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

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