NeuroRehabilitation - Volume 45, issue 4

Authors: Perrin, Paul B. | Henry, Richard S. | Donovan, Emily K. | Cariello, Annahir N. | Lageman, Sarah K. | Villaseñor, Teresita | Dzierzewski, Joseph M. | Arroyo, Monica | Avila, Judith

Article Type: Research Article

Abstract: BACKGROUND/OBJECTIVE: Given the growing population of individuals with Parkinson’s disease (PD) worldwide and the growing need for family members to take on a caregiving role, it is critical that cross-cultural differences be examined in order to better meet the needs of PD caregivers. The purpose of this study was to examine the connections between the unmet needs and mental health of PD caregivers differentially in Mexico and the United States. METHODS: In Parkinson’s clinics at public, academic medical centers, PD caregivers from Mexico (n  = 148) and the United States (n  = 105) completed measures of unmet family needs and …mental health. RESULTS: Caregivers in the United States had higher unmet needs for emotional support and for a community support network than caregivers in Mexico, although caregivers at the two sites had comparable levels of anxiety and depression. Unmet family needs explained 29.5% of the variance in caregiver anxiety in the United States (p  < 0.001) but only 5.7% in Mexico (p  = 0.209). Unmet family needs explained 30.4% of the variance in caregiver depression in the United States (p  < 0.001) and 14.0% in Mexico (p  = 0.001). In the United States, unmet needs for emotional support and for instrumental support uniquely predicted caregiver anxiety and depression, and in Mexico only the unmet need for instrumental support was a unique predictor. CONCLUSIONS: PD caregivers in the United States are at increased risk for poor emotional and community support, and these unmet needs channel directly into caregiver anxiety and depression. In Mexico, where caregivers have stronger emotional and community support, caregivers’ unmet need for instrumental support generates anxiety and depression. Important targets for PD caregiver interventions may differ between Mexico and the United States. Show more

Keywords: Cross-cultural, Parkinson’s caregivers, family needs, mental health

DOI: 10.3233/NRE-192894

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 433-442, 2019

Authors: Sayadi, Jamasb | Sayadi, Lohrasb Ross | Fijany, Arman | Chopan, Mustafa | Hermanowicz, Neal

Article Type: Research Article

Abstract: BACKGROUND: Parkinson’s disease (PD) is a neurodegenerative movement disorder that results in a variety of motor deficits such as unsteady gait, bradykinesia, resting tremor, and rigidity. OBJECTIVE: The objective of this study was to quantify and assess the challenges and preferences Parkinson’s disease patients have regarding footwear. METHODS: A 13-question survey was designed to assess footwear challenges and preferences among PD patients. A total of 89 PD patients, both male and female, were surveyed in the outpatient setting at UC Irvine during their appointments with the senior author. RESULTS: A majority of the PD …patients in our cohort (64%) reported experiencing difficulties wearing shoes on their own. Patients who experienced difficulties wearing shoes were significantly more likely to report having been forced to make changes to their desired outfits (p  = 0.0011), choosing not to wear dress shoes due to their discomfort (p  = 0.0175), and preferring shoes without laces (p  = 0.0 048). CONCLUSIONS: The present study is the first attempt to use a survey to quantify the challenges and preferences reported by PD patients in regard to their usage of footwear. Inspired by our findings, the study team designed a novel dress shoe prototype that may address some of the difficulties and concerns gathered through our survey. Show more

DOI: 10.3233/NRE-192897

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 443-448, 2019

Authors: Kaut, Oliver | Janocha, Laura | Weismüller, Tobias J. | Wüllner, Ullrich

Article Type: Research Article

Abstract: BACKGROUND: Gastrointestinal dysfunctions are common in Parkinson’s disease. Their management is still challenging and new treatment options are needed. OBJECTIVE: To test whether transcutaneous vagal nerve stimulation can improve gastrointestinal dysfunction in patients with Parkinson’s disease. METHODS: We performed a randomized double-blind pilot study enrolling patients suffering from Parkinson’s disease with gastroenteric complaints. Patients were randomized to use either a sham-device or to stimulate the vagal nerve with an electric device over the course of four weeks with four stimulations per day. Ten patients (aged 69.6±4.6 years) were randomized for the intervention group, and nine patients …(aged 67.2±6.3 years) used a sham-device. Clinical outcome was evaluated using the Gastrointestinal Symptom Rating Scale whereas gastrointestinal motility was measured with the 13 C-octanoic acid breath test. RESULTS: In the treatment group, vagal nerve stimulation improved the Gastrointestinal Symptom Rating Scale comparing before and after stimulation (before, 8.7±6.09; after 5.67±3.08; p -value 0.48). This improvement was not observed in the sham group (before, 7.44±4.85; after, 5.67±3.08; p -value 0.16). In the 13 C-octanoic acid breath test no significant changes were detectable. CONCLUSIONS: Vagal nerve stimulation is well tolerated with no side effects and may be a promising non-invasive therapy option to improve gastroenteric symptoms in Parkinson’s disease. Show more

Keywords: Transcutaneous vagal nerve stimulation, delayed gastric emptying, Parkinson’s disease

DOI: 10.3233/NRE-192909

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 449-451, 2019

Authors: Nordio, Sara | Burgio, Francesca | D’Imperio, Daniela | De Biagi, Francesa | Cosentino, Elena | Meneghello, Francesa

Article Type: Research Article

Abstract: BACKGROUND: Anoxic brain injury (ABI) is a neurological condition associated to a severe deterioration of brain functioning, whose symptomatology and clinical outcomes may be heterogeneous: cognitive deficits, language disorders like dysarthria and swallowing impairments. Nevertheless, there is still a lack of information on the rehabilitation outcomes. OBJECTIVE: To confirm the occurrence of communication and swallowing deficits in 37 ABI patients and to examine whether intensive rehabilitation may contribute to any improvements and its relation to ABI severity and functional autonomy. METHODS: 37 patients, hospitalized at IRCCS San Camillo Hospital from 2011 to 2018 were analyzed retrospectively. …All patients completed a functional evaluation and a language and swallowing assessment, within one week from hospital admission (T0). The assessment was repeated after an intensive rehabilitation treatment (T1). RESULTS: Results show that dysphagia is a frequent and severe outcome in anoxic patients, whereas communication disorders (aphasia and dysarthria) are less severe. Moreover, ABI patients seem to be positively sensitive to an intensive rehabilitation program. CONCLUSIONS: An early multidisciplinary management of communicative-linguistic and swallowing functions is crucial in order to prevent adverse events and to plan a tailored rehabilitation pathway. Show more

Keywords: Anoxic patients, language disorders, dysphagia, dysarthria, rehabilitation treatment, clinical outcomes, functional autonomy

DOI: 10.3233/NRE-192884

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 453-461, 2019

Authors: Park, Eo Jin | Yoo, Seung Don | Kim, Hee-Sang | Lee, Jong Ha | Yun, Dong Hwan | Kim, Dong Hwan | Chon, Jin Mann | Lee, Seung Ah | Soh, Yun Soo | Kim, Yong | Han, Young Rok | Yoo, Myung Chul | Choi, Kwang Min | Seo, Yun Kyung | Lee, Do Hun | Choi, Young Hwa | Jeong, Kwi Hyun | Son, Jung Eun

Article Type: Research Article

Abstract: BACKGROUND: Dysphagia and dysarthria tend to coexist in stroke patients. Dysphagia can reduce patients’ quality of life, cause aspiration pneumonia and increased mortality. OBJECTIVE: To evaluate correlations among swallowing function parameters and acoustic vowel space values in patients with stroke. METHODS: Data from stroke patients with dysarthria and dysphagia were collected. The formant parameter representing the resonance frequency of the vocal tract as a two-dimensional coordinate point was measured for the /a/, /ae/, /i/, and /u/vowels, and the quadrilateral vowel space area (VSA) and formant centralization ratio (FCR) were measured. Swallowing function was evaluated by a …videofluoroscopic swallowing study (VFSS) using the videofluoroscopic dysphagia scale (VDS) and penetration aspiration scale (PAS). Pearson’s correlation and linear regression analyses were used to assess the correlation of VSA and FCR to VDS and PAS scores. RESULTS: Thirty-one stroke patients with dysphagia and dysarthria were analyzed. VSA showed a negative correlation to VDS and PAS scores, while FCR showed a positive correlation to VDS score, but not to PAS score. VSA and FCR were significant factors for assessing dysphagia severity. CONCLUSIONS: VSA and FCR values were correlated with swallowing function and may be helpful in predicting dysphagia severity associated with stroke. Show more

Keywords: Dysphagia, dysarthria, vowel space, stroke

DOI: 10.3233/NRE-192904

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 463-469, 2019

Authors: Alashram, Anas R. | Padua, Elvira | Romagnoli, Cristian | Annino, Giuseppe

Article Type: Research Article

Abstract: BACKGROUND: The upper extremity spasticity following stroke limits individuals’ activities of daily living. Focal muscle vibration (FMV) is a device producing vibration signals affecting the central nervous system. OBJECTIVE: This systematic review was conducted to investigate the effects of FMV on individuals with stroke, and to identify the effective training protocol in reducing upper extremities spasticity post-stroke. METHODS: We searched in SCOPUS, PEDro, PUBMED, REHABDATA, and Web of Science for randomized clinical trials (RCTs) and pseudo-RCTs published in English. The outcome measure included is the Modified Ashworth Scale (MAS). The methodological quality of the included trials …was evaluated using the Cochrane Collaboration’s instrument. Effect sizes were calculated. RESULTS: Eight articles published from 2012 to 2019 were included in this systematic review. A total of 268 post-stroke patients, 28.73% of which were females, were included in all studies. The methodological quality for included studies ranged from moderate to high. FMV showed some evidence in reducing hemiplegic upper extremity spasticity in patients with stroke. CONCLUSIONS: The FMV may be an efficient intervention in reducing upper extremity spasticity in the stroke population. The efficient treatment protocol and dosage remain unclear. Additional randomized controlled trials are strongly needed to study the effects of FMV on spasticity in individuals with stroke. Show more

Keywords: Vibration, upper extremity, stroke, spasticity, rehabilitation

DOI: 10.3233/NRE-192863

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 471-481, 2019

Authors: Bunketorp-Käll, Lina | Pekna, Marcela | Pekny, Milos | Blomstrand, Christian | Nilsson, Michael

Article Type: Research Article

Abstract: BACKGROUND: Persons with stroke commonly have residual neurological deficits that seriously hamper mobility. OBJECTIVE: To investigate whether horse-riding therapy (H-RT) and rhythm and music-based therapy (R-MT) affect functional mobility in late phase after stroke. METHODS: This study is part of a randomized controlled trial in which H-RT and R-MT was provided twice weekly for 12 weeks. Assessment included the timed 10-meter walk test (10 mWT), the six-minute walk test (6 MWT) and Modified Motor Assessment Scale (M-MAS). RESULTS: 123 participants were assigned to H-RT (n  = 41), R-MT (n  = 41), or control (n  = 41). Post-intervention, the H-RT …group completed the 10 mWT faster at both self-selected (–2.22 seconds [95% CI, –3.55 to –0.88]; p  = 0.001) and fast speed (–1.19 seconds [95% CI, –2.18 to –0.18]; p  = 0.003), with fewer steps (–2.17 [95% CI, –3.30 to –1.04]; p  = 0.002 and –1.40 [95% CI, –2.36 to –0.44]; p = 0.020, respectively), as compared to controls. The H-RT group also showed improvements in functional task performance as measured by M-MAS UAS (1.13 [95% CI, 0.74 to 1.52]; p = 0.001). The gains were partly maintained at 6 months among H-RT participants. The R-MT did not produce any immediate gains. However, 6 months post-intervention, the R-MT group performed better with respect to time; –0.75 seconds [95% CI, –1.36 to –0.14]; p  = 0.035) and number of steps –0.76 [95% CI, –1.46 to –0.05]; p = 0.015) in the 10 mWT at self-selected speed. CONCLUSIONS: The present study supports the efficacy of H-RT in producing immediate gains in gait and functional task performance in the late phase after stroke, whereas the effectiveness of R-MT is less clear. Show more

Keywords: Stroke, rehabilitation, randomized controlled trial, horse-riding therapy, music therapy

DOI: 10.3233/NRE-192905

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 483-492, 2019

Authors: Sakuma, Kaoru | Tateuchi, Hiroshige | Nishishita, Satoru | Okita, Yusuke | Kitatani, Ryosuke | Koyama, Yumiko | Ibuki, Satoko | Ichihashi, Noriaki

Article Type: Research Article

Abstract: BACKGROUND: Disturbed lower limb coordination is thought to limit gait ability in patients with stroke. However, the relationship of lower limb coordination with gait kinematics and physical function has not yet been clarified. OBJECTIVE: The purpose of the study was to clarify the gait kinematic and physical function variables that most affect intralimb coordination by using the continuous relative phase (CRP) between the thigh and shank. METHODS: Fifteen participants with stroke were enrolled in this study. Kinematic and kinetic measurements were recorded during gait at preferred speeds. CRP was defined as the difference between the thigh …and shank phase angles. RESULTS: Stepwise analysis revealed that non-paretic CRP during the propulsive phase was a determinant of gait speed. The paretic knee extension and flexion angles were determinants of the CRP during the propulsive phase in the non-paretic limb. Stepwise analysis showed that the paretic knee extension angle was a determinant of the CRP during the propulsive phase in the paretic limb. Stepwise analysis revealed that the paretic knee extensor muscle strength was a determinant of the CRP during the propulsive phase in both limbs. CONCLUSIONS: Our study indicates that improvement in knee movement during the stance phase may improve coordination. Show more

Keywords: Stroke, gait, coordination

DOI: 10.3233/NRE-192923

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 493-499, 2019

Authors: Wall, Anneli | Borg, Jörgen | Palmcrantz, Susanne

Article Type: Research Article

Abstract: BACKGROUND: Few previous studies have assessed self-perceived functioning, disability and recovery after electromechanically-assisted gait training (EAGT). OBJECTIVE: To compare self-perceived functioning, disability and recovery after EAGT and after conventional gait training in the subacute stage after stroke, using the Stroke Impact Scale (SIS), and factors associated with self-perceived recovery, assessed at 6 months after stroke. METHODS: Patients were randomized into two groups performing a 4-week intervention period of incorporated EAGT using the Hybrid Assistive Limb (HAL) or conventional physiotherapy only. RESULTS: There were no significant differences in self-perceived strength, ADL, mobility, participation and percentage …of recovery between intervention groups (p  > 0.05). Self-perceived mobility was associated with improvements in objectively assessed walking speed/endurance and balance (R2 0.717, p  = 0.002), and self-perceived recovery with self-perceived activities of daily living (ADL) ability (R2 0.34, p  = 0.001). CONCLUSIONS: This study indicates that EAGT and conventional gait training in the subacute stage after stroke have no differential impact on self-perceived functioning, disability and recovery at 6 months after stroke. Further, the study highlights the importance of interventions targeting ADL and self-care independence during stroke rehabilitation to enhance self-perceived recovery and clinical aspects to be targeted to enhance perceived mobility. Show more

Keywords: Hybrid assistive limb, stroke, rehabilitation, robotics, walking, activities of daily living

DOI: 10.3233/NRE-192929

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 501-511, 2019

Authors: Dubiel, Rosemary | Williams, Benecia | Sullivan, Erin | Callender, Librada | Bennett, Monica | Driver, Simon

Article Type: Research Article

Abstract: OBJECTIVE: To determine the prevalence of vitamin D deficiency among individuals with traumatic brain injury (TBI) undergoing acute inpatient rehabilitation. SETTING: Inpatient rehabilitation. PARTICIPANTS: Participants were admitted from November 1st, 2010 through June 30th, 2015 with diagnosis of mild-severe TBI and had serum 25 OH vitamin D levels checked upon admission. 369 out of 845 met inclusion. DESIGN: Retrospective cohort. MAIN MEASURES: 25 OH vitamin D, vitamin D treatment. RESULTS: The majority of patients were male (67%), Caucasian (89%) with private insurance (61%) and a mean age of 43.5±21.0 years. …25 OH vitamin D levels were categorized: deficient (<20 ng/mL), insufficient (20–29.9 ng/mL), and sufficient (≥30 ng/mL). There were 95 (26%) patients that were deficient, 131 (36%) that were insufficient, and 143 (39%) that were sufficient. Race/ethnicity was found to be significant (p  = 0.0145) with the largest percentage of Hispanics found in the insufficient and deficient categories, and the largest percentage of Blacks in the deficient category. Most patients with deficient or insufficient vitamin D levels were prescribed vitamin D replacement during their rehab stay (p  < 0.0001). CONCLUSION: The majority of patients undergoing acute inpatient rehabilitation were found to have insufficient or deficient vitamin D levels, therefore it should be routinely screened and treated as indicated. Show more

Keywords: Brain injuries, vitamin D, rehabilitation

DOI: 10.3233/NRE-192888

Citation: NeuroRehabilitation, vol. 45, no. 4, pp. 513-517, 2019