NeuroRehabilitation - Volume 42, issue 1

Authors: Manikowska, Faustyna | Chen, Brian Po-Jung | Jóźwiak, Marek | Lebiedowska, Maria K.

Article Type: Research Article

Abstract: BACKGROUND: Weakness is a major impairment in many movement disorders, including cerebral palsy (CP), which presents as a decrease in muscle strength. Manual muscle testing (MMT) is very popular in clinical practice, however it has many limitations. OBJECTIVE: (1) Whether maximum voluntary contraction (MVC) measures differ across clinical MMT groups; (2) Whether an association exists between clinical MMT score groups and instrumental MVC measures. METHODS: Twenty-one participants with spastic CP were recruited (11 females and 10 males; age = 13.46±3.62 years). To achieve the aims of the study, we investigated the relationship between qualitative (MMT) and instrumental (MVC) …measures of knee flexor muscles’ strength in patients with CP. RESULTS: MVC values increased somewhat proportionally with increasing MMT score group (p  = 0.032, MS = 207.54, F = 3.75). The differences in MVC values was only statistically significant between score groups 3 and 5. A weak correlation (R = 0.4, MVC = –2.54 + 4.50 MMT, p  < 0.01) was found between measured MVCs and the MMT score groups. CONCLUSIONS: In pediatric research studies, instrumental MVC should be preferred over MMT scoring. Also, MMT score groups higher than 3 should be modified in clinical testing of children and adolescents with cerebral palsy. Show more

Keywords: Physical examination, maximum voluntary contraction, muscle strength, electromyography

DOI: 10.3233/NRE-172179

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 1-7, 2018

Authors: Parente, Frederick | Finley, John-Christopher

Article Type: Research Article

Abstract: BACKGROUND: Subjective Organization (SO) refers to the human tendency to impose organization on our environment. Persons with Acquired Brain Injury (ABI) often lose the ability to organize however, there are no performance based measures of organization that can be used to document this disability. OBJECTIVE: The authors propose a method of association rule analysis (AR) that can be used as a clinical tool for assessing a patient’s ability to organize. METHOD: Twenty three patients with ABI recalled a list of twelve unrelated nouns over twelve study and test trials. Several measures of AR computed on these …data were correlated with various measures of short-term, long-term, and delayed recall of the words. RESULTS: All of the AR measures correlated significantly with the short-term and long-term memory measures. The confidence measure was the best predictor of memory and the number of association rules generated was the best predictor of learning. CONCLUSIONS: The confidence measure can be used as a clinical tool to assess SO with individual ABI survivors. Show more

Keywords: Subjective Organization, association rules analysis, memory, brain injury, recall

DOI: 10.3233/NRE-172227

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 9-15, 2018

Authors: Legris, Nicolas | Devilliers, Hervé | Daumas, Anaïs | Carnet, Didier | Charpy, Jean-Pierre | Bastable, Philip | Giroud, Maurice | Béjot, Yannick

Article Type: Research Article

Abstract: OBJECTIVE: To adapt the SS-QoL into French and test its psychometric properties. METHODS: Seventy-seven patients from a population-based registry were enrolled 3 months after their stroke. SS-QoL, NIHSS score, Barthel index, HAD, FSS, SF-36 scales, and MMSE were administered at enrolment. SS-QoL was re-administered at 15 days and 2 months. Internal consistency was assessed by Cronbach’s α coefficients, factorial validity by an exploratory factor analysis and external validity by Mann-Whitney test and Spearman’s correlations (ρ ), comparing SS-QoL scores with those obtained from established scales. Reliability was assessed by intra-class correlation coefficients (ICC) and responsiveness by standardized …effect sizes (ES). RESULTS: Test-retest and inter-observer reliabilities were excellent (ICC> 0.88). Internal consistency was acceptable (α = 0.65–0.91), except for the Personality domain (α = 0.58). Factor analysis individualized eight homogenous axes. SS-QoL scores were different between groups opposed by their modified Rankin score at enrolment or their overall quality of life compared with pre-stroke status (p  < 0.001). Ten of the twelve domains correlated moderately (ρ > 0.35) to strongly (ρ > 0.5) with established measures. Nine domains were mildly to moderately responsive to change (ES> 0.3). CONCLUSION: The French version of the SS-QoL is a valid, reliable and moderately responsive instrument. Show more

Keywords: Stroke, quality of life, outcome, scale, validation

DOI: 10.3233/NRE-172178

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 17-27, 2018

Authors: Bang, Dae-Hyouk | Shin, Won-Seob | Choi, Ho-Suk

Article Type: Research Article

Abstract: BACKGROUND: Reducing compensatory strategies during repetitive upper-limb training may be helpful in relearning motor skills. OBJECTIVE: To explore the effects of modified constraint-induced movement therapy (mCIMT), additionally modified by adding trunk restraint (TR), on upper-limb function and activities of daily living (ADLs) in early post-stroke patients. METHODS: Twenty-four participants with early stroke were randomly assigned to mCIMT combined with TR (mCIMT + TR) or mCIMT alone. Each group underwent twenty sessions (1 h/d, 5 d/wk for 4 weeks). Patients were assessed with the action research arm test (ARAT), the Fugl-Meyer Assessment-Upper extremity (FMA-UE), the Modified Barthel index (MBI), the …Maximal elbow extension angle during reaching (MEEAR), and Motor Activity Logs (MAL-AOU and MAL-QOM). RESULTS: The mCIMT + TR group exhibited greater improvement in the ARAT, FMA-UE, MBI, MEEAR, and MAL-AOU, and MAL-QOM than the mCIMT group. Statistical analyses showed significant differences in ARAT (P  = 0.003), FMA-UE (P  = 0.042), MBI (P  = 0.001), MEEAR (P  = 0.002), and MAL-AOU (P  = 0.005) between the groups. CONCLUSION: Modified CIMT combined with TR may be more effective than mCIMT alone in improving upper-limb function and ADLs in patients with early stroke. Show more

Keywords: Early stroke, modified constraint-induced movement therapy, trunk restraint, upper-limb function

DOI: 10.3233/NRE-172176

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 29-35, 2018

Authors: Lee, Joo-Hyun | Park, Ji-Hyuk

Article Type: Research Article

Abstract: BACKGROUND: Although there is a myriad of unilateral assessments for stroke survivors, few address bilateral function, which is critical for many daily living tasks. OBJECTIVE: To develop an activities of daily living list of tasks requiring bilateral upper extremity function for use when assessing patients with stroke. METHOD: A list of 938 items was generated based on a literature review, opinions of occupational therapists and patients with stroke. A panel of professional experts then validated that the items were bilateral and functional. Similar items were then combined and duplicates eliminated. RESULTS: The list was …reduced to 69 items and 40 items were selected based on the content validity index. Based on the bilateral function, importance, expansion, and deletion criteria, the expert panel selected 27 items that best represented bilateral activities of daily living. CONCLUSIONS: A final list of 27 activities of daily living requiring bilateral function was generated and validated. Future work will focus on development of a tool to assess bilateral upper extremity function of patients with stroke. Show more

Keywords: Stroke, assessment, bilateral upper extremity function

DOI: 10.3233/NRE-172152

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 37-42, 2018

Authors: Mazzoleni, S. | Battini, E. | Crecchi, R. | Dario, P. | Posteraro, F.

Article Type: Research Article

Abstract: BACKGROUND: Significant results have been shown when an upper limb robot-assisted rehabilitation is delivered to stroke patients. OBJECTIVE: To evaluate the effects of upper limb robot-assisted rehabilitation on motor recovery in stroke patients who underwent a treatment based on a haptic device. METHODS: Thirty-nine stroke patients (twenty-three subacute and sixteen chronic) underwent rehabilitation training by using MOTORE/Armotion haptic system. Thirteen healthy subjects were recruited for comparison purpose. The following clinical outcome measures were used: Chedoke-McMaster Stroke Assessment, Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FM), Medical Research Council, Motricity Index (MI), Box and Block Test (B&B) and …Modified Barthel Index (mBI). The following parameters were computed: mean speed, maximum speed, mean time, path length, normalized jerk, mean force, mean error, mean energy expenditure and active patient-robot interaction percentage. The assessments were carried-out before and after treatment. RESULTS: Significant changes were observed in both groups in the FM, MI, B&B and mean speed. Significant changes were observed in mBI, mean time, mean force, mean energy expenditure and active patient-robot interaction percentage in subacute stroke patients. In chronic stroke patients significant changes were found on the MAS-elbow. CONCLUSIONS: The haptic device used is at least as effective as an existing device used in similar studies. Show more

Keywords: Stroke, rehabilitation, upper limb, haptics, robotics

DOI: 10.3233/NRE-172166

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 43-52, 2018

Authors: Fotiadou, Styliani | Aggeloussis, Nikolaos | Gourgoulis, Vassilios | Malliou, Paraskevi | Papanas, Nikolaos | Giannakou, Erasmia | Iliopoulos, Ioannis | Vadikolias, Konstantinos | Terzoudi, Aikaterini | Piperidou, Haritomeni

Article Type: Research Article

Abstract: BACKGROUND: The search for reliable techniques to assess gait in stroke patients is crucial for the design and follow-up of rehabilitation programs. OBJECTIVE: To assess the reproducibility of kinematic and kinetic gait parameters in chronic stroke patients using a three-dimensional gait analysis system. METHODS: Ten chronic stroke patients were assessed while walking along a 20 m walkway at their natural speed, using a gait analysis system of six infrared cameras and two force plates. Each patient performed 10 gait trials on 2 separate days. Inter-measurement agreement was assessed with the Coefficient of Multiple Correlation, while Root Mean …Square Differences were used to quantify the variability of the trials. RESULTS: The majority of kinetics and kinematics showed excellent reproducibility in all patients. Joints’ power seemed to be more reliable compared with joints’ angle and moment. Most parameters presented greater variability in non-paretic than the paretic leg, while they were less variable in the sagittal compared with the non-sagittal planes. Less than 10 trials were sufficient to obtain excellent reproducibility for most kinematic and kinetic parameters. CONCLUSIONS: The reproducibility of movement assessment through three-dimensional gait analysis appears excellent in chronic stroke patients. Show more

Keywords: Stroke, gait analysis, rehabilitation, movement, clinical assessment, reliability

DOI: 10.3233/NRE-172195

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 53-61, 2018

Authors: Hadoush, Hikmat | Al-Jarrah, Muhammed | Khalil, Hanan | Al-Sharman, Alham | Al-Ghazawi, Sadik

Article Type: Research Article

Abstract: BACKGROUND: A number of studies have examined the therapeutic effects of transcranial direct current stimulation (tDCS) stimulation in patients with Parkinson’s disease (PD) using unilateral anodal stimulation applied either on the left or right brain hemisphere. However, PD involves the dysfunctions of both brain hemispheres. OBJECTIVES: This study investigates the therapeutic effects of bilateral anodal tDCS stimulation on balance and fear of fall outcomes in patient with PD. METHODS: Eighteen patients with idiopathic PD completed the study. Ten sessions of bilateral anodal tDCS stimulation were applied over the FC1 and FC2 targeting both pre-frontal and motor …areas for each patient, 5 sessions per week for 2 weeks. Berg Balance Scale (BBS), Falls Efficacy Scale-International (FES-I), and 10 meters walk test (10mwt) were applied before and after the stimulation therapy. RESULTS: Paired t -test showed a significant increase in the BBS scores and decrease in the FES-I scores after the bilateral tDCS compared with those scores before tDCS therapy (P  < 0.05), as well improvement in the 10mwt scores. CONCLUSION: Our data showed that bilateral anodal tDCS serves as an effective, safe and feasible approach for rehabilitation of patients with PD with the issues related to balance and fear of fall. Show more

Keywords: Parkinson’s disease, transcranial direct current stimulation, bilateral hemisphere stimulation, balance, fear of fall

DOI: 10.3233/NRE-172212

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 63-68, 2018

Authors: Brincks, John | Christensen, Lars Ejsing | Rehnquist, Mette Voigt | Petersen, Jesper | Sørensen, Henrik | Dalgas, Ulrik

Article Type: Research Article

Abstract: BACKGROUND: To improve walking in persons with multiple sclerosis (MS), it is essential to understand the underlying mechanisms of walking. This study examined strategies in net joint power generated or absorbed by hip flexors, hip extensors, hip abductors, knee extensors, and plantar flexors in mildly disabled persons with MS and healthy controls at different walking speeds. METHODS: Thirteen persons with MS and thirteen healthy controls participated and peak net joint power was calculated using 3D motion analysis. RESULTS: In general, no differences were found between speed-matched healthy controls and persons with MS, but the fastest walking …speed was significantly higher in healthy controls (2.42 m/s vs. 1.70 m/s). The net joint power increased in hip flexors, hip extensors, hip abductors, knee extensors and plantar flexors in both groups, when walking speed increased. Significant correlations between changes in walking speed and changes in net joint power of plantar flexors, hip extensors and hip flexors existed in healthy controls and persons with MS, and in net knee extensor absorption power of persons with MS only. CONCLUSION: In contrast to previous studies, these findings suggest that mildly disabled persons with MS used similar kinetic strategies as healthy controls to increase walking speed. Show more

Keywords: Multiple sclerosis, kinetic strategies, motion analysis, fast walking speed, matched healthy controls

DOI: 10.3233/NRE-172225

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 69-79, 2018

Authors: Swinnen, Eva | Deliens, Tom | Dewulf, Elke | Van Overstraeten, Shauni | Lefeber, Nina | Van Nieuwenhoven, Johan | Ilsbroukx, Stephan | Kerckhofs, Eric

Article Type: Research Article

Abstract: OBJECTIVE: The aim of this study was to collect patients’ and healthcare professionals’ opinions about lower limb orthoses (LL-orthoses): 1) the positive and negative aspects; 2) the differences in wearing them according to location; and 3) their recommendations for future modifications. METHODS: Four focus group discussions were performed, with in total twenty patients with MS with a prescribed LL-orthosis and seven healthcare professionals. Audiotaped discussions were transcribed and qualitatively processed (NVivo11). RESULTS: Healthcare professionals and patients state that a LL-orthosis improves gait and reduces the risk of falling. Some negative aspects were indicated like stigmatization, difficulties …to put on and off the LL-orthosis and the aesthetic aspects. Several patients mentioned that they did not get enough or no correct information about the adaptability and use of the orthoses. Opinions regarding differences in wearing according to location (e.g. in and outside the rehabilitation center) were diverse. Recommendations for future changes were e.g. more refined and firmer orthoses. CONCLUSIONS: The opinions collected are interesting for taking into account in the process of construction and delivering of LL-orthoses. Future research should focus on the opinions concerning different types of LL-orthosis in relation with the severity of the limitations of the patients. Show more

Keywords: Multiple sclerosis, orthoses, ankle foot orthoses, acceptation, opinions

DOI: 10.3233/NRE-172222

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 81-92, 2018

Authors: Andrenelli, Elisa | Galli, Federica Lucia | Gesuita, Rosaria | Skrami, Edlira | Logullo, Francesco Ottavio | Provinciali, Leandro | Capecci, Marianna | Ceravolo, Maria Gabriella | Coccia, Michela

Article Type: Research Article

Abstract: BACKGROUND: Dysphagia is a critical symptom of Neuromuscular Diseases and is often associated with considerable morbidity and mortality. OBJECTIVE: This study is designed to investigate the prevalence of dysphagia and to identify different clinical profiles of swallowing disorders in Myotonic Dystrophy type 1 (DM1) and Amyotrophic Lateral Sclerosis (ALS), the most common Neuromuscular Diseases in the adult age. METHODS: Consecutive DM1 and ALS patients from 2013 to 2015 referred to a Centre for Neuromuscular Disease were enrolled. A comprehensive assessment of swallowing function with a Clinical Swallowing Examination and Fluid and Food Trials was performed. …RESULTS: 157 patients were included: 86 ALS, 71 DM1. The dysphagic patients affected by ALS and DM1 (79% and 86% of the respective samples) showed two different profiles. ALS patients with dysphagia were older and underweight. They experienced a global dysfunction of the oral and pharyngeal phases with more difficulty in swallowing thin liquids. Conversely, DM1 patients with dysphagia were younger and tended to obesity. Most of them showed impairment of oral phase and had more frequently difficulty in swallowing solid bolus. CONCLUSION: The recognition of specific clinical profiles supports and guides the detection of swallowing disorders in patients with neuromuscular diseases. Show more

Keywords: Swallowing, dysphagia, Amyotrophic Lateral Sclerosis, Myotonic Dystrophy, neuromuscular diseases

DOI: 10.3233/NRE-172272

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 93-102, 2018

Authors: Nolvi, Maria | Brogårdh, Christina | Jacobsson, Lars | Lexell, Jan

Article Type: Research Article

Abstract: BACKGROUND: Sense of Coherence (SOC) is important for successful adaptation and mental well-being in people with life-long medical conditions. Late effects of polio (LEoP) often lead to a life-long disability, but no study has assessed SOC in this population. OBJECTIVE: To assess SOC in persons with LEoP and to explore the association between SOC, demographics (age, gender, marital status and level of education) and variables related to LEoP (age at polio onset, number of years from polio until onset of LEoP and self-rated disability). METHOD: Ninety-three community-dwelling persons with clinically verified LEoP responded to a postal …survey with the Sense of Coherence Scale (SOC-13). A hierarchical multiple regression analysis was performed to explore the associations with SOC. RESULTS: SOC varied considerably among the participants. The mean and median SOC-13 total sum score was 71.8 and 76 points, which is similar to age-matched non-disabled people. The number of years before onset of LEoP and self-rated disability together with the participants’ marital status and level of education explained 37% (p  < 0.001) of the variance in SOC. CONCLUSION: Persons with LEoP have a level of SOC indicating that they generally have the ability to understand, handle and being motivated when dealing with stressful events and problems arising in their lives as a result of their disability. Being married and having a higher education, living many years before onset of LEoP and perceiving a mild to moderate disability contributed to a strong SOC. Show more

Keywords: Adaptation, psychological, disabled persons, Postpoliomyelitis syndrome, rehabilitation, Sense of Coherence

DOI: 10.3233/NRE-172198

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 103-111, 2018

Authors: Milicin, Cristian | Sîrbu, Elena

Article Type: Research Article

Abstract: INTRODUCTION: Lower motor neurons are the only neurons of the central nervous system (CNS) with the ability to regenerate without any intervention after an axotomy. AIM: This present study was conducted to analyze clinical and electrophysiological parameters in four groups of upper limb peripheral neuropathies, before and after treatment, comparing the results obtained after three cures of complex rehabilitation therapy. MATERIALS AND METHODS: We selected a number of 107 patients (66 women and 41 men) aged between 29 and 77 years (mean age = 49.6). Clinical (muscular strength, sensitivity) and electrophysiological parameters (accommodation coefficient α , nerve conduction …velocity) were analyzed. All patients received 3 comprehensive treatment cures, each cure of 14 days and a rest period of 3 months between the cures. RESULTS: From the total of 107 patients included in the study, 52 were diagnosed with brachial plexus palsy, 27 with radial nerve palsy, 18 with median nerve palsy and 10 with ulnar nerve palsy. We did not observe a statistically significant difference between the mean age of males (47.2) and females (51.2) (p  = 0.07), but peripheral neuropathies were more common in young males. At the end of the rehabilitation treatment all patients achieved better outcomes in muscle strength, sensitivity, adjustment coefficient α and nerve conduction velocity (p  < 0.001). CONCLUSION The intervention of a physical therapy program in patients with peripheral neuropathies provided significantly better outcomes in clinical and electrophysiological parameters. Our rehabilitation protocol can be considered an alternative in order to stimulate and accelerate the nerve regeneration process. Show more

Keywords: Motor neurons, muscle strength, sensitivity, nerve conduction velocity

DOI: 10.3233/NRE-172220

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 113-119, 2018

Authors: Swinnen, Eva | Lefeber, Nina | Werbrouck, Amber | Gesthuizen, Yelena | Ceulemans, Lisa | Christiaens, Sofie | De Wael, Lise | Buyl, Ronald | Ilsbroukx, Stephan | Van Nieuwenhoven, Johan | Michielsen, Marc | Lafosse, Christophe | Kerckhofs, Eric

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Because user-satisfaction and acceptance may partly determine the grade of compliance to an orthotic device (OD), the aim of this multicentre observational study was to inquire the reasons for acceptance and the user-satisfaction of an OD of the lower limb in male and female central neurological movement disorders (CNMD) patients. METHODS: Persons with CNMD having at least one prescribed OD of the lower limb were included. Two questionnaires were used: the MIRAD-ACCORT-II (reasons for acceptance) and a modified version of the D-QUEST 2.0 (user-satisfaction). Descriptive analyses were performed and to analyse the differences between the …males’ and females’ answers Chi2 - and Mann-Whitney U tests were used. RESULTS: Twenty-six stroke and 23 multiple sclerosis patients participated (53% males). “Comfort”, “safety”, “effectiveness” and “ease of use” were reported as most important aspects. 86% of the patients were (very) satisfied about their OD. Only for the aspect safety, compared to males, significant more females reported that if the OD is not safe enough they will not use it. CONCLUSION: For both, males and females, aspects related to comfort and functionality were reported as much more important than the esthetical aspects, and in general they are quite satisfied with the OD and the process of providing the OD. Orthopaedic technicians and health care providers can take these aspects into account when developing, constructing and providing OD’s. Show more

Keywords: Stroke, multiple sclerosis, satisfaction, acceptation, ankle-foot-orthotics, gait

DOI: 10.3233/NRE-172214

Citation: NeuroRehabilitation, vol. 42, no. 1, pp. 121-130, 2018