NeuroRehabilitation - Volume 35, issue 3

Authors: Luchesi, K.F. | Kitamua, S. | Mourão, L.F.

Article Type: Research Article

Abstract: Background: Dysphagia-related complications, such as aspiration pneumonia and malnutrition, are major causes of death among patients with Amyotrophic Lateral Sclerosis (ALS). Objective: To analyze clinical features associated with worsened swallowing and non-oral feeding in ALS. Methods: This is a long-term study of 33 ALS patients, who were observed between 2006 and 2011 in three month intervals. These subjects underwent Fiberoptic Endoscopic Evaluation of Swallowing and Functional Oral Intake Scale classification. Survival analysis was performed using Cox Regression. Results: The worsening of swallowing functionality was more rapid in late-onset ALS patients (risk of 4% per …year) and individuals with bulbar onset ALS (risk of 188% per year). Non-oral feeding was associated with both the later onset of ALS symptoms (risk of 7.5% per year) and shorter disease duration (risk of 13% per year). Conclusion: Worsened swallowing was more rapid in individuals who were older at symptoms onset and who had bulbar onset ALS. Non-oral feeding was associated with both age at symptoms onset and shorter disease duration. Show more

Keywords: Dysphagia, deglutition, survival analysis, Amyotrophic Lateral Sclerosis, disease progression

DOI: 10.3233/NRE-141149

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 535-542, 2014

Authors: Raji, Parvin | Ansari, Noureddin Nakhostin | Naghdi, Soofia | Forogh, Bijan | Hasson, Scott

Article Type: Research Article

Abstract: Background: The Semmes-Weinstein Monofilament Test (SWMT) is a clinical widely used test to quantify the sensibility in patients with Carpal Tunnel Syndrome (CTS). No study has investigated the relationship between the SWMT and sensory nerve conduction studies (SNCS) in patients with CTS. Objective: To assess the relationship between the SWMT and SNCS findings in patients with CTS. Methods: This cross-sectional clinical measurement study included 35 patients with CTS (55 hands) with a mean age of 45 ± 12 years. The outcome measures were the SWMT and SNCS measures of distal latency (DLs), amplitude (AMPs), and nerve …conduction velocity (NCV). The median innervated fingers were tested using SWMT and electrodiagnostic tests. The primary outcome was the correlations between the SWMTs and NCS measures. Results: All of the patients/hands had abnormal NCS findings. When looking at the three digits of interest (thumb, index and middle), the thumb SWMTs had the highest number of abnormal findings (58.2%), with the middle digit having the lowest (45.5%). All NCS findings were statistically different between abnormal and normal thumb SWMTs and abnormal and normal total summed SWMTs. There were significant moderate correlations between thumb SWMT scores and all NCS outcomes. Conclusions: Although only approximately 50% of the CTS diagnosed through NCS are corroborated through SWMT; the significant associations between SWMT and NCS measures suggest that SWMT is a valid test for assessing sensations in patients with CTS. Show more

Keywords: Carpal Tunnel Syndrome, Semmes-Weinstein Monofilament Test, nerve conduction study

DOI: 10.3233/NRE-141150

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 543-552, 2014

Authors: Hynes, S.M. | Fish, J. | Manly, T.

Article Type: Research Article

Abstract: Background: Multitasking measures, in which a series of tasks must be completed within a naturalistic setting not fully under the experimenter's control, have been shown to be more sensitive than traditional measures in detecting organisational problems in people with difficulties in executive functioning. There are a number of drawbacks to such tasks however. They can take considerable time to administer and are demanding in terms of examiners noting and recording all relevant aspects of performance. This potentially leaves them more open to subtle bias. One method that could offset these limitations is to video record performance. Objectives: The …practicality and outcome of using video ratings to accurately score performance off-line is investigated here. Methods: Nineteen participants completed a Multiple Errands Task (MET) while wearing a body-worn camera. Their performance was scored “live” and by an independent rater who had only access to video footage of the task. Results: Significant relationships were seen on all variables of the MET between the live and video ratings. The inter-rater reliability of the measure appears strong. Conclusion: We provide initial support for the use of a video rater when assessing performance on an MET. Show more

Keywords: Rehabilitation, memory; neurorehabilitation, assessment, therapy, executive function

DOI: 10.3233/NRE-141151

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 553-562, 2014

Authors: Glegg, Stephanie M.N. | Holsti, Liisa | Stanton, Sue | Hanna, Steven | Velikonja, Diana | Ansley, Barbara | Sartor, Denise | Brum, Christine

Article Type: Research Article

Abstract: Background: Virtual reality (VR) is a relatively new treatment tool with emerging evidence supporting its use in neurorehabilitation, although no information exists about how therapists use VR clinically. Objective: This study's purpose was to document current practice in GestureTek VR use for inpatient acquired brain injury (ABI) rehabilitation as a benchmark for clinicians integrating the approach into practice, and to inform future research to improve its clinical applicability. Methods: As part of a larger study examining barriers and facilitators to VR use, participating therapists at two rehabilitation centres documented descriptive data about client demographics and VR …treatment programme characteristics for 29 ABI clients on their caseloads over eight months. Results: Differences between the clinical population and published research samples were apparent. Treatment characteristics and several outcomes of interest paralleled those in the literature; however, novel outcome areas were identified as research gaps. By study's end, more than half of clients' VR programmes had been discontinued, for reasons consistent with documented barriers to VR use. Conclusions: These findings can help bridge the knowledge-to-action gap by informing the design of research that has high clinical relevance, and by providing a point of reference for clinicians incorporating VR into their practices. Show more

Keywords: Brain injury, rehabilitation, virtual reality, GestureTek, clinical applicability

DOI: 10.3233/NRE-141152

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 563-577, 2014

Authors: Hiyamizu, Makoto | Maeoka, Hiroshi | Matsuo, Atsushi | Morioka, Shu

Article Type: Research Article

Abstract: Background: Studies suggest that the observation of others' actions leads to enhanced motor skill learning. Objective: We examined whether others' or self-action observation is effective for standing balance learning. In addition, we examined cortical activation during action observation using functional near-infrared spectroscopy. Methods: Thirty-nine healthy young subjects were assigned randomly to the Control, Other-Observation (O-O), and Self-Observation (S-O) groups. The subjects learned to stand on a tilting platform while maintaining a horizontal position. The Control group alternated each trial with a rest period. The O-O and S-O groups were provided with information related to their performance …during the rest period: the O-O group observed another person, while the S-O group observed their previous performance. Cortical activation was assessed by changes of hemoglobin oxygenation (oxyHb). Results: A 2-way analysis of variance with repeated measures on balance performance revealed a significant difference in post-training (p < 0.05) and retention (p < 0.01) only in the S-O group. And an increase of oxyHb levels at post-training in the S-O group was observed in the supplementary motor area. Conclusion: Self-action observation improved standing balance and brain activity during training and at 24 h after training. Show more

Keywords: Action observation, balance, motor learning, fNIRS

DOI: 10.3233/NRE-141153

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 579-585, 2014

Authors: Shin, Yoon Kyum | Lee, Dong Ryul | Kim, Do Hyun | Lee, Jae Jin | You, Sung (Joshua) Hyun | Yi, Chung Hwi | Jeon, Hye Seon

Article Type: Research Article

Abstract: Background: Gait impairments from a neuromuscular imbalance are crucial issues in cerebral palsy. The purpose of our study was to compare the effects of the assistive tubing gait (ATG) and assistive-resistive tubing gait (ARTG) on improving the vasti and hamstring muscle imbalance during the initial contact to mid-stance phases in individuals with spastic diplegic cerebral palsy (CP). Methods: Fourteen age-matched individuals including seven normal individuals (11.7 years) and seven individuals with CP (12.9 years) were recruited. All participants underwent electromyography (EMG) measurement of the unilateral vasti and hamstring muscle activity during the three gait training conditions of no-tubing …gait (NTG), ATG, and ARTG. A statistical one-way repeated-measure analysis of variance (ANOVA) was used to determine differences in the vasti and hamstring activity, the vasti/hamstring ratio, and the knee joint angle across the three gait training conditions for each group. Results: The initial vasti and hamstring muscle imbalance in CP was significantly improved by applying the ARTG compared with the ATG. The vasti/hamstring ratio during the ARTG was compatible with the ratio value obtained from the NTG of normal individuals. The knee joint angle in CP was not improved in this short-term intervention. Conclusions: The ARTG proportionately increased the vasti activation and reciprocally inhibited the hamstring activity, subsequently improving the neuromuscular imbalance associated with the flexed-knee gait in individuals with spastic diplegic CP. Show more

Keywords: Neuromuscular imbalance, reciprocal inhibition, spastic diplegic CP, tubing gait

DOI: 10.3233/NRE-141154

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 587-596, 2014

Authors: Nsenga Leunkeu, Angeline | Lelard, Thierry | Shephard, Roy J. | Doutrellot, Pierre-Louis | Ahmaidi, Said

Article Type: Research Article

Abstract: Background: Gait cycle and pressure distribution patterns can now be recorded quite simply and reproducibly with inexpensive in-sole pressure recorders. However, it is not known whether such readings are sufficiently stable to provide useful information in monitoring children with spastic hemiplegic cerebral palsy (HCP). Objective: The aim of this study was to asses the reproducibility of gait cycle and plantar pressure in HCP. Methods: Fourteen children with HCP (Gross Motor Function Classification System level I or II) undertook two walking trials (4 × 12 meters at self-selected speeds) with a one-week inter-test interval. Spatio-temporal gait cycle …parameters and peak plantar pressures were measured at each visit, using Parotec in-shoe pressure sensors. Results: In the unaffected limb, satisfactory reproducibility was found for measurements of velocity, step frequency, time of double support, and step duration, but not for step amplitude or contact time. However, in the affected limb, only velocity and step duration showed moderate reproducibility. Likewise, all of 8 pressure measurements were reproducible for the unaffected limb, but pressures for the affected limb were only consistent at 4 sites (metatarsals 4-5, lateral heel, lateral mid-foot and hallux). Conclusions: Since plantar pressures are unstable only in the affected limb, the cause of variation is likely immediate spasm during movement of this limb rather than a more permanent change of posture. Some spatio-temporal parameters and plantar pressure readings have sufficient stability in both unaffected and affected limbs to allow their use when evaluating gait and planning therapy for children with HCP. Show more

Keywords: Bland-Altman tests, children, hemiplegic cerebral palsy, rehabilitation, gait cycle, peak plantar pressures

DOI: 10.3233/NRE-141155

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 597-606, 2014

Authors: Kim, Yushin | Kim, Jungjin | Shim, Jae Kun | Suh, Dong-Won | Yoon, BumChul

Article Type: Research Article

Abstract: Background: Sensitivity of the myofascial trigger point (MTrP) can be inhibited by electrical stimulation of remote site. However, it remains unclear whether remote pain control of the MTrP occurs in the same spinal segment or in the supraspinal system. Objectives: The aims of this study were to identify whether the remote pain control occurs in the spinal segment corresponding to the MTrP or in the supraspinal system. Methods: Test subjects (n = 10) received transcutaneous electrical nerve stimulation for 5 minutes, whereas control subjects (n = 10) received no intervention. The threshold for tactile sensory modulation …at the lateral elbow was assessed using Von Frey filaments. The pressure sensitivities of MTrPs in both the infraspinatus and upper trapezius muscles were quantified by algometry. Measurements were performed at baseline and 1 and 15 minutes after the intervention. Results: Increases of the tactile threshold at the remote site decreased the sensitivity of the MTrP innervated by same spinal segment. However, no changes were observed at MTrP sites innervated by contralateral fibers or those from different spinal segment. Conclusion: MTrP sensitivity is more strongly affected by interventions at remote ipsilateral sites in the same spinal segment than by stimulation of extra-segmental sites. Show more

Keywords: Remote pain control, myofascial trigger points, transcutaneous electrical nerve stimulation, hypoalgesia, tactile sensory modulation

DOI: 10.3233/NRE-141156

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 607-614, 2014

Authors: Wallace, Sarah E. | Purdy, Mary | Skidmore, Elizabeth

Article Type: Case Report

Abstract: Background: Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. Objective: The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication …breakdowns. Methods: Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. Results: Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. Conclusions: Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting. Show more

Keywords: Aphasia, acute rehabilitation, multimodal treatment, stroke

DOI: 10.3233/NRE-141136

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 615-625, 2014

Authors: Morris, Lottie L. | Dysch, Leon | Salkovskis, Paul M. | Giffin, Nicola

Article Type: Case Report

Abstract: Background: Stiff Person Syndrome (SPS) is a rare neurological condition, characterised by rigidity in the trunk and limbs. Comorbid anxiety is common and known to exacerbate stiffness. Objective: This case study examines the extent to which psychological treatment of comorbid anxiety alleviated stiffness in a patient whose condition was exacerbated by social anxiety. Methods: A patient was treated using cognitive behavioural therapy, focussing on reducing anxiety and therefore stiffness by addressing rumination, self-focussed attention, and distressing cognitions relating to walking in public. The patient's walking, stiffness, and anxiety were assessed during and post-therapy using questionnaires. …Results: Walking, stiffness, and anxiety improved during treatment. At five months' follow up, while the improvement in anxiety was maintained, walking and stiffness had deteriorated. The patient and his Neurologist felt that this deterioration was biological, rather than psychological in nature. Conclusions: This is the first published case where SPS has been ameliorated (albeit temporarily) using psychological therapy, and has important implications for future research and treatment. Show more

Keywords: Stiff Person Syndrome, stiff man syndrome, cbt, psychotherapy

DOI: 10.3233/NRE-141147

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 627-631, 2014