NeuroRehabilitation - Volume 45, issue 2

Authors: Dehem, Stéphanie | Montedoro, Vincenza | Brouwers, Isaline | Edwards, Martin Gareth | Detrembleur, Christine | Stoquart, Gaëtan | Renders, Anne | Heins, Sophie | Dehez, Bruno | Lejeune, Thierry

Article Type: Research Article

Abstract: BACKGROUND: The ROBi GAME project aims to implement serious games on robots to rehabilitate upper limb (UL) motor function in children with cerebral palsy (CP). Serious game characteristics (target position, level of assistance/resistance, level of force) are typically adapted based on the child’s assessment before and continuously during the game (measuring UL working area, kinematics and muscle strength). OBJECTIVE: This study developed an UL robotic motor assessment protocol to configure the serious game. METHODS: Forty-nine healthy children and 20 CP children participated in the study. The clinical assessment consisted of the child’s UL length and isometric …force. The robot assessment consisted of the child’s UL working area (WA), the UL isometric and isokinetic force in three directions and the UL kinematics during a pointing task toward targets placed at different distances. RESULTS: Results showed that WA and UL isometric force were moderately to highly correlated with clinical measures. Ratios between the UL isokinetic force generated on three directions were established. The velocity and straightness indexes of all children increased when they had to reach to targets placed more distant. CONCLUSIONS: This protocol can be integrated into different serious games in order to continuously configure the game characteristics to a child’s performance. Trial registration: The study was registered at ClinicalTrials.gov (NCT02543424), 12 August 2015. Show more

Keywords: Cerebral palsy, upper limb, robotic, motor assessment, serious game

DOI: 10.3233/NRE-192745

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 137-149, 2019

Authors: Burgess, Gillian | Jensen, Lou E.

Article Type: Research Article

Abstract: The number of adults diagnosed with brain tumors is increasing, as are the survival rates. Neurological impairments from brain tumors can impact activity and participation. Adults with brain tumors benefit from post-acute rehabilitation. However, there is limited evidence from the acute care setting. The purpose of this study was to examine how acute care occupational therapy services were utilized and whether patients made functional gains after receiving occupational therapy services. A retrospective chart review of 153 electronic medical records was completed for patients who received occupational therapy services at a large teaching hospital. Data collected included number of occupational therapy …visits, the types of interventions, and patient performance using the Boston University Activity Measure for Post-Acute Care “6 Clicks for Daily Activity” short form (AM-PAC). More than half the patients received one occupational therapy visit (54.2%) with a median length of stay of three days. Most interventions focused on activities of daily living (ADLs). Of those patients who received more than one visit, 67% showed improvements in their AM-PAC scores. Occupational therapy practitioners provided interventions that addressed ADLs, and patients demonstrated gains in functional performance. These findings suggest that patients benefit from occupational therapy services provided in the acute care setting. Show more

Keywords: Neurorehabilitation, occupational therapy, oncology, rehabilitation

DOI: 10.3233/NRE-192799

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 151-161, 2019

Authors: McKeon, Ashlee B. | Stocker, Ryan P.J. | Germain, Anne

Article Type: Review Article

Abstract: OBJECTIVE: To synthesize the current evidence on sleep disturbances in military service members (SMs) and veterans with traumatic brain injury (TBI). METHODS: An electronic literature search first identified abstracts published from 2008–2018 inclusively referencing sleep, TBI, and military personnel from Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn, and Persian Gulf veterans. Selection criteria eliminated studies on non-combat TBI, open or penetrating injuries, and articles where the relationship between sleep and TBI was not directly examined. Articles on all military branches and components, those currently serving and veterans—ranging from medical chart reviews to clinical trials, were included. …Forty-one articles were selected for full text-review. RESULTS: Twenty-four papers estimated the prevalence of sleep disturbances in TBI. Eight studies demonstrated the contribution of common co-occurring conditions, most notably posttraumatic stress disorder, to the relationship between disrupted sleep and TBI. Ten studies differentiated sleep profiles between military SMs and veterans with and without acute TBI and detected significant differences in sleep disturbances across the course of injury. Longitudinal studies were scarce but helped to establish the temporal relationship between sleep disturbances and TBI and isolate sleep-related mechanisms influencing TBI prognosis. Only three studies reported on interventions for improving sleep quality and TBI symptoms. Systematic research testing assessments and interventions that target sleep disturbances for improving sleep, TBI symptoms, and long-term functional outcomes were identified as critical knowledge gaps. CONCLUSION: Findings unequivocally establish that sleep disturbances are highly prevalent in SMs and veterans with TBI. However, studies testing the effectiveness of treatments for improving sleep in military groups with TBI have been limited and their results inconsistent. This review highlights a critical opportunity for advancing military medicine through future research aimed at identifying and testing sleep-focused treatments in SMs and veterans with combat-related TBI. Show more

Keywords: Sleep disturbance, traumatic brain injury, military, service members, veterans, Operation Iraqi Freedom, Operation Enduring Freedom, Operation New Dawn, Persian Gulf veterans

DOI: 10.3233/NRE-192804

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 163-185, 2019

Authors: West, Anders | Simonsen, Sofie Amalie | Jennum, Poul | Cyril Hansen, Niklas | Schønsted, Marie | Zielinski, Alexander | Sander, Birgit | Iversen, Helle K.

Article Type: Research Article

Abstract: BACKGROUND: Daylight entrains the central circadian pacemaker to the 24-hour day and is crucial for optimal alertness and sleep-quality. Rehabilitation patients tend to lack exposure to sufficient natural light. OBJECTIVE: Installed diurnal naturalistic light may reduce the known disrupted sleep quality and fatigue seen in post stroke patients. METHODS: Stroke patients were randomized to either an intervention rehabilitation unit (IU) equipped with naturalistic lighting (artificial sunlight spectrum) or to a control rehabilitation unit (CU) with standard indoor lighting. At inclusion and discharge, fatigue and subjective sleep quality were measured. RESULTS: Ninety stroke patients were …included between May 2014, and June 2015. At discharge, patients from the IU experienced less fatigue than the CU patients, based on the Multidimensional Fatigue Inventory questionnaire general (IU, n  = 28; CU, n  = 30; diff – 20.6%, 95% confidence interval (CI) [– 35.0%; – 3.0%]; P  = 0.025) and the Rested Statement (IU, n  = 28; CU, n  = 30; diff + 41.6%, 95% CI [+4.6%; +91.8%]; P  =  0.025). No differences were detected between groups in sleepiness or subjective sleep quality by the Pittsburgh Sleep Quality Index. CONCLUSIONS: Fatigue was significantly reduced in rehabilitation patients exposed to naturalistic lighting during admission. Show more

Keywords: Sleep, fatigue, circadian rhythm, clinical trials, stroke, light

DOI: 10.3233/NRE-192752

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 187-200, 2019

Authors: Aprile, Irene | Iacovelli, Chiara | Goffredo, Michela | Cruciani, Arianna | Galli, Manuela | Simbolotti, Chiara | Pecchioli, Cristiano | Padua, Luca | Galafate, Daniele | Pournajaf, Sanaz | Franceschini, Marco

Article Type: Research Article

Abstract: BACKGROUND: End-effector robots allow intensive gait training in stroke subjects and promote a successful rehabilitation. A comparison between conventional and end-effector Robot-Assisted Gait Training (RAGT) in subacute stroke patients is needed. OBJECTIVE: To investigate the efficacy of end-effector RAGT in subacute stroke patients. METHODS: Twenty-six subacute stroke patients were divided into two group: 14 patients performed RAGT (RG); 12 patients performed conventional gait training (CG). Clinical assessment and gait analysis were performed at the beginning (T0) and at the end (T1) of the rehabilitation. RESULTS: The RG revealed a significant improvement in body function, …activities, participation scales, and in the distance measured with the 6 MWT. The affected lower limb’s spasticity significantly decreased at T1. In gait analysis, RG showed significantly increases in many parameters. The CG significantly improved clinical assessments but showed no significant changes in gait parameters. Statistically significant differences between RG and CG were found in MRC-HE, TCT, 10 MWT, 6 MWT, and TUG. No significant difference between groups was registered in gait kinematics. CONCLUSIONS: Both rehabilitation treatments produce promising effects in subacute stroke patients. RAGT device offers a more intensive, controlled, and physiological gait training and significantly improved deambulation. Show more

Keywords: Stroke, Robot-Assisted Gait Training, end-effector device, neurologic gait disorders, rehabilitation

DOI: 10.3233/NRE-192778

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 201-212, 2019

Authors: Thielman, Gregory | Yourey, Lucas

Article Type: Research Article

Abstract: BACKGROUND: With increased practice of real-time ultrasound imaging in the physical therapy profession, it is essential to evaluate the utility of its use post stroke. OBJECTIVE: Evaluate relationship of spastic brachialis muscle architectural parameters with clinical measures of upper extremity function and spasticity. METHODS: Eleven post stroke individuals with spasticity of the upper limb had their brachialis muscle pennation angle and fascicle length measured in the affected and unaffected upper arm, at rest. Involved side upper extremity Fugl-Meyer, Modified Ashworth Scale, and grip strength were collected and compared to muscle architectural parameters of affected and unaffected …brachialis muscles. RESULTS: Affected side brachialis pennation angle was significantly greater than the unaffected side, and affected fascile length was significantly shorter than the unaffected side. Function levels were found to be significantly higher in those with greater fascile lengths and lower pennation angles. Higher Fugl-Meyer scores of the affected upper extremity were inversely correlated with lower Modified Ashworth Scale scores. CONCLUSIONS: An objective method of quantifying spasticity can assist in determining if functional gains made post stroke are due to compensations in movement, or due to physiological changes. Ultrasound imaging may be used as an alternative to the Modified Ashworth score to quantify muscular parameters in spastic muscles post stroke. Show more

Keywords: Real-time ultrasound imaging, stroke, spasticity, upper extremity, Modified Ashworth Scale

DOI: 10.3233/NRE-192742

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 213-220, 2019

Authors: Park, Ji-Su | Lee, Gihyoun | Choi, Jong-Bae | Hwang, Na-Kyoung | Jung, Young-Jin

Article Type: Research Article

Abstract: BACKGROUND: Game-based exercise is effective for improving strength and motor function in stroke patients undergoing rehabilitation, and it creates fun and motivation for exercise. OBJECTIVE: We investigated the effect of game-based exercise on hand strength, motor function, and compliance in stroke patients. METHODS: Fifty stroke patients were randomly divided into experimental and control groups. The experimental group performed a game-based hand resistance exercise. This exercise was divided into isotonic and isometric types and was performed 30 min/day, 5 days/week, for 6 weeks with 70% of the 1-repetition maximum. In contrast, the control group was given a traditional …manual exercise by the occupational therapist, and the type of exercise and time involved were the same as those in the experimental group. The primary outcome measure was hand strength test measured using a dynamometer. Secondary outcome measures were manual function tests (MFT) and hand function tests using box and block test (BBT). Subject-based reports of motivation, fun, pain/fatigue evaluated on 0 to 10 numeric rating scales were compared between groups. RESULTS: After training, hand strength, MFT and BBT was improved in the experimental group compared to the control group (P  < 0.001, both). Subject-based reports of motivation and fun was significantly greater in the experimental group than the control group (P  < 0.001, both), except to pain/fatigue (P  = 0.728). CONCLUSIONS: In conclusion, we demonstrated that game-based exercise is more effective than manual exercise in improving muscle strength, motor function, and compliance in stroke patients. Show more

Keywords: Game, motor function, muscle strength, resistance exercise, stroke

DOI: 10.3233/NRE-192829

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 221-227, 2019

Authors: Andrews, A.W. | Vallabhajosula, S. | Ramsey, C. | Smith, M. | Lane, M.H.

Article Type: Research Article

Abstract: BACKGROUND: Normative data for the equivalent of gait speed via the Wheelchair Propulsion Test (WPT) do not exist for wheelchair users. OBJECTIVE: The purposes of the current study were to: 1) determine the reliability of the WPT, 2) propose and compare normative values for the WPT for young adult males and females utilizing three different propulsion techniques, and 3) compare how different wheelchair types affect performance on the WPT. METHODS: 50 young adults (25 of each sex) performed the WPT using three different propulsion techniques in three different types of wheelchairs. Participants were asked to propel …a wheelchair over 10 m at a comfortable speed. Time and number of pushes were recorded for three trials for each propulsion technique in each type of wheelchair. RESULTS: All of the ICC(2,2) values were >0.83 for speed and number of pushes. Normative values for speed, number of pushes, push frequency and effectiveness categorized by propulsion technique, sex and wheelchair type were developed. CONCLUSIONS: Preliminary normative values have been established for young adults performing the WPT. This study highlights the need to maintain consistency of the wheelchair type and propulsion technique between trials in order for the WPT to be reliable. Show more

Keywords: Wheelchair, locomotion, reliability, normal distribution

DOI: 10.3233/NRE-192779

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 229-237, 2019

Authors: Beckerman, Heleen | Heine, Martin | van den Akker, Lizanne E. | de Groot, Vincent

Article Type: Research Article

Abstract: BACKGROUND: Walking tests, like the 2-minute fast walk test, are simple, inexpensive performance-based tests, and therefore seem attractive to estimate the aerobic fitness in people with chronic diseases. OBJECTIVE: To determine the criterion validity of the 2-minute fast walk test for estimating aerobic capacity in patients with Multiple Sclerosis (MS), by comparing it with the peak oxygen uptake (VO2peak in mL/kg/min) as measured by Cardiopulmonary Exercise Testing (CPET) on a cycle ergometer. METHODS: The 2 min fast walk test was performed on a marked indoor trajectory, using a static start protocol. Aerobic capacity (VO2peak, in mL/kg/min) was …derived from CPET on a cycle ergometer. Criterion validity was tested by means of Pearson’s correlation coefficient and should be at least 0.70 for a good criterion validity of the 2 min walk test. Linear regression analysis was applied to more precisely estimate VO2peak. RESULTS: In total 141 people with severe MS-related fatigue (mean age 47.0 years (range 23–68 years), 73% women, median disease duration 7.8 years (range 0.3 – 28.7 years)) performed both tests. The distance walked in two minutes ranged from 52.0 to 290.0 m (mean 175.1 m, sd 44.9 m), while the VO2peak varied between 11.31 and 40.28 mL/kg/min (mean 22.52 mL/kg/min, sd 6.07 mL/kg/min). The correlation between the 2 min walk test and VO2peak was 0.441 (95% CI: 0.309–0.570). The absolute residual error in estimated VO2peak was 5.47 mL/kg/min. CONCLUSIONS: Due to the poor correlation found between the 2 min walk test and VO2peak, the 2-min walk test cannot be recommended as a valid alternative for estimating aerobic capacity in persons with MS. Show more

Keywords: Exercise capacity, multiple sclerosis, 2 minute walk test, criterion validity

DOI: 10.3233/NRE-192792

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 239-245, 2019

Authors: de Sire, Alessandro | Bigoni, Matteo | Priano, Lorenzo | Baudo, Silvia | Solaro, Claudio | Mauro, Alessandro

Article Type: Research Article

Abstract: BACKGROUND: There are few evidences on safety of Constraint-Induced Movement Therapy (CIMT), as well as its effects in neurological conditions, including multiple sclerosis (MS). OBJECTIVE: To evaluate safety and effectiveness of a 2-week CIMT protocol on upper limb activity of progressive MS patients through a three-dimensional (3D) kinematic analysis. METHODS: In this randomized single-blind pilot study, we randomly allocated patients affected by progressive MS reporting a reduced use of one upper limb into two different groups: CIMT group (less affected limb blocked by a splint) and control group (undergoing bi-manual treatment). Primary outcome was CIMT safety. …Furthermore, we assessed CIMT effects through clinical outcomes (hand grip strength, HGS, and 9 Hole Peg Test, 9HPT) and 3D kinematic analysis (normalized jerk, number of movement units, going phase duration, mean velocity, endpoint error). All evaluations were performed at baseline (T0) and after 2 weeks of treatment (T1) for both arms in both groups. RESULTS: Ten MS patients, mean aged 51.0±7.7 years, were randomly allocated in the 2 groups. After treatment, no differences were found in the blocked arm. Furthermore, CIMT group showed significant improvements in clinical and kinematic parameters. CONCLUSIONS: CIMT might be considered a safe and effective technique in MS patients. Show more

Keywords: Multiple sclerosis, rehabilitation, upper extremity, muscle strength, physical therapy modalities, constraint-induced movement therapy, kinematics

DOI: 10.3233/NRE-192762

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 247-254, 2019

Authors: Santos, Pietro | Machado, Tácia | Santos, Luan | Ribeiro, Nildo | Melo, Ailton

Article Type: Research Article

Abstract: BACKGROUND: Studies have demonstrated that the combination of Nintendo Wii (NW) with Conventional Exercises (CE) was effective in the rehabilitation of patients with Parkinson’s Disease (PD), but there are no studies comparing the effects of this combination on both techniques isolated. OBJECTIVE: To investigate if the effects of the combination of NW to CE are superior to isolated techniques in the rehabilitation of balance, gait, functional mobility and improvement of the quality of life of individuals with PD. METHODS: 45 patients with PD were divided into three groups, NW alone, CE alone and NW plus EC. …The sessions occurred for 50 minutes, twice a week and evaluations administered before and after the 2-month intervention. RESULTS: Significant differences were found in the pre and post intervention analyzes of all the outcomes in the three groups, but there was no difference between the groups. The effect size was evaluated, in which the NW plus CE group had a greater magnitude of the therapeutic effect. CONCLUSION: The NW plus CE was statistically as effective as each intervention alone in the rehabilitation of patients with PD, however, the use of this combination provided a magnitude of the therapeutic effect superior to the other groups. Show more

Keywords: Parkinson’s disease, virtual reality, conventional exercises, rehabilitation

DOI: 10.3233/NRE-192771

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 255-263, 2019

Authors: Brincks, John | Jørgensen, Julie Brøbech | Giese, Iben Engelbrecht | Palle, Marie Louise | Callesen, Jacob | Johnsen, Erik | Næss-Schmidt, Erhard Trillingsgaard | Dalgas, Ulrik

Article Type: Research Article

Abstract: BACKGROUND: Clinical tests that can discriminate between people at risk of falling and those not at risk are warranted. The discriminative properties of the Six-Spot Step Test was investigated in people with Parkinson’s disease at risk of falling. METHODS: Eighty-one participants with a median age of 69 years (Q1–Q3:63–74) and a median Hoehn and Yahr score of 2.5 (Q1–Q3:2–3) completed the Six-Spot Step Test and the Timed “Up and Go” test. A mini-BESTest score of 19 or below was used as a cut-off for defining risk of falling, and a receiver operating characteristics curve was generated to determine …clinical relevant cut-off scores. RESULTS: A cut-off score of 7.0 and 6.8 seconds identified people not at risk of falling, while 11.1 and 9.4 seconds identified people at risk of falling for the Six-Spot Step Test and the Timed “Up and Go” test, respectively. When maximizing the sensitivity and specificity a cut-off score of 9.2 (accuracy of 84%) and 8.1 seconds (accuracy of 70%) was found for the Six-Spot Step Test and the Timed “Up and Go” test, respectively. CONCLUSION: The Six-Spot Step Test discriminates accurately between people with Parkinson’s disease at risk of falling and people not at risk. Show more

Keywords: Walking agility, risk of falling, Parkinson’s disease, clinical test, discriminative properties

DOI: 10.3233/NRE-192801

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 265-272, 2019

Authors: Kalyani, H.H.N. | Sullivan, K.A. | Moyle, G. | Brauer, S. | Jeffrey, E.R. | Kerr, G.K.

Article Type: Research Article

Abstract: BACKGROUND: While dance may improve motor features in Parkinson’s disease (PD), it is not yet clear if the benefits extend to non-motor features. OBJECTIVE: To determine whether dance classes based on Dance for PD® , improve cognition, psychological symptoms and Quality of Life (QoL) in PD. METHODS: Participants were allocated to a Dance Group (DG; n  = 17) or Control Group (CG: n  = 16). Participants had early-stage PD (Hoehn & Yahr: DG = 1.6±0.7, CG = 1.5±0.8) with no cognitive impairment (Addenbrooke’s score: DG = 93.2±3.6, CG = 92.6±4.3). The DG undertook a one-hour class, twice weekly for 12 weeks, while the CG had treatment …as usual. Both groups were assessed for disease severity (MDS-UPDRS), cognition (NIH Toolbox® cognition battery, Trail Making Test), psychological symptoms (Hospital Anxiety and Depression Scale, MDS-UPDRS-I) and QoL (PDQ-39, MDS-UPDRS-II). RESULTS: Group comparison of pre-post change scores showed that selected cognitive skills (executive function and episodic memory), psychological symptoms (anxiety and depression) as well as QoL (PDQ-39 summary index) were significantly improved by the intervention (DG > CG, p ’s < 0.05, Cohen’s d  > 0.8). DISCUSSIONS and CONCLUSION: Dance classes had a clear benefit on psychological symptoms, QoL and a limited cognitive benefit. Follow-up assessment is required to confirm the durability of these effects. Show more

Keywords: Parkinson’s disease, dance, cognition, psychological symptoms, quality of life

DOI: 10.3233/NRE-192788

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 273-283, 2019

Authors: De Luca, Rosaria | Latella, Desiree | Maggio, Maria Grazia | Di Lorenzo, Giuseppe | Maresca, Giuseppa | Sciarrone, Francesca | Militi, David | Bramanti, Placido | Calabrò, Rocco Salvatore

Article Type: Research Article

Abstract: BACKGROUND: Parkinson’s disease (PD) is a neurodegenerative disease due to dopamine deficiency in the basal ganglia, leading to motor symptoms such as bradykinesia, tremor, stiffness, and postural instability. This disease may also be associated with a broad spectrum of non-motor symptoms. More than 24% of patients with PD have one or more cognitive symptoms. OBJECTIVE: To evaluate the effects of computer-assisted cognitive rehabilitation (CACR) in Parkinson’s disease (PD). METHODS: Sixty patients with PD were enrolled in this study and were randomly divided into control group (CG) and experimental group (EG). Each participant was evaluated at the …beginning (T0) and at the end of training (T1). The CG underwent standard cognitive training (SCT) while EG performed CACR using the ERICA platform, aimed at improving several cognitive domains. In both the group, each training consisted of 3 sessions a week, each of these lasting sixty minutes, for eight weeks. RESULTS: Although both the groups had significant improvement after CR, we observed more significant changes in the EG, especially concerning attention, orientation and visual-spatial domains. CONCLUSIONS: Our data demonstrate that CACR is more effective than SCT in improving visual-spatial and executive deficits, in patients affected by PD. Show more

Keywords: Parkinson’s disease, cognitive dysfunctions, cognitive rehabilitation, computer assisted cognitive rehabilitation

DOI: 10.3233/NRE-192789

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 285-290, 2019

Authors: Amatya, Bhasker | Young, Jamie | Khan, Fary

Article Type: Other

Abstract: The aim of this commentary is to discuss the rehabilitation perspective in the recently published Cochrane Review “Non-pharmacological interventions for chronic pain in multiple sclerosis” by Amatya, Young & Khan.1 , under the direct supervision of Multiple Sclerosis and Rare Diseases of the CNS group. This Cochrane Corner is produced in agreement with NeuroRehabilitation by Cochrane Rehabilitation.

Keywords: Multiple sclerosis, chronic pain, non-pharmacological intervention, rehabilitation

DOI: 10.3233/NRE-189009

Citation: NeuroRehabilitation, vol. 45, no. 2, pp. 291-293, 2019