NeuroRehabilitation - Volume 41, issue 2

Authors: Flansbjer, Ulla-Britt | Lexell, Jan | Brogårdh, Christina

Article Type: Research Article

Abstract: BACKGROUND: Reduced gait performance is common in persons with late effects of polio. OBJECTIVE: To identify predictors of change in gait performance over four years in persons with late effects of polio. METHODS: Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed “Up & Go” (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors …of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength. RESULTS: There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p  < 0.05), FGS (1.7%; p  < 0.001), and 6MWT (0.7%; p  < 0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (p  < 0.001). CONCLUSION: The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength. Show more

Keywords: Post poliomyelitis syndrome, gait, outcome assessment, longitudinal, rehabilitation

DOI: 10.3233/NRE-162057

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 403-411, 2017

Authors: Bulguroglu, I. | Guclu-Gunduz, A. | Yazici, G. | Ozkul, C. | Irkec, C. | Nazliel, B. | Batur-Caglayan, H.Z.

Article Type: Research Article

Abstract: BACKGROUND: Pilates is an exercise method which increases strength and endurance of core muscles and improves flexibility, dynamic postural control and balance. OBJECTIVE: To analyze and compare the effects of Mat and Reformer Pilates methods in Patients with Multiple Sclerosis (MS). METHODS: Thirty-eight patients with MS were included in the study. Participants were randomly divided into 3 groups as Mat Pilates, Reformer Pilates and control groups. The subjects in the Pilates groups did Mat or Reformer Pilates for 8 weeks, 2 days a week. The control group did breathing and relaxation exercises at home. Balance, functional …mobility, core stability, fatigue severity and quality of life were evaluated. RESULTS: Balance, functional mobility, core stability, fatigue severity and quality of life improved after Pilates in Mat and Reformer Pilates groups (p  < 0.05). On the other hand, we could not find any changing in the control group (p  > 0.05). When the gain obtained in the Pilates groups is compared, it has been observed that progress has been more in trunk flexor muscle strength in the Reformer Pilates group (p  < 0.05) and that the gain has been similar in the other parameters (p  > 0.05). CONCLUSIONS: As a result, patients with MS have seen similar benefits in Reformer Pilates and Mat Pilates methods. Show more

Keywords: Pilates, Multiple Sclerosis, balance, fatigue, quality of life

DOI: 10.3233/NRE-162121

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 413-422, 2017

Authors: Lena, Francesco | Iezzi, Ennio | Etoom, Mohammad | Santilli, Marco | Centonze, Diego | Foti, Calogero | Grillea, Giovanni | Modugno, Nicola

Article Type: Research Article

Abstract: BACKGROUND: Pisa syndrome (PS) or lateral axial dystonia is often seen in patients with Parkinson’s disease (PD). It is characterized by a marked and reversible lateral flexion of the trunk (LFT) more than 10°. OBJECTIVE: To assess the effectiveness of a program of postural exercises and assess the effectiveness in term of pattern of muscular hyperactivity. METHODS: A total of 6 patients with PD and PS enrolled in the program of 10 sessions of postural exercise (90 min/session). EMG of thoraco-lumbar paraspinal muscles was performed to detect the pattern of muscular hyperactivity. Outcomes were examined using the …Unified Parkinson’s Disease Rating Scale part II and part III, degree of LFT and Visual Analogues Scale for back pain. RESULTS: EMG showed two patterns of muscular hyperactivity; ipsilateral to the bending side and contralateral to the bending side. The exercise improved the outcomes in both groups. Patients with muscular hyperactivity ipsilateral to the bending side gained more improvements. CONCLUSION: Our results show that the exercise may be considered as a possible treatment for patients with PD and PS irrespective of the pattern of muscular activation. The effectiveness of exercise differed according to the pattern of muscular activation. Show more

Keywords: Parkinson’s disease, Pisa syndrome, dystonia, lateral trunk flexion, exercise, rehabilitation, axial bending

DOI: 10.3233/NRE-162033

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 423-428, 2017

Authors: Yesil, Hilal | Akkoc, Yesim | Karapolat, Hale | Güler, Ayse | Sungur, Ulas | Evyapan, Dilek | Gokcay, Figen

Article Type: Research Article

Abstract: BACKGROUND: Lower urinary tract dysfunction (LUTD) is one of the most frequently encountered problems in stroke. OBJECTİVE: To assess the validity and reliability of the Turkish Danish Prostatic Symptom Score (DAN-PSS) in stroke patients with LUTD. METHODS: A total of 50 patients were included in the study. The reliability was assessed using Cronbach α and intraclass correlation coefficient (ICC) methods, and the validity using the correlations between the subgroup and overall scores of DAN-PSS and the scores of the Barthel Index (BI), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and Short Form 36 (SF-36). …RESULTS: The Cronbach α values were found >0.97 and ICC 0.953-0.990 for all subgroup scores. We found a significant negative correlation between all the sub-scores of DAN-PSS and the BI, and a significant positive correlation between all the sub-scores of DAN-PSS and ICIQ-SF (p  < 0.05). The symptom score of DAN-PSS had a significant negative correlation with the physical functioning, physical and emotional role subdomains of the SF-36 survey (p  < 0.05). CONCLUSIONS: We have shown the reliability and validity of the Turkish DAN-PSS, and we think that it will be useful to utilize it in the monitoring of patients with stroke and in clinical studies. Show more

Keywords: Stroke, Danish Prostatic Symptom Score, validity, lower urinary tract dysfunction

DOI: 10.3233/NRE-162136

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 429-435, 2017

Authors: Khallaf, Mohamed E. | Ameer, Mariam A. | Fayed, Eman E.

Article Type: Research Article

Abstract: BACKGROUND: Most stroke patients experience hand impairments that can result in persistent limitations in daily activities. OBJECTIVE: This study aimed at estimating the immediate and retention effects of task specific training and wrist/fingers extension splint on hand joints range of motion and function after stroke. METHODS: Twenty-four right handed patients with first ever stroke represented the sample of the study. The participants were randomly assigned into two equal groups. The study group received task specific exercises five times a week for an hour concurrently with wrist/fingers extension splint which was used two hours for each three …hours (day and night) excluding exercises and sleeping hours for 16 weeks. The control group received traditional passive stretch and range of motion exercises. Manual dexterity and upper limb function were assessed by nine holes peg test and Fugl-Meyer upper extremity and hand. Goniometry was used for measuring wrist, metacarpophalangeal, thumb carpometacarpal joints active range of motion. RESULTS: Significant improvements were observed in nine holes peg test, Fugl-Meyer upper extremity and hand scores and ranges of motion at post-intervention and follow-up compared to pre-intervention at P ≤0.05. CONCLUSIONS: The results of this study provide an evidence that task specific training and wrist/fingers extension splint are effective in improving fingers dexterity, upper extremity function and wrist/hand range of motion. Show more

Keywords: Task specific training, hand, splint, stroke

DOI: 10.3233/NRE-162128

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 437-444, 2017

Authors: Shin, Jin | Chung, Yijung

Article Type: Research Article

Abstract: BACKGROUND: Many patients who have suffered from a stroke show decreased walking ability, characterized by asymmetric gait. For such patients, the recovery of symmetry in walking is important. OBJECTIVES: The purpose of this study is to investigate the effect of visual feedback with rhythmic auditory cue on treadmill gait in persons with chronic stroke. METHODS: Seventeen chronic subjects who have been diagnosed at least six months or before were recruited in G Hospital, located in Incheon. The subjects who were enrolled in this study were instructed to walk randomly on a treadmill: treadmill with visual feedback …and rhythmic auditory cue (VF+RAC), treadmill with visual feedback (VF), general treadmill (Control; non-feedback). Three factors were observed and estimated: paretic step length, non-paretic step length, spatial asymmetry ratio at comfortable speed. Also, in VF and VF+RAC, calibration of feedback accuracy was measured. RESULTS: Results showed that paretic step length and spatial asymmetry ratio were significantly improved in VF+RAC compared to that of the VF and control (p  < 0.05). Accuracies of paretic and non-paretic leg were significantly increased in VF+RAC than that of the VF (p  < 0.05). CONCLUSIONS: According to this result, it seems that application of VF+RAC in treadmill gait significantly improved gait of these patients. Also, we can conclude that VF+RAC in treadmill gait is thought to be useful in clinical settings where there are many chronic patients who are in need of improvement in their gait ability. Show more

Keywords: Gait, visual feedback, rhythmic auditory cue, stroke

DOI: 10.3233/NRE-162139

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 445-452, 2017

Authors: Lin, Li-Fong | Huang, Shih-Wei | Chang, Kwang-Hwa | Ouyang, Jin-Han | Liou, Tsan-Hon | Lin, Yen-Nung

Article Type: Research Article

Abstract: BACKGROUND: Robot-assisted gait training has been introduced as a practical treatment adjunctive to traditional stroke rehabilitation to provide high-intensity repetitive training. The design of robots is usually based on either the end-effector and exoskeleton method. The novel Robot Gait Training System (RGTS), a hybrid mixed type of end-effector and exoskeleton, tries to combine advantages from both methods. OBJECTIVE: This preliminary study was conducted to report whether this novel system is feasible and safe when applied to non-ambulatory subacute patients with stroke. METHODS: Six patients with stroke participated in this study and received 15 daily RGTS sessions. …The outcome measures included the lower extremity subscale of the Fugl-Meyer Assessment (FMA-LE), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), and Barthel Index (BI). These measurements were performed at the pretest and posttest. RESULTS: The RGTS demonstrated significant after-before changes in the FMA-LE, PASS, BBS and BI (p  < 0.05), which indicated improvements substantially across the neurological status, balance, and activities of daily living after intervention. CONCLUSIONS: This study demonstrated that the novel RGTS designed was practical, safe, and suitable to use in substantial leg dysfunction with stroke. Show more

Keywords: Robot gait training, stroke, neuroplasticity, balance

DOI: 10.3233/NRE-162137

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 453-461, 2017

Authors: Bos, Hannah R. | Babbage, Duncan R. | Leathem, Janet M.

Article Type: Research Article

Abstract: BACKGROUND: Individuals living with traumatic brain injury commonly have difficulties with prospective memory—the ability to remember a planned action at the intended time. Traditionally a memory notebook has been recommended as a compensatory memory aid. Electronic devices have the advantage of providing a cue at the appropriate time to remind participants to refer to the memory aid and complete tasks. Research suggests these have potential benefit in neurorehabilitation. OBJECTIVE: This study aimed to investigate the efficacy of a memory notebook and specifically a smartphone as a compensatory memory aid. METHODS: A single case series design was …used to assess seven participants. A no-intervention baseline was followed by training and intervention with either the smartphone alone, or a memory notebook and later the smartphone. Memory was assessed with weekly assigned memory tasks. RESULTS: Participants using a smartphone showed improvements in their ability to complete assigned memory tasks accurately and within the assigned time periods. Use of a smartphone provided additional benefits over and above those already seen for those who received a memory notebook first. CONCLUSIONS: Smartphones have the potential to be a useful and cost effective tool in neurorehabilitation practice. Show more

Keywords: Smartphone, rehabilitation, prospective memory, traumatic brain injury

DOI: 10.3233/NRE-151528

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 463-481, 2017

Authors: Brown, Jessica | Hux, Karen | Hey, Morgan | Murphy, Madeline

Article Type: Research Article

Abstract: PURPOSE: Many college students with TBI rely on external strategies and supports to compensate for persistent memory, organization, and planning deficits that interfere with recalling and executing daily tasks. Practitioners know little, however, about the supports students with TBI choose for this purpose, the reasoning behind their choice, or preferred features of selected supports. The purpose of this study was to explore these issues. METHOD: We collected and analyzed quantitative and qualitative data from eight college students with TBI for completion of a concurrent triangulation mixed-methods design. Data analysis included evaluation and triangulation of participant demographic information, survey …responses about persistent post-injury symptoms, transcripts from semi-structured interviews about cognitive support devices and strategies, and ranking results about specific compensatory tools. RESULTS: Results suggest that college students with TBI prefer high-tech external supports—sometimes with the addition of low-tech, paper supports—to assist them in managing daily tasks. This preference related to features of portability, accessibility, and automatic reminders. An electronic calendar was the most-preferred high-tech support, and a paper checklist was the most-preferred low-tech support. CONCLUSIONS: Rehabilitation professionals should consider implementing high-tech supports with preferred characteristics during treatment given the preferences of students with TBI and the consequent likelihood of their continued long-term use following reintegration to community settings. Show more

Keywords: Traumatic brain injury, student survivors, cognitive deficits, external supports

DOI: 10.3233/NRE-162065

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 483-499, 2017

Authors: Byrne, Christopher | Coetzer, Rudi | Addy, Karen

Article Type: Research Article

Abstract: BACKGROUND: Previous research examining the use of self-reported cognitive impairment as a reliable predictor of actual objective cognitive impairment (OCI) has provided mixed results. OBJECTIVE: The current study aimed to examine the potential discrepancy between subjective and objective cognitive impairment in a sample of individuals with an acquired brain injury (ABI). METHOD: Twenty-four participants, recruited from a community brain injury service, completed an objective neuropsychological assessment and a series of self-report questionnaires assessing psychological affect and perceived cognitive difficulties. RESULTS: Correlational analyses revealed no association between objective cognitive impairment and self-reported subjective cognitive impairment. …Conversely, psychological affect, such as anxiety and depression, was found to be highly correlated with subjective cognitive impairment. A hierarchical regression analysis revealed psychological affect as a significant predictor of subjective cognitive impairment. Objectively measured cognitive impairment was found to be non-significant. CONCLUSIONS: These findings suggest that an individual’s subjective experience of their cognitive difficulties following ABI are not associated with their actual objective cognitive impairment. Clinicians may benefit from considering other possible psychological factors that may play a more crucial role in a patient’s appraisals of their cognitive impairments. Show more

Keywords: Cognitive impairment, psychological affect, subjective impairment, objective impairment, neuropsychological rehabilitation

DOI: 10.3233/NRE-162015

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 501-512, 2017

Authors: Mogensen, Jesper | Wulf-Andersen, Camilla

Article Type: Research Article

Abstract: The focus of the present article is the home and family environment of patients suffering acquired brain injury. In order to obtain the optimal outcome of posttraumatic cognitive rehabilitation it is important (a) to obtain a sufficient intensity of rehabilitative training, (b) to achieve the maximum degree of generalization from formalized training to the daily environment of the patient, and (c) to obtain the best possible utilization of “cognitive reserves” in the form of cognitive abilities and “strategies” acquired pretraumatically. Supplementing the institution-based cognitive training with (potentially computer-based) home-based training these three goals may more easily be met. Home-based training …supports a higher intensity of training. Training in the home environment also allows better utilization of cognitive strategies acquired pretraumatically and more direct transfer of training results from formalized training to activities of daily living of the patient. Show more

Keywords: Acquired brain injury, cognitive training, cognitive rehabilitation, home-based training, cognitive reserve, brain reserve, family, advanced technology

DOI: 10.3233/NRE-160007

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 513-518, 2017

Authors: Wulf-Andersen, Camilla | Mogensen, Jesper

Article Type: Research Article

Abstract: Acquired brain injury (ABI) severely affects both the injured patient and her/his family. This fact alone calls for a therapeutic approach addressing not only the individual victim of ABI but also her/his family. Additionally, the optimal outcome of posttraumatic cognitive rehabilitation may be best obtained by supplementing the institution-based cognitive training with home-based training. Moving cognitive training and other therapeutic interventions into the home environment does, however, constitute an additional challenge to the family structure and psychological wellbeing of all family members. We presently argue in favour of an increased utilization of family-based intervention programs for the families of brain …injured patients – in general and especially in case of utilization of home-based rehabilitative training. Show more

Keywords: Acquired brain injury, rehabilitation, family, family interventions

DOI: 10.3233/NRE-162007

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 519-525, 2017

Authors: Olabarrieta-Landa, Laiene | Romero, Alfonso Caracuel | Panyavin, Ivan | Arango-Lasprilla, Juan Carlos

Article Type: Research Article

Abstract: OBJECTIVE: To examine the prevalence of perceived ethical misconduct in clinical practice, teaching, and research in the field of neuropsychology in Spain. METHOD: Two hundred and fifteen self-identified mental health professionals who engage in neuropsychology practice in Spain completed an online survey from July to December of 2013. In the ethics section of the survey, participants were asked to identify if neuropsychologists they know who work in their country engaged in specific kinds of ethical misconduct. RESULTS: 41% reported receiving formal training in professional ethics. The clinical findings are as follows. The highest rate of perceived …misconduct was found in the area of professional training and expertise, with an average of 40.7%, followed by research/publications (25.6%), clinical care (23.9%), and professional relationships (8.8%). Specifically, regarding training, over half of respondents (56.7%) know professionals who claim themselves to be neuropsychologists, even though they lack proper training or expertise and 46.0% know professionals in the field who do not have adequate training for experience to be working in the field. Regarding research/publications, 41.9% of respondents know professionals who appear as authors on publications where they have not made a significant contribution. Regarding clinical care, over one third of respondents endorse knowing professionals who (1) provide results of neuropsychological evaluations in such a way that patients or other professionals are not likely to understand (37.2%) and (2) do not have the skills or training to work with patients who are culturally different from them (34.9%). CONCLUSIONS: Less than half of survey respondents reported receiving ethics training. It is possible that introducing more or improved ethics courses into pre-graduate and/or graduate school curriculums, and/or requiring continuing ethics education certification may reduce perceived ethical misconduct among neuropsychological professionals in Spain. Show more

Keywords: Ethics, Spain, neuropsychology

DOI: 10.3233/NRE-162144

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 527-538, 2017

Authors: Olabarrieta-Landa, Laiene | Torre, Esther Landa | López-Mugartza, Juan Carlos | Bialystok, Ellen | Arango-Lasprilla, Juan Carlos

Article Type: Research Article

Abstract: OBJECTIVE: To conduct a literature review of the administration and scoring criteria used in normative studies of verbal fluency tests (VFT), and to propose a new model for the administration and scoring of phonological, semantic, and action VFT for use in Spanish-speakers. METHODS: A literature search was performed using four databases Dialnet, ProQuest (PsycINFO, PsycArticles), Science Direct (Elsevier), and PubMed and 47 articles met the following criteria: 1) articles which contained normative data of phonological, semantic, or action VFT, 2) published between 2000 and 2015, 3) published in English or Spanish, 4) used healthy population. RESULTS: …Of 2087 citations retrieved, 47 eligible studies were reviewed. The majority of the studies have been conducted in the USA, and with English and Spanish speakers. Only 12 studies provided the instruction, and 23 clearly describe the scoring guidelines. Moreover, among the studies that provided these information important discrepancies were found. Therefore, a new administration and scoring guidelines are presented, which may resolve this problem and be utilized in Spanish speaking countries. CONCLUSIONS: This review showed that still there is no consensus regarding the administration and scoring of VFT. A new method of administration and scoring is presented that can be use with Spanish-speakers. Show more

Keywords: Verbal fluency test, Spanish speakers, administration, scoring, review

DOI: 10.3233/NRE-162102

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 539-565, 2017

Authors: Costa, Vanessa | Brighina, Filippo | Piccoli, Tommaso | Realmuto, Sabrina | Fierro, Brigida

Article Type: Research Article

Abstract: BACKGROUND: Noninvasive transcranial stimulation methods have been increasingly employed in order to improve cognitive performance in neurological patients. In previous studies with both stroke patients and healthy subjects, noninvasive stimulation of temporal-parietal regions and their homologue produced an improvement in linguistic tasks. OBJECTIVE: The aim of the current study was to evaluate if anodal transcranial direct current stimulation (tDCS) over Brodmann areas 39/40 (angular and supramarginal gyri) could promote the recovery of linguistic functions, in particular comprehension and naming, in a single patient affected by dementia. METHODS: Three preliminary explorative single sessions (right-side anodal, left-side anodal …and sham tDCS) were carried out (Experiment 1). This procedure allows targeting the more effective site of stimulation for the treatment. Subsequently, we carried out a five-days tDCS treatment on the selected hemisphere (Experiment 2). RESULTS: We report verb comprehension amelioration after 5 days of anodal tDCS over the right BAs 39/40 compared with the placebo tDCS. This result is maintained until two weeks after the end of the 5-days treatment. CONCLUSIONS: Our findings provide new evidence for the therapeutic use of tDCS in degenerative diseases, suggesting that an explorative study can be useful for targeting the more appropriate stimulation site, and confirm the involvement of right-sided areas associated with language activities. Show more

Keywords: Aphasia, language recovery, neurodegenerative diseases, neuroplasticity, transcranial direct current stimulation

DOI: 10.3233/NRE-162062

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 567-575, 2017