NeuroRehabilitation - Volume 35, issue 4

Authors: Lannin, Natasha A. | Laver, Kate | Henry, Kareena | Turnbull, Michelle | Elder, Megan | Campisi, Josephine | Schmidt, Julia | Schneider, Emma

Article Type: Review Article

Abstract: Background: Adults who survive traumatic brain injury (TBI) often receive case (care) management to overcome the difficulties commonly faced negotiating a number of different health and social care services and systems. Little is known about the effectiveness of a case management intervention. Objective: To examine the effects of case management for patients with severe head injury on outcome, family function, and provision of rehabilitation services. Methods: Systematic review methodology. Electronic databases (Medline, CINAHL, Psycbite and OTSeeker) were searched up to 7/1/2013. A total of 655 articles were screened of which six met the criteria for inclusion …in the review. Study quality was evaluated using the PEDro scale or AMSTAR checklist dependent on study design. Results: One systematic review, three controlled trials and two case series reports were appraised. There was significant clinical heterogeneity between studies and studies scored poorly on the appraisal checklists. Due to methodological limitations, there was no clear evidence of effectiveness or ineffectiveness of case management after brain injury. Conclusion: Principal findings are that there is a paucity of applicable research on case management, and a need to evaluate the impact of case management on life participation outcomes. Show more

Keywords: Case management, managed care programs, review, brain injuries, rehabilitation

DOI: 10.3233/NRE-141161

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 635-641, 2014

Authors: Willerslev-Olsen, Maria | Lorentzen, Jakob | Nielsen, Jens Bo

Article Type: Research Article

Abstract: Background: Foot drop and toe walking are frequent concerns in children with cerebral palsy (CP). Increased stiffness of the ankle joint muscles may contribute to these problems. Objective: Does four weeks of daily home based treadmill training with incline reduce ankle joint stiffness and facilitate heel strike in children with CP? Methods: Seventeen children with CP (4–14 years) were recruited. Muscle stiffness and gait ability were measured twice before and twice after training with an interval of one month. Passive and reflex-mediated stiffness were measured by a dynamometer which applied stretches below and above reflex threshold. …Gait kinematics were recorded by 3-D video-analysis during treadmill walking. Foot pressure was measured by force-sensitive foot soles during treadmill and over-ground walking. Results: Children with increased passive stiffness showed a significant reduction in stiffness following training (P = 0.01). Toe lift in the swing phase (P = 0.014) and heel impact (P = 0.003) increased significantly following the training during both treadmill and over-ground walking. Conclusions: Daily intensive gait training may influence the elastic properties of ankle joint muscles and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP. Show more

Keywords: Cerebral palsy, gait training, passive muscle stiffness

DOI: 10.3233/NRE-141180

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 643-655, 2014

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

Article Type: Research Article

Abstract: Background: Information on altered foot pressures during ambulation would clarify how far limb deformities modify walking patterns in cerebral palsy (CP), and whether such data can inform prognosis and guide rehabilitation. Objective: To compare patterns of plantar pressures during walking between children with CP and their able-bodied (AB) peers. Methods: Twenty-five children/adolescents (10 with hemiplegia, 5 with diplegia, and 10 AB, respective ages 13.0 ± 1.9, 13.0 ± 0.6 and 14.0 ± 0.7 years) walked a 12 m line at a self-selected speed. Spatio-temporal parameters and peak in-shoe plantar pressures were recorded for both feet, using …the Parotec analysis system. Results: Walking speeds (m·−1 ) differed significantly between groups (0.65 ± 0.13, hemiplegia, 0.93 ± 0.22 diplegia and 1.26 ± 0.05 AB), with shorter stride lengths in CP. Contact time, double support time and step duration were also shorter in hemiplegia. Plantar pressures differed substantially and consistently between AB and CP, with increased medial heel pressures in hemiplegia, and reduced hallux and lateral heel pressures but increased lateral, medial mid-foot and first metatarsal pressures in diplegia. Conclusions: Substantial alterations in spatio-temporal parameters (greater in hemiplegia than in diplegia) and plantar pressure distribution reflect attempts to compensate for poor stability of posture in CP. Further study of these adaptive changes holds clinical promise in providing data relevant to the design of orthotics, determinations of prognosis and the planning of neurorehabilitation. Show more

Keywords: Children, cerebral palsy, rehabilitation, gait cycle, plantar pressures

DOI: 10.3233/NRE-141163

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 657-663, 2014

Authors: Plata Bello, Julio | Modroño, Cristián | González-Mora, José Luis

Article Type: Research Article

Abstract: Background: A great deal of research has focused on demonstrating the existence of mirror neurons in humans and the factors that modulate their activity after their discovery in macaques approximately two decades ago. Objectives: With this in mind, the parieto-frontal mirror neuron system (MNS) has been described as a brain network that is activated when either an action is executed or as it is observed. The clinical importance of these findings have been related with neurological and psychiatric disorders, but no one has focused until now on the possibilities that this network could provide to achieve better results …in neurosurgical patients. Methods and results: One of the applications of the MNS with clinical significance is the observation based rehabilitation programs. These programs have demonstrated their usefulness in certain pathologic entities but as yet there are no reports regarding neurosurgical patients in the literature. The activation of brain areas during observation of motor actions which are also activated when those actions are executed define the physiopathological principle of this kind of therapy that has been shown to get better results than standard rehabilitation programs and that should also be tested on neurosurgical patients. If observation based rehabilitation is considered, the MNS should be as intact as possible. Indeed, the surgeon can try to respect mirror areas during surgery by mapping them pre-surgically. Furthermore, damage to the MNS is associated with some degree of cognitive impairment, so better functional results can be achieved by respecting these mirror areas. Conclusion: Therefore, the aim of the present work is to describe how the MNS can contribute to neurosurgery and to put forward the hypothesis that by considering and using MNS properties better functional outcomes can be achieved. Show more

Keywords: Mirror neurons, observation based rehabilitation, neurosurgery

DOI: 10.3233/NRE-141167

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 665-671, 2014

Authors: Chong, Hyun Ju | Han, Soo Jeong | Kim, Yong Jae | Park, Hye Young | Kim, Soo Ji

Article Type: Research Article

Abstract: Background: While a number of studies have tested the therapeutic effectiveness of playing musical instruments, such as the electronic keyboard using Musical Instrument Digital Interface (MIDI), it is still unclear whether outcomes of electronic keyboard playing are related to hand function tests. Objective: The purpose of this study was to investigate the correlation between MIDI-keyboard playing and hand function tests, including grip strength, Box and Block test (BBT), and Jensen-Taylor Hand Function Test (JTHF). Methods: A total of 66 stroke patients were recruited from medical centers and were classified into acute (n = 21), subacute (n …= 28), and chronic (n = 17) recovery stages. The participants' mean age was 60.5 years. The MIDI-keyboard playing protocol based on sequential key pressing was implemented. All hand function tests were performed by certified occupational therapists. Results: MIDI scores from participants at all three recovery stages were significantly correlated with BBT and grip strength. Overall, MIDI-keyboard playing scores demonstrated moderate to high correlations with hand function tests except for participants at the chronic stage and the JTHF, which showed no correlation. Conclusions: These findings suggest that MIDI-keyboard playing has great potential as an assessment tool of hand function, especially hand dexterity in acute and subacute stroke patients. Further studies are needed to refine the specific keyboard playing tasks that increase responsiveness to traditional hand function tests. Show more

Keywords: Hand function, stroke rehabilitation, MIDI-keyboard playing

DOI: 10.3233/NRE-141166

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 673-680, 2014

Authors: Cha, Yuri | Kim, Young | Hwang, Sujin | Chung, Yijung

Article Type: Research Article

Abstract: Background: Motor relearning protocols should involve task-oriented movement, focused attention, and repetition of desired movements. Objectives: To investigate the effect of intensive gait training with rhythmic auditory stimulation on postural control and gait performance in individuals with chronic hemiparetic stroke. Methods: Twenty patients with chronic hemiparetic stroke participated in this study. Subjects in the Rhythmic auditory stimulation training group (10 subjects) underwent intensive gait training with rhythmic auditory stimulation for a period of 6 weeks (30 min/day, five days/week), while those in the control group (10 subjects) underwent intensive gait training for the same duration. Two …clinical measures, Berg balance scale and stroke specific quality of life scale, and a 2-demensional gait analysis system, were used as outcome measure. To provide rhythmic auditory stimulation during gait training, the MIDI Cuebase musical instrument digital interface program and a KM Player version 3.3 was utilized for this study. Results: Intensive gait training with rhythmic auditory stimulation resulted in significant improvement in scores on the Berg balance scale, gait velocity, cadence, stride length and double support period in affected side, and stroke specific quality of life scale compared with the control group after training. Conclusions: Findings of this study suggest that intensive gait training with rhythmic auditory stimulation improves balance and gait performance as well as quality of life, in individuals with chronic hemiparetic stroke. Show more

Keywords: Gait, rhythmic auditory stimulation, stroke

DOI: 10.3233/NRE-141182

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 681-688, 2014

Authors: Manson, Gerome A. | Alekhina, Maria | Srubiski, Shirley L. | Williams, Camille K. | Bhattacharjee, Arindam | Tremblay, Luc

Article Type: Research Article

Abstract: Background: Robotic guidance has been shown to facilitate motor skill acquisition, through altered sensorimotor control, in neurologically impaired and healthy populations. Objective: To determine if robot-guided practice and online visual feedback availability primarily influences movement planning or online control mechanisms. Methods: In this two-experiment study, participants first performed a pre-test involving reaches with or without vision, to obtain baseline measures. In both experiments, participants then underwent an acquisition phase where they either actively followed robot-guided trajectories or trained unassisted. Only in the second experiment, robot-guided or unassisted acquisition was performed either with or without online vision. …Following acquisition, all participants completed a post-test that was the same as the pre-test. Planning and online control mechanisms were assessed through endpoint error and kinematic analyses. Results: The robot-guided and unassisted groups generally exhibited comparable changes in endpoint accuracy and precision. Kinematic analyses revealed that only participants who practiced with the robot exhibited significantly reduced the proportion of movement time spent during the limb deceleration phase (i.e., time after peak velocity). This was true regardless of online visual feedback availability during training. Conclusion: The influence of robot-assisted motor skill acquisition is best explained by improved motor planning processes. Show more

Keywords: Motor control, robot, upper-limb, assistance, rehabilitation

DOI: 10.3233/NRE-141168

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 689-700, 2014

Authors: Hussain, Shahid

Article Type: Research Article

Abstract: Background: Robot assisted gait training is a rapidly evolving rehabilitation practice. Various robotic orthoses have been developed during the past two decades for the gait training of patients suffering from neurologic injuries. These robotic orthoses can provide systematic gait training and reduce the work load of physical therapists. Biomechanical gait parameters can also be recorded and analysed more precisely as compared to manual physical therapy. Objectives: A review of robotic orthoses developed for providing gait training of neurologically impaired patients is provided in this paper. Methods: Recent developments in the mechanism design and actuation methods of …these robotic gait training orthoses are presented. Control strategies developed for these robotic gait training orthoses in the recent years are also discussed in detail. These control strategies have the capability to provide customised gait training according to the disability level and stage of rehabilitation of neurologically impaired subjects. Results: A detailed discussion regarding the mechanism design, actuation and control strategies with potential developments and improvements is provided at the end of the paper. Conclusions: A number of robotic orthoses and novel control strategies have been developed to provide gait training according to the disability level of patients and have shown encouraging results. There is a need to develop improved robotic mechanisms, actuation methods and control strategies that can provide naturalistic gait patterns, safe human-robot interaction and customized gait training, respectively. Extensive clinical trials need to be carried out to ascertain the efficacy of these robotic rehabilitation orthoses. Show more

Keywords: Control strategies, gait rehabilitation, neurologic injuries, robot desing, robotic orthosis

DOI: 10.3233/NRE-141174

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 701-709, 2014

Authors: De Luca, Rosaria | Calabrò, Rocco Salvatore | Reitano, Simone | Digangi, Giuseppina | Bertè, Francesco | Sergi, Giuseppa | Bramanti, Placido

Article Type: Case Report

Abstract: Objective: Aim of this study was to evaluate the effects of an emerging rehabilitative tool (“Power-AFA” - software) in the recovery of a patient with chronic non-fluent aphasia. Material and methods: A 56-year-old woman, affected by post-stroke severe expressive aphasia, underwent two different intensive rehabilitation trainings, including either standard language rehabilitation alone or a proper PC based speech training in addition to conventional treatment. We evaluated her cognitive and psychological profile in two separate sessions, before and after the two different trainings, by using a proper psychometric battery, to assess cognitive status, language abilities, and to estimate the …presence of mood alterations and coping strategies. The overall PC-program was articulated in 6 sessions/weekly for 3 months. Results: Only at the end of the PC-training, we observed an important improvement in peculiar cognitive domains (attention and memory functions), in denomination, in verbal understanding ability, in written, in communication skills as well as an optimization of the mood and coping styles. Conclusions: Computer-based cognitive and language rehabilitation, using proper and dedicated software, may be a valuable tool in improving either communication or cognitive skills in patient affected by aphasia, even in the chronic state. Show more

Keywords: PC-training, chronic aphasia, stroke

DOI: 10.3233/NRE-141175

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 711-717, 2014

Authors: Jani, Mansi Pankaj | Gore, Geeta Bharat

Article Type: Research Article

Abstract: Background: Communication and swallowing problems are common as a result of neurological conditions like stroke, traumatic brain injury, neoplasms of the nervous systems, viral encephalitis, diseases affecting neuromuscular junction and neuro degenerative conditions. The most frequently encountered problems are dysarthria, aphasia, dysphagia and apraxia of speech. Objectives: Although these disorders are mentioned in literature, very few studies describing the occurrence in different neurological conditions are available in Indian context. Hence, a need was felt to carry out such a study. Methodology: A heterogenous group of forty patients with neurological conditions were assessed for presence of speech, …language and swallowing problems. A percent analysis was carried out to determine the occurrence of aphasia, dysarthria and dysphagia in general, in specific diseases and also to describe type of aphasia and dysarthria according to the characteristics presented. Results: It was seen that the most frequently occurring disorder was dysarthria (60%), followed by dysphagia (55%) and aphasia (18%). It was also noted that dysarthria and dysphagia co-existed in around 45% patients with neurological diseases. Conclusions: It can be concluded that speech, language and swallowing problems are frequent in individuals with neurological conditions. Speech language pathologist plays an important role as a member of the rehabilitation team in a neurological setup with respect to identifying these problems and initiating intervention at the earliest. Hence, it is necessary for speech language pathologist to be well versed with the features each disorder may present with in terms of communication and swallowing. Show more

Keywords: Neurological disorders, dysarthria, dysphagia, aphasia, speech language pathologist

DOI: 10.3233/NRE-141165

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 719-727, 2014