NeuroRehabilitation - Volume 34, issue 2

Authors: Pistilli, Emidio E. | Rice, Tracy | Pergami, Paola | Mandich, Mary Beth

Article Type: Research Article

Abstract: Background: Idiopathic toe walking is characterized by persistent toe walking in the absence of clinically diagnosed neuromuscular disease. Treatment options in children diagnosed with idiopathic toe walking include: observation, physical therapy, serial casting, or Achilles tendon (heel cord) lengthening surgery. Objective: In this case report, we present a non-invasive serial casting protocol to treat severe and persistent toe walking in an 18-month old child, diagnosed as an idiopathic toe walker following neurological examination. Methods: A series of below knee casts was used to provide a consistent stretch to the plantar flexor muscles. Upon removal of each …set of casts, passive range of motion at the ankles was measured with a goniometer. Results: Four sets of casts, each lasting approximately one week, increased passive ankle dorsiflexion to 10° of neutral and established a heel-toe walking gait. Improvements in ankle range of motion and gait were maintained upon repeated examinations at 3, 7, and 12 months post-casting. Conclusions: These results demonstrate that non-invasive procedures, such as serial casting, can be successful in very young children diagnosed as idiopathic toe walkers. Early identification and intervention for this diagnosis may eliminate the need for invasive surgeries and associated risks in this population. Show more

Keywords: Equinus, contracture, toe walking

DOI: 10.3233/NRE-131043

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 215-220, 2014

Authors: Hansson, Eva Ekvall | Beckman, Anders | Näslund, Anna | Persson, Sylvia | Janson, Sara | Troein, Margareta

Article Type: Research Article

Abstract: Background: Dizziness is seldom the only symptom among patients who develop stroke but patients, hospitalized for vertigo are at higher risk of stroke than the general population. The proportions of patients who have remaining dizziness after a stroke seem to be unclear. Objectives: To study the frequency of dizziness among stroke patients referred to rehabilitation in primary health care and to study the relation between dizziness and gender, age, activity and self-rated health. Methods: Patients with first-time stroke who were referred to rehabilitation in primary health care after the initial hospital stay were included. Dependence/independence in …daily activities and self-rated health was measured. A question about whether the patient had experienced any dizziness or unsteadiness was asked. Results: Sixty three patients were included in the study, (39 men, 24 women) aged 36–85 years. The majority of patients were dizzy (70%). Being female increased the risk of being dizzy substantially (OR 9.43). Patients with dizziness had poorer self-rated health than patients without dizziness (p = 0.001). Conclusion: Dizziness is a common symptom among patients with stroke, especially among female patients, and is associated with lower self-rated health. Therefore, it is important to address dizziness in the rehabilitation of stroke patients. Show more

Keywords: Stroke, dizziness, gender, self-rated health

DOI: 10.3233/NRE-131028

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 221-226, 2014

Authors: Hung, Chi-Yao | Tseng, Sung-Hui | Chen, Shih-Ching | Chiu, Hou-Chang | Lai, Chien-Hung | Kang, Jiunn-Horng

Article Type: Research Article

Abstract: Background: Whether post-stroke spasticity is associated with autonomic status is unclear. The purpose of our study was to determine whether spasticity in post-stroke patients is associated with heart rate variability (HRV), an indicator of sympathetic and parasympathetic regulation. Objective: To determine whether HRV is associated with spasticity in post-stroke patients. Methods: Our cross-sectional observational study included 21 post-stroke patients with varying degrees of knee spasticity. We measured patients' heart rate variability (HRV) during the morning and afternoon of the same day using the modified Ashworth assessment and the pendulum test. The relationship between HRV and the …spasticity parameters was evaluated based on the Pearson correlation coefficient (r). Results: The data for the morning measurements showed that the relaxation index negatively correlated with the high frequency (HF) power of HRV (r = −0.47, P < 0.05), and positively correlated with the low frequency (LF) power of HRV (r = 0.47, P < 0.05) and the LF/HF power ratio (r = 0.55, P < 0.05). Similar correlations were observed between the diurnal differences of HRV and the relaxation index. No correlation was observed among the data for the afternoon measurements. Conclusions: Higher parasympathetic tone and lower sympathetic tone are associated with a higher degree of knee spasticity in post-stroke patients. Further studies are warranted to confirm our findings and investigate the pathological mechanisms involved. Show more

Keywords: Heart rate variability, autonomic status, post-stroke spasticity, pendulum test, diurnal change

DOI: 10.3233/NRE-131027

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 227-233, 2014

Authors: Kojima, Kosuke | Ikuno, Koki | Morii, Yuta | Tokuhisa, Kentaro | Morimoto, Shigeru | Shomoto, Koji

Article Type: Research Article

Abstract: Background: Mirror therapy (MT) and electromyography-triggered neuromuscular stimulation (ETMS) are both effective treatments for impaired upper limbs following stroke. A combination of these two treatments (ETMS-MT) may result in greater gain than either treatment alone. Objectives: The feasibility and possible effects of ETMS-MT upon upper extremity function were investigated in stroke patients. Methods: Thirteen post-acute stroke patients were randomly assigned to an immediate ETMS-MT group or a delayed ETMS-MT group and then underwent an 8-week training program. The immediate ETMS-MT group received ETMS-MT in addition to physical and occupational therapy (PT+OT) for 4 weeks. They then …received only PT+OT for the next 4 weeks. In the delayed ETMS-MT group, interventions were provided in the reverse order. The main outcome measure was the Fugl-Meyer Assessment (FMA). Results: The immediate ETMS-MT group showed significantly greater gain in FMA in the first 4 weeks. The delayed ETMS-MT group showed significantly greater gain in active range of motion during the latter 4 weeks. No adverse effects were reported following ETMS-MT. Conclusion: ETMS-MT might be as effective as independent MT or ETMS without causing any side effects. Future research should focus upon the direct comparisons between independent and combined interventions. Show more

Keywords: Electromyography-triggered neuromuscular stimulation, mirror therapy, stroke rehabilitation, upper extremity, hemiplegia

DOI: 10.3233/NRE-131038

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 235-244, 2014

Authors: Manigandan, J. Bala | Ganesh, G. Shankar | Pattnaik, Monalisa | Mohanty, Patitapaban

Article Type: Research Article

Abstract: Background: Glenohumeral subluxation is the most frequent complication in post stroke hemiplegia and its reduction has been considered an important goal. Though it has been demonstrated that cyclical electrical stimulation of posterior deltoid and supraspinatus muscles can reduce subluxation, the role of biceps has not been given due consideration. Objective: The purpose of this study was to determine whether electrical stimulation to the long head of biceps could more effectively reduce gleno humeral subluxation. Methods: 24 patients were selected and consecutively assigned to group 1 (electrical stimulation to supraspinatus & posterior deltoid) and group II (electrical …stimulation to supraspinatus, posterior deltoid & long head of the biceps) along with routine physiotherapy and occupational therapy for a period of 5 weeks. All patients were assessed for shoulder subluxation, pain and shoulder active abduction range of motion at the time of recruitment to study and after 5 weeks of therapy. Results: Both the groups showed significant improvement in parameters measured. Tukey's post hoc analysis showed the results were more significant in Group II. Conclusions: Electrical stimulation to biceps along with the supraspinatus and posterior deltoid can more effectively reduce shoulder subluxation. Show more

Keywords: Electric stimulation therapy, gleno humeral subluxation, shoulder, stroke

DOI: 10.3233/NRE-131041

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 245-252, 2014

Authors: Yaliman, A. | Kesiktas, N. | Ozkaya, M. | Eskiyurt, N. | Erkan, O. | Yilmaz, E.

Article Type: Research Article

Abstract: Objective: To establish the intrarater and interrater reliability of Wisconsin Gait Scale (WGS) in hemiplegic patients. Design: Repeated-measures reliability study using video data of stroke patients. Setting: Rehabilitation department of the university hospital. Participitants: Nineteen hemiplegic patients with 3–9 months stroke history and two physiatrists and two physical therapists. Interventions: Video recordings were assessed twice, at an interval of 2 days, by the two physiatrists and two physical therapists. Main outcome measure: Wisconsin Gait Scale. Results: Internal consistency coefficients for the WGS were excellent; Cronbach scores were 0.91 …and 0.94 for the first and third days. Coefficient of Repeatability (CR) for observers' WGS assessments were ranged between 4.23–5.76 and intraclass correlation coefficients for total WGS score were indicated very high interrater reliability at the begining and end, respectively 0.91 and 0.96. Intraclass correlation coefficients for fourteen items of WGS ranged from 0.81 to 1. “Hip hiking at mid-swing”, “Circumduction at mid-swing” and “Hip extension of the affected leg” were the items with lowest correlation coefficients. Intrarater reliability for total WGS scores ranged from 0.75 to 0.90. Conclusion: WGS was found excellent in reliability and may provide an objective means to document the findings from observational gait analysis, which is frequently used in clinical practice by rehabilitation teams. Show more

Keywords: Gait, stroke, Wisconsin Gait Scale, reliability

DOI: 10.3233/NRE-131033

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 253-258, 2014

Authors: Seo, Jeong Pyo | Do, Kyung Hee | Jung, Gil Su | Seo, Sang Wan | Kim, Kyoung | Son, Su Min | Kim, Yeung Ki | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: The lateral corticospinal tract (CST) is one of the most important neuronal pathways that mediate voluntary movements in the human brain. However, little is known about the role of the lateral CST on the gait. We attempted to investigate differences in gait pattern using a motion analysis system according to the integrity of the contralateral CST, which was classified using diffusion tensor tractography (DTT) in chronic hemiparetic stroke patients. Methods: We recruited 16 chronic hemiparetic stroke patients and 12 normal subjects for this study. DTT findings of the CST for patients were classified into two groups: group …A (eight patients); the integrity of the CST was preserved, group B (eight patients) – the CST was discontinued at or below the stroke lesion. We compared variables of gait between group A, group B, and normal controls using the motion analysis system. Results: Group A and the control group showed a significantly higher peak angle for ankle dorsiflexion, knee internal rotation, and hip flexion, compared with group B (p < 0.05). On the other hand, the peak angle for ankle plantarflexion/external rotation, knee flexion/abduction, and hip extension of group A and group B were significantly lower than those of the control group (p < 0.05). Conclusion: We found that severe injury of the contralateral CST caused decreased movement of ankle dorsiflexion, knee internal rotation, and hip flexion in chronic hemiparetic stroke patients. As a result, the circumduction and abduction gait pattern in stroke patients is closely associated with severe injury of the contralateral CST. Show more

Keywords: Corticospinal tract, diffusion tensor imaging, stroke, motion analysis, gait

DOI: 10.3233/NRE-131046

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 259-266, 2014

Authors: Dickstein, Ruth | Levy, Sandra | Shefi, Sara | Holtzman, Sarit | Peleg, Sara | Vatine, Jean-Jacques

Article Type: Research Article

Abstract: Background: Stroke is the leading cause of adult disability, with walking impairment being a devastating indicator of chronic post-stroke hemiparesis. Limited resources exist for individual treatments; therefore, the delivery of safe group exercise therapy is highly desired. Objective: To examine whether the application of group-based motor imagery practice to community-dwelling individuals with chronic hemiparesis improves gait. Methods: Sixteen individuals with chronic hemiparesis from two community centers participated in the study, with eight from each center. Four participants in each center received five weeks of the experimental intervention, consisting of group-based motor imagery exercises of gait tasks, …followed by five weeks of control treatment of motor imagery exercises for the affected upper extremity. Four other subjects in each center received the same treatments in reverse order. Pre- and post intervention measurements included clinical and biomechanical gait parameters. Results: Comparisons within (pre- vs. post) and between treatments (experimental vs. control) indicated no significant change in any gait variable. Nevertheless, the verbal reports of most participants alluded to satisfaction with the experimental intervention and to an increase in self-confidence. Conclusions: Despite the lack of evidence for the effectiveness of group-based motor imagery practice in improving gait among individuals with chronic hemiparesis, the contrast between the measured outcomes and the positive verbal reports merits further inquiry. Show more

Keywords: Stroke, gait, CVA, rehabilitation

DOI: 10.3233/NRE-131035

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 267-276, 2014

Authors: Yoo, In-gyu | Jung, Min-ye | Yoo, Eun-young | Park, Ji-hyuk | Kang, Dae-hyuk | Lee, Jin

Article Type: Research Article

Abstract: Background: Stroke patients have major problems with impaired upper-extremity function. Unfortunately, many patients do not experience a full recovery from movement deficits in the upper extremities. Objectives: The purpose of this study was to compare the effectiveness of inter-limb learning transfer (ILT) to the contralateral upper limb after both hemisphere-specific and -unspecific ipsilateral upper limb training for stroke patients with hemiparesis. Methods: Twenty-four stroke patients with hemiparesis participated. The hemisphere-specific training group performed reaching movements in a customized training setting in which non-dominant limb training participants began from a single starting location and proceeded to one …of three target locations (1S3T condition); the dominant limb training participants started from one of three starting locations and proceeded to a single target location (3S1T condition). The hemisphere-unspecific training group performed these movements starting under reverse-start and target conditions. Results: The non-dominant to dominant limb transfer, the hemisphere-specific training group performance time decreased significantly as compared with the pre-training session (p < 0.05). Also, the isolation contraction ratio was decreased significantly from that of the pre-training session in the biceps brachii muscles and increased significantly in the upper trapezius muscles (p < 0.05). And, dominant to non-dominant limb transfer in the hemisphere-specific training group significantly increased RMS amplitudes from the pre-training session in the biceps brachii and triceps muscles (p < 0.05). Also, the isolation contraction ratio was increased significantly from that of the pre-training session in the biceps brachii muscles and decreased significantly in the upper trapezius muscles (p < 0.05). However, the hemisphere-unspecific training group showed no significant differences in inter-limb learning transfer (ILT). Conclusion: The transfer of hemisphere-specific training from one arm to the other had a more positive influence on functional recovery than did hemisphere-unspecific training for patients with stroke and hemiparesis. Show more

Keywords: Electromyography, hemisphere, inter-limb learning transfer

DOI: 10.3233/NRE-131040

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 277-286, 2014

Authors: Galen, Sujay S. | Clarke, Celia J. | Mclean, Alan N. | Allan, David B. | Conway, Bernard A.

Article Type: Research Article

Abstract: Background: Strength changes in lower limb muscles following robot assisted gait training (RAGT) in subjects with incomplete spinal cord injury (ISCI) has not been quantified using objective outcome measures. Objective: To record changes in the force generating capacity of lower limb muscles (recorded as peak voluntary isometric torque at the knee and hip), before, during and after RAGT in both acute and subacute/chronic ISCI subjects using a repeated measures study design. Methods: Eighteen subjects with ISCI participated in this study (Age range: 26–63 years mean age = 49.3 ± 11 years). Each subject participated in the …study for a total period of eight weeks, including 6 weeks of RAGT using the Lokomat system (Hocoma AG, Switzerland). Peak torques were recorded in hip flexors, extensors, knee flexors and extensors using torque sensors that are incorporated within the Lokomat. Results: All the tested lower limb muscle groups showed statistically significant (p < 0.001) increases in peak torques in the acute subjects. Comparison between the change in peak torque generated by a muscle and its motor score over time showed a non-linear relationship. Conclusions: The peak torque recorded during isometric contractions provided an objective outcome measure to record changes in muscle strength following RAGT. Show more

Keywords: Incomplete spinal cord injury, lokomat, peak torque, dynamometry, muscle strength, body weight supported treadmill training

DOI: 10.3233/NRE-131042

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 287-295, 2014