NeuroRehabilitation - Volume 36, issue 1

Authors: Brogårdh, Christina | Lexell, Jan

Article Type: Editorial

DOI: 10.3233/NRE-141183

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 1-3, 2015

Authors: Lexell, Jan | Brogårdh, Christina

Article Type: Research Article

Abstract: Introduction: Rehabilitation is often described as a process that starts when the diagnosis is made and continues as long as the person needs interventions. This process comprises four steps: assessment, goal setting, interventions and outcome measurement. In each step, the WHO International Classification of Functioning, Disability and Health (ICF) can be used and the results can be summarized in a rehabilitation plan. Objectives: In this brief review, we describe the use of the ICF in the neurorehabilitation process in the form of an ICF based rehabilitation plan and how the rehabilitation plan can facilitate interdisciplinary team work in …each of the four steps that comprise the rehabilitation process. Conclusion: An ICF based rehabilitation plan that comprises a common language, understood by team members, patients and their family, is a valuable tool in the rehabilitation of persons with injuries and diseases to the nervous system. The use of the ICF has thereby enabled the development of a common framework for our neurorehabilitation methodology, regardless of diagnosis or disability. Show more

Keywords: Disability evaluation, International Classification of Functioning, Disability and Health; nervous system diseases, outcome and process assessment (health), patient outcome assessment, physical and rehabilitation medicine

DOI: 10.3233/NRE-141184

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 5-9, 2015

Authors: Tempest, Stephanie | Jefferson, Richard

Article Type: Research Article

Abstract: Introduction: Although deemed a globally accepted framework, there remains scare evidence on the process and outcome of implementing the International Classification of Functioning, Disability and Health (ICF) within neurorehabilitation. Objectives: This review briefly explores the existing, broader literature and then reports on two action research projects, undertaken in England, specifically within stroke and neurorehabilitation. Working with participants, including clinicians from in-patient and community settings, there are now 35 different ways identified for the use of the ICF. Conclusion: The outcome of the first project highlights that using the ICF enhances communication within and beyond the acute …stroke service, fosters holistic thinking and clarifies team roles. To adopt it into clinical practice, the ICF must be adapted to meet local service needs. The use of action research has facilitated the knowledge translation process which has enabled the ICF to become a clinical reality in neurorehabilitation, with clinicians identifying a range of potential uses. Show more

Keywords: International Classification of Functioning, Disability and Health, implementation, neurorehabilitation

DOI: 10.3233/NRE-141185

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 11-15, 2015

Authors: Raggi, A. | Leonardi, M. | Covelli, V. | Sattin, D. | Scaratti, C. | Schiavolin, S. | Willems, M. | Meucci, P.

Article Type: Research Article

Abstract: Introduction: Neurological conditions are associated with high levels of disability. Objectives: The aim of this study was to describe, using the International Classification of Functioning, Disability and Health (ICF), the most relevant aspects of disability in patients with neurological conditions. We collated data from previous studies on myasthenia gravis, migraine, Parkinson's disease, multiple sclerosis, traumatic brain injury, stroke, epilepsy, vegetative state and minimally conscious state, and identified as relevant those ICF categories reported by at least 50% of patients in each condition. Conclusions: Records from 1310 patients were available. A total of 97 ICF categories were …reported, and 21 were commonly addressed in more than five conditions. Approximately half of the categories in body functions were related to mental and movement-related functions and more than 25% of the activities-related categories involved activities that require the support from a caregiver. Environmental factors were mostly reported as facilitators. Our data indicate a residual mind-body dichotomy, the relevance of disability not only for the patients but also for their caregivers, and the difficulties in addressing barriers in the environment. Show more

Keywords: Disability, ICF classification, mental functions, mobility, barriers

DOI: 10.3233/NRE-141186

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 17-22, 2015

Authors: Raggi, A. | Covelli, V. | Leonardi, M. | Meucci, P. | Scaratti, C. | Schiavolin, S. | Willems, M. | Sattin, D.

Article Type: Research Article

Abstract: Introduction: The aim of this study was to explore the most relevant determinants of severe disability in a heterogeneous sample of patients with neurological conditions. Objectives: We used data from previous studies on patients with myasthenia gravis (MG), migraine, Parkinson's disease (PD), multiple sclerosis, traumatic brain injury (TBI), stroke and epilepsy (349 patients, aged 18–74 years; mean 48.0, SD 11.7). We calculated count-based extension indexes to address severe disability, and hierarchical logistic regression to assess the association between severe disability, sociodemographic and health status information. Conclusions: Results show that sociodemographic variables played a minor role, while …health state information was a stronger determinant of severe disability. Compared to the reference value of TBI patients, those with MG, PD and epilepsy had higher odds to have severe difficulties undertaking daily activities despite the presence of environmental factors. Our results contrast with those of previous studies, mostly derived from general populations, showing the different impact of clinical and sociodemographic variables. Show more

Keywords: Disability, ICF classification, mental functions, mobility, barriers

DOI: 10.3233/NRE-141187

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 23-29, 2015

Authors: Martinuzzi, Andrea | De Polo, Gianni | Bortolot, Sonia | Pradal, Monica

Article Type: Research Article

Abstract: Introduction: One of the major intended uses of the International Classification of Functioning, Disability and Health (ICF) is the clinical world of rehabilitation. The intrinsic qualities of ICF, especially in its children and youth version (ICF-CY) seem to perfectly match the needs for the complex process of pediatric neurorehabilitation. Objectives: We here report on the effect that the implementation of ICF-CY had on team members and families when it was used as a guiding structure in framing the rehabilitation project in a pediatric outpatient clinic dealing with adolescents with cerebral palsy and complex needs. The two-year experience was …positive and an ad-hoc questionnaire delivered to team members and families returned very positive remarks. Conclusion: The main messages coming from this experience is on the feasibility of the introduction of ICF-CY language and the bio-psycho-social model in the described setting and on the positive response by the stakeholders. Show more

Keywords: Disability, cerebral palsy, ICF-CY, pediatric neurorehabilitation, rehabilitation teams

DOI: 10.3233/NRE-141188

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 31-36, 2015

Authors: Laxe, Sara | Cieza, Alarcos | Castaño-Monsalve, Beatriz

Article Type: Research Article

Abstract: Introduction: Traumatic brain injury is a sudden and unexpected condition that gives rise to different impairments in body functions and structures leading to dramatic life changes, not only to the patient but also to his or her family and ultimately in the wider society. As a health strategy, rehabilitation aims to reduce disability and increasing the quality of life of those people that suffer from TBI but also to reduce the social burden associated with it. Functioning is the starting point of rehabilitation and the use of measurement instruments and classifications are commonly used tools for its definition. Within the …endorsement of the ICF by WHO, there is now a classification and a conceptual framework for the description of functioning providing an opportunity of a full understanding of the experience of TBI. Objective: This paper aims to identify the utility of ICF in TBI as well as bringing new challenges for further clinical practice and research. Conclusions: ICF has shown itself to be useful in the content comparison of measurement instruments. It has also been used to describe the functional profile of individuals with TBI in both acute and chronic phases making it possible to draw comparisons across other health conditions. Furthermore, the development of the TBI ICF Core Sets provided an item bank to describe not only functional status but also to set goals and plan interventions. Overall, we now have a potentially useful tool in rehabilitation of TBI that allows us to understand the full burden of traumatic brain injury. Show more

Keywords: Traumatic brain injury, ICF, TBI ICF Core Sets, functioning, disability

DOI: 10.3233/NRE-141189

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 37-43, 2015

Authors: Arvidsson, Patrik | Granlund, Mats | Thyberg, Mikael

Article Type: Review Article

Abstract: Introduction: Interdisciplinary differences regarding understanding the International Classification of Functioning, Disability and Health (ICF) concepts activity/participation may hinder its unifying purpose. In the ICF model, functioning (and disability) is described as a tripartite concept: 1) Body structures/functions, 2) Activities, and 3) Participation. Activities refer to an individual perspective on disability that does not tally with the basic structure of social models. Objective: To review how activity and participation are actually used in studies of intellectual disability (ID). Conclusion: Based on 16 papers, four different usages of activity/participation were found. 1) Theoretical reference to tripartite ICF concept …with attempts to use it. 2) Theoretical reference to tripartite ICF concept without actual use of activities. 3) “Atheoretical” approach with implicit focus on participation. 4) Theoretical reference to bipartite concept with corresponding use of terms. The highlighted studies have in common a focus on participation. However, the usage of the term “activity” differs both within and between studies. Such terminology will probably confuse interdisciplinary communication rather than facilitating it. Also, the use of an explicit underlying theory differs, from references to a tripartite to references to a bipartite concept of disability. This paper is focused on ID, but the discussed principles regarding the ICF and interdisciplinary disability theory are applicable to other diagnostic groups within rehabilitation practices. Show more

Keywords: Activity, ICF, intellectual disability, interdisciplinary rehabilitation, participation

DOI: 10.3233/NRE-141190

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 45-49, 2015

Authors: Demirtas-Tatlidede, Asli | Alonso-Alonso, Miguel | Shetty, Ravi P. | Ronen, Itamar | Pascual-Leone, Alvaro | Fregni, Felipe

Article Type: Research Article

Abstract: Background: Contralesional hemispheric repetitive transcranial magnetic stimulation (rTMS) may improve motor function in mild to moderate stroke and effects are considered to be mediated through transcallosal motor fibers. Objective: This study aimed to investigate the safety of contralesional rTMS in a selected group of severe chronic stroke patients. Methods: Ten sessions of 1 Hz rTMS were applied to contralesional primary motor cortex (M1) using neuronavigated stimulation and changes in motor impairment were evaluated before, during and after rTMS applications and at 4-weeks follow-up. Neurophysiological response to stimulation was assessed through cortical excitability evaluations. The relationship between …functional and neurophysiological response to rTMS and microstructural integrity of transcallosal motor fibers were searched using diffusion tensor imaging (DTI) based fractional anisotropy (FA). Results: rTMS was well-tolerated with high compliance and no dropouts; no seizures or motor worsening occurred. Transcallosal FA values revealed a positive linear relationship with the mild motor improvement detected after rTMS while higher FA values were observed in subjects with better motor outcome. Cortical excitability showed a significant change in contralesional short-interval intracortical inhibition indicating altered plasticity following rTMS. Conclusions: Our results suggest that noninvasive neuromodulation of the contralesional hemisphere may present a possibility to assist adaptive neuroplastic changes in severe chronic stroke. Implementation of DTI-derived measures of transcallosal microstructural integrity may allow for individually-tailored interventions to guide processes of interhemispheric neuroplasticity. Further research is warranted to establish the clinical value of these findings in neurorehabilitation settings for subjects with chronic severe stroke. Show more

Keywords: Severe stroke, cerebrovascular disease, repetitive transcranial magnetic stimulation (rTMS), diffusion tensor imaging (DTI), neurorehabilitation, cortical excitability

DOI: 10.3233/NRE-141191

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 51-59, 2015

Authors: Ansari, Noureddin Nakhostin | Naghdi, Soofia | Fakhari, Zahra | Radinmehr, Hojjat | Hasson, Scott

Article Type: Case Report

Abstract: Background: Spasticity is a common symptom that can be detrimental to the quality of life and daily function of patients with stroke. Objective: To introduce the use of dry needling (DN) as a novel method for the treatment of affected upper limb spasticity in a patient with chronic ischemic stroke who was admitted at the Stroke Physiotherapy Clinic. Methods: The pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) on the affected side were needled. The patient received deep DN for 1 session, and the duration of needling for each muscle was 1 …minute. The main outcomes were the Modified Modified Ashworth Scale (MMAS) muscle spasticity score, and the Hmax /Mmax ratio which were measured before (T0), immediately after (T1), and 15 minutes after the end of needling (T2). Results: The case was a 53-year-old man with a 13-year history of right hemiparesis poststroke. After DN, the spasticity scores improved and maintained as indicated in the MMAS grades (PT 3 to 2, finger flexors 1 to 0) and the Hmax /Mmax ratio (0.39, 0. 29, and 0.32 at T0, T1, and T2, respectively). The patient was able to voluntarily extend the wrist and fingers slightly after DN. The upper limb Brunnstrom recovery stage (3 to 4) and hand function (2 to 3) improved and maintained. The passive supination increased at T1 (75°) and T2 (50°) compared to T0 (38°). Conclusions: This prospective case report presents dry needling as a novel method in neurorehabilitation for the treatment of poststroke spasticity. Further research is recommended. Show more

Keywords: Stroke, spasticity, dry needling, H-reflex

DOI: 10.3233/NRE-141192

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 61-65, 2015