NeuroRehabilitation - Volume 38, issue 4

Authors: Golos, Anat | Bedell, Gary

Article Type: Research Article

Abstract: BACKGROUND: Children with traumatic brain injury are often restricted in their participation due to impairments and environmental barriers. Reliable and valid instruments are essential for monitoring their participation over time. OBJECTIVE: To examine the construct validity and internal consistency of the Child and Adolescent Scale of Participation (CASP) across a 3-year period. METHODS: A longitudinal prospective cohort study (USA) that included 926 children (0–18 years) with TBI and arm injury. Three measures were administered at 3, 12, 24, and 36 months post-injury: The CASP, Pediatric Quality of Life Inventory (PedsQL), and Adaptive Behavior Assessment Scale …II (ABAS). RESULTS: Associations between the CASP and PedsQL and ABAS were moderate-to-high at all time periods. Internal consistency of the CASP and its sub-sections was high, with a pattern of gradual increase over time. Factor analyses indicated a clearer four factor solution at 3, 12 and 24 months resembling the four CASP sub-sections. CONCUSIONS: Results provide evidence of convergent validity and internal consistency of the CASP and support its use for assessing participation of children with TBI over time. Prudence should be taken when considering use of factor scores due to differences in factor solutions found in this study and prior studies. Show more

Keywords: Measurement, participation, children, youth, psychometrics, validity, reliability

DOI: 10.3233/NRE-161322

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 311-319, 2016

Authors: Laures-Gore, Jacqueline | Marshall, Rebecca Shisler

Article Type: Case Report

Abstract: BACKGROUND: Despite the potential behavioral and neurological benefits of Mindfulness Meditation (MM), its use in treating stroke related communication disabilities appears to be underexplored. Specifically, aphasia, a language disorder resulting from stroke, may be amenable to the benefits of MM because of the observed attention problems often underlying the language symptoms. OBJECTIVE: The current paper presents a case report of an adult with aphasia who was trained in MM. METHOD: An adult with aphasia completed a five-day mindfulness training, and was assessed on measures of language, attention, and physiological measures of cortisol and heart rate …variability. She completed four assessments: two baseline measures, immediately post training, and one week post training (maintenance). RESULTS: Overall, changes were observed in both psychophysiological measures (heart rate and heart rate variability) and behavioral measures (word productivity, phrase length, word generation, decreased impulsivity, and increased attention). CONCLUSION: Given the psychophysiological and behavioral changes observed in this individual, further exploration of the influence of MM in the treatment of post-stroke aphasia is warranted. Show more

Keywords: Aphasia, mindfulness, meditation, attention, language, heart rate, cortisol

DOI: 10.3233/NRE-161323

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 321-329, 2016

Authors: Schow, Trine | Harris, Paul | Teasdale, Thomas William | Rasmussen, Morten Arendt

Article Type: Research Article

Abstract: BACKGROUND: Balance problems and binocular visual dysfunction (BVD) are common problems after stroke, however evidence of an effective rehabilitation method are limited. OBJECTIVE: To evaluate the effect of a four-month rehabilitation program for individuals with balance problems and BVD after a stroke. METHODS: About 40 sessions of 1.5 hours duration over four months with visual therapy and balance rehabilitation, was provided to all 29 participants, aged 18-67 years, in groups of 7-8 individuals. Several measures for BVD, balance, gait, Health Related Quality Of Life (HRQoL) and functional recovery were used at baseline, at the end …of training and at a six-month follow up (FU). RESULTS: We found significant improvements in stereopsis, vergence, saccadic movements, burden of binocular visual symptoms, balance and gait speed, fatigue, HRQoL and functional recovery. Moreover, 60% of the participants were in employment at the six-month FU, compared to only 23% before training. All improvements were sustained at the six-month FU. CONCLUSIONS: Although a control group is lacking, the evidence suggests that the positive improvement is a result of the combined visual and balance training. The combination of balance and visual training appears to facilitate changes at a multimodal level affecting several functions important in daily life. Show more

Keywords: Stroke, balance, visual dysfunction

DOI: 10.3233/NRE-161324

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 331-341, 2016

Authors: Bang, Dae-Hyouk | Shin, Won-Seob

Article Type: Research Article

Abstract: BACKGROUND: Body weight-supported treadmill training assisted by a robotic gait orthosis is a helpful tool for restoring a symmetrical gait pattern in people with gait discrepancies. OBJECTIVE: This study’s aim was to compare the effects of robot-assisted gait training (RAGT) versus treadmill gait training (TGT) on spatiotemporal gait parameters, balance, and activities-specific balance confidence with stroke patients. METHODS: Eighteen participants with stroke were randomly assigned to RAGT or TGT. Each group underwent twenty sessions (1 h/d, 5 d/wk for 4 weeks). Patients were assessed with gait parameters (gait speed, cadence, step length, and double limb support …period) using the GAITRite, the Berg Balance Scale (BBS) score, and the activities-specific balance confidence (ABC) score before and after the intervention. RESULTS: Gait speed (P  = 0.003), cadence (P  = 0.002), step length (P  = 0.004), the BBS score (P  = 0.048), and the ABC score (P  = 0.017) were significantly higher in the RAGT group than in the TGT group, while the double limb support period was significantly lower in the RAGT group (P  = 0.043). CONCLUSION: RAGT using Lokomat may be more effective than TGT in improving waking ability, balance, and balance confidence in patients with chronic stroke. Show more

Keywords: Rehabilitation, robot-assisted gait training, stroke

DOI: 10.3233/NRE-161325

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 343-349, 2016

Authors: Kitatani, Ryosuke | Ohata, Koji | Hashiguchi, Yu | Sakuma, Kaoru | Yamakami, Natsuki | Yamada, Shigehito

Article Type: Research Article

Abstract: BACKGROUND: Increased ankle muscle coactivation during gait represents an adaptation strategy to compensate for postural instability in adults after stroke. Although increased ankle muscle coactivation is correlated with gait disorders in adults after stroke, it remains unclear which physical impairments are the most predictive clinical factors explaining ankle muscle coactivation during gait. OBJECTIVE: To investigate these physical impairments in adults after stroke using stepwise multiple regression analyses. METHODS: The magnitude of ankle muscle coactivation during gait was quantified with a coactivation index (CoI) for the first and second double support (DS2), and single support (SS) …phases in 44 community-dwelling adults after stroke. Paretic motor function, sensory function, spasticity, ankle muscle strength, and balance ability were evaluated. RESULTS: The regression analysis revealed that the balance ability and paretic ankle plantarflexor muscle strength were significant factors determining the CoI during the SS phase on the paretic side. For the CoI during the DS2 phase on the paretic side, only the balance ability was selected as a significant factor. CONCLUSION: Adults with impaired balance ability and paretic ankle muscle weakness after stroke used a compensation strategy of increased ankle muscle coactivation on the paretic side to enhance postural stability during gait. Show more

Keywords: Co-contraction, gait, stroke, hemiplegia, electromyography

DOI: 10.3233/NRE-161326

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 351-357, 2016

Authors: De Baets, Liesbet | Jaspers, Ellen | Van Deun, Sara

Article Type: Research Article

Abstract: BACKGROUND: Clinical scapulohumeral tests are lacking post-stroke. OBJECTIVE: To test reliability and discriminant validity of clinical scapulohumeral assessments post-stroke. METHODS: Following tests were assessed in 57 individuals with stroke (IwS) (subdivided in a low, moderate, high proximal arm function (PAF) group) and 15 healthy controls: (1) Observation of tilting/winging; (2) shoulder girdle position tests (pectoralis minor index, acromial index, scapular distance test); (3) scapular lateral rotation measurement; (4) maximal humeral elevation and (5) medial rotation test were executed. 15 IwS were measured twice by the same assessor to determine test-retest reliability. Differences between controls and …IwS and between IwS with different levels of PAF were assessed. RESULTS: ICCs were very high for all tests (>0.80), except the pectoralis minor index (0.66). Weighted Kappas were high for observation and the medial rotation test (>0.70). Group differences were found for observation, lateral rotation and humeral elevation. IwS compared to controls, and IwS with lower compared to higher PAF generally showed increased lateral rotation (p  < .01); decreased maximal active humeral elevation (p  < .001); and more often tilting and winging (p  < .05). CONCLUSIONS: The use of these tests in clinical settings will allow for identification of altered scapular characteristics, which will enhance treatment planning for PAF post-stroke. Show more

Keywords: Scapula, movement patterns, clinical test, stroke

DOI: 10.3233/NRE-161327

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 359-370, 2016

Authors: Niemeier, Janet P. | Leininger, Shelley L. | Whitney, Marybeth P. | Newman, Mark A. | Hirsch, Mark A. | Evans, Susan L. | Sing, Ronald F. | Huynh, Toan T. | Guerrier, Tami P. | Perrin, Paul B.

Article Type: Research Article

Abstract: BACKGROUND/OBJECTIVE: The study explored whether premorbid substance use disorder (SUD) predicts acute traumatic brain injury (TBI) outcomes. METHODS: 143 participants with moderate (34.2%) and severe (65.8%) TBI were enrolled at two Level 1 trauma center inpatient brain injury rehabilitation units. Acute outcomes were measured with the Disability Rating Scale (DRS), the FIMTM ; self and informant ratings of the Patient Competency Rating Scale (PCRS); self and family rating of the Frontal Systems Behavioral Scale (FrSBe), and the Neurobehavioral Rating Scale-Revised (NRS-R). RESULTS: Hierarchical linear modeling revealed that SUD history significantly predicted trajectories of PCRS clinician …ratings, PCRS self-family and PCRS self-clinician discrepancy scores, and more negative FrSBE family ratings. These findings indicate comparatively greater post-injury executive functions (EF) impairments, particularly self-awareness (SA) of injury-related deficits, for those with SUD history. No significant SUD* time interaction effect was found for FIM or NRS-R scores. CONCLUSIONS: SUD history and TBI are associated with impaired SA and EF but their co-occurrence is not a consistent predictor of acute post-injury functional outcomes. Pre-morbid patient characteristics and rater expectations and biases may moderate associations between SA and recovery after TBI. Show more

Keywords: Traumatic brain injury, substance use disorder, rehabilitation

DOI: 10.3233/NRE-161328

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 371-383, 2016

Authors: Stampacchia, Giulia | Gerini, Adriana | Mazzoleni, Stefano

Article Type: Research Article

Abstract: BACKGROUND: Intrathecal Baclofen is available to treat severe generalized spasticity in Multiple Sclerosis (MS) unresponsive to oral drug delivery. OBJECTIVE: The aims of this study were to investigate the effects and the drug dosage of intrathecal Baclofen in a selected population of MS patients, affected by severe spasticity at long term follow-up. METHODS: A prospective cohort study of 14 MS patients is presented. Spasticity and pain were periodically assessed and the Baclofen dosage was adjusted. RESULTS: The initial Baclofen dosage was 136.2 ± 109.3 μg, then it was increased at 12 months to …228.6 ± 179.2 μg (p  < 0.05). The subsequent dose adjustments did not result in significant changes up to 76 months. Spasticity on the lower limbs decreased significantly from pre-implantation assessment (median: 3.5, IQR: 3.0–4.0) to 12 months evaluation (median: 0.5, IQR: 0.0–2.0) (p  < 0.001); no further decrease was observed after 24 months (median: 0.5, IQR: 0.0–1.5); when pain was present, it decreased. Some effects on cerebellar symptoms were observed. Botulinum toxin injections were used with intrathecal Baclofen therapy. CONCLUSIONS: A reduced spasticity and pain was observed after the intrathecal Baclofen infusion for at least 76 months. To obtain these results a dosage adjustment was needed only in the first year after the implantation. Show more

Keywords: Multiple sclerosis, chronic progressive, muscle spasticity, intrathecal implant, botulinum toxin, pain

DOI: 10.3233/NRE-161329

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 385-393, 2016

Authors: Santos, Cleber Luz | Noronha, Diana Oliveira | Lessa, Paulo Itamar Ferraz | Camatti, Janine Ribeiro | Victor de Oliveira Fernandes, Iasmyn Adélia | Barbosa Paixão, Alaí | Sá, Kátia Nunes | Baptista, Abrahão Fontes | de Lucena, Rita de Cássia Saldanha

Article Type: Research Article

Abstract: BACKGROUND: Muscle Force (MF) and amplitude of active movement (AAM) are progressively affected in amyotrophic lateral sclerosis (ALS). These measurements are correlated with mobility but influence it in a distinct manner. OBJECTIVE: To determine the influence of MF and AAM on the mobility of the subjects with ALS. METHODS: The formula for identifying the covariables and scale of mobility of the Amyotrophic Lateral Sclerosis Assessment Questionnaire were applied to 23 subjects with ALS. The MF data of the knee and ankle flexors and extensors were collected in the most affected limb. In conjunction, the AAM …of hip and knee flexion were captured. Multiple linear regressions were used, considering alpha ≤0.05. RESULTS: MF and AAM interfered in mobility and are responsible for 63.6% of the variation in mobility. The variable that explained this variation was the AAM of hip flexion. The stage of disease was considered a covariable. CONCLUSION: AAM of hip flexion is a safe predictor of mobility in ALS. Retarding loss of this AAM may maintain these subjects functional for a longer time. It was not possible to use MF of the muscles evaluated to predict mobility. Show more

Keywords: Amyotrophic Lateral Sclerosis, limitation of mobility, muscle force

DOI: 10.3233/NRE-161330

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 395-400, 2016

Authors: Krishnan, Shilpa | Brick, Rachelle S. | Karg, Patricia E. | Tzen, Yi-Ting | Garber, Susan L. | Sowa, Gwendolyn A. | Brienza, David M.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the validity of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) during acute care and inpatient rehabilitation following spinal cord injury (SCI) by determining critical cutoff points and assessing the ability to predict risk for pressure ulceration (PrU). DESIGN: Retrospective. METHODS: Sensitivity, specificity, and area under the curve (AUC) for the receiver operating characteristic were determined for the scale’s ability to predict PrU 2-3 and 5-7 days after administrating the SCIPUS during acute care, and 5-7 and 14-21 days after administrating the SCIPUS during inpatient rehabilitation. RESULTS: During acute hospitalization, …SCIPUS’s ability to assess risk for PrUs within 2-3 days was determined at cutoff score of 15 with 100% sensitivity and 75% specificity, AUC = 0.85. The scale was unable to assess PrU risk at 5-7 days, AUC < 0.6 at cutoff score of 13. During inpatient rehabilitation, the scale was unable to assess PrU risk at 5-7 and 14-21 days, AUC < 0.6 at cutoff score of 9. CONCLUSIONS: The SCIPUS could predict PrU occurring within 2-3 days following administration during acute, but unable to predict over a longer term within acute or inpatient rehabilitation. Improved PrU risk assessment following SCI may be possible with modification to the SCIPUS. Show more

Keywords: Spinal cord injury, pressure ulcer, risk assessment, validity, sensitivity, specificity

DOI: 10.3233/NRE-161331

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 401-409, 2016

Authors: Pham, Christine | Bitonte, Robert

Article Type: Research Article

Abstract: BACKGROUND: Hippotherapy is the use of equine movement in physical, occupational, or speech therapy in order to obtain functional improvements in patients. Studies show improvement in motor function and sensory processing for patients with a variety of neuromuscular disabilities, developmental disorders, or skeletal impairments as a result of using hippotherapy. OBJECTIVE: The primary objective of this study is to identify the pervasiveness of hippotherapy in Southern California, and any factors that impair its utilization. METHODS: One hundred and fifty-two rehabilitation centers in the Southern California counties of Los Angeles, San Diego, Orange, Riverside, San Bernardino, …San Diego, San Luis Obispo, Santa Barbara, Ventura, and Kern County were identified, and surveyed to ascertain if hippotherapy is utilized, and if not, why not. RESULTS: Through a review of forty facilities that responded to our inquiry, our study indicates that the majority of rehabilitation centers are familiar with hippotherapy, however, only seven have reported that hippotherapy is indeed available as an option in therapy at their centers. CONCLUSION: It is concluded that hippotherapy, used in a broad based array of physical and sensory disorders, is limited in its ability to be utilized, primarily due to remuneration issues. Show more

Keywords: Hippotherapy, equine assisted therapy, rehabilitation centers, neuromusculoskeletal dysfunction

DOI: 10.3233/NRE-161332

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 411-417, 2016

Article Type: Other

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 419-422, 2016

Article Type: Other

Citation: NeuroRehabilitation, vol. 38, no. 4, pp. 423-424, 2016