NeuroRehabilitation - Volume 41, issue 1

Authors: Krebs, Hermano Igo

Article Type: Introduction

DOI: 10.3233/NRE-171451

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 1-3, 2017

Authors: Duret, Christophe | Mazzoleni, Stefano

Article Type: Research Article

Abstract: BACKGROUND: During the last two decades, extensive interaction between clinicians and engineers has led to the development of systems that stimulate neural plasticity to optimize motor recovery after neurological lesions. This has resulted in the expansion of the field of robotics for rehabilitation. Studies in patients with stroke-related upper-limb paresis have shown that robotic rehabilitation can improve motor capacity. However, few other applications have been evaluated (e.g. tremor, peripheral nerve injuries or other neurological diseases). PURPOSE: This paper presents an overview of the current use of upper limb robotic systems for neurorehabilitation, and highlights the rationale behind …their use for the assessment and treatment of common neurological disorders. CONCLUSIONS: Rehabilitation robots are little integrated in clinical practice, except after stroke. Although few studies have been carried out to evaluate their effectiveness, evidence from the neurosciences and indications from pilot studies suggests that upper limb robotic rehabilitation can be applied safely in various other neurological conditions. Rehabilitation robots provide an intensity, quality and dose of treatment that exceeds therapist-mediated rehabilitation. Moreover, the use of force fields, multi-sensory environments, feedback etc. renders such rehabilitation engaging and motivating. Future studies should evaluate the effectiveness of rehabilitation robots in neurological pathologies other than stroke. Show more

Keywords: Hemiparesis, motor learning, multiple sclerosis, neglect, neurorehabilitation, Parkinson disease, robotics, spinal cord injury, stroke

DOI: 10.3233/NRE-171452

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 5-15, 2017

Authors: Pizzamiglio, Sara | Desowska, Adela | Shojaii, Pegah | Taga, Myriam | Turner, Duncan L.

Article Type: Research Article

Abstract: BACKGROUND: Muscle co-contraction is a strategy of increasing movement accuracy and stability employed in dealing with force perturbation of movement. It is often seen in neuropathological populations. The direction of movement influences the pattern of co-contraction, but not all movements are easily achievable for populations with motor deficits. Manipulating the direction of the force instead, may be a promising rehabilitation protocol to train movement with use of a co-contraction reduction strategy. Force field learning paradigms provide a well described procedure to evoke and test muscle co-contraction. OBJECTIVE: The aim of this study was to test the muscle …co-contraction pattern in a wide range of arm muscles in different force-field directions utilising a robot-mediated force field learning paradigm of motor adaptation. METHOD: Forty-two participants volunteered to participate in a study utilising robot-mediated force field motor adaptation paradigm with a clockwise or counter-clockwise force field. Kinematics and surface electromyography (EMG) of eight arm muscles were measured. RESULTS: Both muscle activation and co-contraction was earlier and stronger in flexors in the clockwise condition and in extensors in the counter-clockwise condition. CONCLUSIONS: Manipulating the force field direction leads to changes in the pattern of muscle co-contraction. Show more

Keywords: Motor adaptation, force-field learning, EMG, co-contraction, rehabilitation

DOI: 10.3233/NRE-171453

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 17-29, 2017

Authors: Grosmaire, Anne-Gaëlle | Duret, Christophe

Article Type: Research Article

Abstract: BACKGROUND: Repetitive, active movement-based training promotes brain plasticity and motor recovery after stroke. Robotic therapy provides highly repetitive therapy that reduces motor impairment. However, the effect of assist-as-needed algorithms on patient participation and movement quality is not known. OBJECTIVE: To analyze patient participation and motor performance during highly repetitive assist-as-needed upper limb robotic therapy in a retrospective study. METHODS: Sixteen patients with sub-acute stroke carried out a 16-session upper limb robotic training program combined with usual care. The Fugl-Meyer Assessment (FMA) score was evaluated pre and post training. Robotic assistance parameters and Performance measures were …compared within and across sessions. RESULTS: Robotic assistance did not change within-session and decreased between sessions during the training program. Motor performance did not decrease within-session and improved between sessions. Velocity-related assistance parameters improved more quickly than accuracy-related parameters. CONCLUSIONS: An assist-as-needed-based upper limb robotic training provided intense and repetitive rehabilitation and promoted patient participation and motor performance, facilitating motor recovery. Show more

Keywords: Hemiparesis, assist-as-needed, motor performance, participation, robotic therapy

DOI: 10.3233/NRE-171454

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 31-39, 2017

Authors: Friel, Kathleen M. | Lee, Peter | Soles, Lindsey V. | Smorenburg, Ana R.P. | Kuo, Hsing-Ching | Gupta, Disha | Edwards, Dylan J.

Article Type: Research Article

Abstract: BACKGROUND: Robotic therapy can improve upper limb function in hemiparesis. Excitatory transcranial direct current stimulation (tDCS) can prime brain motor circuits before therapy. OBJECTIVE: We tested safety and efficacy of tDCS plus robotic therapy in an adult with unilateral spastic cerebral palsy (USCP). METHODS: In each of 36 sessions, anodal tDCS (2 mA, 20 min) was applied over the motor map of the affected hand. Immediately after tDCS, the participant completed robotic therapy, using the shoulder, elbow, and wrist (MIT Manus). The participant sat in a padded chair with affected arm abducted, forearm supported, and hand grasping …the robot handle. The participant controlled the robot arm with his affected arm to move a cursor from the center of a circle to each of eight targets (960 movements). Motor function was tested before, after, and six months after therapy with the Wolf Motor Function Test (WMFT) and Fugl-Meyer (FM). RESULTS: Reaching accuracy on the robot task improved significantly after therapy. The WMFT and FM improved clinically meaningful amounts after therapy. The motor map of the affected hand expanded after therapy. Improvements were maintained six months after therapy. CONCLUSIONS: Combined tDCS and robotics safely improved upper limb function in an adult with USCP. Show more

Keywords: Neuromodulation, neuroplasticity, rehabilitation

DOI: 10.3233/NRE-171455

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 41-50, 2017

Authors: Cortes, Mar | Medeiros, Ana Heloisa | Gandhi, Aasta | Lee, Peter | Krebs, Hermano Igo | Thickbroom, Gary | Edwards, Dylan

Article Type: Research Article

Abstract: BACKGROUND: Recovering hand function has important implications for improving independence of patients with tetraplegia after traumatic spinal cord injury (SCI). Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that has potential to improve motor function. OBJECTIVE: To investigate the effects of one session of 1 mA, 2 mA, and sham anodal tDCS (a-tDCS) in the upper extremity (hand) motor performance (grasp and lease) in patients with chronic cervical SCI. METHODS: Eleven participants with incomplete SCI were randomized to receive 20 minutes of 1 mA, 2 mA, or sham stimulation over the targeted motor cortex over three separated …sessions. Hand motor performance was measured by a hand robotic evaluation (kinematics) and the Box and Blocks (BB) test before and after the stimulation period. RESULTS: A significant improvement on the grasp mean to peak speed ratio (GMP) was observed in the 2 mA group (pre: 0.38±0.02; post: 0.43±0.03; mean±SEM; p  = 0.031). There was no statistically significant difference in BB test results, however the 2 mA intervention showed a positive trend for improvement. CONCLUSIONS: A single session of 2 mA of a-tDCS showed gains in hand motor function in patients with chronic SCI that were not observed in functional clinical scales. The use of robotic kinematics showed promising results in assessing small changes in motor performance. Further studies are necessary to determine whether tDCS can be an effective long-term rehabilitation strategy for individuals with SCI. Show more

Keywords: tDCS, hand robot, motor recovery, spinal cord injury

DOI: 10.3233/NRE-171456

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 51-59, 2017

Authors: Chang, Johanna L. | Lin, Regina Y. | Saul, Maira | Koch, Philip J. | Krebs, Hermano Igo | Volpe, Bruce T.

Article Type: Research Article

Abstract: BACKGROUND: Robotic driven treatment plans targeting isolated joints of the upper limb have improved the sensorimotor condition of patients with stroke. Similar intensive efforts to allay lower limb gait impairment have not been so successful. In patients with stroke, targeted robot assisted training of the ankle joint, in a seated position, has demonstrated significant alterations in ankle stiffness and foot-ankle orientation at foot strike which may provide a new treatment option for gait impairment. OBJECTIVE: To determine if isolated robot-assisted training of the ankle joint improves chronic hemiparetic gait in patients with stroke who are categorized according …to baseline gait impairment. METHODS: Patients with chronic stroke (>6mo) and hemiparetic gait (N = 29) received 18 sessions of isolated robot-assisted motor training of the ankle (3×/week for 6 weeks). All participants had stable clinical baseline scores across three admission measures, and no participant was receiving simultaneous outpatient rehabilitation. Baseline gait speed determined three impairment groups: high, >0.8 m/s; medium, 0.4–0.8 m/s; low, <0.4 m/s. Outcome measures included the Berg Balance Scale, the 6 Minute Walk Test, and the 10 Meter Walk Test, and were recorded upon admission, discharge, and 3 months following intervention. RESULTS: Three distinct and significant between-group patterns of recovery emerged for gait speed. The within-group analysis showed that the medium and high group exhibited significant improvements in gait speed and endurance upon discharge, that were maintained at 3-months. Gait speed improvements were clinically significant (>0.16 m/s) for the high function group across all gait speed and endurance measures at discharge and at 3 months. The moderate group also exhibited clinically significant improvements at follow-up on the 10 Meter Walk Test, fast pace (0.16 m/sec), and approached clinical significance for the 10 Meter Walk comfortable pace (0.12 m/sec). The low group had small but significant improvements, at discharge on two of the three gait measures, and these improvements were maintained at 3 months. For balance measures, the low and moderate impairment groups had significant improvements at discharge that were robust on follow-up measure. The high function group demonstrated no significant change in balance. CONCLUSIONS: Joint-specific robotic training of the paretic ankle provided the most benefit to individuals with moderate or mild gait speed impairments after stroke. Baseline gait speed function (low, moderate, high) was associated with three distinct recovery profiles. This suggests that severity-specific intervention may be critical to improving efficiency of stroke recovery. Show more

Keywords: Stroke, hemiparesis, robotic training, gait rehabilitation, physical therapy

DOI: 10.3233/NRE-171457

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 61-68, 2017

Authors: Michmizos, Konstantinos P. | Krebs, Hermano Igo

Article Type: Research Article

Abstract: BACKGROUND: Robot-aided sensorimotor therapy imposes highly repetitive tasks that can translate to substantial improvement when patients remain cognitively engaged into the clinical procedure, a goal that most children find hard to pursue. Knowing that the child’s brain is much more plastic than an adult’s, it is reasonable to expect that the clinical gains observed in the adult population during the last two decades would be followed up by even greater gains in children. Nonetheless, and despite the multitude of adult studies, in children we are just getting started: There is scarcity of pediatric robotic rehabilitation devices that are currently …available and the number of clinical studies that employ them is also very limited. PURPOSE: We have recently developed the MIT’s pedi-Anklebot, an adaptive habilitation robotic device that continuously motivates physically impaired children to do their best by tracking the child’s performance and modifying their therapy accordingly. The robot’s design is based on a multitude of studies we conducted focusing on the ankle sensorimotor control. In this paper, we briefly describe the device and the adaptive environment we built around the impaired children, present the initial clinical results and discuss how they could steer future trends in pediatric robotic therapy. CONCLUSIONS: The results support the potential for future interventions to account for the differences in the sensorimotor control of the targeted limbs and their functional use (rhythmic vs. discrete movements and mechanical impedance training) and explore how the new technological advancements such as the augmented reality would employ new knowledge from neuroscience. Show more

Keywords: Rehabilitation robotics, robot-aided therapy, robot-aided neurorehabilitation, pediatric, cerebral palsy, adaptive robotic therapy

DOI: 10.3233/NRE-171458

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 69-76, 2017

Authors: Hirano, Satoshi | Saitoh, Eiichi | Tanabe, Shigeo | Tanikawa, Hiroki | Sasaki, Shinya | Kato, Daisuke | Kagaya, Hitoshi | Itoh, Norihide | Konosu, Hitoshi

Article Type: Research Article

Abstract: BACKGROUND: In a patient with severe hemiplegia, the risk of the knee giving way is high during the early stage of gait exercise with an ankle-foot orthosis. However, use of a knee-ankle-foot orthosis has many problems such as large amount of assistance and compensatory motions. To resolve these problems, we have engaged in the development of the Gait Exercise Assist Robot (GEAR). OBJECTIVE: To evaluate the improvement efficiency of walk with GEAR in a stroke patient. METHODS: The subject was a 70-year-old man presented with left thalamus hemorrhage and right hemiplegia. The patient underwent exercise …with the GEAR 5 days a week, for 40 minutes per day. We evaluated the Functional Independence Measure score for walk (FIM-walk score) every week. The control group consisted of 15 patients aged 20–75 years with hemiplegia after primary stroke, who had equivalent walking ability with the subject at start. As the primary outcome, we defined improvement efficiency of FIM-walk, which was gain of FIM-walk divided the number of required weeks. RESULTS: Improvement efficiency of FIM-walk of the subject was 1.5, while that of control group was 0.48±3.2 (mean±SD). CONCLUSIONS: GEAR is potentially useful for gait exercise in hemiplegic patients. Show more

Keywords: Robotic therapy, gait training, stroke

DOI: 10.3233/NRE-171459

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 77-84, 2017

Authors: Tanabe, Shigeo | Koyama, Soichiro | Saitoh, Eiichi | Hirano, Satoshi | Yatsuya, Kanan | Tsunoda, Tetsuya | Katoh, Masaki | Gotoh, Takeshi | Furumoto, Ayako

Article Type: Research Article

Abstract: BACKGROUND: Patients with tetraplegia can achieve independent gait with lateral-type powered exoskeletons; it is unclear whether medial-type powered exoskeletons allow for this. OBJECTIVE: To investigate gait training with a medial-type powered exoskeleton wearable power-assist locomotor (WPAL) in an individual with incomplete cervical (C5) and complete thoracic (T12) spinal cord injury (SCI). METHODS: The 60-session program was investigated retrospectively using medical records. Upon completion, gait performance was examined using three-dimensional motion analyses and surface electromyography (EMG) of the upper limbs. RESULTS: The subject achieved independent gait with WPAL and a walker in 12 sessions. …He continuously extended his right elbow; his left elbow periodically flexed/extended. His pelvic inclination was larger than the trunk inclination during single-leg stance. EMG activity was increased in the left deltoid muscles during ipsilateral foot-contact. The right anterior and medial deltoid muscle EMG activity increased just after foot-off for each leg, as did the right biceps activity. Continuous activity was observed in the left triceps throughout the gait cycle; activity was unclear in the right triceps. CONCLUSIONS: These results suggest the importance of upper limb residual motor function, and may be useful in extending the range of clinical applications for robotic gait rehabilitation in patients with SCI. Show more

Keywords: Clinical feasibility, gait, robotic exoskeleton, spinal cord injury

DOI: 10.3233/NRE-171460

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 85-95, 2017

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

Authors: Lam, Charlene L.M. | Yiend, Jenny | Lee, Tatia M.C.

Article Type: Review Article

Abstract: BACKGROUND: White matter lesions (WML) are prevalent in older adults. The association between WML and cognition in different subtypes of Mild Cognitive Impairment (MCI) is inconsistent in the literature. OBJECTVES: We aim to provide a systematic review on the impact of WML in different subtypes of MCI, and discuss the recent findings on white matter plasticity. METHODS: We reviewed peer-reviewed articles from January 2011 to August 2016 and identified 12 studies investigating the association between WML and subtypes of MCI with both neuroimaging and cognitive measures. RESULTS: Our review shows that 1) WM …abnormality was identified between different subtypes of MCI and healthy controls on diffusion imaging; 2) neither visual ratings of WML nor its volumetry differentiate different subtypes of MCI or its prognosis to dementia; and 3) cognitive correlates of WML were evident in the Amnestic-type MCI in the domains of memory, language, psychomotor speed, attention and executive functions. CONCLUSION: Cognitive reserve and the plasticity of white matter may modulate the impact of WML on the manifestation of the neurodegenerative disease. Further research is needed to study the plasticity of white matter in the MCI population to evaluate its potential clinical application. Show more

Keywords: White matter, Mild Cognitive Impairment, cognitive reserve, neuroplasticity, cognition

DOI: 10.3233/NRE-171471

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 189-204, 2017

Authors: Gougeon, Marie-Anne | Zhou, Lei | Nantel, Julie

Article Type: Research Article

Abstract: BACKGROUND: This study aimed to assess the effect of walking with Nordic Walking (NW) poles on postural stability and gait spatial-temporal characteristics in individuals with PD and to determine the cognitive load associated operating the poles. METHODS: Twelve individuals with PD (age: 61.6±11.7) were asked to perform four 90 s walking trials; with/without poles and with/without verbal fluency task (category fluency) after a 6-week independent NW training. We assessed gait spatial-temporal characteristics, and trunk postural stability using the APDM accelerometry system. RESULTS: Trunk frontal range of motion and peak velocity were smaller in NW compared to …normal walking with and without the cognitive task (p  < 0.01). Cadence, gait speed and stride length decreased in both pole conditions when performed with the cognitive task (p  < 0.05). However stride length was longer with poles compared to without poles. CONCLUSIONS: The reduced range of motion and velocity of the trunk in the frontal plane of motion suggest that NW can improve postural stability independently of the addition of a cognitive task. Compared to normal walking, spatial-temporal characteristics did not further decline when the cognitive task was combined to NW. This suggests that NW is a suitable practice for gait rehabilitation protocols in PD. Show more

Keywords: Nordic Walking, gait, Parkinson disease, trunk stability, postural balance

DOI: 10.3233/NRE-171472

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 205-210, 2017

Authors: Ozinga, Sarah J. | Koop, Mandy Miller | Linder, Susan M. | Machado, Andre G. | Dey, Tanujit | Alberts, Jay L.

Article Type: Research Article

Abstract: BACKGROUND: Postural instability is a hallmark of Parkinson’s disease. Objective metrics to characterize postural stability are necessary for the development of treatment algorithms to aid in the clinical setting. OBJECTIVE: The aim of this project was to validate a mobile device platform and resultant three-dimensional balance metric that characterizes postural stability. METHODS: A mobile Application was developed, in which biomechanical data from inertial sensors within a mobile device were processed to characterize movement of center of mass in the medial-lateral, anterior-posterior and trunk rotation directions. Twenty-seven individuals with Parkinson’s disease and 27 age-matched controls completed …various balance tasks. A postural stability metric quantifying the amplitude (peak-to-peak) of sway acceleration in each movement direction was compared between groups. The peak-to-peak value in each direction for each individual with Parkinson’s disease across all trials was expressed as a normalized value of the control data to identify individuals with severe postural instability, termed Cleveland Clinic-Postural Stability Index. RESULTS: In all conditions, the balance metric for peak-to-peak was significantly greater in Parkinson’s disease compared to controls (p  < 0.01 for all tests). CONCLUSIONS: The balance metric, in conjunction with mobile device sensors, provides a rapid and systematic metric for quantifying postural stability in Parkinson’s disease. Show more

Keywords: Parkinson’s disease, postural stability, mobile device, biomechanics

DOI: 10.3233/NRE-171473

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 211-218, 2017

Authors: Kuo, Yu-Chi | Chan, Jomei | Wu, Yu-Ping | Bernard, Jeffrey R. | Liao, Yi-Hung

Article Type: Research Article

Abstract: PURPOSE: The purpose of this study was to investigate the effects of 4-weeks expiratory muscle strength training (EMST) on the maximum expiratory pressure (PEmax) and quality of life (QoL) in patients with Parkinson disease (PD). METHODS: Thirteen outpatients diagnosed with PD participated in this study, and were assigned into either a 5DE training group (5DE group; n  = 4; 75% PEmax for 5-d/wk), 3DE training group (3DE group; n  = 5; 75% PEmax for 3-d/wk) and control group (3DC group; n  = 4; 0% PEmax for 3-d/wk) by matching their Hoehn and Yahr scale, genders, and age. The PEmax and …Parkinson disease questionnaire-39 item (PDQ-39) were evaluated pre- and post-intervention. RESULTS: The posttest PEmax of the 5DE was significantly higher than that of the 3DC (P  < 0.05). Moreover, 5DE and 3DE but not 3DC significantly increased PEmax after training. There were no differences in the overall quality of life in PD patients measured by PDQ-39 among three groups, but the 5DE group significantly improved the mobility constructs of PDQ-39 compared with 3DC (P  < 0.05). CONCLUSION: Both 5 d/wk and 3 d/wk of EMST effectively enhance respiratory muscle strength and improve mobility construct measured by PDQ-39 in patients with PD. Show more

Keywords: Parkinson disease, maximum expiratory pressures (PEmax), Parkinson disease questionnaire-39 item (PDQ-39)

DOI: 10.3233/NRE-171474

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 219-226, 2017

Authors: Brincks, John | Andersen, Elisabeth Due | Sørensen, Henrik | Dalgas, Ulrik

Article Type: Research Article

Abstract: BACKGROUND: It is relevant to understand the possible influence of impaired postural balance on walking performance in multiple sclerosis (MS) gait rehabilitation. OBJECTIVE: We expected associations between impaired postural balance and complex walking performance in mildly disabled persons with MS, but not in healthy controls. METHODS: Thirteen persons with MS (Expanded Disability Status Scale = 2.5) and 13 healthy controls’ walking performance were measured at fast walking speed, Timed Up & Go and Timed 25 Feet Walking. Postural balance was measured by stabilometry, 95% confidence ellipse sway area and sway velocity. RESULTS: Except from sway …velocity (p  = 0.07), significant differences were found between persons with MS and healthy controls in postural balance and walking. Significant correlations were observed between sway area and Timed Up & Go (r  = 0.67) and fastest safe walking speed (r  = –0.63) in persons with MS but not in healthy controls (r  = 0.52 and r  = 0.24, respectively). No other significant correlations were observed between postural balance and walking performance in neither persons with MS nor healthy controls. CONCLUSION: Findings add to the understanding of postural balance and walking in persons with MS, as impaired postural balance was related to complex walking performance. Exercises addressing impaired postural balance are encouraged in early MS gait rehabilitation. Show more

Keywords: Multiple sclerosis, static postural balance, dynamic postural balance, complex walking

DOI: 10.3233/NRE-171475

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 227-235, 2017

Authors: Felter, Cara E. | Bentley, Jacob A. | Sadowsky, Cristina L. | Wegener, Stephen T.

Article Type: Research Article

Abstract: BACKGROUND: There is a lack of evidence regarding the psychosocial characteristics of individuals with spinal cord injury (SCI) undergoing activity-based restorative therapy (ABRT) treatment. OBJECTIVES: This study seeks to describe the hopefulness of a sample of ABRT participants and describe the relationship between hopefulness and level of rehabilitation engagement. METHODS: A prospective cross-sectional cohort study was conducted using a convenience sample of 73 individuals with SCI (mean time since injury = 66.6 months) seeking out-patient, post-acute rehabilitation at a metropolitan ABRT center. Outcome measures included a demographic survey, The Hope Scale, the Patient Health Questionare-9 and the …Hopkins Rehabilitation Engagement Rating Scale. RESULTS: The ABRT group reported higher levels of hope (M  = 54.78, SD  = 7.13) than have been reported in a sample of individuals with SCI seeking traditional rehabilitation in the acute (M  = 24.58, SD  = 4.06) setting. Rehabilitation engagement was not related to hopefulness in the ABRT group. CONCLUSIONS: The ABRT group demonstrated high levels of hopefulness. The difference in hopefulness noted between this group and previous studies could be due to the time elapsed since injury, the presence of choice in the rehabilitation process, or the possibility that individuals who chose to participate in ABRT may have inherently different hopefulness characteristics than the broader SCI population. Show more

Keywords: Spinal cord injury, hope, rehabilitation, positive psychology

DOI: 10.3233/NRE-171476

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 237-240, 2017

Authors: Drummond, Melanie | Douglas, Jacinta | Olver, John

Article Type: Research Article

Abstract: BACKGROUND: Olfactory impairment (OI) can present in up to 66% of all individuals following traumatic brain injury (TBI) and can have significant implications for everyday life. OBJECTIVE: To investigate the predictive factors, natural progression and consequences of OI following TBI in individuals 12 months post injury. METHODS: In this prospective longitudinal study, 37 adults (28 males, 9 females), mean age 42.3 years (SD 19.4), with predominately severe TBI (mean length of posttraumatic amnesia (PTA) 28.6 days, SD 22.6) were assessed using the University of Pennsylvania Smell Identification Test (UPSIT). Each participant also participated in an …open ended interview to allow exploration of their experience of having OI. RESULTS: Thirty (83.33%) of the participants demonstrated persisting OI at 12 months. Nineteen of these participants demonstrated no change in their OI severity category and 4 produced a poorer performance. Thirteen participants (36.11%) demonstrated some recovery with 6 of these performing within the ‘normal’ range for age andgender. CONCLUSIONS: OI is an enduring impairment for a substantial proportion of individuals who experience it following severe TBI. It impacts a range of everyday activities, regardless of its severity, and requires comprehensive management during rehabilitation. Show more

Keywords: Acquired brain injury, traumatic brain injury, rehabilitation, olfaction, olfactory impairment, smell

DOI: 10.3233/NRE-171477

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 241-248, 2017

Authors: Di Martino, Siria | Unti, Elisa | Tramonti, Caterina | Mazzucchi, Sonia | Bonuccelli, Ubaldo | Rossi, Bruno | Ceravolo, Roberto | Chisari, Carmelo

Article Type: Research Article

Abstract: BACKGROUND: Pisa syndrome (PS) represents an important source of disability in Parkinson’s disease (PD). Currently no consensus has been reached on its definition or diagnostic criteria, and therapeutic approaches are unspecific and often futile. Recently the role of abdominal muscles, and in particular of the external oblique (EO), in the pathogenesis of PS was hypothesized. OBJECTIVES: To evaluate the role of EO and propose a combined therapeutic approach in the management of PS. METHODS: Ten PD patients with PS underwent a combined protocol based on repeated lidocaine injection in EO and rehabilitation program. RESULTS: …Our data confirm the primary role of EO muscles in PS pathogenesis and showed an improvement in truncal flexion and balance with a positive impact on patients’ quality of life after treatment. CONCLUSIONS: These data highlight the need for accurate characterization of PS focusing on the role of abdominal muscles and the need for a specific rehabilitation protocol for PS management. Show more

Keywords: Parkinson’s disease, postural deviation, trunk dystonia

DOI: 10.3233/NRE-171478

Citation: NeuroRehabilitation, vol. 41, no. 1, pp. 249-253, 2017