapy spread over a 16-week …period. Primary outcome measures: The Canadian Occupational Performance Measure (COPM) and Shoulder Rating Questionnaire (SRQ). Secondary outcome measure: Disability of Arm Shoulder and Hand (DASH). Results: Improvements (mean (95% CI)) were found in the performance and satisfaction scores of the COPM +2.3 (0.9–3.7) and +1.4 (0.4–2.4) points, respectively and the SRQ +14.8 (7.4–22.0) points. The majority of patients (6 out of 8) also demonstrated improvements in the DASH. Conclusion: The proposed physical and occupational therapy program, may be effective for patients with subacute NA, as demonstrated by improvements in activity, performance and participation. Show more

Keywords: Neuralgic amyotrophy, interdisciplinary studies, physical therapy, occupational therapy, upper limb rehabilitation

DOI: 10.3233/NRE-130993

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 657-665, 2013

Authors: O'Neil, Rochelle L. | Skeel, Reid L. | Ustinova, Ksenia I.

Article Type: Research Article

Abstract: Background: Virtual reality games and simulations have been utilized successfully for motor rehabilitation of individuals with traumatic brain injury (TBI). Little is known, however, how TBI-related cognitive decline affects learning of motor tasks in virtual environments. Objective: To fill this gap, we examined learning within a virtual reality game involving various reaching motions in 14 patients with TBI and 15 healthy individuals with different cognitive abilities. Methods: All participants practiced ten 90-second gaming trials to assess various aspects of motor learning. Cognitive abilities were assessed with a battery of tests including measures of memory, executive functioning, …and visuospatial ability. Results: Overall, participants with TBI showed both reduced performance and a slower learning rate in the virtual reality game compared to healthy individuals. Numerous correlations between overall performance and several of the cognitive ability domains were revealed for both the patient and control groups, with the best predictor being overall cognitive ability. Conclusions: The results may provide a starting point for rehabilitation programs regarding which cognitive domains interact with motor learning. Show more

Keywords: Cognitive ability, virtual reality, traumatic brain injury

DOI: 10.3233/NRE-130985

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 667-680, 2013

Article Type: Other

DOI: 10.3233/NRE-2013-33419

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 681-687, 2013

Article Type: Other

DOI: 10.3233/NRE-2013-33420

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 689-691, 2013