NeuroRehabilitation - Volume 44, issue 4

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