NeuroRehabilitation - Volume 37, issue 2

Authors: Balasch i Bernat, Mercè | Balasch i Parisi, Sebastiá | Sebastián, Enrique Noé | Moscardó, Lirios Dueñas | Ferri Campos, Joan | López Bueno, Laura

Article Type: Research Article

Abstract: BACKGROUND: A wide variety of well-validated assessment scales of functioning and disability have been developed for stroke population. However, these instruments have limitations in their interpretation. Therefore, determining cut-off points for their categorization becomes necessary. OBJECTIVES: To determine cut-off points for the BI, FIM and FAM scales to differentiate clinical disability categories and to establish the relationship between mRS and DOS scales. METHODS: One hundred and six adults with ischemic or haemorrhagic stroke were mainly recruited from a rehabilitation facility (Hospitales Nisa, Valencia, Spain). RESULTS: A high correlation was observed between the DOS and …mRS scales (Kendall’s tau-b = 0.475; p  = 0.000) although a certain amount of disagreement between the two scales was detected. The cut-off points were 62.90 (95% CI, 57.26–69.29) and 21.30 (95% CI, 16.34–26.03) for the BI; 70.62 (95% CI, 66.65–75.22) and 38.29 (95% CI, 34.07–42.25) for the FIM; and 116.07 (95% CI, 110.30–122.68) and 66.02 (95% CI, 59.20–72.35) for the FAM. CONCLUSION(S): DOS was observed to be more demanding than the mRS, in terms of patient independence. Additionally, the lower cut-off points separating the levels of severe and moderate disability in the BI, FIM and FAM were determined. These findings would facilitate practitioners clinical interpretation of disability levels in post-stroke patients. Show more

Keywords: Stroke, activities of daily living, disability, rehabilitation, clinical evaluation

DOI: 10.3233/NRE-151249

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 165-172, 2015

Authors: Ouellette, D.S. | Timple, C. | Kaplan, S.E. | Rosenberg, S.S. | Rosario, E.R.

Article Type: Research Article

Abstract: BACKGROUND: The goal of this study was to predict the discharge location for stroke patients. OBJECTIVE: To design a tool to assess a community discharge that will assist in development of individualized care plans and discharge planning. METHODS: Patients (N  = 407) hospitalized for an acute stroke in an inpatient rehabilitation facility were used for this retrospective study. Admission data from the Functional Independence Measure (FIM) and Simplified Stroke Rehabilitation Assessment of Movement (S-STREAM) were used to determine predictive factors for a community discharge. RESULTS: Logistic regressions and chi-square analyses were used to determine admission …factors that predict a community discharge and the cut off score for each predictive variable. The S-STREAM, Motor FIM, Total FIM, FIM Bladder, FIM bed transfer, FIM toilet transfer, FIM bathing, and FIM memory were predictive of a community discharge. A predictive tool with a sensitivity and specificity of 76% and 64% was developed using the combined relative risk scores of the S-Stream, FIM Bladder, FIM Bed Transfer and FIM Memory. CONCLUSIONS: By using outcome data at the time of admission, a discharge destination can be predicted for stroke patients with significant sensitivity and specificity. Show more

Keywords: Stroke, outcome, discharge destination, case management, community discharge

DOI: 10.3233/NRE-151250

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 173-179, 2015

Authors: Triccas, L. Tedesco | Burridge, J.H. | Hughes, A. | Verheyden, G. | Desikan, M. | Rothwell, J.

Article Type: Research Article

Abstract: BACKGROUND: Neurorehabilitation technologies such as robot therapy (RT) and transcranial Direct Current Stimulation (tDCS) can promote upper limb (UL) motor recovery after stroke. OBJECTIVE: To explore the effect of anodal tDCS with uni-lateral and three-dimensional RT for the impaired UL in people with sub-acute and chronic stroke. METHODS: A pilot randomised controlled trial was conducted. Stroke participants had 18 one-hour sessions of RT (Armeo® Spring) over eight weeks during which they received 20 minutes of either real tDCS or sham tDCS during each session. The primary outcome measure was the Fugl-Meyer assessment (FMA) for UL impairments …and secondary were: UL function, activities and stroke impact collected at baseline, post-intervention and three-month follow-up. RESULTS: 22 participants (12 sub-acute and 10 chronic) completed the trial. No significant difference was found in FMA between the real and sham tDCS groups at post-intervention and follow-up (p  = 0.123). A significant ‘time’ x ‘stage of stroke’ was found for FMA (p  = 0.016). A higher percentage improvement was noted in UL function, activities and stroke impact in people with sub-acute compared to chronic stroke. CONCLUSIONS: Adding tDCS did not result in an additional effect on UL impairment in stroke. RT may be of more benefit in the sub-acute than chronic phase. Show more

Keywords: Transcranial direct current stimulation, robot therapy, stroke, rehabilitation, upper limb, motor recovery

DOI: 10.3233/NRE-151251

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 181-191, 2015

Authors: Park, Jin | Park, So-yeon | Kim, Yong-wook | Woo, Youngkeun

Article Type: Research Article

Abstract: BACKGROUND: Generally, treadmill training is very effective intervention, and rhythmic auditory stimulation is designed to feedback during gait training in stroke patients. OBJECTIVE: The purpose of this study was to compare the gait abilities in chronic stroke patients following either treadmill walking training with rhythmic auditory stimulation (TRAS) or over ground walking training with rhythmic auditory stimulation (ORAS). METHODS: Nineteen subjects were divided into two groups: a TRAS group (9 subjects) and an ORAS group (10 subjects). Temporal and spatial gait parameters and motor recovery ability were measured before and after the training period. Gait ability …was measured by the Biodex Gait trainer treadmill system, Timed up and go test (TUG), 6 meter walking distance (6MWD) and Functional gait assessment (FGA). RESULTS: After the training periods, the TRAS group showed a significant improvement in walking speed, step cycle, step length of the unaffected limb, coefficient of variation, 6MWD, and, FGA when compared to the ORAS group (p  <  0.05). CONCLUSION: Treadmill walking training during the rhythmic auditory stimulation may be useful for rehabilitation of patients with chronic stroke. Show more

Keywords: Gait, rhythmic auditory stimulation, stroke, treadmill walking

DOI: 10.3233/NRE-151252

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 193-202, 2015

Authors: Niwa, Sayoko | Shimodozono, Megumi | Kawahira, Kazumi

Article Type: Research Article

Abstract: BACKGROUND: Stroke frequently induces visual problems, which impair activities of daily living, lead to falls, and require rehabilitation. However, visual dysfunction has not been well characterized in stroke. OBJECTIVE: The purpose of this study was to characterize visual function in patients with stroke and the association of these characteristics with neurological dysfunction and lesion hemisphere. METHODS: In 40 patients with stroke and 321 control subjects, we carried out an assessment of a broad panel of visual and neurological functional metrics to identify risk factors for specific visual impairments in stroke. RESULTS: Patients with stroke …exhibited a significantly higher rate of occurrence for impairments in all visual metrics assessed, when compared to healthy controls. Risk for particular visual deficits varied according to lesion side (right versus left hemisphere) and specific types of neurological dysfunction. CONCLUSIONS: Detailed assessment of visual function in patients with stroke can help to clarify the risk of various types of visual impairment. Moreover, as visual function assessment in patients with stroke is difficult, knowledge of the correlation of visual impairments with different neurological dysfunctions observed in stroke and lesion side will help predict vision problems and inform optimal corrective measures in treating patients with stroke. Show more

Keywords: Stroke, visual function, frontal-lobe dysfunction, trail making test part A

DOI: 10.3233/NRE-151253

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 203-211, 2015

Authors: Beom, Jaewon | Jang, Hye Jin | Han, Tai Ryoon | Oh, Byung-Mo | Paik, Nam-Jong | Yang, Eun Joo | Lee, Shi-Uk

Article Type: Research Article

Abstract: BACKGROUND: The association between fatty replacement of rotator cuff and hemiplegic upper extremity function has not been defined yet. Moreover, the relationships among rotator cuff tears, shoulder pain, spasticity, and fatty replacement were not clearly studied. OBJECTIVE: We investigated the association of fatty replacement of the supraspinatus and infraspinatus muscles with tendon tear in stroke or brain-injured patients. METHODS: A total of 72 hemiplegic patients were enrolled in 3 hospitals, and ultrasonography of both shoulders was performed once. Fatty replacement of the supraspinatus and infraspinatus was graded by the visibility of outer contours, pennate pattern, central …tendon, and echogenicity. RESULTS: Fatty replacement was observed in 22 (30.6%) out of the 72 patients (in 18 supraspinatus muscles and 12 infraspinatus). Inter-rater agreement (kappa value) between the 2 physiatrists was 0.530 for the supraspinatus, and 0.411 for the infraspinatus. The Fugl-Meyer assessment score, Brunnstrom stage, and modified Barthel index were significantly lower in patients with fatty replacement of the supraspinatus or infraspinatus (group 1) than in those without (group 2). The motor power of both shoulders, the pain-free range of motion, spasticity, and hemiplegic shoulder pain were comparable between the two groups. The tear rate of the supraspinatus, infraspinatus, or subscapularis tendon at the hemiplegic side was higher than that at the contralesional side in each group, although there was no significant difference between group 1 and group 2. CONCLUSION: Disuse leading to muscle atrophy rather than rotator cuff tear might be the cause of fatty replacement of these muscles, which may be associated with decreased function of the hemiplegic upper extremities. Show more

Keywords: Atrophy, rotator cuff, brain injuries, ultrasonography, hemiplegia

DOI: 10.3233/NRE-151254

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 213-219, 2015

Authors: Steel, Joanne | Ferguson, Alison | Spencer, Elizabeth | Togher, Leanne

Article Type: Research Article

Abstract: BACKGROUND: There is minimal speech pathology literature on communication presentation during post-traumatic amnesia (PTA) and the early recovery period after traumatic brain injury. While a body of research reports on other cognitive and behavioural functions during PTA, language and/or cognitive communication are not routinely the primary focus of current research literature. OBJECTIVE: This critical synthesis provides an overview of research to date on communication during PTA to inform speech pathology assessment practice and to assist with information provision to the multidisciplinary team and family members. METHODS: A search was conducted of studies reporting on language, cognition, …and cognitive communication during the acute, inpatient and early recovery period after TBI. These were examined for relevance to speech pathology practice during PTA and acute confusional state. RESULTS: Historic and recent literature has described types of language and communication impairment during PTA and early recovery after TBI. Recently, aspects of communication impairment during PTA have been found relevant for outcome prediction. Few studies were found originating from speech pathology on communication during PTA. CONCLUSIONS: Communication disruption forms a key feature of PTA. Existing literature indicates that speech pathology monitoring of communication during PTA may be of benefit as part of multidisciplinary team management during early recovery. Show more

Keywords: Post-traumatic amnesia, traumatic brain injury, cognitive-communication, speech pathology, aphasia, assessment, acute, recovery

DOI: 10.3233/NRE-151255

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 221-234, 2015

Authors: Eastman, Amelia | Chang, Douglas G.

Article Type: Research Article

Abstract: BACKGROUND: Cognitive rest is the recommendation for all patients with acute sports concussion. OBJECTIVE/METHODS: A comprehensive literature search was conducted for the research question “What is the optimal cognitive load for patients with a sports concussion?” RESULTS: Seven studies met the inclusion criteria. The optimal cognitive load for patients after sports concussion is yet to be determined. CONCLUSIONS: Additional controlled trials of cognitive rehabilitation are needed to establish best clinical practice. The authors suggest memory training, cognitive behavioral therapy, and environmental interventions as areas of future research for sports concussion injuries.

Keywords: Brain concussion, sports, brain injury, cognitive therapy, cognitive symptoms, rest

DOI: 10.3233/NRE-151256

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 235-244, 2015

Authors: Cugusi, Lucia | Solla, Paolo | Serpe, Roberto | Carzedda, Tatiana | Piras, Luisa | Oggianu, Marcello | Gabba, Silvia | Di Blasio, Andrea | Bergamin, Marco | Cannas, Antonino | Marrosu, Francesco | Mercuro, Giuseppe

Article Type: Research Article

Abstract: BACKGROUND: Several studies have clearly shown that physical exercise can reduce the progression of motor symptoms in Parkinson’s Disease (PD). However, little is known about the effects of a Nordic Walking (NW) program in PD patients. OBJECTIVE: To determine the effects of a NW program on motor and non-motor symptoms, functional performances and body composition in PD patients. METHODS: Twenty PD patients (16M, 4F, 67.3±7.8 years) were enrolled and randomly assigned to NW group (NWg, n  = 10) and Control group (Cg, n  = 10). The training consisted in 2 sessions per week for 12 weeks. Training effects …were assessed by functional and instrumental tests and motor and non-motor symptoms were assessed by UPDRS-III, Hoehn and Yahr scale, PD Fatigue Scale, Beck Depression Inventory-II, Starkstein Apathy Scale, and Non-Motor Symptoms Scale. RESULTS: Significant changes in resting HR, in walked distance (p  <  0.05), and in lower limbs muscles strength (p  <  0.005) were observed in NWg. Both balance abilities and safety with mobility were increased (p  <  0.005). Significant variations in some circumferences and body composition were registered. Finally, a significant improvement in motor and non-motor symptoms was detected: UPDRS-III, HY scale, PFS-16, BDI-II, SAS, NMSS. CONCLUSIONS: A tailored exercise program including NW proved to be an effective way to improve daily activities and both motor and non-motor symptoms in PD patients. Show more

Keywords: Nordic Walking, Parkinson’s disease, motor symptoms, non-motor symptoms, functional performance, body composition

DOI: 10.3233/NRE-151257

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 245-254, 2015

Authors: Acarer, Ahmet | Karapolat, Hale | Celebisoy, Nese | Ozgen, Gulnur | Colakoglu, Zafer

Article Type: Research Article

Abstract: BACKGROUND: Patients with Parkinson’s disease complain about restrictions in their daily life activities and impairment in their mobility and balance. OBJECTIVE: The aim of this study was to compare the effects of vestibular rehabilitation on functioning, quality of life, balance, and postural stability in patients with Parkinson’s disease. METHODS: The patients with Parkinson’s disease divided into a rehabilitation group (Group 1, n: 29) and a control group(Group 2, n: 11). All patients were evaluated before and after eight weeks of customized vestibular rehabilitation for motor score (Unified Parkinson’s Disease Rating Scale); quality of life (Parkinson’s Disease …Questionnaire-39); balance (Activities-Specific Balance Confidence Scale [ABC], Timed Up and Go Test, Dynamic Gait Index [DGI], and Berg Balance Scale [BBS]); and postural stability (Modified Clinical Test for Sensory Interaction on Balance [mCTSIB]. RESULTS: There were significant differences in the pre- and post-exercise ABC, BBS, and DGI scores in Group 1 (p  <  0.05). A statistically significant impairment was observed in mCTSIB (firm and foam eyes closed [EC]) in the control group (p  <  0.05). There were no significant intergroup differences in any of the parameters evaluated (p  >  0.05). CONCLUSION: In this study, vestibular rehabilitation was found to be effective for improving balance in patients with Parkinson’s disease. Show more

Keywords: Vestibular rehabilitation, Parkinson’s disease, balance

DOI: 10.3233/NRE-151258

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 255-262, 2015

Authors: Santiago, Lorenna Marques de Melo | de Oliveira, Daniel Antunes | de Macêdo Ferreira, Louise Gabriella Lopes | de Brito Pinto, Hyanne Yasmim | Spaniol, Ana Paula | de Lucena Trigueiro, Larissa Coutinho | Ribeiro, Tatiana Souza | de Sousa, Angélica Vieira Cavalcanti | Piemonte, Maria Elisa Pimentel | Lindquist, Ana Raquel Rodrigues

Article Type: Research Article

Abstract: BACKGROUND: Mental practice has shown benefits in the rehabilitation of neurological patients, however, there is no evidence of immediate effects on gait of individuals with Parkinson’s disease. OBJECTIVE: Determine the effects of mental practice activity added to physical practice on the gait of individuals with Idiopathic Parkinson’s Disease (IPD). METHODS: 20 patients classified with stage 2 and 3, according to the Hoehn and Yahr scale were randomized into 2 groups. The experimental group (N  = 10) was submitted to a single session of mental practice and physical practice gait protocol and the control group (N  = 10) only …to physical practice. The primary outcomes were stride length and total stance and swing time. Secondary outcomes were hip range of motion, velocity and mobility. Subjects were reassessed 10 minutes, 1 day and 7 days after the end of the session. RESULTS: There was no statistically significant difference between the groups. An intragroup difference was observed in velocity, stride length, hip range of motion, and mobility, as well as total stance and swing time. These results were also observed on follow-ups. CONCLUSIONS: Mental practice did not have a greater effect on the gait of individuals with IPD than physical practice, after a single session. Show more

Keywords: Primary parkinsonism, motor imagery, three-dimensional gait analysis

DOI: 10.3233/NRE-151259

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 263-271, 2015

Authors: Kalron, Alon | Zeilig, Gabi

Article Type: Review Article

Abstract: BACKGROUND: Cognitive impairment is a well-established sequela of people suffering from neurological pathologies. OBJECTIVE: To examine the effects of exercise intervention programs on cognitive performance in participants suffering from stroke, multiple sclerosis and Parkinson’s disease. METHODS: Four online databases (CINAHL, Cochrane Library, MEDLINE, PEDro) were comprehensively searched from their inception through December 2014. The search query was phrased as follows: In people suffering from MS, stroke or Parkinson’s disease, do exercise intervention programs improve cognitive performance? RESULTS: Twelve controlled clinical trials met our inclusion criteria. Studies were classified according to three clinical subgroups: Parkinson’s …disease (n  = 3), stroke (n  = 1) and multiple sclerosis (n  = 8). Eight studies employed an aerobic intervention program; one used an active exercise program based on virtual reality systems, three reports examined the effect of yoga and one compared the intervention program with sport climbing. Significant improvements in cognition were found in nine out of the twelve studies. Nevertheless, the total effect size was non-significant (0.18 (95% CI, – 4.1, 3.8)) for changes in executive functions. CONCLUSION: Due to lack of commonality between measures of cognition, training sequences and intervention period, it remains unclear as to whether exercise training can be effective in improving the cognitive functions of neurological patients. Show more

Keywords: Exercise, cognition, stroke, multiple sclerosis, Parkinson’s disease

DOI: 10.3233/NRE-151260

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 273-289, 2015

Authors: Brogårdh, Christina | Lexell, Jan

Article Type: Research Article

Abstract: BACKGROUND: Many persons with late effects of polio experience new or increased impairments, which can lead to walking limitations in daily life. No study has comprehensively analyzed how various self-reported impairments are associated with different aspects of self-reported walking limitations. OBJECTIVE: To determine the associations between self-reported impairments and self-reported walking limitations in persons with late effects of polio. METHODS: Three hundred and twenty-five persons (175 women and 150 men) with verified late effects of polio responded to the Self-reported Impairments in Persons with late effects of Polio (SIPP; 13-items) and to the Walking Impact Scale …(Walk-12; 12 items). RESULTS: The overall correlation (rho) between the total sum scores of the SIPP and the Walk-12 was 0.61 (p  <  0.01). Of the 156 correlation coefficients (SIPP vs Walk-12), 151 (97% ) were significant at the 1% level. Self-reported muscle weakness, muscle fatigue, muscle and/or joint pain during physical activity and general fatigue had the strongest correlations (rho: 0.33 to 0.64) to the self-reported walking limitations, whereas memory difficulties, sleep disturbances and concentration difficulties had the weakest correlations (rho: 0.10 to 0.34). CONCLUSION: There are weak to moderate associations between self-reported impairments and walking limitations in persons with late effects of polio. By limiting the impact of those impairments that are strongest associated with walking, clinicians may improve walking ability. However, the strength of the associations implies that other rehabilitation interventions should be considered for improving overall performance in daily activities related to walking. Show more

Keywords: Impairments, postpoliomyelitis syndrome, questionnaires, rehabilitation, walking

DOI: 10.3233/NRE-151261

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 291-298, 2015

Authors: Ebata, Shigeto | Hatsushika, Kyousuke | Ohba, Tetsuro | Nitta, Kyohko | Akaike, Hiroshi | Masuyama, Keisuke | Haro, Hirotaka

Article Type: Research Article

Abstract: BACKGROUND: Some patients develop dysphagia after OC arthrodesis with RA. A previous report has indicated that establishing appropriate occipito-C2 is important for avoiding these side effects. However, a more recent report has demonstrated that the O-C2 angle did not have a significant effect on the incidence of postoperative dysphagia. OBJECTIVE: To investigate the swallowing function of patients with rheumatoid arthritis (RA) before and after they underwent occipitocervical (OC) fusion. METHODS: The study was performed in collaboration with the Departments of Orthopaedic, Otorhinolaryngology, and Rehabilitation. Seven consecutive patients (3 men and 4 women; mean age, 66.4 years) …with RA-induced upper cervical deformity were enrolled from 2013 to 2014. The patients underwent deglutition analysis, which was performed by otorhinolaryngologists, before and after surgery, and comprised videofluoroscopy and fiberoptic endoscopy. We examined the relationship between imaging studies and swallowing function. RESULTS: Preoperatively, subjective dysphagia was reported by 2 patients. Videofluoroscopy identified dysmotility of the epiglottis and incomplete closure of the laryngeal inlet in 2 patients, with contrast medium entering the larynx, and endoscopy identified food residue in the larynx of 1 patient during swallowing evaluation. Postoperatively, 2 patients with preoperative impaired deglutition showed dysphagia. Imaging examinations of the 2 patients revealed a 10°-reduction in the O-C2 angle of 1 patient, but the angle was unchanged in the other patient. CONCLUSIONS: To the best of our knowledge, this is the first report to evaluate swallowing function before and after O-C3 arthrodesis. The preoperative O-C2 angle was unchanged after surgery. Impairment of deglutition may be closely associated with air leakage from the oropharynx due to impaired mobility of the soft palate. Because the precise mechanism of dysphagia has not been fully elucidated, further study using dynamic videofluoroscopy and videoendoscopy is needed to examine the swallowing mechanism. Show more

Keywords: Rheumatoid arthritis, cervical deformity, occipitocervical arthrodesis, deglutition, videofluoroscopic examination, videoendoscopic examination

DOI: 10.3233/NRE-151262

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 299-304, 2015

Authors: Padula, William V. | Subramanian, Prem | Spurling, April | Padula, William V. | Jenness, Jonathan

Article Type: Research Article

Abstract: BACKGROUND: Following a neurologic event such as traumatic brain injury (TBI), cerebrovascular accident (CVA), and chronic neurological conditions including Parkinson’s disease, multiple sclerosis, and cerebral palsy a shift in the visual midline (egocenter) can directly affect posture, balance and spatial orientation. As a consequence, this increases the risk of fall (RoF) and injury that imposes a major financial burden on the public health system. OBJECTIVE: To determine if there is a statistically significant change in balance with the intervention of yoked prisms to reduce the risk of fall in subjects with neurological impairments. METHODS: Ambulation of …thirty-six subjects was evaluated on a pressure sensitive mat before and after intervention with yoked prisms. Changes in gait and balance were analyzed in the anterior-posterior (AP) and medial-lateral (ML) axes during ambulation. RESULTS: T -tests for each measure comparing the difference-of-differences to a zero change at baseline returned statistically significant reductions in both AP (p  <  0.0001; 95% CI: 1.368– 2.976) and ML (p  = 0.0002; 95% CI: 1.472– 4.173) imbalances using specifically directed yoked prisms to correct the visual midline deviation. CONCLUSION: These findings demonstrate that yoked prisms have the potential to provide a cost-effective means to restore the visual midline thereby improving balance, reduce RoF and subsequent injury. Show more

Keywords: Visual midline shift syndrome, yoked prisms, balance, spatial visual process, visual egocenter

DOI: 10.3233/NRE-151263

Citation: NeuroRehabilitation, vol. 37, no. 2, pp. 305-314, 2015