NeuroRehabilitation - Volume 39, issue 2

Authors: Degelaen, Marc | De Borre, Ludo | Buyl, Ronald | Kerckhofs, Eric | De Meirleir, Linda | Dan, Bernard

Article Type: Research Article

Abstract: BACKGROUND: Children with cerebral palsy show dysfunctional postural control which interferes with their functional performance and daily-life activities. OBJECTIVE: The aim of the study was to identify the effect of a 3D supporting garment on trunk postural control and interjoint coordination during gait in children with bilateral cerebral palsy. METHODS: We analyzed tridimensional trunk motion, trunk-thigh and interjoint coordination in 15 4–10 year-old children with bilateral spastic cerebral palsy (GMFCS I or II) and 16 4–10 year-old typically developing children while walking with or without a supporting garment. RESULTS: We found significantly changes …in the coordination between trunk and lower limbs in children with cerebral palsy. Step velocity and cadence both increased significantly in children with cerebral palsy but in controls, the cadence remained unaltered. Interjoint coordination between hip-knee and knee-ankle was altered during the stance phase only in the subgroup of children with cerebral palsy without any limitations in ankle joint passive range of motion. CONCLUSION: 3D supporting garments improve trunk-thigh and lower limb interjoint coordination in walking in children with bilateral cerebral palsy. Show more

Keywords: 3D supporting garment, cerebral palsy, postural control, interjoint coordination

DOI: 10.3233/NRE-161349

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 175-181, 2016

Authors: Gogola, Anna | Gnat, Rafał | Dziub, Dorota | Gwóźdź, Michalina | Zaborowska, Małgorzata

Article Type: Research Article

Abstract: BACKGROUND : The aim of the study was to evaluate the activation of lateral abdominal muscles (LAM) in response to neurodevelopmental traction technique as assessed by ultrasounds as well as to compare the effects of different traction forces. OBJECTIVE: An experiment with repeated measurements of the dependent variables was conducted. Thirty-seven children (22 girls) participated. METHODS: Measurements of LAM thickness (indicating LAM activation) were performed bilaterally during traction of 5% body weight: 1) in neutral position, 2) in 20° posterior trunk inclination; during traction of 15% body weight: 3) in neutral position, 4) in 20° posterior …trunk inclination. The ultrasound technology was employed. RESULTS: When applying the lighter traction the superficial LAM (external and internal oblique muscles) showed significant changes. The mean thickness of both muscles during traction increased (both p  < 0.001). The deepest transversus abdominis showed no response (p  > 0.05). Stronger traction elicited smaller changes. External and internal oblique muscles showed significant increases (p  < 0.001, p  < 0.01, respectively). Transversus abdominis became less thick during stronger traction (p  < 0.01). CONCUSIONS: The neurodevelopmental traction technique elicits the changes in LAM thickness in children with typical development. The superficial LAM show more distinct responses than the profound LAM. Stronger traction induces smaller LAM thickness changes than lighter traction. Show more

Keywords: Neurodevelopmental treatment, traction technique, ultrasound, reliability

DOI: 10.3233/NRE-161350

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 183-190, 2016

Authors: Brown, Jessica A. | Hux, Karen

Article Type: Research Article

Abstract: BACKGROUND: Individuals with acquired brain injury (ABI) often struggle planning and executing tasks outside daily routines. Given the pervasive effects executive functioning challenges have on independent living, professionals need methods of assessing these skills. OBJECTIVE: This study’s purpose was to evaluate an ecologically-valid procedure to assess novel task planning and execution by adults with ABI. METHODS: The researchers implemented a single group design across two phases. Participants included nine adults with severe ABI. In the first experimental phase, participants created a plan for executing tasks that required adherence to pre-determined rules; in the second phase, …participants executed the tasks. The researchers tallied information units recorded during the planning phase, performed momentary time-sampling to document observations about participant behaviors, and collected speed, accuracy, and rule violation data about task completion. RESULTS: Planning strategies implemented by most participants were limited to word-for-word copying of some or all of the specified tasks. On average, participants attempted and accurately performed less than half the required tasks and exhibited high rule violation rates. CONCLUSIONS: Given further development and refinement, the implemented procedures may serve as a basis for developing an ecologically-valid tool for evaluating executive functioning in adults with ABI. Show more

Keywords: Ecologically-valid assessment, task planning, functional task execution, acquired brain injury

DOI: 10.3233/NRE-161351

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 191-203, 2016

Authors: Byrne, Christopher | Coetzer, Rudi

Article Type: Review Article

Abstract: BACKGROUND: The consequences of aggressive behavior following ABI have an impact at both an individual and systemic level. In contrast to other ABI sequelae, aggressive behavior has been shown to increase over time without appropriate timely interventions. OBJECTIVE: The current meta-analysis aimed to systematically review the current literature examining psychological interventions for aggressive behavior following ABI. The meta-analysis also aimed to provide a statistical synthesis of the available evidence. METHOD: Following the PRISMA guidelines, an electronic and ancestral search of the available literature identified eleven studies (N = 123) that met the inclusion criteria for the review. …Non-overlap effect sizes (Tau-U) were calculated to synthesize the available evidence from single case experimental design studies (SCEDs; N = 7). Standardized mean difference effect sizes (d) were calculated to synthesize the available evidence from group studies (N = 4). RESULTS: A medium omnibus effect size (weighted d = –0.46, 95% CI: –0.69 <> –0.24) was found for group studies. Similarly, the overall effect size (Tau-U) for SCEDs was –0.59 (95% CI: –0.72 <> –0.46), indicating a 59% reduction in aggressive behaviour compared to baseline. CONCLUSION: The findings of the meta-analysis suggest that psychological interventions for aggressive behavior are at least moderately effective at reducing aggressive behavior following ABI. Show more

Keywords: Aggressive behavior, acquired brain injury, rehabilitation, meta-analysis, single case experimental design, evidence based practice, psychological interventions

DOI: 10.3233/NRE-161352

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 205-221, 2016

Authors: Adams, Deana | Dahdah, Marie

Article Type: Research Article

Abstract: BACKGROUND: Qualitative research methods allowed the investigator to contribute to the development of new theories and to examine change in processes over time, which added rich detail to existing knowledge of the use of coping and adaptive strategies by traumatic brain injury survivors and their primary caregivers (Ponsford, Sloan, & Snow, 2013 ). The advantages of phenomenological study were that it allows flexibility to explore and understand meanings attached by people to well-studied concepts such as coping, resiliency, and adaptation or compensation. Phenomenological study was sensitive to contextual factors. It also permitted the study of in-depth dynamics of …coping and adaptive strategies of TBI survivors and primary caregivers, while understanding the social and psychological implications of the phenomenon. OBJECTIVE: To explore the needs and deficits of adult traumatic brain injury (TBI) survivors and primary caregivers; and to identify their self-initiated coping and adaptive strategies. Significant to this study was the development of coping and adaptive strategies by the participants after their discharge from inpatient and rehabilitation treatment. The compensatory skills taught in treatment settings did not transfer to the home environment. Therefore, these strategies developed independently from previous treatment recommendations contributed to the development of theory related to rehabilitation and counseling. Distinctive to this study was the similarity of coping and adaptive strategies developed from both mild and severe traumatic brain injury survivors. METHODS: This study consisted of eleven with TBI and six primary caregivers (N = 17), who participated in a series of semi-structured interviews aimed at discovering the coping and adaptive strategies utilized in dealing with the effects of brain injury. A Qualitative Phenomenological design was employed. RESULTS: Patience and understanding, support, and professional help were identified by TBI survivors and caregivers as being their most relevant needs. Self-reported deficits included short-term memory loss (STM), fatigue, anger, and personality changes, and the strategies that TBI survivors and caregivers identified tended to address their problems with these specific day-to-day deficits. Problem focused, emotion focused, and avoidant coping were utilized to some degree in their adjustment to home life and activities of daily living. Participants offered suggestions for mental health professionals addressing how to more effectively work with brain injury survivors and their primary caregivers. CONCLUSION: TBI survivors and caregivers had multiple self-reported unaddressed needs following their discharge from facility-based treatment. They reported spontaneously engaging in various coping and adaptive strategies to address their needs and deficits. However, further education regarding potential post-TBI challenges and strategies for addressing them are needed, including a need for community and mental health resources. Show more

Keywords: Coping skills, anger, social support, brain injuries, caregivers, mental health

DOI: 10.3233/NRE-161353

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 223-237, 2016

Authors: Imhoff, Sarah | Lavallière, Martin | Teasdale, Normand | Fait, Philippe

Article Type: Review Article

Abstract: BACKGROUND: Due to the heterogeneity of the lesion following a traumatic brain injury (TBI) and the complexity of the driving task, driving assessment and rehabilitation in TBI individuals is challenging. Conventional driving assessment (on-road and in-clinic evaluations) has failed demonstrating effectiveness to assess fitness to drive in TBI individuals. OBJECTIVE: We aimed to determine if driving simulators represent an interesting opportunity in assessing and rehabilitating driving skills in TBI individuals. METHODS: We searched PubMed, CINAHL and Cochrane library databases between 27-02-2014 and 08-04-2014 for articles published since 2000 with the contents of simulator driving assessment …and rehabilitation. RESULTS: Out of 488, eight articles with the subject of simulator driving assessment and two with the subject of simulator driving rehabilitation in individuals with TBI were reviewed. CONCLUSIONS: Driving simulators represent a promising avenue for the assessment and rehabilitation of driving skills in TBI individuals as it allows control of stimuli in a safe, challenging and ecologically valid environment and offer the opportunity to measure and record driving performance. Additional studies, however, are needed to document strengths and limitations of this method. Show more

Keywords: Traumatic brain injury, assessment, rehabilitation, driving, simulator

DOI: 10.3233/NRE-161354

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 239-251, 2016

Authors: Chang, Won Hyuk | Sohn, Min Kyun | Lee, Jongmin | Kim, Deog Young | Lee, Sam-Gyu | Shin, Yong-Il | Oh, Gyung-Jae | Lee, Yang-Soo | Joo, Min Cheol | Han, Eun Young | Kim, Yun-Hee

Article Type: Research Article

Abstract: BACKGROUND: There are a few reports on the impact of central facial palsy and dysarthria on quality of life (QOL) in stroke patients. OBJECTIVE: To investigate the impact of central facial palsy on QOL compared with dysarthria during the chronic phase in patients with first-ever strokes. METHODS: This study represents an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation study. We selected data from patients with functional independence of 0 or 1 by the modified Rankin Scale at 6 months after stroke onset, who showed an impairment only in National Institute of …Health Stroke Scale items 4 (facial palsy) or 10 (dysarthria). Assessments included the European Quality of Life-5 Dimensions (EQ-5D) and the Geriatric depression scale-short form (GDS-SF). RESULTS: Data from 149 patients were selected for this analysis from 3,929 patients who were followed up at 6 months. Thirty-nine and 110 patients were classified into the facial palsy and dysarthria groups, respectively. The groups did not differ significantly in baseline characteristics or functional assessments. EQ-5D was significantly lower in the facial palsy group than in the dysarthria group at 6 months after stroke (p  = 0.036). GDS-SF was significantly higher in the facial palsy group than in the dysarthria group (p  = 0.005). CONCLUSIONS: The results of this study revealed that central facial palsy clearly has a more negative impact on QOL than dysarthria in chronic stroke patients with functional independence. Show more

Keywords: Dysarthria, depression, facial palsy, quality of life, stroke

DOI: 10.3233/NRE-161355

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 253-259, 2016

Authors: Pedersen, Malene | Bundgaard, Tina H. | Zeeman, Peter | Jørgensen, Jørgen R. | Sørensen, Peter M.B. | Berro, Hamza M. | Larsson, Bodil W.

Article Type: Case Report

Abstract: BACKGROUND: Chronic stroke patients are primarily referred to general rehabilitation, rather than to specific neurorehabilitation. Currently, there are no Danish clinical guidelines for chronic stroke, but recent research in neuroplasticity has contributed to possible rehabilitation interventions for these patients. OBJECTIVE: The purpose of this project is to describe the use of a specialized neuroplastic approach in combination with an already existing training program. METHODS: The project is designed as an action research project concerning four participants with chronic stroke. Through ten intervention, a neuroplastic focus has been added to their group training program including daily …home training. Participants were tested before and after the intervention with MAS, DGI, 6MWT, SSQLS. RESULTS: All four participants improved their functional levels and their quality of life following the intervention. CONCLUSIONS: This report indicates that a specific neuroplastic focus in combination with action research has an impact on the participants with chronic stroke. However, there is still no clarity regarding what type of rehabilitation methods can be considered the most efficacious in promoting neuroplasticity. This case report serves as a pilot project for further studies of how to implement neuroplasticity in physical therapy. Show more

Keywords: Neuroplasticity, chronic stroke, action research, physiotherapy, case report

DOI: 10.3233/NRE-161356

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 261-272, 2016

Authors: Jani, Mansi Pankaj | Gore, Geeta Bharat

Article Type: Research Article

Abstract: BACKGROUND: Motor neurone disease also commonly known as Amyotrophic Lateral Sclerosis (ALS) is a neurological condition which affects various motor functions of the body. Dysphagia (disordered swallowing) is commonly seen in patients with ALS having bulbar symptoms. OBJECTIVES: Research reveals presence of dysphagia in patients with ALS at various stages of swallowing using instrumental assessment. However, very few studies have been done focussing on clinical profiling of swallowing in these patients. Hence, a need was felt to profile the specific characteristics. METHODOLOGY: Five patients diagnosed with ALS were assessed for presence of swallowing disorder using …a swallowing checklist which focussed on assessing each stage of swallowing. RESULTS: Results revealed that patients with ALS exhibit difficulties in oral preparatory, oral and pharyngeal stages of swallowing. Inability to hold bolus, reduced mastication, residue in the oral cavity and nasal regurgitation while swallow were observed due to the affected oromotor functions. Swallow reflex was delayed in all the patients. Cough before and during swallow was also observed. CONCLUSION: Dysphagia is a common symptom in patients with ALS and occurs due to the affected oromotor functions. Specific information of the stages of swallowing helps in planning treatment in clinical practice. Show more

Keywords: Amyotrophic Lateral Sclerosis, dysphagia, oro-pharyngeal

DOI: 10.3233/NRE-161357

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 273-276, 2016

Authors: Stampacchia, Giulia | Rustici, Alessandro | Bigazzi, Samuele | Gerini, Adriana | Tombini, Tullia | Mazzoleni, Stefano

Article Type: Research Article

Abstract: BACKGROUND: Powered robotic exoskeletons represent an emerging technology for the gait training of Spinal Cord Injured (SCI) persons. The analysis of the psychological and physical impact of such technology on the patient is crucial in terms of clinical appropriateness of such rehabilitation intervention for SCI persons. OBJECTIVE: To investigate the acceptability of overground robot-assisted walking and its effect on pain and spasticity. METHODS: Twenty-one SCI persons participated in a walking session assisted by a powered robotic exoskeleton. Pain assessed using a Numeric Rating Scale (NRS) and muscle spasticity, assessed as subjective perception using an NRS …scale and as objective assessment using the Modified Ashworth scale and the Penn scale, were evaluated before and after the walking experience. Positive and negative sensations were investigated using a questionnaire. The patient’s global impression of change (PGIC) scale was administrated as well. RESULTS: After the walking session a significant decrease in the muscle spasticity and pain intensity was observed. The SCI persons recruited in this study reported (i) a global change after the walking session, (ii) high scores on the positive and (iii) low scores on the negative sensations, thus indicating a good acceptability of the robot-assisted walking. CONCLUSIONS: The overground robot-assisted walking is well accepted by SCI persons and has positive effects in terms of spasticity and pain reduction. Show more

Keywords: Spinal cord injury, robotics, rehabilitation, spasticity, pain

DOI: 10.3233/NRE-161358

Citation: NeuroRehabilitation, vol. 39, no. 2, pp. 277-283, 2016