NeuroRehabilitation - Volume 34, issue 2

Authors: Vincent-Onabajo, Grace Oluwatitofunmi | Hamzat, Talhatu Kolapo | Owolabi, Mayowa Ojo

Article Type: Research Article

Abstract: Background: Several studies have examined gender differences in various stroke outcomes. There is however little information on the influence of gender on post-stroke functioning in the context of the International Classification of Functioning, Disability and Health (ICF). Objective: Gender differences in selected components of functioning, namely motor performance (body function), activity and participation, were examined in a sample of Nigerian stroke survivors. Methods: This longitudinal study involved consenting first-incidence stroke survivors who were consecutively recruited from in-patient wards of a University teaching hospital in northern Nigeria. Demographic and clinical data were obtained at recruitment while motor …performance, activity and participation were assessed at the 1st, 3rd, 6th, 9th and 12th months using the Simplified Fugl Meyer scale, the Functional Independence Measure Motor Sub-scale and the London Handicap Scale respectively. Results: Participants were thirty-three male (60%) and 22 female (40%) stroke survivors who did not significantly differ in age, stroke sub-type, laterality and initial severity (P > 0.05). There were also no significant differences in motor performance, activity and participation between the male and female stroke survivors across the time points. Conclusion: Gender differences were not observed in the components of functioning over the first 12 months post-stroke. Show more

Keywords: Activity, functioning, gender, ICF, motor performance, Nigeria, participation, stroke

DOI: 10.3233/NRE-141047

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 297-304, 2014

Authors: Middleton, Laura E. | Lam, Benjamin | Fahmi, Halla | Black, Sandra E. | McIlroy, William E. | Stuss, Donald T. | Danells, Cynthia | Ween, Jon | Turner, Gary R.

Article Type: Research Article

Abstract: Background: Functional contributions of cognitive impairment may vary by domain and severity. Objective: (1) To characterize frequency of cognitive impairment by domain after stroke by severity (mild: −1.5 ≤ z-score < −2; severe: Z ≤ −2) and time (sub-acute: < 90d; chronic: 90d–2yrs); and (2) To assess the association of cognitive impairment with function in chronic stroke. Methods: Cognitive function was characterized among 215 people with sub-acute or chronic stroke (66.8 years, 43.3% female). Z-scores by cognitive domain were determined from normative data. Function was defined as the number of IADLs minimally independent. Results: …76.3% of sub-acute and 67.3% of chronic stroke participants had cognitive impairment in ≥ 1 domain (p-for-difference = 0.09). Severe impairment was most common in psychomotor speed (sub-acute: 53.5%; chronic: 33.7%). Impairment in executive function was common (sub-acute: 39.5%; chronic: 30.7%) but was usually mild. Severe impairment in psychomotor speed, visuospatial function, and language and any impairment in executive function and memory was associated with IADL impairment (p < 0.03). Conclusions: Mild cognitive impairment is common after stroke but is not associated with functional disability. Impairment in psychomotor speed, executive function, and visuospatial function is common and associated with functional impairment so should be a focus of screening and rehabilitation post-stroke. Show more

DOI: 10.3233/NRE-131030

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 305-312, 2014

Authors: Ertekin, Özge | Özakbaş, Serkan | İdiman, Egemen

Article Type: Research Article

Abstract: Background: The caregivers of Multiple Sclerosis (MS) individuals are usually burdened with a wide range of MS-related caregiving tasks which may result in damages of their daily life and quality of life (QOL). Objectives: This study was designed to compare according to the disability level (1) the walking ability, quality of life (QOL), and disease impact of the MS patients (2) and the burden, QOL, self-efficacy and life satisfaction of their caregivers; (3) to determine the relationship between these outcome results, disease duration and caregivers' age. Methods: 772 MS patients were recruited, 47 MS patients and …their 47 caregivers finished the study. Disability, walking ability, QOL, disease impact of the MS participants; the burden, QOL, self-efficacy, life satisfaction of the caregivers were evaluated. Results: MS Patients with higher disability had significantly worse scores on the MSWS-12, MUSIQOL, MSIS-29, and PDSS (p < 0.01). The caregivers facing with higher disability had significantly worse scores on CBI and CAREQOL (p < 0.01). Conclusions: The impairments on disability level, walking and QOL of MS patients were related to OQL declines and increased burden of their caregivers. Therefore, it may be important to provide acceptable education and support strategies with individual intervention while defining the needs and goals of the MS patients and their caregivers to improve the rehabilitation success. Show more

Keywords: Multiple sclerosis, caregiver, quality of life, burden, disability, self-efficacy, life satisfaction

DOI: 10.3233/NRE-131037

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 313-321, 2014

Authors: Swinnen, Eva | Baeyens, Jean-Pierre | Pintens, Seppe | Van Nieuwenhoven, Johan | Ilsbroukx, Stephan | Clijsen, Ron | Buyl, Ronald | Goossens, Maggie | Meeusen, Romain | Kerckhofs, Eric

Article Type: Research Article

Abstract: Background: Although the trunk is important for maintaining balance during walking only very limited information about the trunk muscle activity during walking with body weight support (BWS) is reported in literature. Objective: The aim of this study was to measure the effect of BWS on the trunk muscle activity during treadmill walking. Methods: 14 persons with multiple sclerosis and 14 healthy persons walked on a treadmill with 0%, 10%, 20%, 30%, 50% and 70% BWS. Bilateral EMG measurements (surface electrodes) on the m. rectus abdominis, m. obliquus externus, m. erector spinae and m. multifidus were performed. …The maximal muscle activation was presented as a percentage of a performance related reference contraction. A repeated measures ANOVA with simple contrasts was applied (SPSS20). Results: In general when comparing walking with BWS with walking with 0% BWS there is an increase in m. obliquus externus activity and a decrease in back muscle activity. With increasing percentages of BWS an increase in activity of the abdominal muscles and a decrease in back muscle activity was found, with most changes in high percentages BWS. Conclusion: Based on the results, it is recommended to decrease the percentage BWS as fast as possible beneath 30% BWS. Show more

Keywords: Abdominal muscles, back muscles, body weight support, electromyography, EMG, gait, gait analysis, multiple sclerosis, rehabilitation, treadmill, walking

DOI: 10.3233/NRE-131044

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 323-335, 2014

Authors: Guclu-Gunduz, Arzu | Citaker, Seyit | Irkec, Ceyla | Nazliel, Bijen | Batur-Caglayan, Hale Zeynep

Article Type: Research Article

Abstract: Background: Although there are evidences as to Pilates developing dynamic balance, muscle strength and flexibility in healthy people, evidences related to its effects on Multiple Sclerosis patients are insufficient. Objectives: The aims of this study were to investigate the effects of Pilates on balance, mobility, and strength in ambulatory patients with Multiple Sclerosis. Methods: Twenty six patients were divided into two groups as experimental (n = 18) and control (n = 8) groups for an 8-week treatment program. The experimental group underwent Pilates and the control group did abdominal breathing and active extremity exercises at home. …Balance and mobility were measured with Berg Balance Scale and Timed up and go test, upper and lower muscle strength with hand-held dynamometer. Confidence in balance skills while performing daily activities was evaluated with Activities Specific Balance Confidence Scale. Results: Improvements were observed in balance, mobility, and upper and lower extremity muscle strength in the Pilates group (p < 0.05). No significant differences in any outcome measures were observed in the control group (p > 0.05). Conclusion: Due to its structure which is made up of balance and strengthening exercises, Pilates training may develop balance, mobility and muscle strength of MS patients. For this reason, we think that, Pilates exercises which are appropriate for the disability level of the patient may be suggested. Show more

Keywords: Multiple sclerosis, pilates, balance, mobility, strength

DOI: 10.3233/NRE-130957

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 337-342, 2014

Authors: Pierchała, Katarzyna | Lachowska, Magdalena | Morawski, Krzysztof | Niemczyk, Kazimierz

Article Type: Research Article

Abstract: Objective: The purpose was to assess learning and rehabilitation effect and their influence on Sensory Organization Test results in young and elderly patients with peripheral, central and mixed vestibular pathology. Material and methods: 26 patients with different vestibular system deficits participated in this study. Rehabilitation was held five days a week, for two weeks. To assess learning effect, SOT was administered to each patient twice and compared: 1) on the day preceding the beginning of rehabilitation (SOT1), and 2) on the first day of rehabilitation (SOT2). To evaluate rehabilitation effect, results of SOT2 were compared to SOT3 (administered …on the last day of rehabilitation). Results: Learning effect showed similar improvement in CS in all groups but young. Rehabilitation caused further improvement in CS in all groups but central pathology. This improvement was similar between those groups. There was no significant difference found between learning and rehabilitation effect in CS. Conclusions: The results of our study indicate that none of the groups achieved significant benefit from rehabilitation based on sensory conflicts that would overcome the learning effect. However, the lack of significant advantage of rehabilitation over learning does not mean that it does not exist. Show more

Keywords: Computerized dynamic posturography, sensory organization test, vestibular rehabilitation, sensory conflicts, balance, posture

DOI: 10.3233/NRE-131034

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 343-353, 2014

Authors: Bai, Ou | Huang, Dandan | Fei, Ding-Yu | Kunz, Richard

Article Type: Research Article

Abstract: Background: Mental practice using motor imagery of limb movement may facilitate motor recovery in persons who have experienced cerebrovascular accident (CVA). However, the lack of a feedback mechanism that can monitor the quality of the motor imagery affects patients' engagement and motivation to participate in the mental practice training program. Objective: This study investigates the effect of novel real-time motor imagery-associated cortical activity feedback on motor imagery-based mental practice training. Methods: Ten healthy volunteers were randomly assigned into intervention and control groups. Both groups participated in a five-visit motor imagery-based mental practice training program managed over …a period of two months. The intervention group received mental practice training with real-time feedback of movement-associated cortical activity—beta band (16–28 Hz) event-related desynchronization (ERD) in electroencephalography (EEG), using a novel custom-made brain-computer interface (BCI) system. The control group received the mental practice training program without EEG cortical feedback. Motor excitability was assessed by measuring the frequency power magnitude of the EEG rhythmic activity associated with physical execution of wrist extension before and after the motor imagery-based mental practice training. Results: The EEG frequency power magnitude associated with the physical execution of wrist extension was significantly lower (i.e. more desynchronized) after the mental practice training in the intervention group that received real-time cortical feedback (P < 0.05), whereas no significant difference in EEG frequency power magnitude associated with the physical execution of wrist extension was observed before and after mental practice training in the control group who did not receive feedback. Conclusions: The mental practice training program with motor imagery-associated cortical feedback facilitated motor excitability during the production of voluntary motor control. Motor imagery-based mental practice training with movement-associated cortical activity feedback may provide an effective strategy to facilitate motor recovery in brain injury patients, particularly during the early rehabilitation stage when full participation in physical and occupational therapy programs may not be possible due to excessive motor weakness. Show more

Keywords: Motor imagery, mental practice, motor control, electroencephalography (EEG), brain-computer interface (BCI), event-related desynchronization (ERD)

DOI: 10.3233/NRE-131039

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 355-363, 2014

Authors: Wehman, Paul | Chen, Chin-Chih | West, Michael | Cifu, Gabriella

Article Type: Research Article

Abstract: Background: Despite of a growing body of research on vocational and educational difficulties for students with traumatic brain injury (TBI), only limited empirical studies specifically examined how school transition services facilitate later employment outcomes. Objective: This exploratory, prospective longitudinal study examined the prevalence of employment and characteristics of transition planning practices that promoted positive school-to-work transition for students with TBI. Method: The participants (n = 200) was drawn from the National Longitudinal Transition Study-2 (NLTS-2), a ten-year study which followed a large nationally representative sample of youth with disabilities through secondary education in into young adulthood. …Logistic regression was used to investigate the associations between student, school, and collaborative engagement in the planning process and employment outcomes up to 8 years after high school. Results: Among youth with TBI, 51% held current employment at the time of interview and 73% had been employed at any time after high school. Findings showed that students with TBI who had transition goals for postsecondary education were more likely to be employed at some point since leaving high school. The findings also support active student engagement and leadership in the transition planning process, and the inclusion of outside organizations and individuals. Conclusions: Findings indicate the impact of student, school and adult service agency engagement in transition planning processes. Implications for educational practices and future research are discussed. Show more

Keywords: Traumatic brain injury, school-to-work transition, postschool outcomes

DOI: 10.3233/NRE-131029

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 365-372, 2014

Authors: van Vliet-Ruissen, Cora | McKinlay, Audrey | Taylor, Annabel

Article Type: Research Article

Abstract: Background: There is little information regarding the impact that traumatic brain injury (TBI) has on the functioning of mothers at risk of child abuse. Objective: This study evaluated adult functioning (e.g. child abuse, substance use, criminal convictions, and mental health problems) of mothers, at high risk for child abuse, who also had a history of TBI compared with those without TBI. It was hypothesised that mothers with a history of TBI would engage in higher rates of dysfunctional behaviour compared to those with no history of TBI. Method: Participants were 206 women engaged in a child …abuse prevention programme for mothers who are highly socially disadvantaged, and at high risk for child abuse. Using historical data collected as part of the referral, and self report intake process, this study compared child abuse, mental health problems (depression, anxiety, substance use) and rates of criminal offending for mothers with a history of TBI versus those with no history of TBI. Results: Mothers with TBI were no more likely than those without TBI to have engaged in child abuse. However, mothers with a history of TBI were significantly more likely to have one or more mental health problems, engage in substance use and have a history of criminal offending. Conclusions: Parents with TBI who have been identified as high risk for engaging in child abuse have increased risk for mental health problems and criminal offending. These issues need to be considered when designing parenting programmes in order for intervention strategies to be effective. Show more

Keywords: Traumatic brain injury, prevalence, mothers, child abuse, parenting

DOI: 10.3233/NRE-131032

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 373-380, 2014

Authors: Liu, Jie | Li, Sheng | Li, Xiaoyan | Klein, Cliff | Rymer, William Z. | Zhou, Ping

Article Type: Research Article

Abstract: Background: Electrical stimulation of muscle or nerve is a very useful technique for understanding of muscle activity and its pathological changes for both diagnostic and therapeutic purposes. During electrical stimulation of a muscle, the recorded M wave is often contaminated by a stimulus artifact. The stimulus artifact must be removed for appropriate analysis and interpretation of M waves. Objectives: The objective of this study was to develop a novel software based method to remove stimulus artifacts contaminating or superimposing with electrically evoked surface electromyography (EMG) or M wave signals. Methods: The multiple stage method uses a …series of signal processing techniques, including highlighting and detection of stimulus artifacts using Savitzky-Golay filtering, estimation of the artifact contaminated region with Otsu thresholding, and reconstruction of such region using signal interpolation and smoothing. The developed method was tested using M wave signals recorded from biceps brachii muscles by a linear surface electrode array. To evaluate the performance, a series of semi-synthetic signals were constructed from clean M wave and stimulus artifact recordings with different degrees of overlap between them. Results: The effectiveness of the developed method was quantified by a significant increase in correlation coefficient and a significant decrease in root mean square error between the clean M wave and the reconstructed M wave, compared with those between the clean M wave and the originally contaminated signal. The validity of the developed method was also demonstrated when tested on each channel's M wave recording using a linear electrode array. Conclusions: The developed method can suppress stimulus artifacts contaminating M wave recordings. Show more

Keywords: M wave, stimulus artifact suppression, electromyography (EMG)

DOI: 10.3233/NRE-131045

Citation: NeuroRehabilitation, vol. 34, no. 2, pp. 381-389, 2014