NeuroRehabilitation - Volume 35, issue 4

Authors: Allart, Etienne | Paquereau, Julie | Rogeau, Caroline | Daveluy, Walter | Kozlowski, Odile | Rousseaux, Marc

Article Type: Research Article

Abstract: Background: Stroke often leads to upright standing and walking impairments. Clinical assessments do not sufficiently address ecological aspects and the patient's subjective evaluation of function. Objective: To perform a pilot assessment of the psychometric properties of the Lower Limb-Function Assessment Scale (LL-FAS). Methods: The LL-FAS includes 30 items assessing the patient's perception (in a questionnaire) and the examiner's perception (in a practical test) of upright standing and walking impairments and their impact on activities of daily living. We analyzed the LL-FAS's reliability, construct validity, internal consistency, predictive validity and feasibility. Results: Thirty-five stroke patients …were included. The scale's mean ± SD completion time was 25 ± 6 min. Intra-observer reliability was good to excellent (intraclass correlation coefficients (ICC >0.82). Interobserver reliability was moderate (0.67 < ICC < 0.9). The questionnaire and test items showed excellent construct validity for neuromotor disabilities (p < 0.05), postural ability (Postural Assessment Scale for Stroke; p < 10−5 ), severity of gait disorders (Gait Assessment and Intervention Tool; p < 10−3 ), walking ability (New Functional Ambulation Categories, 10 m walk test, Rivermead Mobility Index; p < 10−3 ) and functional level (Barthel Index; p < 10−3 ). Internal consistency (Cronbach-α >0.9) and predictive validity were excellent. Conclusions: The LL-FAS showed fair psychometric properties in this pilot study and may be of value for evaluating post-stroke lower limb impairment. Show more

Keywords: Stroke, posture, walking, gait, assessment, scale

DOI: 10.3233/NRE-141171

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 729-739, 2014

Authors: Middleton, Addie | Fritz, Stacy L. | Liuzzo, Derek M. | Newman-Norlund, Roger | Herter, Troy M.

Article Type: Research Article

Abstract: Background: Transcranial direct current stimulation (tDCS) may provide a safe, non-invasive technique for modulating neural excitability during neurorehabilitation. Objective: 1) Assess feasibility and potential effectiveness of tDCS as an adjunct to standard upper extremity (UE) physical therapy (PT) for motor impairments resulting from neurological insult. 2) Determine sustainability of improvements over a six month period. Methods: Five participants with chronic neurologic insult (stroke or traumatic brain injury > 6 months prior) completed 24 sessions (40 minutes, three times/week) of UE-PT combined with bihemispheric tDCS delivered at 1.5 mA over the motor cortex during the first 15 …minutes of each PT session. Outcomes were assessed using clinical (UE Fugl-Meyer, Purdue Pegboard, Box and Block, Stroke Impact Scale) and robotic (unimanual and bimanual motor control) measures. Change in scores and associated effects sizes from Pre-test to Post-test and a six month Follow-up were calculated for each participant and group as a whole. Results: Scores on UE Fugl-Meyer, Box and Block, Purdue Pegboard, Stroke Impact Scale, and robotic measures improved from Pre- to Post-test. Improvements on UE Fugl-Meyer, Box and Block, and robotic measures were largely sustained at six months. Conclusions: Combining bihemispheric tDCS with UE-PT in individuals with neurological insult warrants further investigation. Show more

Keywords: tDCS, stroke, TBI, upper extremity, rehabilitation

DOI: 10.3233/NRE-141178

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 741-754, 2014

Authors: Linnemann, Mia | Tibæk, Maiken | Kammersgaard, Lars Peter

Article Type: Research Article

Abstract: Background: Post traumatic hydrocephalus (PTH) is a frequent complication during rehabilitation following severe TBI. However, the diagnosis of PTH is not straightforward and despite shunting recovery may be delayed. Objective: To study the influence of PTH on recovery and outcome during rehabilitation. Methods: We studied 417 patients with severe TBI admitted consecutively to a single hospital-based neurorehabilitation department serving Eastern Denmark between 2000 and 2010. Demographics (age and gender) and clinical characteristics (length of acute treatment, post traumatic amnesia (PTA), level of consciousness, injury severity (ISS), and admission FIM™), and PTH were related to recovery (discharge …FIM™), outcome (GOS), and length of rehabilitation stay. Results: Patients with PTH were older, brain injury more severe, and acute treatment was longer. At discharge they had more disability, longer rehabilitation stays, and unfavorable outcome. However, after adjusted multiple regression analyses PTH was not associated with disability at discharge or outcome. Instead, PTH was associated with longer stay for rehabilitation. Conclutions: Shunting for PTH does not affect recovery and outcome per se, but prolongs lengths of stay by almost 3 weeks. Therefore, patients treated for PTH are as likely to benefit from rehabilitation as patients without, but require longer rehabilitation stays. Show more

Keywords: Brain injury, traumatic, hydrocephalus, rehabilitation, outcome, prediction

DOI: 10.3233/NRE-141160

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 755-761, 2014

Authors: Corral, Luisa | Conde, Laura | Guillamó, Elisabet | Blasi, Juan | Juncadella, Montserrat | Javierre, Casimiro | Viscor, Ginés | Ventura, Josep L.

Article Type: Research Article

Abstract: Background: Circulating progenitor cells (CPC) treatments may have great potential for the recovery of neurons and brain function. Objective: To increase and maintain CPC with a program of exercise, muscle electro-stimulation (ME) and/or intermittent-hypobaric-hypoxia (IHH), and also to study the possible improvement in physical or psychological functioning of participants with Traumatic Brain Injury (TBI). Methods: Twenty-one participants. Four groups: exercise and ME group (EEG), cycling group (CyG), IHH and ME group (HEG) and control group (CG). Psychological and physical stress tests were carried out. CPC were measured in blood several times during the protocol. …Results: Psychological tests did not change. In the physical stress tests the VO2 uptake increased in the EEG and the CyG, and the maximal tolerated workload increased in the HEG. CPC levels increased in the last three weeks in EEG, but not in CyG, CG and HEG. Conclusions: CPC levels increased in the last three weeks of the EEG program, but not in the other groups and we did not detect performed psychological test changes in any group. The detected aerobic capacity or workload improvement must be beneficial for the patients who have suffered TBI, but exercise type and the mechanisms involved are not clear. Show more

Keywords: Traumatic brain injury, circulating progenitor cells, exercise, physiology

DOI: 10.3233/NRE-141172

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 763-769, 2014

Authors: Choi, Seong-Youl | Lee, Jae-Shin | Song, A-Young

Article Type: Research Article

Abstract: Objectives: This study performed meta-analysis on the literatures that surveyed cognitive test to forecast unsafe driving by older drivers and identified objective and consistent cognitive test for predicting unsafe driving of older drivers. Selection criteria: The study of RCT (Randomized Control Trial) that conducted cognitive test by classifying older drivers into safe-drivers and unsafe-drivers was done and a total of nine studies suitable for the selection criteria were chosen. Search strategy: To meet subject selection, online search was performed by keyword such as “Older”, “Driving”, “Safe”, “Cognition”, etc. Qualitative analysis of the study was conducted using …Jadad evaluation. Quantitative analysis also conducted statistical heterogeneity, effect size, sensitivity and publication bias every cognitive assessment tool. Result: The Jadad evaluation grade of the studies was assessed on papers of a high quality – all study received over 3 points. The result of the effect sizes was that TMT-B, TMT-A, UFOV-subtest 2 and MMSE were statistically significant (P < .05). As a result, TMT-B was “Big effect size”, TMT-A and UFOV-subtest 2 were “Medium effect sizes” and MMSE was “Small effect size.” Conclusion: TMT-A, TMT-B and UFOV-subtest 2 were found to be useful as cognitive test tools to forecast unsafe driving of older drivers. Show more

Keywords: Cognitive test, meta-analysis, older drivers, unsafe driving

DOI: 10.3233/NRE-141170

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 771-778, 2014

Authors: Nardo, Alice | Anasetti, Federica | Servello, Domenico | Porta, Mauro

Article Type: Research Article

Abstract: Background: Despite Deep Brain Stimulation (DBS) improves cardinal symptoms of Parkinson's Disease (PD), its effect on walking impairment is less evident. Robotic-assisted rehabilitation systems could serve as “add-on” physical therapy for PD patients. This systems are able to anticipate and correct the trajectory of patients' motion to improve their motor function recovery. Objective: Aim of the present study was the quantitative assessment of the effects of a Robotic-Assisted Rehabilitation Protocol (RARP) on gait patterns by means of three-dimensional gait analysis on PD patients treated with DBS. Methods: 9 patients with PD treated with DBS were submitted …to 5 weeks robotic-assisted rehabilitation sessions. Three-dimensional gait analysis was performed before the starting session, and one day after the last session using an optoelectronic system with passive markers. Results: The RARP showed significant improvements on spatio-temporal gait parameters and on the Unified Parkinson's Disease Rating Scale motor score. Conclusions: The RARP with Lokomat may have positive effects on spatio-temporal gait parameters of PD patients and it could be an adjunct therapy for patients treated with DBS. On the other hand kinematic and kinetic gait parameters did not show significant improvements, remaining almost comparable before and after the RARP. Show more

Keywords: Parkinson's disease, gait analysis, robotic-assisted rehabilitation, deep brain stimulation, locomotor system

DOI: 10.3233/NRE-141173

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 779-788, 2014

Authors: Cugusi, Lucia | Solla, Paolo | Zedda, Francesca | Loi, Martina | Serpe, Roberto | Cannas, Antonino | Marrosu, Francesco | Mercuro, Giuseppe

Article Type: Research Article

Abstract: Background: Several studies have clearly shown that strategies of health promotion, such as fitness and general exercise programs, may improve quality of life (QoL), motor and non-motor functions in Parkinson's disease (PD) patients. However, little is known about the effects of specific Adapted Physical Activity (APA) programs on PD patients. Objective: To determine the effects of an APA program on motor and non-motor symptoms, functional performances and QoL in PD patients. Methods: Nine consecutive PD patients (5 men, 4 women, 64.4 ± 6.8 years) able to ambulate independently (Hoehn and Yahr: from stage 1 to 3) …and not demented, were enrolled. Patients performed an APA program, 3 sessions/week, for 9 weeks. Exercises focused on balance, walking, strength and functional activities. Functional effects were assessed by Six Minute Walking Test (6MWT), Five Time Sit to Stand Test (FTSST), Berg Balance Scale (BBS), Sit and Reach Test (SRT), and Timed Up and Go test (TUG). Motor impairment and disability were assessed using the Unified Parkinson's Disease Rating Scale – part III (UPDRS-III) and the Hoehn and Yahr Scale, respectively. Non-motor symptoms were evaluated by PD Fatigue Scale (PFS), Beck Depression Inventory II (BDI-II) and PD Quality of life scale, 8 items (PDQ-8). Results: A significant decrease in resting HR (67.55 ± 10.85 vs 70.22 ± 12.34 bpm, p < 0.05) and a significant increase in walked distance (p < 0.0005) were observed. A significant impairment of the muscles strength was noted (FTSST, p < 0.05). BBS showed a significant increase in balance abilities (p < 0.0005) and safety with mobility (TUG, p < 0.005) was enhanced. Finally, a significant improvement in motor and non-motor symptoms was detected: UPDRS-III (p < 0.00005), PFS (p < 0.005), BDI-II (p < 0.05) and PDQ-8 (p < 0.05). Conclusions: A tailored exercise program in PD patients could be effective as an adjunct to conventional therapy on improving daily activities, motor and non-motor symptoms, with better QoL. Show more

Keywords: APA, Parkinson's disease, QoL

DOI: 10.3233/NRE-141162

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 789-794, 2014

Authors: Malloy, Jessica R. | Valentin, Juliana C. | Hands, Gabrielle L. | Stevens, Christina A. | Langmore, Susan E. | Noordzij, J. Pieter | Stepp, Cara E.

Article Type: Research Article

Abstract: Objective: To compare performance of individuals with Parkinson's disease (PD) and age-matched controls on a visuomotor tracking task controlled via surface electromyography (sEMG). Methods: Twenty-seven adults with PD and twenty-four older controls produced dry swallows and completed a visuomotor tracking task utilizing both static and dynamic targets. sEMG was recorded at the anterior neck and submental surface during both tasks. Results: There was no significant difference in visuomotor tracking ability between cohorts. Post hoc analyses indicated that there was no significant difference between participant groups in the strength or duration of swallows as measured by sEMG …but that participants with PD showed a trend for decreased swallow durations at the anterior neck (padj = 0.067) whereas controls showed a trend for increased durations at the anterior neck (padj = 0.112), compared to the submental surface. However, there were no significant correlations between swallowing behavior and visuomotor tracking ability. Conclusion: There were no significant differences in visuomotor tracking performance between individuals with PD and controls. Furthermore, there was no relationship between tracking ability and swallowing behavior. We conclude that sEMG-mediated biofeedback may have limited promise as a tool for treating PD-related dysphagia. Show more

Keywords: Swallowing, dysphagia, Parkinson's disease, surface electromyography, biofeedback

DOI: 10.3233/NRE-141169

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 795-803, 2014

Authors: Op ’t Eijnde, Bert | Keytsman, Charly | Wens, Inez | Hansen, Dominique

Article Type: Research Article

Abstract: Background: Whole-body cooling improves exercise tolerance in patients with multiple sclerosis (pwMS). To be able to exercise at greater intensities and/or for longer durations with whole-body cooling, it should be examined whether this compromises skeletal muscle oxidative capacity (assessed by exercise-onset VO2 kinetics). Objective: To study the impact of whole-body cooling on exercise-onset VO2 kinetics in pwMS. Methods: From 12 pwMS (EDSS 3.5 ± 1.5) and 12 healthy age, BMI, and gender-matched subjects exercise-onset VO2 kinetics (mean response time [MRT]) and body temperature were determined under normothermic and hypothermic (pre-exercise 60-min whole-body cooling) …conditions during submaximal exercise testing (two 6-min constant-load exercise bouts). Moreover, heart rate, blood lactate content, expiratory volume and ratings of perceived exertion (RPE) were assessed during exercise. Results: Exercise heart rate (−7 ± 6 beats/min) and end-exercise body temperature (−0.9 ± 0.5°C) was significantly lower in hypothermic vs. normothermic conditions in both populations (p < 0.05). In pwMS exercise RPE was lower in hypothermic vs. normothermic condition (p = 0.056). No significantly different MRT was found between normothermic vs. hypothermic conditions in both populations. Conclusions: Lowering body temperature prior to endurance exercise does not affect muscle oxidative capacity in pwMS, but lowers RPE, thus making it possible to prescribe exercises of greater intensity and/or longer duration. Show more

Keywords: Multiple sclerosis, endurance exercise, oxygen uptake kinetics, oxidative capacity, whole-body cooling

DOI: 10.3233/NRE-141159

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 805-811, 2014

Authors: Rudroff, T. | Kindred, J.H. | Koo, P.J. | Karki, R. | Hebert, J.R.

Article Type: Research Article

Abstract: Background: In patients with Multiple Sclerosis (MS), comparative leg muscle strength asymmetries are common and typically accompanied by walking difficulties. Underlying mechanisms for these asymmetries are not completely known, but altered muscle energetics may play a role. Objective: To investigate glucose uptake asymmetries in leg muscles of patients with mild MS during walking. Methods: Eight MS and 8 healthy control (CON) participants performed a 15-min treadmill walking test at self-selected speed. They were injected with a glucose tracer (18 F-FDG) two minutes into the test and immediately upon completion, underwent Positron Emission Tomography/Computed Tomography (PET/CT) imaging. …Results: MS group walked at a lower speed than the healthy control group (P < 0.01), however it was found that: 1) ([18 F]-FDG) uptake in knee and hip flexors was higher compared to the CON group (P = 0.02); 2) the MS group exhibited asymmetrical strength of the knee flexors (P = 0.03); 3) [18 F]-FDG uptake was significantly lower in the weaker knee flexors of patients with MS (P < 0.01). Conclusions: [18 F]-FDG uptake and strength asymmetries in the legs of patients with MS indicate greater metabolic costs during activity, which may play a major role in premature muscle fatigability and subsequent impaired walking capacity. Show more

Keywords: Positron emission tomography, glucose uptake, strength asymmetries, multiple sclerosis

DOI: 10.3233/NRE-141179

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 813-823, 2014