NeuroRehabilitation - Volume 38, issue 2

Authors: Glintborg, Chalotte | Hansen, Tia G.B.

Article Type: Research Article

Abstract: PURPOSE: Best practice guidelines for neurorehabilitation recommend coordinated rehabilitation programmes to ensure seamless service transitions and comprehensive rehabilitation practices. However, this recommendation for practice and the evidence informing its advancement is based on unexamined assumptions. Therefore, this study investigates bio-psycho-social outcomes and perceptions of a coordinated rehabilitation programme. METHOD: In a prospective, naturalistic mixed methods study, rehabilitation outcomes for 82 adults (18–66 years) with moderate to severe acquired brain injury were investigated. Clients who received the coordinated rehabilitation programme KORE (n  = 27) were compared to clients from the same area who received standard rehabilitation prior to the implementation …of the KORE programme (n  = 37) and clients who received other coordinated efforts elsewhere (n  = 18). The study employed quantitative data from standardized tests (Functional Independence Measure, Major Depression Inventory, Quality of life, and Impact on Participation and Autonomy Questionnaire, as well as information on return to work and qualitative interviews with clients (n  = 82) and their relatives (n  = 40). RESULTS: Outcomes did not improve from hospital discharge to two years later. Notably, physiological recovery had probably been achieved to the extent possible, but depression and reduced psychological well-being remained prevalent across groups. Qualitative interviews suggested several barriers to improvement, such as identity dilemmas and unmet needs for psychological support, while rehabilitation services focused on physical and practical training. CONCLUSION: Coordinated interventions do not guarantee comprehensive rehabilitation and better outcomes for clients with acquired brain injury. Psychological support seems to be important and largely unaddressed. Show more

Keywords: ABI, quality of life, psychological rehabilitation, bio-psycho-social outcome

DOI: 10.3233/NRE-161301

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 99-113, 2016

Authors: Do, Ji-Hye | Yoo, Eun-Young | Jung, Min-Ye | Park, Hae Yean

Article Type: Research Article

Abstract: Background: Hemiplegic cerebral palsy is a neurological symptom appearing on the unilateral arm and leg of the body that causes affected upper/lower limb muscle weakening and dysesthesia and accompanies tetany and difficulties in postural control due to abnormal muscle tone, and difficulties in body coordination. Objectives: The purpose of this study was to examine the impact of virtual reality-based bilateral arm training on the motor skills of children with hemiplegic cerebral palsy, in terms of their upper limb motor skills on the affected side, as well as their bilateral coordination ability. Methods: The research subjects were …three children who were diagnosed with hemiplegic cerebral palsy. The research followed an ABA design, which was a single-subject experimental design. The procedure consisted of a total of 20 sessions, including four during the baseline period (A1), 12 during the intervention period (B), and four during the baseline regression period (A2), For the independent variable bilateral arm training based on virtual reality, Nintendo Wii game was played for 30 minutes in each of the 12 sessions. For the dependent variables of upper limb motor skills on the affected side and bilateral coordination ability, a Wolf Motor Function Test (WMFT) was carried out for each session and the Pediatric Motor Activity Log (PMAL) was measured before and after the intervention, as well as after the baseline regression period. To test bilateral coordination ability, shooting baskets in basketball with both hands and moving large light boxes were carried out under operational definitions, with the number of shots and time needed to move boxes measured. The results were presented using visual graphs and bar graphs. Results: The study’s results indicated that after virtual reality-based bilateral arm training, improvement occurred in upper limb motor skills on the affected sides, and in bilateral coordination ability, for all of the research subjects. Measurements of the effects of sustained therapy after completion of the intervention, during the baseline regression period, revealed that upper limb motor skills on the affected side and bilateral coordination ability were better than in the baseline period for all subjects. Conclusion: This study confirmed that for children with hemiplegic with cerebral palsy, bilateral arm training based on virtual reality can be an effective intervention method for enhancing the upper limb motor skills on the affected side, as well as bilateral coordination ability. Show more

Keywords: Bilateral arm training, hemiplegic cerebral palsy, virtual reality

DOI: 10.3233/NRE-161302

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 115-127, 2016

Authors: Swinnen, Eva | Goten, Laura Vander | De Koster, Berdien | Degelaen, Marc

Article Type: Review Article

Abstract: BACKGROUND: Dysfunctional postural control and pathological thorax and pelvis motions are often observed in children with cerebral palsy (CP) and can be considered as an indicator of diminished dynamic stability. OBJECTIVE: The aim of this study was to identify the differences between children with CP and typically developing children in three-dimensional thorax and pelvis kinematics during walking. METHODS: Three electronic databases were searched by using different combinations of keywords. The methodological quality of the studies was assessed by two researchers with the Strobe quality checklist. RESULTS: Ten studies (methodological quality: 32% to 74%) with …in total 259 children with CP and 220 typically developing children (mean age: 7.6 to 13.6 year) were included. Compared to typically developing children, children with bilateral CP showed an increased range of motion of the thorax, pelvis and spine during walking. The results of the children with unilateral CP were less clear. CONCLUSION: In general, children with bilateral CP showed larger movement amplitudes of the trunk compared to children without CP. This increase in movement amplitudes could influence the dynamic stability of the body during walking. In children with unilateral CP, the results were less obvious and further research on this topic is required. Show more

Keywords: Cerebral palsy, gait analysis, kinematics, thorax, spine

DOI: 10.3233/NRE-161303

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 129-146, 2016

Authors: Smith, Andrew J. | Campbell, Ransom W. | Harrison, Patti Kelly | Harrison, David W.

Article Type: Research Article

Abstract: BACKGROUND: The current case study presents a 43 year old African American woman admitted to a Tertiary Care Rehabilitation unit at a major medical center for concerns over left-sided anesthesia and weakness. Head scans indicate a right middle cerebral arterial distribution infarct altering blood flow in temporal, parietal, and occipital regions in the right cerebral hemisphere. OBJECTIVE: Physician and therapist reports (i.e., speech and occupational therapists) referred the patient for a neuropsychological evaluation for concerns over the patient’s capacity to recognize the severity of her deficits and self-care, with potential rule-outs indicated by the extant literature on right …CVA for anosognosia, anosodiaphoria, and left hemibody/hemispace neglect. METHODS: The current case integrates interdisciplinary physician notation, magnetic resonance imaging and magnetic resonance angiogram, observations and reports from speech and occupational therapy, and neuropsychological assessment via standardized tests and neurobehavioral syndrome analysis. RESULTS: Evidence was found for co-occurring syndromes of moderate anosognosia, anosodiaphoria, and left hemibody/hemispatial neglect derived from shared functional cerebral space with overlapping temporal, parietal, and occipital damage. CONCLUSIONS: Clinical implications are discussed, including recommendations for therapy approaches based on functional cerebral space theory that may indicate the use of known techniques (e.g., for left hemibody neglect) that may also have therapeutic implications for treating other, more mercurial co-occurring syndromes of anosognosia and anosodiaphoria. Show more

Keywords: Left hemineglect, anosognosia, anosodiaphoria, middle cerebral artery, insight, cerebrovascular accident, stroke, neglect, neglect disorders, emotion, cerebral hemisphere

DOI: 10.3233/NRE-161304

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 147-154, 2016

Authors: Bahia, Mariana Mendes | Mourão, Lucia Figueiredo | Chun, Regina Yu Shon

Article Type: Research Article

Abstract: BACKGROUND: Stroke is the leading cause of mortality and disability worldwide. Important sequels are frequent, including dysphagia and communication disorders. OBJECTIVE: to determine the prevalence of dysphagia and communication disorders following stroke, and to identify if communication disorders can predict dysphagia. METHODS: Thirty-one prospective and consecutive patients were admitted to the Otolaryngology-Dysphagia Outpatient Clinic with diagnosis of ischemic or hemorrhagic stroke. Stroke was confirmed by computed tomography or magnetic resonance imaging, and medical evaluation. All patients had a swallowing and communication evaluation. We compared patients with and without dysphagia, and established the co-occurrence among dysphagia and …communication disorders. RESULTS: Twenty-five patients presented dysphagia. Aphasia occurred in 32.3% of the patients; dysarthria in 45.2% . Dysphagia and aphasia co-occurred in 29% of the population; dysphagia and dysarthria in 45.2% ; the three conditions co-occurred in 22.6% . Dysarthria was a predictor of dysphagia, and it was associated with the presence of oral stage problems. CONCLUSIONS: A comprehensive evaluation of dysphagia, aphasia, and dysarthria are important to improve clinical outcome following stroke. The identification of dysarthria as a predictor of dysphagia can help identify risk for dysphagia in stroke and assist in the therapeutic process of swallowing problems. Show more

Keywords: Deglutition disorder, aphasia, dysarthria, stroke

DOI: 10.3233/NRE-161305

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 155-162, 2016

Authors: Xu, Benlei | Yan, Tiebin | Yang, Yuanle | Ou, Ruiqing | Huang, Shuping

Article Type: Research Article

Abstract: BACKGROUND: Functional electrical stimulation is a widely used technique for rehabilitation. OBJECTIVE: To assess the efficacy of walking-pattern-based four-channel functional electric stimulation and its influence on the gait features of stroke patients with hemiplegia. METHODS: A total of 21 stroke patients with hemiplegia were enrolled into the study. The walking gaits of patients were investigated before, during and after walking-pattern-based FES treatment using the gait analysis system. The changes of gait indexes were comparatively analyzed. RESULTS: After walking-pattern-based FES therapy, the pace, stride rate, gait cycle, and step length of stroke patients with hemiplegia …were 50.19 ± 14.45 cm/s, 36.85 ± 5.85 time/min, 1.6643 ± 0.2626 sec, 80.3333 ± 15.1438 cm, respectively. The motion range of hip and knee joint were 47.5238 ± 10.7453, 56.7619 ± 14.5255, respectively. We found these indexes were significantly improved compared with those before FES treatment (P  <  0.05). The single swing rate (injured extremity/uninjured extremity) after FES treatment was 1.5589 ± 0.4550. The statistical results showed that the gait cycle, pace, stride rat, and single swing rate (injured extremity/uninjured extremity) were significantly improved after FES treatment (P  <  0.05). CONCLUSIONS: Our results demonstrate that walking-paradigm based FES we developed is effective for treating stroke patients during rehabilitation. Show more

Keywords: Stroke, hemiparalysis, functional electrical stimulation, gait analysis

DOI: 10.3233/NRE-161306

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 163-169, 2016

Authors: Kim, Ha Yeon | Yang, Sung Phil | Park, Gyu Lee | Kim, Eun Joo | You, Joshua (Sung) Hyun

Article Type: Research Article

Abstract: BACKGROUND: Robot-assisted and treadmill-gait training are promising neurorehabilitation techniques, with advantages over conventional gait training, but the neural substrates underpinning locomotor control remain unknown particularly during different gait training modes and speeds. OBJECTIVE: The present optical imaging study compared cortical activities during conventional stepping walking (SW), treadmill walking (TW), and robot-assisted walking (RW) at different speeds. METHODS: Fourteen healthy subjects (6 women, mean age 30.06, years ± 4.53) completed three walking training modes (SW, TW, and RW) at various speeds (self-selected, 1.5, 2.0, 2.5, and 3.0 km/h). A functional near-infrared spectroscopy (fNIRS) system determined cerebral hemodynamic changes …associated with cortical locomotor network areas in the primary sensorimotor cortex (SMC), premotor cortex (PMC), supplementary motor area (SMA), prefrontal cortex (PFC), and sensory association cortex (SAC). RESULTS: There was increased cortical activation in the SMC, PMC, and SMA during different walking training modes. More global locomotor network activation was observed during RW than TW or SW. As walking speed increased, multiple locomotor network activations were observed, and increased activation power spectrum. CONCLUSIONS: This is the first empirical evidence highlighting the neural substrates mediating dynamic locomotion for different gait training modes and speeds. Fast, robot-assisted gait training best facilitated cortical activation associated with locomotor control. Show more

Keywords: Cortical activation, functional near-infrared spectroscopy, gait training modes and speeds, neurorehabilitation

DOI: 10.3233/NRE-161307

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 171-178, 2016

Authors: Wilkinson, David | Podlewska, Aleksandra | Sakel, Mohamed

Article Type: Research Article

Abstract: OBJECTIVE: To gain ‘first-in-man’ evidence that repeated caloric vestibular stimulation (CVS), a non-invasive form of neuro-modulation, can induce a lasting and clinically-relevant reduction in Parkinson’s Disease (PD) symptoms. METHODS: A 70 yr old male, diagnosed with PD 7 years prior to study enrolment, self-administered CVS at home 2×20 minutes per day for three months using a solid-state portable device. Standardised neuropsychological assessments of motor, cognitive, affective and independent function were carried out prior to stimulation, at the start and end of the sham (month 1) and active (months 2–3) phases, and 5 months post-stimulation. RESULTS: Relative to …the pre-stimulation baseline, behavioural improvements that exceeded the minimal detectable change were observed on the EQ5D, Unified Parkinson’s Disease Rating Scale, Schwab and England scale, 2 minute walk, Timed up and go, Non-motor symptom assessment scale for PD, Montreal cognitive assessment, Hospital depression scale and Epworth sleepiness scale. The level of change exceeded the threshold for a minimal clinically important difference on all scales for which a threshold has been published. By contrast, little improvement was seen during the sham (i.e. placebo) phase. CONCLUSION: Caloric vestibular stimulation may offer a novel, home-based method of relieving everyday symptoms of PD, and merits further evaluative study. Show more

Keywords: Treatment, neuro-degeneration, balance

DOI: 10.3233/NRE-161308

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 179-182, 2016

Authors: Kubsik, Anna | Klimkiewicz, Robert | Janczewska, Katarzyna | Klimkiewicz, Paulina | Jankowska, Agnieszka | Woldańska-Okońska, Marta

Article Type: Research Article

Abstract: BACKGROUND: Multiple sclerosis is one of the most common neurological disorders. It is a chronic inflammatory demyelinating disease of the CNS, whose etiology is not fully understood. Application of new rehabilitation methods are essential to improve functional status. OBJECTIVE: The material studied consisted of 120 patients of both sexes (82 women and 38 men) aged 21–81 years. The study involved patients with a diagnosis of multiple sclerosis. The aim of the study was to evaluate the effect of laser radiation and other therapies on the functional status of patients with multiple sclerosis. METHODS: Patients were randomly …divided into four treatment groups. The evaluation was performed three times – before the start of rehabilitation, immediately after rehabilitation (21 days of treatment) and subsequent control – 30 days after the patients leave the clinic. The following tests were performed for all patients to assess functional status: Expanded Disability Status Scale (EDSS) of Kurtzke and Barthel Index. RESULTS: Results of all testing procedures show that the treatment methods are improving the functional status of patients with multiple sclerosis, with the significant advantage of the synergistic action of laser and magneto stimulation. The combination of laser and magneto stimulation significantly confirmed beneficial effect on quality of life. The results of these studies present new scientific value and are improved compared to program of rehabilitation of patients with multiple sclerosis by laser radiation which was previously used. CONCLUSIONS: This study showed that synergic action of laser radiation and magneto stimulation has a beneficial effect on improving functional status, and thus improves the quality of life of patients with multiple sclerosis. The effects of all methods of rehabilitation are persisted after cessation of treatment applications, with a particular advantage of the synergistic action of laser radiation and magneto stimulation, which indicates the possibility to elicitation in these methods the phenomenon of the biological hysteresis. Show more

Keywords: Multiple sclerosis, laser radiation, magneto stimulation, physiotherapy

DOI: 10.3233/NRE-161309

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 183-190, 2016

Authors: Agiovlasitis, Stamatis | Motl, Robert W.

Article Type: Research Article

Abstract: BACKGROUND: An equation for predicting the gross oxygen uptake (gross-VO2 ) during walking for persons with multiple sclerosis (MS) has been developed. Predictors included walking speed and total score from the 12-Item Multiple Sclerosis Walking Scale (MSWS-12). OBJECTIVE: This study examined the validity of this prediction equation in another sample of persons with MS. METHODS: Participants were 18 persons with MS with limited mobility problems (42 ± 13 years; 14 women). Participants completed the MSWS-12. Gross-VO2 was measured with open-circuit spirometry during treadmill walking at 2.0, 3.0, and 4.0 mph (0.89, 1.34, and 1.79 m·s–1 …). REULTS: Absolute percent error was small: 8.3 ± 6.1% , 8.0 ± 5.6% , and 12.2 ± 9.0% at 2.0, 3.0, and 4.0 mph, respectively. Actual gross-VO2 did not differ significantly from predicted gross-VO2 at 2.0 and 3.0 mph, but was significantly higher than predicted gross-VO2 at 4.0 mph (p  <  0.001). Bland-Altman plots indicated nearly zero mean difference between actual and predicted gross-VO2 with modest 95% confidence intervals at 2.0 and 3.0 mph, but there was some underestimation at 4.0 mph. CONCLUSIONS: Speed and MSWS-12 score provide valid prediction of gross-VO2 during treadmill walking at slow and moderate speeds in ambulatory persons with MS. However, there is a possibility of small underestimation for walking at 4.0 mph. Show more

Keywords: Energy expenditure, gait, disability, MSWS-12

DOI: 10.3233/NRE-161310

Citation: NeuroRehabilitation, vol. 38, no. 2, pp. 191-197, 2016