NeuroRehabilitation - Volume 35, issue 1

Authors: Tramonti, Francesco | Fanciullacci, Chiara | Giunti, Giulia | Rossi, Bruno | Chisari, Carmelo

Article Type: Research Article

Abstract: Background: While the positive effects of rehabilitation on physical functioning are well documented in stroke literature, more controversial results arise from the evaluation of the impact on quality of life. Objective: The aim of the present study is to examine the associations among functional status and different measures of quality of life in a sample of inpatients undergoing rehabilitation programmes, and to consider the role of psychological distress, coping strategies and social support. Methods: Twenty-nine stroke survivors were evaluated at the admission to a hospital-based Rehabilitation Unit and just before discharge. Questionnaires for the evaluation of …functional status, health-related QoL, individualised QoL, psychological distress, coping strategies and social support were administered to them. Results: While functional status improves significantly after treatment, individualised evaluations of QoL seem to be less affected. Adaptive coping strategies and social support showed significant correlations with positive outcomes on specific QoL domains, whereas psychological distress was associated with negative outcomes. Conclusions: The data from the present study support the evidence that different measures of QoL and functional status are not strongly associated one another, and that psychological distress, coping strategies and social support can be significantly related to specific outcome measures. Show more

Keywords: Stroke, functional status, quality of life, coping, family, social support

DOI: 10.3233/NRE-141092

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 1-7, 2014

Authors: Finch, Emma | Fleming, Jennifer | Clark, Kathy | Hayward, Kathryn S.

Article Type: Case Report

Abstract: Background: Thrombolysis with recombinant tissue plasminogen activator (rtPA) is part of routine acute stroke clinical practice worldwide. Yet, it is unclear how rtPA influences specific rehabilitation outcomes, such as motor, cognitive and communication function. Objective: The present study aimed to collect pilot data about the effects of rtPA on communication and motor recovery during the first three months post-rtPA. Methods: Four individuals who received thrombolysis with rtPA for a single left hemisphere ischaemic stroke completed an assessment battery two weeks and three months post-stroke. Information pertaining to allied health service usage was also investigated. …Results: Reliable changes in assessment scores were observed for lower limb function in two participants with severe functional limitations. There was no reliable change in lower limb function for the two milder participants, or for any participants in upper limb or language function. Service usage varied between participants. Two participants required extensive inpatient rehabilitation. Three participants required outpatient or community rehabilitation. Conclusions: Tailoring of the service delivery approach may be required for individuals who receive rtPA based on functional limitations evident post-rtPA. Future research into the impact of rtPA on motor, cognitive and communication recovery after stroke is vital to inform rehabilitation programs and optimize outcomes. Show more

Keywords: Thrombolysis, interdisciplinary, rehabilitation, stroke, outcome, tissue plasminogen activator

DOI: 10.3233/NRE-141091

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 9-16, 2014

Authors: Hayward, Kathryn S. | Kuys, Suzanne S. | Barker, Ruth N. | Brauer, Sandra G.

Article Type: Research Article

Abstract: Background: Severe arm disability is considered to indicate poor potential to recover arm function. Objective: Determine if stroke survivors with severe upper arm disability can achieve a clinically important change in arm function on discharge from inpatient rehabilitation. Methods: 618 stroke survivors from 16 inpatient rehabilitation units were assessed on admission and discharge using the Motor Assessment Scale Item 6 Upper Arm Function (MAS6). Admission scores defined participants with severe (MAS6 ≤2) and mild/moderate (MAS6 >2) upper arm disability. A clinically important change was evaluated according to: 1) statistical significance; 2) minimal clinical importance difference (MCID); …and 3) shift in disability status i.e., severe to mild/moderate. Achievers of a MCID and shift were compared to non-achievers. Results: Stroke survivors with severe upper arm disability (n = 226) demonstrated a significant improvement in arm function (p < 0.001) at discharge. A MCID was achieved by 68% (n = 155) and a shift from severe to mild/moderate upper arm disability on discharge by 45% (n = 102) of participants. Achievers had a significantly shorter interval from stroke onset to inpatient rehabilitation admission (p < 0.002). Conclusion: Stroke survivors with severe upper arm disability can achieve a clinically important change during inpatient rehabilitation. Show more

Keywords: Stroke, inpatient rehabilitation, functional recovery, severe, motor

DOI: 10.3233/NRE-141096

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 17-23, 2014

Authors: Rousseaux, Marc | Daveluy, Walter | Kozlowski, Odile | Allart, Etienne

Article Type: Research Article

Abstract: Background: Hemiplegic patients with supraspinal spasticity can present with a flexor pattern at the hip and knee that hampers both passive and active functions. Objective: To investigate the efficacy of OnabotulinumtoxinA injections on this flexor scheme. Methods: This open-label observational study included eleven patients who had suffered a unilateral stroke or traumatic brain injury. All had impairment in the activities of daily living caused by severe hip and knee flexion. OnabotulinumtoxinA injections of 300–400U (total dose) were administered to the iliopsoas (iliacus) and knee flexors and, when necessary, to other muscles of the hip and knee. …Evaluations were performed pre-treatment (weeks −4 to −8, and day 1) and post-treatment (week 10 and week 21): spasticity, range of motion, limb positioning, passive functions and pain. Results: A modest improvement in hip and knee extension was observed, as evidenced by the Modified Ashworth Score and range of passive extension movements. Limb positioning was also improved. Clear benefits were found on passive functioning, including toileting, dressing and bed facilities, as well as pain levels. Active functions remained unchanged. More definite improvement was found in patients with severe difficulties. Conclusions: OnabotulinumtoxinA injection can contribute to reducing the consequences of disabling lower limb flexion. Show more

Keywords: Botulinum toxin type-A, lower limb, muscle spasticity, onabotulinumtoxinA

DOI: 10.3233/NRE-141093

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 25-30, 2014

Authors: Nakamura, Junji | Kita, Yorihiro | Yuda, Tomohisa | Ikuno, Koki | Okada, Yohei | Shomoto, Koji

Article Type: Case Report

Abstract: Background: A recent study investigated the effects of galvanic vestibular stimulation (GVS) on pusher behavior (PB) in post-stroke patients. However, there have been no reports about the effects of multisession GVS on PB. Objective: The purpose of this study was to investigate the feasibility and effects of multisession GVS combined with physical therapy for PB in stroke patients. Methods: Two stroke patients who showed PB were enrolled. The ABAB single-case design was used. Each phase lasted 1 wk. In phases A1 and A2, the patients underwent a 60-min-long physical therapy session 5 days a week. In …phases B1 and B2, they underwent GVS for 20 min before each physical therapy session, and then the same physical therapy program as in phases A1 and A2 were performed. PB was evaluated using the Scale for Contraversive Pushing (SCP) and the Burke Lateropulsion Scale (BLS). Outcomes were tested at the baseline and after each phase. Results: In both patients, the SCP scores were reduced only during phase B2. Although the BLS scores improved at the A1 phase, a larger improvement was seen at the two B phases. Conclusions: Multisession GVS combined with physical therapy may have positive effects on PB in clinical setting. Show more

Keywords: Pusher behavior, galvanic vestibular stimulation, stroke, rehabilitation, electrical stimulation, posture control

DOI: 10.3233/NRE-141094

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 31-37, 2014

Authors: Fernandes, Aline Braga Galvão Silveira | Oliveira dos Passos, Jacilda | Paiva de Brito, Deyvson | Fernandes Campos, Tania

Article Type: Research Article

Abstract: Background: Stroke is a major cause of motor disability in adults and needs interventions that contribute to motor recovery. Objective: This study aimed to compare the immediate effect of the training with virtual reality game in stroke patients according side brain injury. Methods: The participants included 20 patients (10 right brain injury), mean age of 50.6 ± 9.2 years, and 20 healthy subjects of 50.9 ± 8.8 years. All participants made a kinematic evaluation of drinking a cup of water before and after training with the table tennis game of the XBOX 360 Kinect® , in …two series of 10 tries of 45 s, with 15 minutes rest between them, a total of 30 minutes. Data were analyzed by ANOVA. Results: There was a significant difference in the number of hits between patients and healthy subjects groups, in which patients had a lower performance in all the trials (p = 0.008). After the training, only patients with right brain injury improved their shoulder and elbow angles, approaching the left upper limb movement pattern of healthy subjects (p < 0.05). Conclusion: Patients with right brain injury responded better to the virtual reality game, suggesting introduction of new treatment techniques that promote neurorehabilitation. Show more

Keywords: Stroke, brain injury, hemiparesis, motor disability

DOI: 10.3233/NRE-141105

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 39-45, 2014

Authors: Rotenberg-Shpigelman, Shlomit | Rosen-Shilo, Lee | Maeir, Adina

Article Type: Research Article

Abstract: Background: Self-awareness is a significant predictor of neurorehabilitation process and outcome and encompasses metacognitive knowledge and online awareness. The literature focuses primarily on intellectual awareness and research on online awareness is lacking. Objective: To examine online awareness for functional tasks, how it is affected by task experience and its relationships with neurogenic and psychogenic factors. Methods: Thirty six adults with ABI attending neurorehabilitation participated in this study. Online awareness was measured as the discrepancy between subjective ratings of performance and performance on functional tasks, as rated by experienced therapists. Participants' ratings were recorded before and immediately …after task experience, as well as following a mediated review of task steps. The Impaired Self-Awareness scale (ISA) and the Denial of Disability scale (DD) rated neurogenic and psychogenic mechanisms of unawareness. Results: Results indicated significant differences between therapists' and participants' ratings before and after IADL task performance, and following mediation. Participants typically overestimated their functional independence and did not significantly change their ratings after task experience. Significant moderate to strong correlations were found between online awareness measures and both DD and ISA scales. Conclusions: Overestimation of functional independence is common in persons with ABI, is related to both neurogenic and psychogenic factors and is not significantly affected by single task experience. Further studies are required to examine the effect of theoretically driven awareness interventions in neurorehabilitation. Show more

Keywords: Online awareness, task performance, neurorehabilitation, ABI

DOI: 10.3233/NRE-141101

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 47-56, 2014

Authors: Lee, Yuen Shan Christine | Ashman, Teresa | Shang, Andrea | Suzuki, Wendy

Article Type: Research Article

Abstract: Background: Physical exercise has been proven to be an effective method for improving cognition and mood, but little is known about its benefits among individuals with traumatic brain injury. Objective: This pilot study investigated the feasibility of a combined exercise and self-affirmation intervention (IntenSati) for enhancing cognition and mood in individuals with TBI. It was hypothesized that this intervention would improve individuals' cognition and mood following the completion of the program. Method: This intervention was held at an outpatient rehabilitation department in an urban medical center. A wait-list control design was conducted. Twenty-one adult participants—at least …12-months post-TBI—enrolled in the study. Twelve of them completed the study. Assessment was conducted at three time-points throughout the study using neuropsychological and self-report measures to evaluate participants' cognition and mood. Following initial evaluation, participants were assigned into either the immediate intervention group or the waitlist control group. During the intervention, participants attended the program twice a week over the course of 8 weeks. Debriefing was conducted following the completion of the program. Results: Both independent t tests and paired t tests were utilized. Results indicated that the intervention group experienced less depressive symptoms following the completion of the IntenSati program compared to the waitlist control group. Participants also reported having less depressive symptoms, experienced more positive affect, and had a higher quality of life following the completion of the program. Moderate-to-large effect sizes were found on decrease in negative affect. However, results associated with cognitive benefits were mixed. The participants tolerated the program well and reported satisfaction with the program. Conclusions: Results from this study indicated that the IntenSati exercise program is a feasible and beneficial intervention for individuals with TBI as supported by the positive impact on their mood and quality of life. Show more

Keywords: Traumatic brain injury, physical exercise, cognition, mood

DOI: 10.3233/NRE-141100

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 57-65, 2014

Authors: Castaño Monsalve, B. | Laxe, Sara | Bernabeu Guitart, M. | Bulbena Vilarrasa, Antoni | Quemada, Jose Ignacio

Article Type: Research Article

Abstract: Neurobehavioral disorders are common consequences of traumatic brain injury (TBI) that should be objectively assessed in this population. The use of scales allows us to unify terms both in clinical practice and investigative work; it also constitutes a useful guide in clinical interviews and makes it possible to see outcome changes in patients with or without intervention. The aim of this study is to review the most frequently neurobehavioral scales used to measure the non-cognitive disorders of conduct in TBI patients. Method: A systematic and descriptive literature review was done in Medline, without time limit, which focused on …scales applied to behavioral disorders in moderate and severe TBI patients. Results: Ninety articles were selected for the final review and thirty-seven different scales were identified. Seven of these instruments represent sixty-five percent of all behavioral scales applied in the studies collected and were selected for the present review. There are scales that are more general and include a wide range of neurobehavioral symptoms, like the Neurobehavioral Rating Scale and the Neuropsychiatric Inventory. On the opposite, there are questionnaires that focus on specific symptoms like aggressiveness, agitation and apathy such as the Agitated Behavior Scale or the Apathy Evaluation Scale. The forms for caregiver or staff were the most prevalent in our review. The most representative behavioral scales applied to moderate and severe TBI patients were analyzed using clinical useful, covered domains, item descriptions, administration procedures and psychometric properties. Show more

Keywords: Brain injury, neurobehavioral, emotional, scales, instruments, measure, assessment, disability, neurorehabilitation, outcome

DOI: 10.3233/NRE-141103

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 67-76, 2014

Authors: Smith, Lindsey K. | Goberman, Alexander M.

Article Type: Research Article

Abstract: Background: Various methods of acoustic analysis have been used to describe phonatory deficits in Parkinson disease (PD), including long-time average spectrum (LTAS) analysis. Objective: The aim of this study was to utilize the LTAS to investigate laryngeal deficits in individuals with PD. Methods: Twenty-eight individuals with idiopathic PD and 10 controls were participants for this study. An LTAS was generated from a standard reading sample and analyzed using the following measurements: Mean spectral energy (MSE), first spectral peak, spectral tilt (ST), three spectral slope (SS) measures (i.e., SSF0-1kHz , SS1-5kHz , and SS ratio) and four …spectral moments (mean, standard deviation, skewness, and kurtosis). Results: Individuals with PD were found to demonstrate significantly lower MSE, spectral mean and spectral SD, along with higher spectral skewness compared to control speakers. Furthermore, ST was positively correlated with self-rated symptom severity and self-rated medication effectiveness for individuals with PD. Conclusions: The LTAS findings were consistent with either reduced vocal fold adduction or vocal fold bowing in individuals with PD compared to control speakers. Additionally, vocal fold adductory changes were one possible explanation for correlations between LTAS and self-ratings of medication effectiveness and disease severity. Show more

Keywords: Parkinson disease, long-time average spectrum, LTAS, voice, phonation

DOI: 10.3233/NRE-141102

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 77-88, 2014