NeuroRehabilitation - Volume 40, issue 3

Authors: Pacheco, Thaiana Barbosa Ferreira | Oliveira Rego, Isabelle Ananda | Campos, Tania Fernandes | Cavalcanti, Fabrícia Azevedo da Costa

Article Type: Research Article

Abstract: BACKGROUND: Virtual Reality (VR) has been contributing to Neurological Rehabilitation because of its interactive and multisensory nature, providing the potential of brain reorganization. Given the use of mobile EEG devices, there is the possibility of investigating how the virtual therapeutic environment can influence brain activity. OBJECTIVE: To compare theta, alpha, beta and gamma power in healthy young adults during a lower limb motor task in a virtual and real environment. METHODS: Ten healthy adults were submitted to an EEG assessment while performing a one-minute task consisted of going up and down a step in a …virtual environment – Nintendo Wii virtual game “Basic step” – and in a real environment. RESULTS: Real environment caused an increase in theta and alpha power, with small to large size effects mainly in the frontal region. VR caused a greater increase in beta and gamma power, however, with small or negligible effects on a variety of regions regarding beta frequency, and medium to very large effects on the frontal and the occipital regions considering gamma frequency. CONCLUSIONS: Theta, alpha, beta and gamma activity during the execution of a motor task differs according to the environment that the individual is exposed – real or virtual – and may have varying size effects if brain area activation and frequency spectrum in each environment are taken into consideration. Show more

Keywords: Virtual Reality exposure therapy, physiotherapy, EEG

DOI: 10.3233/NRE-161426

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 391-400, 2017

Authors: Lewis, Frank D. | Horn, Gordon J.

Article Type: Research Article

Abstract: BACKGROUND: A need exists to better understand the impact of depression on functional outcomes following TBI. OBJECTIVES: To evaluate the prevalence and severity of depression among a large group of chronic TBI adults; to determine the impact of depression on outcomes of post-hospital residential rehabilitation programs; and to assess effectiveness of post-hospital residential rehabilitation programs in treating depression. METHODS: 820 adults with moderate to severe traumatic brain injury (TBI) were assigned to one of four groups based on MPAI- 4 depression ratings: (1) Not Depressed, (2) Mildly Depressed, (3) Moderately Depressed, and (4) Severely Depressed. …Functional status was assessed at admission and discharge with the MPAI-4 Participation Index. Differences among groups were evaluated using conventional parametric tests. Rasch analysis established reliability and validity of MPAI-4 data. RESULTS: Rasch analysis demonstrated satisfactory construct validity and internal consistency (Person reliability = 0.89–0.92, Item reliability = 0.99). Of the 820 subjects, 39% presented with moderate to severe depressive symptoms at admission, These subjects demonstrated significantly higher MPAI-4 Participation scores than the mild and not depressed groups. Depressed groups realized significant improvement in symptoms, but, those remaining depressed at discharge had significantly greater disability than those who improved. CONCLUSIONS: Depressive symptoms had a deleterious impact on outcome. Remediation of symptoms during rehabilitation significantly improved outcomes. Show more

Keywords: Traumatic brain injury, outcomes, depression, MPAI-4, Rasch analysis, post-hospital rehabilitation

DOI: 10.3233/NRE-161427

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 401-410, 2017

Authors: Wallace, Sarah E. | Donoso Brown, Elena V. | Fairman, Andrea D. | Beardshall, Koren | Olexsovich, Anna | Taylor, Alicia | Schreiber, James B.

Article Type: Research Article

Abstract: BACKGROUND: Portable electronic devices are increasingly being used for clinical assessment of individuals with cognitive deficits. Prior to implementation of tablet-based assessments, comparison with other standard measures is needed. OBJECTIVE: The study purpose was to compare an iPad administered cognitive assessment known as the Standardized Touchscreen Assessment of Cognition (STAC) to the Cognitive Linguistic Quick Test (CLQT) and the Cognitive Assessment of Minnesota (CAM). METHODS: Eighty-eight neurotypical participants completed the STAC, CAM, and CLQT in a randomized order. The researchers compared the participants’ responses across similar subtests. Performance across iPad comfort levels was also explored. …RESULTS: Findings revealed moderate correlations in some areas of assessment: generative naming and immediate visual memory. The correlations varied across age groups within each area of assessment with no consistent pattern. Additionally, people with comfort using an iPad performed significantly better on three areas of STAC assessment (generative naming category and first letter, and auditory working memory) compared to people who reported no iPad comfort. CONCLUSIONS: Initial testing of the STAC in a neurotypical population identified moderate correlations with standard measures in some subtests; however, additional testing of the STAC is needed to determine the clinical utility and validity of assessing populations with cognitive impairments. Show more

Keywords: Cognitive assessment, computerized assessment, wireless or mobile technology, iPad, self-administered

DOI: 10.3233/NRE-161428

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 411-420, 2017

Authors: Cioncoloni, David | Martelli, Lodovica | Rosignoli, Deborah | Mazzocchio, Riccardo

Article Type: Research Article

Abstract: BACKGROUND: Postural instability may result from altered sequencing of automatic motor programs for anticipatory postural corrections and/or impaired motor learning in Parkinson Disease (PD) patients. Comorbid white matter disease is a major determinant of axial motor impairment, leading to poorer stability than nigrostriatal dopaminergic denervation per se. OBJECTIVE: To assess differences in anticipatory control of postural stability function between subjects affected by PD with comorbid leukoaraiosis (LPD), idiopathic Parkinson disease (IPD) and elderly healthy subjects (EHS) as control group. METHODS: Eight patients with IPD, eight patients with LPD and eight age/weight matched elderly …healthy subjects (EHS) were tested in standing position by measuring the Center of Pressure (CoP) along the anteroposterior axis (CoP-Y) while subjects were expecting three repeated backward surface translation. RESULTS: LPD patients positioned the CoP-Y significantly backward while waiting for the second and third platform translations, with respect to their COP-Y position in preparation for the first translation. The IPD and EHS showed no significant differences in the COP-Y position among the repeated perturbation trials. CONCLUSIONS: LPD patients show inability to rescale an effective preparatory postural pattern to known, repeated postural perturbations suggesting impaired sensory-motor strategies in anticipating perturbations. Anticipatory postural patterns remain effective in IPD patients. Show more

Keywords: Parkinson disease, leukoaraiosis, rehabilitation, postural balance, prognosis

DOI: 10.3233/NRE-161429

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 421-427, 2017

Authors: Piazza, Stefano | Serrano-Muñoz, Diego | Gómez-Soriano, Julio | Torricelli, Diego | Segura-Fragosa, Antonio | Pons, José Luis | Taylor, Julian

Article Type: Research Article

Abstract: OBJECTIVE: Appropriate afferent feedback delivery during the execution of motor tasks is important for rehabilitation after incomplete spinal cord injury (iSCI). However, during leg-cycling therapy, the plantar afferent feedback is minimal. We hypothesize that the augmentation of sensory input by combining cycling with a locomotor-like stimulation of plantar cutaneous innervations (ES-cycling), might help to restore proper spinal processing of sensorimotor function. METHODS: Thirteen non-injured subjects and 10 subjects with iSCI performed 10 minutes of cycling and, on another session, of ES-cycling. To assess spinal processing of sensorimotor function, soleus H-reflex response was tested following a conditioning plantar …electrical stimulation applied at 25–100 ms inter-stimulus intervals (ISI’s), measured before and after the execution of the tasks. RESULTS: Before tasks execution, the conditioned H-reflex response was modulated in non-injured subjects, and absent in subjects with iSCI; after cycling, modulation profiles were unchanged. However, after ES-cycling a significant increase in H-reflex excitability was observed in the non-injured group at 100 ms ISI (p  < 0.05), and in the iSCI group between 50–75 ms ISI (p  < 0.001). CONCLUSION: The loss of reflex modulation in subjects with iSCI suggests reduced spinal processing of sensorimotor function. Reflex modulation recovery after ES-cycling may indicate the partial reactivation of these mechanisms. Show more

Keywords: Spinal cord injury, sensorimotor processing, soleus H-reflex, leg-cycling, afferent feedback

DOI: 10.3233/NRE-161430

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 429-437, 2017

Authors: Wouda, Eva M.N. | Stienstra, Ymkje | van der Werf, Tjip S. | Kerstjens, Huib | de Lange, Wiel C.M. | Coppes, Maarten | Kuijlen, Jos | Tepper, Marga | Akkerman, Onno W.

Article Type: Research Article

Abstract: BACKGROUND: Spinal tuberculosis (TB) accounts for approximately 1% to 3% of all TB cases and it can cause a wide range of neurological symptoms, from none to a complete spinal cord injury (SCI), resulting in complete paraplegia or tetraplegia. OBJECTIVES: To describe the functional and neurological outcome of SCI caused by TB. METHODS: Retrospective data on the admission period was combined with prospectively collected data on long-term follow-up. Primary outcome was neurological outcome in terms of motor function. Secondary outcome measures were functional outcome in terms of level of independence and community participation. Results were …compared to the outcome in patients with SCI due to trauma. RESULTS: Six TB patients with complete motor SCI (American Spinal Injury Association Impairment Scale (AIS) A or B) were compared to eighteen patients with traumatic SCI. Most TB patients regained almost full neurological function (median motor score improved from 50 to 100), and reached high levels of independence, whereas trauma patients did not improve neurologically (median motor score remained 50) and reached a plateau in level of independence. CONCLUSIONS: SCI due to tuberculosis in the Netherlands shows remarkable improvement in both neurological and functional outcome, especially compared with traumatic SCI. Show more

Keywords: Tuberculosis, spinal tuberculosis, spinal cord injuries, rehabilitation, treatment outcome

DOI: 10.3233/NRE-161431

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 439-445, 2017

Authors: Tavernese, E. | Petrarca, M. | Rosellini, G. | Di Stanislao, E. | Pisano, A. | Di Rosa, G. | Castelli, E.

Article Type: Research Article

Abstract: BACKGROUND: Hemiplegic Celebral Palsy (CP) children commonly use AFO orthoses as walking aids. It is known that AFOs may have a detrimental effect on gait. To enhance mechanical properties of AFOs we developed an innovative, custom-made, carbon, ankle-foot orthosis (Ca.M.O) which offers the opportunity to tune its response to the patient’s gait characteristics and/or functional maturity. OBJECTIVE: To assess the efficacy of Ca.M.O. in improving gait in a group of hemiplegic CP children and to compare its performances with those of commonly prescribed AFO. METHODS: A clinical and instrumental gait analysis was performed on a …group of 15 spastic hemiplegic children (WINTERS-GAGE type I-II) walking barefoot, with commonly prescribed AFOs and with Ca.M.O. Temporal, kinematic and kinetic data were collected with an 8 cameras optoelectronic system and 2 force plates. RESULTS: Studied variables were comparable walking with Ca.M.O. and with the commonly prescribed AFO and are significantly different (p  < 0.01) with respect to barefoot condition. CONCLUSIONS: Both types of orthoses normalize the kinematics of the first and second ankle rocker. The main advantage of Ca.M.O. is its modularity that allows to tune its effect on gait in relationship with the progress or involution of the child’s functional development. Show more

Keywords: Cerebral Palsy, monoplegic, infantile, orthotic devices, carbon fiber, Stereophotogrammetry

DOI: 10.3233/NRE-161432

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 447-457, 2017