NeuroRehabilitation - Volume 41, issue 4

Authors: Ahn, Sinae | Hwang, Sujin

Article Type: Review Article

Abstract: BACKGROUND: A variety of cognitive rehabilitation has gained popularity in early childhood with neurodevelopmental disorder at clinical rehabilitation settings. OBJECTIVES: The purpose of this review was to analyze the cognitive therapies used and to analyze the methods applied in children with neurodevelopmental disorders. METHODS: This study searched for experimental studies published between 2006 and 2016 using two databases including EBSCOhost and PubMed. The keywords used included “diagnosis included in the neurodevelopment disorder of DSM-5” AND “cognition” or “cognitive function”. After the searching, this study reviewed the abstracts initially and assessed full articles subsequently, and then we …selected total of 26 studies. Two reviewers independently assessed the level of evidence of qualitative studies using the PICO method, and this study analyzed the frequency of participants, intervention information, and methods used were analyzed. RESULTS: This study was generated a total of 3,115 publications of literature review. Twenty-six studies were included in this review as for the levels of evidence of the qualitative studies selected. 12 studies was received the cognitive therapy for autism spectrum disorder, and 17 studies was participated grade-schooler (5–12 yrs) to investigate the effects of cognitive therapy. Cognitive therapy showed the level I evidence in participants with Autism spectrum disorder, attention-deficit/hyperactivity disorder, and global developmental disorder. CONCLUSIONS: The results of this study provide an indication about the types of cognitive therapies used in children with neurodevelopmental disorders, and provide available and beneficial information of cognitive therapies at research and clinical setting. Show more

Keywords: Children, cognitive therapy, neurodevelopmental disorders, systematic review

DOI: 10.3233/NRE-172146

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 707-719, 2017

Authors: Dahdah, Marie N. | Bennett, Monica | Prajapati, Purvi | Parsons, Thomas D. | Sullivan, Erin | Driver, Simon

Article Type: Research Article

Abstract: BACKGROUND: Virtual reality (VR) technology has demonstrated usefulness in diagnosis, education, and training. Studies supporting use of VR as a therapeutic treatment in medical rehabilitation settings remain limited. This study examines the use of VR in a treatment capacity, and whether it can be effectively integrated into neurorehabilitation. OBJECTIVE: To determine whether immersive VR treatment interventions improve executive dysfunction in patients with brain injury and whether performance is stronger on a VR version of the Stroop than traditional Stroop formats. METHODS: 15 patients with brain injury admitted to day neurorehabilitation. Outcome measures: reaction time, inhibition, and …accuracy indices on VR Stroop; Automated Neuropsychological Assessment Metrics (ANAM) Stroop, Delis-Kaplan Executive Function System Stroop, Golden Stroop, and Woodcock-Johnson, 3rd Edition (WJ-III): Pair Cancellation. RESULTS: Participants demonstrated significantly reduced response time on the word-reading condition of VR Stroop and non-significantly reduced response time on the interference condition. Non-significant improvements in accuracy and inhibition were demonstrated on the color-naming condition of VR Stroop. Significantly improved accuracy under time pressure was found for the ANAM, after VR intervention. CONCLUSION: Implementation of immersive VR interventions during neurorehabilitation is effective in improving specific executive functions and information processing speed in brain-injured patients during the subacute period. Show more

Keywords: Brain injuries, virtual reality exposure therapy, executive function, treatment outcome, inpatients, rehabilitation

DOI: 10.3233/NRE-172183

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 721-734, 2017

Authors: Naro, Antonino | Calabrò, Rocco Salvatore | Pollicino, Patrizia | Lombardo, Carmen | Bramanti, Placido

Article Type: Case Report

Abstract: BACKGROUND: Growing research is focusing on the identification of markers predicting recovery and demonstrating covert awareness in patients with chronic disorders of consciousness (DOC). Herein, we describe the case of a woman who emerged from unresponsive wakefulness syndrome (UWS) after four years, in whom an experimental protocol assessing brain connectivity predicted her awareness recovery, indicating a functional locked-in syndrome (FLIS) diagnosis. CASE DESCRIPTION: A 68-year-old woman was admitted to our institute in 2012 in a UWS secondary to a severe brain hemorrhage, with a Coma Recovery Scale-Revised score of five. Her clinical conditions were stable for about two …years, despite the intensive neurorehabilitation treatment. During hospitalization, she underwent a neurophysiological protocol demonstrating an extensive nociceptive processing within the pain matrix. After 3 years, our subject emerged from UWS, and then from minimally conscious state, being able to communicate properly. DISCUSSION: Approaches investigating brain connectivity may be useful in DOC diagnosis and prognosis, highlighting residual brain networks subtending covert awareness. Hence, our case supports the necessity of taking into account FLIS diagnosis in DOC differential diagnosis and implementing paraclinical follow-up to intercept cases of possible, late recovery of consciousness, thus optimizing the most appropriate management and rehabilitative setting. Show more

Keywords: Case report, misdiagnosis, disorders of consciousness (DOC), functional locked-in syndrome (FLIS), unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS)

DOI: 10.3233/NRE-172160

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 735-738, 2017

Authors: Son, Min Soo | Jung, Do Hee | You, Joshua (Sung) H. | Yi, Chung Hwi | Jeon, Hye Seon | Cha, Young Joo

Article Type: Research Article

Abstract: PURPOSE: To determine the effects of a novel dynamic neuromuscular stabilization (DNS) technique on gross motor function, diaphragm movement, and activation of the external oblique (EO) and internal oblique (IO)/transversus abdominal (TrA) muscles in participants with cerebral palsy (CP). METHOD: Fifteen participants with CP (7 females) underwent DNS intervention for 30 minutes/day, 3 days a week for 4 weeks. Gross motor function, diaphragm movement, and muscle activation were determined using a gross motor function measure (GMFM-88), ultrasound, and electromyography measurements, respectively, before and after the DNS core stabilization intervention. Paired t -tests were used at p  < 0.05. …DESIGN: A single-arm, pretest-posttest clinical trial. RESULTS: GMFM scores for standing, walking, and jumping domains were significantly improved after the intervention (P  < 0.05). Diaphragm descending movement (P  = 0.0001) and activation of the internal oblique and transversus abdominals were initially undetectable, but remarkably increased after the intervention (P  = 0.012). CONCLUSIONS: DNS is a promising, effective intervention for facilitating deep core muscle activation of the underactive muscle chain comprising the diaphragm, internal oblique, and transversus abdominals, thereby improving age-appropriate standing, walking, and jumping in participants with spastic diplegic CP. Show more

Keywords: Dynamic neuromuscular stabilization, ultrasound, diaphragm, cerebral palsy

DOI: 10.3233/NRE-172155

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 739-746, 2017

Authors: Eom, Mi-Ja | Chang, Moon-Young | Oh, Dong-Hwan | Kim, Hyun-Dong | Han, Na-Mi | Park, Ji-Su

Article Type: Research Article

Abstract: BACKGROUND: Recently, resistance expiratory muscle strength training (EMST) has been reported as a remedial treatment for dysphagia. OBJECTIVE: To investigate the effect of resistance EMST on the swallowing function in stroke patients with oropharyngeal dysphagia. METHODS: Forty-two stroke patients with dysphagia were randomly assigned to two groups: an experimental group (n  = 13) and a placebo group (n  = 13). The experimental group performed EMST using a portable EMST device, while the placebo group performed EMST using a sham EMST device with no loading. The intervention was performed 5 days per week for 4weeks, in five sets of …5 breaths through the device for a total of 25 breaths per day. Both groups underwent conventional dysphagia treatment for 30 minutes/day, 5 days/week, for 4 weeks. Videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study (VFSS) were assessed to analyze the oropharyngeal swallowing function. RESULTS: The experimental group showed more improvement in pharyngeal phase of the VDS (p  = 0.018 and 0.006, respectively) and PAS compared to the placebo group (p  = 0.014). CONCLUSIONS: We suggest that EMST could improve the effects of dysphagia observed in post-stroke elderly patients based on swallowing function. Show more

Keywords: Aspiration, dysphagia, expiratory muscle strength training, subacute stroke

DOI: 10.3233/NRE-172192

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 747-752, 2017

Authors: Choi, Jong-Bae | Shim, Sun-Hwa | Yang, Jong-Eun | Kim, Hyun-Dong | Lee, Doo-Ho | Park, Ji-Su

Article Type: Research Article

Abstract: BACKGROUND: Dysphagia after stroke can cause a variety of complications, especially aspiration pneumonia, which can be life-threatening. Therefore, rehabilitation methods to reduce aspiration in patients with dysphagia are important. OBJECTIVE: In the present study, we aimed to investigate the effects of Shaker exercise on aspiration and oral diet level in stroke survivors with dysphagia. METHODS: Participants were randomly assigned to an experimental group (n  = 16) or a control group (n  = 16). Participants in the experimental group performed Shaker exercise and conventional dysphagia therapy, whereas those in the control group performed only conventional dysphagia therapy. All participants …performed training 5 days a week for 4 weeks. Degree of aspiration was assessed using the Penetration-Aspiration Scale (PAS) based on videofluoroscopic swallowing study, while oral diet level was assessed using the Functional Oral Intake Scale (FOIS). RESULTS: The experimental group showed greater improvement on both the PAS (p  < 0.05) and FOIS (p  < 0.05) compared with the control group. CONCLUSIONS: The results of this study suggest that Shaker exercise is a effective exercise for recovery of swallowing function in stroke survivors with dysphagia. Show more

Keywords: Dysphagia, stroke, swallowing, aspiration-penetration

DOI: 10.3233/NRE-172145

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 753-757, 2017

Authors: Jang, Sung Ho | Cho, Ik Tae | Lim, Ji Woon

Article Type: Research Article

Abstract: OBJECTIVES: We investigated the relation between recovery of aphasia and change of injured fasciculus (AF) in the dominant hemisphere using diffusion tensor tractography (DTT) in stroke patients with aphasia. METHODS: Sixteen consecutive right-handed stroke patients with aphasia with injury of the left AF were recruited for this study. The Western Aphasia Battery for assessment of aphasia and DTTs of the AF were used within 30 days of stroke onset and again three months after. DTTs of both AFs were reconstructed, and fractional anisotropy (FA) and voxel number of the AF were measured. RESULTS: A moderate positive …correlation was observed between aphasia quotient (AQ) and voxel number of the left AF (r  = 0.626, p  < 0.01 ). However, no correlation was observed between AQ and FA of the left AF, and voxel number and FA of the right AF. In addition, the language quotient (LQ) of WAB was not correlated with FA and voxel number of the both AFs. CONCLUSIONS: We found a relation between recovery of aphasia from early to chronic stage of stroke and recovery of the injured AF in the dominant hemisphere irrespective of change of the AF in the non-dominant hemisphere. Our results suggest that facilitation of the injured AF in the dominant hemisphere could be an important strategy in neuro-rehabilitation for stroke patients with aphasia. Show more

Keywords: Aphasia, stroke, arcuate fasciculus, diffusion tensor tractography

DOI: 10.3233/NRE-172167

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 759-764, 2017

Authors: Hawkins, Kelly A. | Clark, David J. | Balasubramanian, Chitralakshmi K. | Fox, Emily J.

Article Type: Review Article

Abstract: BACKGROUND: One third of individuals after stroke report an inability to walk in the community. Community mobility requires walking adaptability — the ability to adjust one’s stepping pattern to meet environmental demands and task goals. Walking on uneven terrain (e.g. grass, gravel) has unique requirements and is a critical component of walking adaptability that has not been investigated in the post-stroke population. OBJECTIVE: To summarize current knowledge of biomechanical and neuromuscular modifications during uneven terrain negotiation in healthy individuals and discuss implications of post-stroke impairments. METHODS: Review of eleven studies, identified through a search of relevant …literature on PubMed and CINAHL. RESULTS: On uneven terrain, healthy adults demonstrate numerous gait modifications including a lowered center of mass, increased muscle co-contraction during stance and exaggerated or increased toe clearance during swing. After stroke, changes in muscle activity and limb coordination will likely result in difficulty or inability performing these modifications that healthy adults use to maintain stability and safety when walking on uneven terrain. CONCLUSIONS: Studies of biomechanical and neuromuscular control of walking on uneven terrain are needed to quantify mobility limitations in adults post-stroke. Such investigations will contribute to the understanding of mobility impairments after stroke and the design of critically important intervention strategies. Show more

Keywords: Walking adaptability, uneven terrain, stroke, community ambulation, rehabilitation

DOI: 10.3233/NRE-172154

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 765-774, 2017

Authors: Aprile, Irene | Iacovelli, Chiara | Padua, Luca | Galafate, Daniele | Criscuolo, Simone | Gabbani, Debora | Cruciani, Arianna | Germanotta, Marco | Di Sipio, Enrica | De Pisi, Francesco | Franceschini, Marco

Article Type: Research Article

Abstract: BACKGROUND: The gait recovery is a realist goal in the rehabilitation of almost Stroke patients. Over the last years, the introduction of robotic technologies in gait rehabilitation of stroke patients has had a greatest interest. OBJECTIVE: The aim of this study was to evaluate efficacy of Robotic Gait Training (RGT) in chronic stroke patients. METHODS: Fourteen chronic stroke patients were divided into two groups. Six patients received RGT, eight patients received traditional gait rehabilitation. Patients were assessed with clinical scales, as well as with gait analysis, at the beginning and at the end of the treatment. …RESULTS: Significant changes in some clinical scales for both the groups were detected. In the robotic group, patients showed higher percentage changes in the MRC scale (p  = 0.020), in the 6MWT (p  = 0.043) and in the Ashworth scale (hip: p  = 0.008; knee: p  = 0.043; ankle: p  = 0.043) when compared with the traditional group. With respect to the gait analysis, we did not found any difference neither in the within–group analysis, nor in the between–group analysis. CONCLUSIONS: Both rehabilitation treatments do not change the compensatory strategies in chronic patients but the RGT offers to the patients a more intensive and controlled gait training increasing the gait endurance and decreasing spasticity in the lower limb. Show more

Keywords: Stroke, robotics, rehabilitation, chronic, gait analysis

DOI: 10.3233/NRE-172156

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 775-782, 2017

Authors: Osaka, Hiroshi | Shinkoda, Koichi | Watanabe, Susumu | Fujita, Daisuke | Kobara, Kenichi | Yoshimura, Yosuke | Ito, Tomotaka | Suehiro, Tadanobu

Article Type: Research Article

Abstract: BACKGROUND: Accelerometers provide information regarding balance and gait, but they are rarely used in clinical settings for stroke patients. Clinically, balance is assessed with simple tests, but their relationships with accelerometry results after stroke are unknown. OBJECTIVE: We examined the relationship between accelerometry-assessed gait indices calculated from trunk acceleration and results of the Timed Up and Go (TUG) and Berg Balance Scale (BBS) tests in stroke patients. METHODS: Twenty-nine stroke patients completed assessments with the TUG, BBS, and trunk acceleration during walking using a tri-axial accelerometer. The root mean square (RMS), stride regularity (SR), and step …symmetry (SS), which indicate gait fluctuations, regularity, and symmetry, respectively, were calculated based on trunk acceleration. These were calculated in the vertical (VT), anteroposterior, and mediolateral directions. A multiple linear regression analysis was performed to determine whether these gait indices contributed independently to TUG and BBS results. RESULTS: VT-RMS and VT-SS were significant determinants of TUG, and VT-SS, VT-RMS, and VT-SR were significant determinants of BBS. CONCLUSIONS: This study suggested that the gait indices calculated from trunk acceleration that were relevant to balance were those in the VT direction. These may be useful for evaluating dynamic gait balance in patients with stroke. Show more

Keywords: Berg Balance Scale, falls, gait analysis, stroke, Timed Up and Go test, trunk acceleration

DOI: 10.3233/NRE-172171

Citation: NeuroRehabilitation, vol. 41, no. 4, pp. 783-790, 2017