NeuroRehabilitation - Volume 41, issue 1

Authors: Lemaire, Edward D. | Smith, Andrew J. | Herbert-Copley, Andrew | Sreenivasan, Vidya

Article Type: Research Article

Abstract: BACKGROUND: Recent advances in exoskeleton technology has made lower extremity powered exoskeletons (LEPE) a viable treatment tool to restore upright walking mobility to persons with spinal cord injury (SCI). OBJECTIVE: Evaluate ARKE exoskeleton training within a rehabilitation centre environment. METHODS: Case studies are presented for two male participants, age 41 and 30, motor complete SCI at T6 (N01) and T12 (N02), respectively, as they progress from new LEPE users to independent walking. The ARKE 2.0 LEPE (Bionik Laboratories Inc., Toronto, Canada) was used for all training (hip and knee powered, forearm crutches, control tablet). Data …were collected on session times, activity metrics from ARKE system logs, and qualitative questionnaire feedback. RESULTS AND CONCLUSION: N01 required 18, 30-minute training sessions to achieve independent walking. N01 walked independently within the 12 session target. Foot strikes were frequently before the end of the programmed swing phase, which were handled by the ARKE control system. Subjective ratings of LEPE learning, comfort, pain, fatigue, and overall experience were high for sitting-standing and moderate to high for walking. This reflected the complexity of learning to safely walk. Qualitative feedback supported the continuation of LEPE use in rehabilitation settings based on end-user desire for upright mobility. Show more

Keywords: Exoskeleton, gait, training, neurorehabilitation, spinal cord injury, powered orthosis

DOI: 10.3233/NRE-171461

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 97-103, 2017

Authors: Tăut, Diana | Pintea, Sebastian | Roovers, Jan-Paul W.R. | Mañanas, Miguel-Angel | Băban, Adriana

Article Type: Research Article

Abstract: BACKGROUND: Evidence for the effectiveness of serious games (SGs) and their various features is inconsistent in the motor rehabilitation field, which makes evidence based development of SGs a rare practice. OBJECTIVE: To investigate the effectiveness of SGs in motor rehabilitation for upper limb and movement/balance and to test the potential moderating role of SGs features like feedback, activities, characters and background. METHODS: We ran a meta-analysis including 61 studies reporting randomized controlled trials (RCTs), controlled trials (CTs) or case series designs in which at least one intervention for motor rehabilitation included the use of SGs …as standalone or in combination. RESULTS: There was an overall moderate effect of SGs on motor indices, d  = 0.59, [95% CI, 0.48, 0.71], p  <  0.001. Regarding the game features, only two out of 17 moderators were statistically different in terms of effect sizes: type of activity (combination of group with individual activities had the highest effects), and realism of the scenario (fantasy scenarios had the highest effects). CONCLUSIONS: While we showed that SGs are more effective in improving motor upper limb and movement/balance functions compared to conventional rehabilitation, there were no consistent differences between various game features in their contribution to effects. Further research should systematically investigate SGs features that might have added value in improving effectiveness. Show more

Keywords: Serious game, motor rehabilitation, meta-analysis, effectiveness, game features

DOI: 10.3233/NRE-171462

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 105-118, 2017

Authors: Cohen-Holzer, Marilyn | Sorek, Gilad | Schweizer, Maayan | Katz-Leurer, Michal

Article Type: Research Article

Abstract: BACKGROUND: An intensive hybrid program, combining constraint with bimanual training, improves upper extremity function as well as walking endurance of children with unilateral cerebral palsy (UCP). Endurance improvement may be associated with the cardiac autonomic regulation system (CARS) adaptation, known to be impaired among these children. OBJECTIVE: To examine the influence of an intensive hybrid program on CARS, walking endurance and the correlation with upper extremity function of children with UCP. METHODS: Twenty-four children aged 6–10 years with UCP participated in a hybrid program, 10 days, 6 hours per day. Data were collected pre-, post- …and 3-months post-intervention. Main outcome measures included the Polar RS800CX for heart rate (HR) and heart rate variability (HRV) data, the 6-Minute Walk Test (6MWT) for endurance, and the Assisting Hand Assessment (AHA) and Jebsen-Taylor Test of Hand Function (JTTHF) for bimanual and unimanual function. RESULTS: A significant reduction in HR and an increase in HRV at post- and 3-month post-intervention was noted ( χ 2 2 = 8.3, p  = 0.016) along with a significant increase in 6MWT with a median increase of 81 meters ( χ 2 2 = 11.0, p  = 0.004) at the same interval. A significant improvement was noted in unimanual and bimanual performance following the intervention. CONCLUSIONS: An intensive hybrid program effectively improved CARS function as well as walking endurance and upper extremity function in children with UCP (213). Show more

Keywords: Bimanual, cardiac autonomic regulatory system (CARS), constraint, heart rate, gait endurance, hybrid, variability, unilateral cerebral palsy

DOI: 10.3233/NRE-171463

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 119-126, 2017

Authors: Wolny, Tomasz | Linek, Paweł | Michalski, Paweł

Article Type: Research Article

Abstract: BACKGROUND: The two-point discrimination (2PD) test is widely used in clinical practice to assess tactile acuity and central somatosensory function in stroke patients. OBJECTIVES: The aim of this study was to evaluate the reliability of 2PD test in fingers on the affected and non-affected sides in acute stroke patients. METHODS: This was a single group repeated-measures inter-rater reliability study. Thirty adults with completed ischemic stroke and left paresis participated in the study. Static 2PD sensation was assessed using a standardized Dellon discriminator. Two examiners performed measurements of 2PD sensation on both hands. Each examiner made …three series of measurements at intervals of 1 minute. After 15 minutes, the study was conducted in the same order by a second examiner. RESULTS: The ability for 2PD sensation was significantly reduced in all examined fingers on the affected side in comparison to the non-affected side. The difference was statistically significant (in each case, p  < 0.0001). Inter-rater reliability (ICC2,1 ) for the first measurement at the affected site ranged from 0.95 to 0.98; at the non-affected site ranged from 0.30 to 0.82. Analysis of the average value of three measurements (ICC2,3 ) yielded values for the affected site ranging from 0.98 to 0.99; at the non-affected site ranged from 0.81 to 0.95. CONCLUSIONS: The 2PD sensation values for all fingers were higher for the affected site in comparison to the non-affected site. Conducting three repeatable measurements ensures measurement reliability and repeatability when evaluating 2PD sensation in fingers on both sides in acute stroke patients. Show more

Keywords: Stroke, discrimination sensation, reliability

DOI: 10.3233/NRE-171464

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 127-134, 2017

Authors: Khanittanuphong, Phichamon | Tipchatyotin, Suttipong

Article Type: Research Article

Abstract: BACKGROUND: Gait abnormality commonly resulted from stroke which affected patients living and probably quality of life (QOL). OBJECTIVE: To assess the relationship between gait speed and the QOL in Thai stroke patients and to compare the QOL among three patient groups that were categorized by gait speed: i) household ambulators <0.4 m/s, ii) limited community ambulators 0.4–0.8 m/s and iii) community ambulators >0.8 m/s. METHODS: This was a cross-sectional descriptive research study. The demographic data of 92 stroke patients at Songklanagarind Hospital in Thailand were collected. The gait speed was calculated by the 10 meter walk test. The …Thai version of the Stroke Impact Scale (SIS) 3.0 evaluated the QOL of the patients. RESULTS: The gait speed was correlated with the SIS score (r  = 0.64, p  <  0.001). The relationship between the gait speed and most domains of the SIS (i.e., strength, mobility, hand function, activities of daily living [ADL], emotion, social participation and thinking of recovery) were also statistically significant. The community ambulators had a higher total SIS score (729.8) than the limited community (600.8) or household ambulators (478.8) (p  <  0.001). For each SIS domain mentioned above, there were significant mean scores except for emotion in the community ambulators compared with the others. CONCLUSIONS: The gait speed was significantly correlated with the physical domains of the QOL in stroke patients. The community ambulators had the highest QOL among the three groups. Show more

Keywords: Gait speed, quality of life, stroke, community ambulation

DOI: 10.3233/NRE-171465

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 135-141, 2017

Authors: Nozoe, Masafumi | Kanai, Masashi | Kubo, Hiroki | Takeuchi, Yuka | Kobayashi, Miki | Yamamoto, Miho | Furuichi, Asami | Yamazaki, Makoto | Shimada, Shinichi | Mase, Kyoshi

Article Type: Research Article

Abstract: BACKGROUND: Stroke-related muscle wasting is one of the factors leading to long-term disability and functional dependency. No study has reported an effective therapeutic intervention for such muscle wasting. OBJECTIVE: The purpose of this study was to investigate the effects of neuromuscular electrical stimulation (NMES) on quadriceps muscle mass preservation in patients with acute moderate or severe stroke by using ultrasonography (US). METHODS: Twenty patients with acute, moderate, or severe stroke (age: 68±11 years) were divided into usual care group (control group) and intervention groups (NMES group), respectively. Patients in the NMES group underwent NMES treatment …for bilateral quadriceps muscles for 2 weeks in addition to the usual care. Quadriceps muscle thickness was measured on admission and 2 weeks after the first measurement. RESULTS: The quadriceps muscle thickness on the paretic and non-paretic sides in the NMES group (–12.4% ±12.7%, –5.5% ±15.3%, respectively) significantly decreased to a lesser degree than that in the control group (–29.5% ±12.1%, P  = 0.004; and –22.0% ±16.8%, P  = 0.04, respectively). CONCLUSIONS: NEMS seemed to have preserved the quadriceps muscle mass in patients with moderate or severe acute stroke. Show more

Keywords: Neuromuscular electrical stimulation, muscle wasting, acute stroke

DOI: 10.3233/NRE-171466

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 143-149, 2017

Authors: Moon, Sung-Jun | Kim, Tae-Ho

Article Type: Research Article

Abstract: BACKGROUND: Three-dimensional spine stabilization exercise can strengthen the trunk muscles with minimal spine movement. OBJECTIVE: To investigate the effects of the newly developed Spine Balance three-dimensional (3D) system on trunk strength and gait abilities of chronic stroke patients. METHODS: Twenty-four chronic stroke patients were randomly assigned to an experimental (n  = 12) or control group (n  = 12). The experimental and control groups performed spine stabilization exercise by using the newly developed Spine Balance 3D system and the well-known Bridge exercise thrice a week for 30 min per day for 7 weeks. Timed up and go (TUG) test, …10-m walking test (10-m WT), trunk muscle strength, and gait ability were evaluated before and after 7 weeks of intervention. RESULTS: The 10-m WT, TUG, walking speed, non-affected side step length, and distance in the experimental group, wherein trunk muscle strength was checked by using the Spine Balance 3D system evaluation program, showed more significant improvement than those in the control group (p  < 0.05). CONCLUSION: We suggest that the newly developed Spine Balance 3D system can be a more useful therapeutic tool for rehabilitation of trunk muscle strength and gait abilities than bridge exercise-based spine stabilization exercise in chronic stroke patients. Show more

Keywords: Gait, spine balance 3D system, stroke, trunk strength

DOI: 10.3233/NRE-171467

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 151-159, 2017

Authors: Yu, Ga-Hui | Lee, Jae-Shin | Kim, Su-Kyoung | Cha, Tae-Hyun

Article Type: Research Article

Abstract: BACKGROUND: Rhythm and timing training is stimulation that substitutes for a damaged function controls muscular movement or temporal element, which has positive impacts on the neurological aspect and movement of the brain. OBJECTIVE: This study is to assess the changes caused by rhythm and timing training using an interactive metronome (IM) on upper extremity function, ADL and QOL in stroke patients. METHODS: In order to assess the effects of IM training, a group experiment was conducted on 30 stroke patients. Twelve sessions of IM training were provided for the experimental group three times a week …for four weeks, while the control group was trained with a Bilateral arm Self-Exercise (BSE) for the same period. Both groups were evaluated by pre- and post-tests through MFT, MAL, K-MBI and SS-QOL. RESULT: There were more statistically significant differences (<0.05) in the total score of MFT and the finger control item in the IM Group than in the BSE Group. With respect to ADL, there were more statistically significant differences (<0.05) in the total score of K-MBI and the dressing item in the IM Group than in the BSE Group. CONCLUSION: The study proposes that IM training can be applied as an occupational therapy program in patients with various diseases who need to adjust the time for performing movements as well as stroke patients. Show more

Keywords: Interactive metronome, rhythm and timing, Bilateral arm Self-Exercise (BSE), stroke

DOI: 10.3233/NRE-171468

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 161-168, 2017

Authors: Park, Jihong | Lee, Shi-Uk | Jung, Se Hee

Article Type: Research Article

Abstract: BACKGROUND: Cognitive impairment is frequently seen in patients with stroke. The possible correlation between cognitive function and functional mobility has been proposed; however, the prognostic importance of early cognitive function in recovery of mobility has not been investigated in patients with stroke. OBJECTIVE: The objective of this study is to investigate whether the cognitive function in the acute phase can independently predict the recovery of mobility after stroke, and to determine the cut-off value of each cognitive evaluation test for community ambulation at six months. METHODS: Seventy two patients underwent four domain-specific neuropsychological evaluation tests …at about two weeks after stroke; these included the word list memory test (WMT), construction praxis test (CPT), verbal fluency test (VFT) and Boston naming test (BNT). The Functional Ambulation Category (FAC) and ambulatory zone (AZ) at six months after stroke were investigated as outcome variables. The domain-specific cognitive function, along with other possible predictors for functional mobility, was analyzed with regression analysis. RESULTS: The z-scores of WMT (p  = 0.018) and VFT (p  = 0.012) were related to the independence in ambulation. The z-scores of VFT (p  = 0.006) and CPT (p  = 0.009) were predictors for community ambulation, with the cut-off values of –2.215 for VFT, and of –0.845 for CPT. CONCLUSIONS: Cognitive impairment in the acute phase of stroke can be an independent prognostic factor of functional mobility. Domain-specific neuropsychological evaluation tests should be considered in the acute phase of stroke to predict the recovery of functional mobility. Show more

Keywords: Stroke, cognition, rehabilitation, patient outcome assessment, locomotion

DOI: 10.3233/NRE-171469

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 169-177, 2017

Authors: Stern-Nezer, Sara | Eyngorn, Irina | Mlynash, Michael | Snider, Ryan W. | Venkatsubramanian, Chitra | Wijman, Christine A.C. | Buckwalter, Marion S.

Article Type: Research Article

Abstract: BACKGROUND: Poststroke depression is the most common psychiatric sequelae of stroke, and it’s independently associated with increased morbidity and mortality. Few studies have examined depression after intracranial hemorrhage (ICH). OBJECTIVE: To investigate the relationship between depression, ICH and outcomes. METHODS: A substudy of the prospective Diagnostic Accuracy of MRI in Spontaneous Intracerebral Hemorrhage (DASH) study, we included 89 subjects assessed for depression 1 year after hemorrhage. A Hamilton Depression Rating Scale score >10 defined depression. Univariate, multivariable, and trend analyses evaluated relationships between depression, clinical, radiographic, and inflammatory factors and modified Rankin score (mRS) at …90 days and one year. RESULTS: Prevalence of depression at one year was 15%. Depression was not associated with hematoma volumes, presence of IVH or admission NIHSS, nor with demographic factors. Despite this, depressed patients had worse 1-year outcomes (p  = 0.004) and were less likely to improve between 3 and 12 months, and more likely to worsen (p  = 0.042). CONCLUSION: This is the first study to investigate depression one year after ICH. Post-ICH depression was common and associated with late worsening of disability unrelated to initial hemorrhage severity. Further research is needed to understand whether depression is caused by worsened disability, or whether the converse is true. Show more

Keywords: Depression, ICH, inflammation, outcome, modified rankin scale

DOI: 10.3233/NRE-171470

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 179-187, 2017