NeuroRehabilitation - Volume 44, issue 4

Authors: Yilmazer, Cigdem | Boccuni, Leonardo | Thijs, Liselot | Verheyden, Geert

Article Type: Review Article

Abstract: BACKGROUND: Research mainly focuses on motor recovery of the upper limb after stroke. Less attention has been paid to somatosensory recovery. OBJECTIVE: To review and summarize the effect of upper limb somatosensory interventions on somatosensory impairment, motor impairment, functional activity and participation after stroke. METHODS: Biomedical databases Ovid Medline, EMBASE, Web of Science, PEDro, and OTseeker were searched with an update in May 2018. Randomized controlled trials investigating the effect of somatosensory-specific interventions focusing on exteroceptive, proprioceptive or higher cortical somatosensory dysfunction, or any combination were eligible for inclusion. Quality of included studies were assessed using …Physiotherapy Evidence Database (PEDro) scale. Standardized Mean Differences and Mean Differences and 95% confidence intervals were calculated and combined in meta-analyses. RESULTS: Active somatosensory interventions did not show a significant effect on somatosensation and activity, but demonstrated a significant improvement in motor impairment (SMD = 0.73, 95% CI = 0.14 to 1.32). No study evaluating active somatosensory intervention included participation. Passive somatosensory interventions significantly improved light touch sensation (SMD = 1.13, 95% CI = 0.20 to 2.05). Passive somatosensory interventions did not show significant effects on proprioception and higher cortical somatosensation, motor impairment, activity and participation. CONCLUSIONS: To date, there is low quality evidence suggesting active somatosensory interventions having a beneficial effect on upper limb impairment and very low quality evidence suggesting passive somatosensory interventions improving upper limb light touch sensation. There is a need for further well-designed trials of somatosensory rehabilitation post stroke. Show more

Keywords: Stroke, Upper Limb, Somatosensory Rehabilitation, Somatosensation, Systematic Review, Meta-analysis

DOI: 10.3233/NRE-192687

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 459-477, 2019

Authors: Ofek, Hadas | Alperin, Mordechai | Laufer, Yocheved

Article Type: Research Article

Abstract: OBJECTIVE: To develop a quantitative, inexpensive and easy to use tool, for assessing proprioception of the lower extremity of individuals post-stroke, and examine its test-retest reliability and known-groups validity. METHODS: The Lower Extremity Position Test was developed. Testing procedure: seated subjects were asked to reproduce 12 cm or 22 cm distances on a plastic surface, by verbally stopping passive movement of the foot produced by the tester. The deviation from the target point was measured as the mismatch score. Fifty one subjects post-stroke (n  = 51) participated in prospective test-retest assessment. The tests were performed one week apart by a single …assessor, in physical therapy out-patient clinics. The t -test, ICC and Bland-Altman tests were used to determine known-groups validity by determining leg differences and test-retest reliability. RESULTS: Post-stroke involved foot demonstrated significantly higher mismatch scores then the uninvolved foot did (p  < 0.0001). Good test-retest reliability was demonstrated for the involved leg for both 12 cm and 22 cm distances (ICC = 0.79 and 0.85, respectively). The 95% repeatability ranges were leg related. CONCLUSIONS: The Lower Extremity Position Test (LEPT) is a newly-developed testing tool with good clinical utility, reliable in post-stroke population and has known-group validity (involved versus uninvolved foot). Show more

Keywords: Stroke, position test, proprioception, lower extremity, assessment

DOI: 10.3233/NRE-182662

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 479-484, 2019

Authors: Saleh, Marwa Shafiek Mustafa | Rehab, Nagwa Ibrahim | Aly, Sobhy Mahmoud Abelwahed

Article Type: Research Article

Abstract: BACKGROUND: Patients with stroke are more likely to be at risk of falling, which lead to limitation in their abilities to perform daily living activities and participation in society. Falling is due to an increase in postural sway and a decline in gait ability. Exercise in water helps them to safely and comfortably improve their motor ability by providing low-risk exercise environments. OBJECTIVE: This study was conducted to compare the effect of aquatic versus land motor dual task training on balance and gait of patients with chronic stroke. METHODS: Fifty patients with chronic stroke of both …sexes aging from 45 to 55 years were randomly assigned to aquatic or land group. Both groups received the same motor dual task training either in water or on land for 45 minutes, 3 days a week for six weeks. Measurement of the dynamic balance indices assessed using Biodex Balance System as well as kinematic gait parameters using Biodex Gait Trainer was performed before and after the intervention. RESULTS: There was a significant improvement in all outcome variables post treatment compared with that pre-treatment in both groups (P  < 0.05). There was a significant improvement in patients who received the motor dual task training in water compared with patients treated on the land in overall stability index (P  = 0.02), anteroposterior stability index (P  = 0.03), mediolateral stability index (P  = 0.002), walking speed (P  = 0.01), step length of affected limb (P  = 0.03), step length of non-affected limb (P  = 0.01), and time of support on the affected limb (P  = 0.002). CONCLUSION: Aquatic motor dual task training is more effective in improving balance and gait abilities of patients with chronic stroke than land motor dual task training. Show more

Keywords: Aquatic exercise, balance, chronic stroke, gait, motor dual task training

DOI: 10.3233/NRE-182636

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 485-492, 2019

Authors: Kannan, Lakshmi | Vora, Jinal | Bhatt, Tanvi | Hughes, Susan L.

Article Type: Research Article

Abstract: BACKGROUND: Dual-task (simultaneous motor and cognitive task) (DT) training via virtual-reality exergaming is known to benefit balance control post-stroke. However, the efficacy of such training on DT balance control (volitional and reactive) and cognitive (executive function and attention) domains associated with fall risk remains unclear. OBJECTIVE: We evaluated the efficacy of cognitive-motor exergame training (CMT) (Wii-fit games in conjunction with cognitive tasks) for improving balance control (volitional and reactive) and cognition (executive function and attention) among people with chronic stroke (PwCS). METHODS: Hemiparetic, ambulatory PwCS were randomly assigned to either CMT (n  = 12) or conventional training …(CT) (n  = 12) and underwent six weeks of high-intensity, tapered balance training. The CMT group performed Wii-fit games in conjunction with cognitive tasks, while CT group underwent customized, progressive balance training. Performance under DT conditions on Limits of Stability (volitional) and Slip-Perturbation (reactive) tests, and letter-number sequencing (cognition) determined the efficacy of CMT. RESULTS: Post-intervention, under DT reactive conditions, CMT group improved both motor and cognition, while the CT group improved motor alone. Under DT volitional conditions, motor performance improved only in CMT group. CONCLUSION: Cognitive-motor exergaming appears to be effective for improving balance control and cognition and could be implemented in clinical stroke rehabilitation settings. Show more

Keywords: Dual-task training, cognitive-motor exergaming, Wii-fit Nintendo, chronic stroke rehabilitation

DOI: 10.3233/NRE-182683

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 493-510, 2019

Authors: Lu, Lisa H. | Reid, Matthew W. | Cooper, Douglas B. | Kennedy, Jan E.

Article Type: Research Article

Abstract: BACKGROUND: Many with a history of mild traumatic brain injury (TBI) experience sleep problems, which are also common symptoms of stress-related and mood disorders. OBJECTIVE: To determine if sleep problems contributed unique variance to post-concussive symptoms above and beyond symptoms of posttraumatic stress disorder/major depressive disorder (PTSD/MDD) after mild TBI. METHODS: 313 active duty service members with a history of mild TBI completed sleep, PTSD, and mood symptom questionnaires, which were used to determine contributions to the Neurobehavioral Symptom Inventory. RESULTS: 59% of the variance in post-concussive symptoms were due to PTSD symptom severity …while depressive symptoms and sleep problems contributed an additional 1% each. This pattern differed between those with and without clinical diagnosis of PTSD/MDD. For those with PTSD/MDD, PTSD and depression symptoms but not sleep contributed to post-concussive symptoms. For those without PTSD/MDD, PTSD symptoms and sleep contributed specifically to somatosensory post-concussive symptoms. Daytime dysfunction and sleep disturbances were associated with post-concussive symptoms after PTSD and depression symptoms were controlled. CONCLUSIONS: PTSD symptom severity explained the most variance for post-concussive symptoms among service members with a history of mild TBI, while depression symptoms, daytime dysfunction, and sleep disturbances independently contributed small amounts of variance. Show more

Keywords: Concussion, sports, combat, blast, insomnia, sleep apnea, psychiatry, primary care, stress, dysthymia

DOI: 10.3233/NRE-192702

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 511-521, 2019

Authors: Silverberg, Noah D.

Article Type: Research Article

Abstract: BACKGROUND: Headache is among the most common persistent symptoms after mild traumatic brain injury (mTBI). Currently available treatments have limited efficacy. OBJECTIVE: To present a rationale for a novel behavioral treatment approach and a supporting case series with a multiple baseline design. METHOD: Pervasive avoidance of common headache triggers may be maladaptive, promoting sensitization and restricting life participation. Graded exposure to triggers that are prone to sensitization (e.g., stress, light flicker, loud noise) may represent an alternative behavioral approach to treating chronic headaches after mTBI. The present study reports on a series of physician-referred patients (N … = 4, aged 28–48, enrolled at 9–19 months post-injury) with persistent headache attributed to mTBI. They participated in an 8-session manualized treatment with a registered psychologist. Patients completed a daily headache diary before, during, and after treatment, as well as pre- and post-treatment assessments with a battery of questionnaires. RESULTS: All patients finished treatment and no adverse events were reported. Improvement was variable across measures of headache frequency/intensity, headache trigger avoidance, post-concussion symptoms, disability, and patient global impression of change. CONCLUSION: Future directions for behavioral management of headache triggers as a potential treatment for chronic post-traumatic headaches after mTBI are discussed. Show more

Keywords: Brain concussion, post-traumatic headache, behavior therapy

DOI: 10.3233/NRE-192708

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 523-530, 2019

Authors: Ettenhofer, Mark L. | Guise, Brian | Brandler, Brian | Bittner, Katie | Gimbel, Sarah I. | Cordero, Evelyn | Nelson Schmitt, Shawn | Williams, Kathy | Cox, Daniel | Roy, Michael J. | Chan, Leighton

Article Type: Research Article

Abstract: BACKGROUND: Virtual reality (VR) technology may provide an effective means to integrate cognitive and functional approaches to TBI rehabilitation. However, little is known about the effectiveness of VR rehabilitation for TBI-related cognitive deficits. In response to these clinical and research gaps, we developed Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE), an intervention designed to improve cognitive performance, driving safety, and neurobehavioral symptoms. OBJECTIVE: This pilot clinical trial was conducted to examine feasibility and preliminary efficacy of NeuroDRIVE for rehabilitation of chronic TBI. METHODS: Eleven participants who received the intervention were compared to six wait-listed participants on …driving abilities, cognitive performance, and neurobehavioral symptoms. RESULTS: The NeuroDRIVE intervention was associated with significant improvements in working memory and visual search/selective attention— two cognitive skills that represented a primary focus of the intervention. By comparison, no significant changes were observed in untrained cognitive areas, neurobehavioral symptoms, or driving skills. CONCLUSIONS: Results suggest that immersive virtual environments can provide a valuable and engaging means to achieve some cognitive rehabilitation goals, particularly when these goals are closely matched to the VR training exercises. However, additional research is needed to augment our understanding of rehabilitation for driving skills, cognitive performance, and neurobehavioral symptoms in chronic TBI. Show more

Keywords: Traumatic brain injury, rehabilitation, cognition, virtual reality, driving ClinicalTrials.gov Identifier: NCT02411227

DOI: 10.3233/NRE-192718

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 531-544, 2019

Authors: Attwell, Caroline | Jöhr, Jane | Pincherle, Alessandro | Pignat, Jean-Michel | Kaufmann, Nina | Knebel, Jean-François | Berney, Loric | Ryvlin, Philippe | Diserens, Karin

Article Type: Research Article

Abstract: BACKGROUND: Neurosensory stimulation is effective in enhancing the recovery process of severely brain-injured patients with disorders of consciousness. Multisensory environments are found in nature, recognized as beneficial to many medical conditions. Recent advances detected covert cognition in patients behaviorally categorized as un- or minimally responsive; a state described as cognitive motor dissociation (CMD). OBJECTIVE: To determine effectiveness of a neurosensory stimulation approach enhanced by outdoor therapy, in the early phases of recovery in patients presenting with CMD. METHODS: A prospective non-randomized crossover study was performed. A two-phase neurosensory procedure combined identical individually goal assessed indoor and …outdoor protocols. All sessions were video-recorded and observations rated offline. The frequency of volitional behavior was measured using a behavioral grid. RESULTS: Fifteen patients participated in this study. The outdoor group patients had statistically significant higher number of intentional behaviors than the indoor group on seven features of the grid. Additionally, for all items assessed, total amount of behaviors in the outdoor condition where higher than those in the indoor condition. CONCLUSIONS: Although preliminary, this study provides robust evidence supporting the effectiveness and appropriateness of an outdoor neurosensory intervention in patients with covert cognition, to improve adaptive goal-oriented behavior. This may be a step towards helping to restore functional interactive communication. Show more

Keywords: Neurosensory stimulation, outdoor therapy, cognitive motor dissociation, covert cognition, early rehabilitation, disorders of consciousness

DOI: 10.3233/NRE-192692

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 545-554, 2019

Authors: Bernini, Sara | Alloni, Anna | Panzarasa, Silvia | Picascia, Marta | Quaglini, Silvana | Tassorelli, Cristina | Sinforiani, Elena

Article Type: Research Article

Abstract: BACKGROUND: There is no successful pharmacological treatment for cognitive impairment in Parkinson’s Disease, therefore treatments capable of slowing down the progression of cognitive dysfunction are needed. OBJECTIVE: To evaluate the effectiveness of a cognitive training, supported by the CoRe computerized tool, in patients with Parkinson’s Disease Mild Cognitive Impairment. METHODS: This is a prospective, open-unblinded, randomized, controlled study. After baseline cognitive assessment (T0), enrolled patients were randomized to receive motor rehabilitation plus cognitive intervention (G1) or motor rehabilitation only (G2). Follow-up assessments were scheduled 4 weeks (T1) and 6 months after (T2). Global cognitive functioning scores …(MOCA and MMSE) were considered as primary outcome. Outcome measures at T0, T1 and T2 were compared within- and between-groups. A percentage change score between T0 and next assessments was calculated to identify patients who improved, remain stable or worsened. RESULTS: Differently from G2, G1 showed a medium/large effect size improvement in primary (MoCA) and secondary outcome, both between T0 and T1 and T0 and T2. Moreover, within G1, most patients improved their cognitive state compared to the baseline. CONCLUSIONS: Patients trained with CoRe showed a better evolution of cognitive decline, while untreated patients tended to get worse over time. Show more

Keywords: Cognitive training, executive dysfunctions, Parkinson’s Disease, randomized controlled trial

DOI: 10.3233/NRE-192714

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 555-567, 2019

Authors: Santos, Pietro | Scaldaferri, Giselle | Santos, Luan | Ribeiro, Nildo | Neto, Mansueto | Melo, Ailton

Article Type: Review Article

Abstract: BACKGROUND: Randomized clinical trials (RCTs) used the Nintendo Wii (NW) in the treatment of Parkinson Disease, however, no meta-analysis was developed to determine the effects in these patients. OBJECTIVE: To analyze RCTs that investigated the effects of NW versus traditional physiotherapy on balance rehabilitation and quality of life of patients with PD. METHODS: Electronic research was conducted between December 2018 and January 2019 in the MEDLINE, PEDro, CENTRAL, LILACS and SciELO databases. The methodological quality was evaluated by the PEDro scale and the completeness of the description of the interventions by the TIDieR checklist. Weighted mean …differences (WMD) and 95% confidence interval (CI) were calculated. RESULTS: Five studies were included and presented an average of 5.4 (1.5) on the PEDro scale and 6.7 (1.4) on the TIDieR. Compared to traditional physiotherapy, combined NW and traditional physiotherapy resulted in improvement in balance WMD 1.24 (95% CI: CI: 0.2 to 2.3 N = 72) and quality of life WMD– 8.9 (95% CI: –15.2 to –2.6 N = 56). CONCLUSION: combined NW and traditional physiotherapy was more effective on balance rehabilitation and quality of life of patients with PD, but the values demonstrated a poor methodological quality and a low level of completeness of the intervention descriptions. Show more

Keywords: Parkinson disease, virtual reality, Nintendo Wii, rehabilitation

DOI: 10.3233/NRE-192700

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 569-577, 2019

Authors: Medijainen, Kadri | Pääsuke, Mati | Lukmann, Aet | Taba, Pille

Article Type: Research Article

Abstract: BACKGROUND: Gait function is known to be impaired by Parkinson’s disease (PD). The effect of exercise to improve gait has been widely examined, often with special intervention. However, in clinical settings, physiotherapy rarely consists only of gait training. OBJECTIVE: To examine whether versatile physiotherapy intervention conducted in accordance with European Physiotherapy Guideline for Parkinson’s Disease (EPGPD) is sufficient to increase gait speed (GS). METHODS: Participants (24) with idiopathic PD were randomly enrolled into intervention (IG) and control groups (CG) (n  = 12, 7 females and 5 males in each group). Sixteen one-hour therapy sessions (twice per week) …were conducted for IG. Each session focused on core areas recommended in EPGPD. Participants were assessed twice with 10 weeks between assessments. GS was calculated based on a gait test of Short Physical Performance Battery. Dominant side hip flexion and abduction range of motion (HFLEX & HABD) were measured and Freezing of Gait questionnaire (FOG) was administered. RESULTS: Versatile intervention in groups resulted in increase of GS (ES –0.9 [CI{0.1}–{0.4}] m/s) and HFLEX (ES–0.6 [CI{5.9}–{16.6°}]. FOG was reduced (ES –0.41 [CI {–2.8}{–5.5}]). Re-evaluation HABD differed between groups and indicated large ES (r  = –0.5). CONCLUSIONS: Versatile physiotherapy is sufficient to improve GS, range of motion and reduce FOG. Show more

Keywords: Parkinson’s disease, gait speed, physiotherapy

DOI: 10.3233/NRE-192723

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 579-586, 2019

Authors: Hoque, Maruf | Borich, Michael | Sabatier, Manning | Backus, Deborah | Kesar, Trisha

Article Type: Research Article

Abstract: BACKGROUND: Downslope walking (DSW) is an eccentric-based exercise intervention that promotes neuroplasticity of spinal reflex circuitry by inducing depression of Soleus Hoffman (H)-reflexes in young, neurologically unimpaired adults. OBJECTIVE: The objective of the study was to evaluate the effects of DSW on spinal excitability (SE) and walking function (WF) in people with multiple sclerosis (PwMS). METHODS: Our study comprised two experiments on 12 PwMS (11 women; 45.3±11.8 years). Experiment 1 evaluated acute effects of a single 20-minute session of treadmill walking at three different walking grades on SE, 0% or level walking (LW), – 7.5% DSW, …and – 15% DSW. Experiment 2 evaluated the effects of 6 sessions of DSW, at – 7.5% DSW (with second session being – 15% DSW) on SE and WF. RESULTS: Experiment 1 showed significantly greater acute % H-reflex depression following – 15% DSW compared to LW (p  = 0.02) and – 7.5% DSW (p  = 0.05). Experiment 2 demonstrated significant improvements in WF. PwMS who showed greater acute H-reflex depression during the – 15% DSW session also demonstrated greater physical activity, long-distance WF, and the ability to have greater H-reflex depression after DSW training. Significant changes were not observed in regards to SE. CONCLUSIONS: Though significant changes were not observed in SE after DSW training, we observed an improvement in WF which merits further investigation of DSW in PwMS. Show more

Keywords: Treadmill training, spinal excitability, neuroplasticity, spasticity

DOI: 10.3233/NRE-192701

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 587-597, 2019

Authors: Krieg, Iris | Dalin, Daniela | Heimbach, Bernhard | Wiesmeier, Isabella Katharina | Maurer, Christoph

Article Type: Research Article

Abstract: BACKGROUND: Postural instability in Amyotrophic Lateral Sclerosis (ALS) occurs at an early stage of the disease and often results in falls. As ALS is considered a multisystem neurodegenerative disorder, postural instability may result from motor, sensory and central processing deficits. OBJECTIVE AND METHODS: We analysed postural control of 12 ALS patients and 12 healthy age-matched control subjects. Postural control was characterised by spontaneous sway measures and measures of postural reactions to pseudorandom anterior-posterior platform tilts, which were then correlated with clinical test scores. RESULTS: Spontaneous sway amplitudes and velocities were significantly larger and sway frequencies higher …in ALS patients than in control subjects. ALS patients’ body excursions following platform tilts were smaller, with relatively higher upper body excursions. We found high correlations between abnormal postural reactions and clinical tests representing motor or balance deficits. CONCLUSIONS: We conclude that ALS patients’ postural abnormalities are mainly determined by an abnormal axial control and abnormally small body excursions as a function of support surface tilts, seemingly indicating better postural stabilization than control subjects. The latter contradicts the hypothesis that muscle weakness is the main source for this deficit. Instead, we suggest an altered central control strategy. Show more

Keywords: Amyotrophic Lateral Sclerosis, postural control, sensory weighting, trunk control, balance

DOI: 10.3233/NRE-192698

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 599-608, 2019

Authors: Oaklander, Anne Louise | Gimigliano, Francesca

Article Type: Other

Abstract: BACKGROUND: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a potentially disabling health condition. OBJECTIVE: To assess the effects of different pharmacological interventions used in CIPD. METHODS: To summarize and to discuss the rehabilitation perspective on the published Cochrane Overview “Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overviewof systematic reviews” by Anne Louise Oaklander, et al., representing the Cochrane Neuromuscular Group. RESULTS: Five CSRs and 23 RCTs, reporting data on corticosteroids, plasma exchange and intravenous immunoglobulin, were considered in the overview. CONCLUSIONS: High quality trials investigating the combined effectiveness of drugs and exercise …using ICF based outcomes should be encouraged. Show more

DOI: 10.3233/NRE-189007

Citation: NeuroRehabilitation, vol. 44, no. 4, pp. 609-612, 2019