NeuroRehabilitation - Volume 34, issue 3

Authors: Ponfick, Matthias | Wiederer, Ralf | Bösl, Kathrin | Neumann, Günter | Lüdemann-Podubecka, Jitka | Gdynia, Hans-Jürgen | Nowak, Dennis A.

Article Type: Research Article

Abstract: Background: We investigated if longer weaning is associated with inferior rehabilitative outcome in critical illness polyneuropathy (CIP) and cerebrovascular diseases (CVD). Methods: We analysed retrospectively weaning protocols and medical histories of 171 tracheotomized patients with CIP and CVD. We assessed weaning durations (WD), independence in activities of daily living, as assessed by the functional independence measure (FIM), mortality rates and discharge modalities in each cohort. Weaning was performed using synchronized intermittent mandatory ventilation (SIMV) with Autoflow® and assisted spontaneous ventilation (ASV). Results: WD was significantly longer in CIP compared to CVD (p < 0.001). Despite …shorter in-patient treatment and longer WD, patients with CIP acquired significantly greater gains of improvement than CVD (p = 0.015). Independent living at home was possible in 43% of patients with CIP and in 26% of CVD. Mortality was equal in both groups (13% vs. 6%, p > 0.05). Chronic obstructive pulmonary disease (COPD) showed a trend towards longer weaning durations in both entities (p = 0.06). Higher age significantly correlated with longer WD (p = 0.038, r = 0.16). Longer rehabilitation duration (RD) positively correlated with higher Delta-FIM (DFIM) in both entities (p = 0.006, r = 0.21). Conclusion: Longer weaning and its partly negative influence on rehabilitative outcome can be compensated by longer in-patient rehabilitation in CIP and CVD. Show more

Keywords: Weaning, rehabilitation, critical illness polyneuropathy, stroke, functional independence measure, outcome

DOI: 10.3233/NRE-141066

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 493-498, 2014

Authors: Finch, Emma | Copland, David A.

Article Type: Research Article

Abstract: Background: Language function is susceptible to the effects of brain tumours during both the tumour growth phase and during neurosurgical resection. Aim: This paper aimed to systematically review existing literature to determine the current status of knowledge about language outcomes following neurosurgery. Methods: A systematic review was conducted involving a detailed literature search using online databases, quality assessment of relevant articles and data extraction. Results: Of the 1449 articles retrieved, nine articles satisfied the study criteria. Overall, these studies reported variable patterns of language function post-surgery, however, there was a trend towards an early …post-surgical decline in language function that greatly improved by 3 months. The likelihood of developing post-surgical communication impairments was influenced by a number of factors including pre-operative aphasia and the identification of sub-cortical language tracts inside the tumour margin, however, further research is required to fully elucidate pertinent predictors. Conclusion: These findings have implications for rehabilitation programs following brain tumour surgery and suggest that there are a number of key gaps warranting further investigation. Show more

Keywords: Brain tumour, aphasia, language, language impairment, neurosurgery, systematic review

DOI: 10.3233/NRE-141053

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 499-514, 2014

Authors: Intiso, Domenico | Simone, Valentina | Di Rienzo, Filomena | Iarossi, Andrea | Pazienza, Luigi | Santamato, Andrea | Maruzzi, Giuseppe | Basciani, Mario

Article Type: Research Article

Abstract: Background: Spasticity can be a severe disabling disorder requiring high-dose injections of botulinum toxin type A (BoNT-A). Efficacy and safety of high BoNT-A doses in reducing multi-level spasticity of subjects with brain injury and cerebral palsy were investigated. Pain and functional outcome were also assessed. Method: High doses (up to 840 IU) of incobotulinumtoxinA were injected in adult subjects with severe spasticity of the upper and lower limbs due to brain injury (BI) and cerebral palsy (CP). The Modified Ashworth Scale, Visual Analogue scale, Glasgow Outcome Scale, Franchay Arm Test (FAT) and Barthel Scale were employed to assess …spasticity, pain and functional outcome at baseline, and 4 and 16 weeks after BoNT-A injection. Results: Twenty-two (12 M, 10 F; mean age 38.1 ± 13.7 years) subjects – 16 subjects with BI and 6 with CP – were enrolled. Elbow, wrist, fingers and ankle muscles showed significant spasticity reduction after BoNT-A injections. The mean FAT score improved, but the benefit was not significant. Three (13.6%) subjects complained of mild adverse events. Conclusion: High-dose BoNT-A injections were effective and safe in reducing spasticity of BI and CP subjects. A significant reduction of the pain was also observed, but global functionality and arm dexterity were unchanged. Show more

Keywords: Botulinum toxin, efficacy, high dose, spasticity, brain injury, cerebral palsy

DOI: 10.3233/NRE-141052

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 515-522, 2014

Authors: Medina-Perez, Carlos | de Souza-Teixeira, Fernanda | Fernandez-Gonzalo, Rodrigo | de Paz-Fernandez, Jose Antonio

Article Type: Research Article

Abstract: Background: Although resistance training adaptations in multiple sclerosis (MS) patients have been described, the detraining response in this population is largely unknown. Objective: This study was designed to evaluate the effects of a 12-week detraining period on muscle strength (isometric and endurance) and muscle power of multiple sclerosis (MS) patients that had previously carried out a 12-week resistance training program (RTP). Methods: Forty-two MS patients were randomly assigned into two groups: an exercise group (EG) that performed a 12-week RTP for the knee extensors muscles; and a control group (CG), that did not perform any specific …training. Knee extension maximal voluntary isometric contraction (MVIC), muscle power and muscle endurance were evaluated before and after the RTP, as well as 12 weeks after training completion. A strain gauge was used to measure the maximal voluntary isometric contraction and muscle power was assessed with a linear encoder. Muscle endurance was interpreted as the number of repetitions that a patient could perform in a single set of knee extension exercise. Results: The EG increased MVIC and muscle power after the training period, although the training did not affect muscle endurance. After 12 weeks of detraining, MVIC returned to pre-training values but muscle power was still greater than pre-training values in the EG. The CG did not present any change in the variables measured during the intervention. Conclusions: A 12-week RTP improved MVIC and muscle power in MS patients. Additionally, 12 weeks of detraining blunted strength training adaptations in MS patients, although muscle power training adaptations were still evident after the detraining period. Show more

Keywords: Multiple sclerosis, exercise rehabilitation, progressive resistance training, detraining, muscle strength, muscle power, lower extremity

DOI: 10.3233/NRE-141062

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 523-530, 2014

Authors: Noyes, Katia | Bajorska, Alina | Wasserman, Erin B. | Weinstock-Guttman, Bianca | Mukamel, Dana

Article Type: Research Article

Abstract: Objectives: To assess patient characteristics and risk factors associated with care transitions between skilled nursing facility (SNF) and home care for patients with multiple sclerosis (MS) in an effort to improve outcomes and optimize patient care pathways. Background: MS is a chronic neurologic illness of younger adults that is associated with physical disability, cognitive impairment and a high need for supportive services. Methods: The study was based on the 2005 Nursing Home Minimum Data Set and the Outcome and Assessment Information Set data (n = 10,064). We performed multivariate evaluation of patient risk factors for skilled …nursing facility (SNF) admission and disposition while controlling for potential patient self-selection and other characteristics that affect care utilization. Results: MS patients with recent history of home care use were less likely to be admitted to an acute care hospital and had higher physical disability at SNF admission than SNF patients who did not use home care. Insurance type (Medicaid) and availability of informal caregivers were associated with the use of homecare services after a SNF stay, while patient demographic and clinical characteristics did not explain SNF disposition. Conclusions: Future studies should explore the association between the local availability and affordability of home-based services and physician attitude about community-based care management of disabled patients. Show more

Keywords: Multiple Sclerosis (MS), disability, cognitive impairment, home health care (HHC), Skilled nursing facility (SNF)

DOI: 10.3233/NRE-141056

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 531-540, 2014

Authors: Harro, C.C. | Shoemaker, M.J. | Frey, O. | Gamble, A.C. | Harring, K.B. | Karl, K.L. | McDonald, J.D. | Murray, C.J. | VanDyke, J.M. | Tomassi, E.M. | VanHaitsma, R.J.

Article Type: Research Article

Abstract: Objectives: The purpose of this single-blinded, randomized controlled study was to examine and compare the immediate and retention effects of progressive speed-dependent treadmill training (SDTT) and rhythmic auditory-cued (RAC) training on balance function, fall incidence, and quality of life (QOL) in individuals with PD. Methods: Twenty participants (mean age 66.1 yrs) with idiopathic PD were randomized into either SDTT (n = 10) or RAC (n = 10) progressive, interval-based locomotor training for 6 weeks. Measures included the Berg Balance Scale (BBS), Rapid Step-Up Test (RST), Activities-specific Balance Confidence Scale, Parkinson's Disease Questionnaire-39 (PDQ), and the NeuroCom Sensory Organization …Test (SOT), Motor Control Test, and Limits of Stability (LOS). Fall incidence was assessed prospectively post-training based on six monthly self-report fall calendars. Results: Significant gains in balance measures were observed post-training in BBS, RST and SOT for the RAC group and in RST, SOT and LOS for the SDTT group. Gains were retained at 3 months post-training in all measures for RAC group, but only the RST for the SDTT group. No clear trend in reduction in fall frequency was evident. Conclusion: Externally-cued locomotor training paradigms with progressive speed challenges produced significant improvements in dynamic balance function in persons with PD, with stronger retention of gains in RAC group. Show more

Keywords: Parkinson's disease, locomotor training, rehabilitation

DOI: 10.3233/NRE-141048

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 541-556, 2014

Authors: Harro, Cathy C. | Shoemaker, Michael J. | Frey, Oksana J. | Gamble, April C. | Harring, Kendra B. | Karl, Katherine L. | McDonald, Jeffrey D. | Murray, Carolyn J. | Tomassi, Erika M. | Van Dyke, Jasmine M. | VanHaistma, Rachel J.

Article Type: Research Article

Abstract: Objectives: The purpose of this randomized controlled study was to examine and compare the immediate and retention effects of speed-dependent treadmill training (SDTT) and rhythmic auditory-cued (RAC) overground walking on gait function and fall risk in individuals with Parkinson's disease (PD). Methods: Twenty participants (mean age 66.1 yrs) with idiopathic PD were randomized into either SDTT (n = 10) or RAC (n = 10) progressive, interval-based locomotor training protocols. Immediate and retention training effects on gait function and fall risk were measured by comfortable and fast gait speed (CGS, FGS), 6-Minute Walk Test (6MWT), and Functional Gait Assessment …(FGA). Results: Immediate within-group training effects revealed significant gains in CGS, 6MWT, and FGA for the RAC group, and in FGS, 6-MinuteWalk Test, and FGA for the SDTT group. Retention effects were found at 3-month follow-up for all gait measures in the RAC group, and for FGS and FGA in the SDTT group. No statistically significant differences in immediate or retention training effects on gait measures were found between groups. Conclusions: Externally-cued locomotor training with progressive and interval-based speed challenges, either with RAC overground or on a treadmill, produced significant improvements in walking speed, endurance, and dynamic balance during walking. Show more

Keywords: Parkinson's disease, locomotor training, rehabilitation

DOI: 10.3233/NRE-141051

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 557-572, 2014

Authors: Bertisch, Hilary | Rath, Joseph | Long, Coralynn | Ashman, Teresa | Rashid, Tayyab

Article Type: Research Article

Abstract: Background: The field of positive psychology has grown exponentially within the last decade. To date, however, there have been few empirical initiatives to clarify the constructs within positive psychology as they relate to rehabilitation medicine. Character strengths, and in particular resilience, following neurological trauma are clinically observable within rehabilitation settings, and greater knowledge of the way in which these factors relate to treatment variables may allow for enhanced treatment conceptualization and planning. Objective: The goal of this study was to explore the relationships between positive psychology constructs (character strengths, resilience, and positive mood) and rehabilitation-related variables (perceptions of …functional ability post-injury and beliefs about treatment) within a baseline data set, a six-month follow-up data set, and longitudinally across time points. Methods: Pearson correlations and supplementary multiple regression analyses were conducted within and across these time points from a starting sample of thirty-nine individuals with acquired brain injury (ABI) in an outpatient rehabilitation program. Results: Positive psychology constructs were related to rehabilitation-related variables within the baseline data set, within the follow-up data set, and longitudinally between baseline positive psychology variables and follow-up rehabilitation-related data. Conclusions: These preliminary findings support relationships between character strengths, resilience, and positive mood states with perceptions of functional ability and expectations of treatment, respectively, which are primary factors in treatment success and quality of life outcomes in rehabilitation medicine settings. The results suggest the need for more research in this area, with an ultimate goal of incorporating positive psychology constructs into rehabilitation conceptualization and treatment planning. Show more

Keywords: Rehabilitation, brain injury, positive psychology, resilience, function, positive psychotherapy inventory

DOI: 10.3233/NRE-141059

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 573-585, 2014

Authors: Hong, Seung Pyo | Park, HaeYean | Kwon, Jae-Sung | Yoo, Eunyoung

Article Type: Research Article

Abstract: Background: Eccentric viewing training can be successfully applied in the clinical setting based on positive evidence. Nonetheless, published research should be integrated to provide a conclusive perspective of the efficacy of eccentric viewing training. Objective: Meta-analysis was conducted to examine effectiveness of eccentric viewing training on daily visual activities for individuals with age-related macular degeneration (AMD). Methods: The papers used in this study were located through PubMed, Ovid, ProQuest, EBSCOhost, RISS, and KMbase on studies published between January, 1990 and December, 2012. The keywords for searching were “age-related macular degeneration” and “eccentric viewing”, “eccentric fixation”, “peripheral …vision” or “preferred retinal loci”. The effect sizes were calculated using Comprehensive Meta-Analysis 2.0 and interpreted according to Cohen's criteria. Results: A total of 258 studies were found, among which five papers suited the main selection criteria for final analysis. The entire effect size was 0.660 (95% CI, 0.232 ~ 1.088), indicating a moderate effect size of the eccentric viewing training for individuals with AMD in their daily visual activities (p < 0.05). Conclusions: The results of this study demonstrated the clinical effectiveness of eccentric viewing training for individuals with AMD. This result should be interpreted cautiously, though, given the possibility of publication bias. Show more

Keywords: Age-related macular degeneration, eccentric viewing training, meta-analysis, occupational therapy

DOI: 10.3233/NRE-141055

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 587-595, 2014