NeuroRehabilitation - Volume 46, issue 3

Authors: Moon, Sanghee | Ahmadnezhad, Pedram | Song, Hyun-Je | Thompson, Jeffrey | Kipp, Kristof | Akinwuntan, Abiodun E. | Devos, Hannes

Article Type: Review Article

Abstract: BACKGROUND: Advances in medical technology produce highly complex datasets in neurorehabilitation clinics and research laboratories. Artificial neural networks (ANNs) have been utilized to analyze big and complex datasets in various fields, but the use of ANNs in neurorehabilitation is limited. OBJECTIVE: To explore the current use of ANNs in neurorehabilitation. METHODS: PubMed, CINAHL, and Web of Science were used for the literature search. Studies in the scoping review (1) utilized ANNs, (2) examined populations with neurological conditions, and (3) focused on rehabilitation outcomes. The initial search identified 1,136 articles. A total of 19 articles were included. …RESULTS: ANNs were used for prediction of functional outcomes and mortality (n  = 11) and classification of motor symptoms and cognitive status (n  = 8). Most ANN-based models outperformed regression or other machine learning models (n  = 11) and showed accurate performance (n  = 6; no comparison with other models) in predicting clinical outcomes and accurately classifying different neurological impairments. CONCLUSIONS: This scoping review provides encouraging evidence to use ANNs for clinical decision-making of complex datasets in neurorehabilitation. However, more research is needed to establish the clinical utility of ANNs in diagnosing, monitoring, and rehabilitation of individuals with neurological conditions. Show more

Keywords: Neural networks, rehabilitation, neurological rehabilitation, nervous system diseases

DOI: 10.3233/NRE-192996

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 259-269, 2020

Authors: Rowlands, Leanne | Coetzer, Rudi | Turnbull, Oliver H.

Article Type: Research Article

Abstract: BACKGROUND: Neurorehabilitation services are often delivered through group psycho-education programmes. However, little is known about the therapeutic process at work during such sessions. The present study is the first to gain insight into the therapeutic alliance , during a seven-session group programme. In addition, cognitive, emotional, and demographic predictors of the alliance, and participants’ feelings towards their group members, were investigated, together with predictors of patient engagement. METHODS: Forty-five participants with an acquired brain injury completed a series of questionnaires, and neuropsychological assessment, following group psycho-education. The group facilitator completed a parallel therapeutic alliance questionnaire, and rated participants’ …engagement. RESULTS: Results demonstrated that a strong alliance can be formed in seven group sessions. Notably, no demographic or cognitive factors appear to pose a barrier to developing a therapeutic alliance, nor to group attraction. CONCLUSION: High levels of depression, however, may be a challenge, and clinicians may need to tailor their clinical skills to ensure a good therapeutic relationship with such patients. To promote engagement, clinicians may also need to provide additional support to patients with lower levels of education, working memory, and episodic memory impairment. Show more

Keywords: Therapeutic alliance, working alliance, cognitive predictors, neurorehabilitation, group psycho-education, group interventions, acquired brain injury

DOI: 10.3233/NRE-193005

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 271-285, 2020

Authors: Wuennemann, Marissa J. | Mackenzie, Stuart W. | Lane, Heather Pepper | Peltz, Avrielle R. | Ma, Xiaoyue | Gerber, Linda M. | Edwards, Dylan J. | Kitago, Tomoko

Article Type: Research Article

Abstract: BACKGROUND: Neurological injuries cause persistent upper extremity motor deficits. Device-assisted therapy is an emerging trend in neuro-rehabilitation as it offers high intensity, repetitive practice in a standardized setting. OBJECTIVE: To investigate the effects of therapy duration and staff-participant configuration on device-assisted upper limb therapy outcomes in individuals with chronic paresis. METHODS: Forty-seven participants with chronic upper extremity weakness due to neurological injury were assigned to a therapy duration (30 or 60 min) and a staff-participant configuration (1-to-1 or 1-to-2). Therapy consisted of 3 sessions a week for 6 weeks using the Armeo® Spring device. Clinical assessments …were performed at three timepoints (Pre, Post, and 3 month Follow up). RESULTS: Improvements in upper limb impairment, measured by change in Fugl-Meyer score (FM), were observed following therapy in all groups. FM improvement was comparable between 30 and 60 min sessions, but participants in the 1-to-2 group had significantly greater improvement in FM from Pre-to-Post and from Pre-to-Follow up than the 1-to-1 group. CONCLUSIONS: Device-assisted therapy can reduce upper limb impairment to a similar degree whether participants received 30 or 60 min per session. Our results suggest that delivering therapy in a 1-to-2 configuration is a feasible and more effective approach than traditional 1-to-1 staffing. Show more

Keywords: Device-assisted therapy, chronic hemiparesis, group therapy, motor recovery, neurological rehabilitation

DOI: 10.3233/NRE-192993

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 287-297, 2020

Authors: Olsson, Camilla | Arvidsson, Patrik | Blom Johansson, Monica

Article Type: Research Article

Abstract: BACKGROUND: Knowledge about patients’ executive function is important in the rehabilitation of language and communication in stroke patients with aphasia. Due to linguistic demands, most neuropsychological tests are unsuitable for this population, and it might seem appealing to use informant report of executive function as a substitute. OBJECTIVE: To investigate the relationships between scores on a neuropsychological test and informant ratings of executive function, as well as between the informant ratings and the functional communication ability, in people with severe aphasia after stroke. METHODS: Thirty-eight people with severe aphasia and their significant others participated. Executive function …was tested with parts of the neuropsychological screening instrument CLQT and rated by significant others (informants) using BRIEF-A. Functional communication was assessed with a standardised test and rated by significant others. RESULTS: Results revealed few correlations between CLQT and BRIEF-A. There was no correlation between informant ratings on BRIEF-A and scores on the measures of functional communication. CONCLUSIONS: Informant ratings of executive function do not measure the same construct as, and cannot be used as a substitute for, standardised neuropsychological tests. Informant ratings of executive function do not seem to provide information that is relevant to the understanding of functional communication in people with severe aphasia. Show more

Keywords: Aphasia, executive function, informant rating, functional communication, stroke

DOI: 10.3233/NRE-192998

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 299-310, 2020

Authors: Nguyen, Hoang M. | Aravindakshan, Ashwin | Ross, Jessica M. | Disbrow, Elizabeth A.

Article Type: Research Article

Abstract: BACKGROUND: People with Parkinson disease (PD) have difficulty initiating internally generated movements. We have shown that computer-based cognitive training can improve movement initiation. However, little is known about the optimal duration of training. OBJECTIVES: To determine the optimal training duration for computer-based neurorehabilitation of internally represented movement initiation in people with PD. METHODS: Nineteen PD and twenty-one age-matched control participants, ages 50–85 years, were included in analysis of pre- and post-training evaluation and 30 training sessions. Computer training consisted of cued and un-cued movement trials. The presentation of a cue (a combination of numbers on either …the right, left or both sides of the screen) indicated that participants should respond by typing the numbers. Successful cued trials were followed by un-cued trials consisting of a green filled circle. Participants re-enter the cued sequence, thus producing an internally represented (IR) movement. The training was adaptive. Outcome measures were reaction time and error rate, and cumulative sum (CUSUM) analysis was used to identify peak training improvement. RESULTS: Participants with PD were divided into impaired (IPD) and unimpaired (UPD) groups, based on mean control group pre-training performance. All three groups showed improved RT and error rates for IR trials; however, the IPD group demonstrated significantly greater improvement in reaction time. Training was most effective in participants with greater disease severity and duration. Peak day of training improvement for the IPD group was 8 days. CONCLUSION: Optimal training duration was relatively short and the IPD group demonstrated the most gain, indicating that cognitive training should be tailored to individual needs. Show more

Keywords: Movement initiation, neurorehabilitation, adaptive training

DOI: 10.3233/NRE-192940

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 311-320, 2020

Authors: Tramonti, C. | Di Martino, S. | Chisari, C.

Article Type: Research Article

Abstract: BACKGROUND: An intensive task-oriented circuit training (TOCT) provides a valid approach in improving motor function in Multiple Sclerosis (MS). OBJECTIVE: We aimed at testing the efficacy of TOCT on gait kinematics in MS patients with mild-moderate disability. METHODS: Nineteen MS patients able of independent walking performed 3-D Gait Analysis before (T0) and after (T1) a two-week TOCT program. Patients were clustered in two different subgroups, according to clinical neurological impairments assessed with specific functional system of Expanded Disability Status Scale (EDSS): pyramidal (Group 1) and cerebellar (Group 2) subjects. Spatio-temporal and kinematic data were compared before …and after the TOCT intervention in the total sample of patients and in the two selected subgroups at two time intervals. RESULTS: Data obtained revealed increased dynamic ROM at knee joint after training in the whole study sample. Of note, knee dynamic excursion improved significantly in Group 1 but not in Group 2 patients after TOCT. Moreover, sagittal plane kinematics revealed significant modifications on knee and ankle biomechanics in Group 1 after rehabilitation. CONCLUSIONS: These data point out the benefits of the task specific training on gait dynamics in mild impaired MS subjects, linking to treatment opportunity in patients with a prevalent pyramidal impairment. Show more

Keywords: Multiple sclerosis, task-oriented training, gait analysis, biomechanical phenomena, gait pattern

DOI: 10.3233/NRE-192997

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 321-331, 2020

Authors: Paolucci, Teresa | Bernetti, Andrea | Sbardella, Silvia | La Russa, Chiara | Murgia, Massimiliano | Salomè, Angela | Villani, Ciro | Altieri, Marta | Santilli, Valter | Paoloni, Marco | Agostini, Francesco | Mangone, Massimiliano

Article Type: Research Article

Abstract: BACKGROUD: Patients with MS, regardless of the complexity of the activity or sensory conditions, commonly present a significant postural control deficit compared to healthy subjects. OBJECTIVE: To investigate which postural self-correction strategies are adopted by patients with Multiple Sclerosis versus a group of healthy-subjects and how self-correction can influence the control of postural balance. METHODS: A case-control prospective observational study was conducted. Person with Multiple Sclerosis and a group of healthy volunteers were enrolled. Patients included were instructed with vocal commands, to reach a self-correction posture, and they were compared to healthy subjects. Clinical assessments including …Balance, Stabilometry and Postural evaluation of the spine were performed. RESULTS: Sixty patients (30: control-group; 30: treatment-group) were enrolled. In the treatment group, the analysis reported a significant statistical difference between path length and center of pressure speed in self-correction posture with closed-eyes (p  = 0,049; 0,047) and an improvement in C7 and L3 levels in self-correction posture (p  < 0,01–C7; p  < 0,01–L3). There are significant statistical differences about path length between the two groups in all examined conditions (p  = 0,0001). At sagittal plane evaluation, results show an increase of all measurements in both posture (C7-neutral posture p  = 0,0001; L3-neutral posture p  = 0,0001; C7-self-correction posture p  = 0,0001; L3-self-correction posture p  = 0,0001). CONCLUSION: Further study should investigate dynamic situations and different Multiple Sclerosis forms to complete balance analysis and to establish a correct rehabilitative program with self-correction exercise as powerful focus. Show more

Keywords: Self-correction, postural balance, spine, multiple sclerosis, gait analysis, rehabilitation, proprioceptions

DOI: 10.3233/NRE-192987

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 333-341, 2020

Authors: Ozkul, Cagla | Guclu-Gunduz, Arzu | Eldemir, Kader | Apaydin, Yasemin | Gulsen, Cagri | Yazici, Gokhan | Soke, Fatih | Irkec, Ceyla

Article Type: Research Article

Abstract: BACKGROUND: Exercise training has positive effects on motor and cognitive performance which deteriorates over time in patients with Multiple Sclerosis (MS). The effects of task-oriented circuit training (TOCT) on motor and cognitive performance in patients with MS are not yet clear. OBJECTIVE: The aims of this study are to investigate the effects of TOCT on balance, walking, manual dexterity, cognitive performance, and to determine the extent to which patients are able to transfer changes in their performance to activities of daily living. METHODS: Twenty patients with MS (EDSS: 2–5.5), were randomly assigned to two groups; the …task-oriented circuit training group (TOCTG, n:10) and the control group (CG, n:10). The TOCTG received TOCT twice a week for six weeks while the CG performed the relaxation exercises at home. All patients were assessed by using Modified Sensory Organization Test, Berg Balance Scale, Activities-specific Balance Confidence, Timed Up and Go, Functional Gait Assessment, 12-item Multiple Sclerosis Walking Scale, Nine-Hole Peg Test, Brief Repeatable Battery of Neuropsychological Tests, Multiple Sclerosis Neuropsychological Questionnaire. RESULTS: Balance and walking performance were improved after TOCT (p  < 0.05), whereas manual dexterity and cognitive performance except for verbal memory did not change significantly (p  > 0.05). The CG showed no changes in any measurements (p  > 0.05). CONCLUSIONS: TOCT is quite effective to improve balance and walking in patients with MS. However, further studies are needed to determine the effect of TOCT on cognitive performance. Show more

Keywords: Multiple sclerosis, task-oriented circuit training, balance, walking, cognition

DOI: 10.3233/NRE-203029

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 343-353, 2020

Authors: Ripley, David L. | Gerber, Don | Pretz, Christopher | Weintraub, Alan H. | Wierman, Margaret E.

Article Type: Research Article

Abstract: BACKGROUND: Endocrinopathy, including hypogonadism, is common following traumatic brain injury (TBI). Prior evidence suggests hypogonadism is associated with poorer function. OBJECTIVE: Determine the feasibility, safety, and efficacy of testosterone (T) therapy in hypogonadal men following TBI in acute rehabilitation. DESIGN: Randomized, double blind, placebo-controlled pilot trial. SETTING: Inpatient rehabilitation brain injury unit. PARTICIPANTS: Men ages 18 –65, post moderate to severe TBI receiving inpatient rehabilitation. INTERVENTIONS: Transdermal T gel or placebo. MAIN OUTCOME MEASURES: Revised FIM™ score, strength, adverse events. RESULTS: Of 498 screened, 70 participants …were enrolled, and 22 meeting all criteria were randomized into placebo (n  = 10) or physiologic T therapy (n  = 12). There was no significant difference between groups in rate of improvement on the FIM™ (intercepts t  = –0.31, p  = 0.7593, or slopes t  = 0.61, p  = 0.5472). The Treatment group demonstrated the greatest absolute improvement in FIM™ scores and grip strength compared to Placebo or Normal T groups. There was no difference in adverse events between groups. Percentage of time with agitation or aggression was highest in the Placebo group. CONCLUSIONS: Although there were no significant differences in rates of recovery, treatment group subjects showed greater absolute functional and strength improvement compared to the Placebo or Normal T groups. Show more

Keywords: Traumatic brain injury, TBI, hypogonadism, testosterone, outcomes, function, Functional Independence Measure (FIM), strength, agitation, aggression, randomized drug trial, Registered on ClinicalTrials.gov #NCT01201863

DOI: 10.3233/NRE-192992

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 355-368, 2020

Authors: Kwak, Eun Hee | Wi, Soohyun | Kim, MinGi | Pyo, Soonil | Shin, Yoon-Kyum | Oh, Kyung Ja | Han, Kyunghun | Kim, Yong Wook | Cho, Sung-Rae

Article Type: Research Article

Abstract: BACKGROUND: Cognitive and emotional disturbances are common serious issues in patients with traumatic brain injury (TBI). However, predictors associated with neuropsychological functions were not consistent. OBJECTIVE: To investigate factors affecting cognition and emotion in patients with TBI, we evaluated executive function, memory, and emotion based on injury severity and lesion location. METHODS: Neuropsychological outcomes of 80 TBI patients were evaluated via Wisconsin Card Sorting Test (WCST), Color Trail Test (CTT), Controlled Oral Word Association Test (COWAT), Everyday Memory Questionnaire (EMQ), Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), and Agitated Behavior Scale (ABS). WCST, CTT, and …COWAT assessed executive function; EMQ assessed everyday memory; and GDS, STAI, and ABS assessed emotion. Patients were categorized according to lateralization of lesion and existence of frontal lobe injury. RESULTS: Patients with longer duration of loss of consciousness (LOC) showed more severe deficits in everyday memory and agitated behaviors. The frontal lesion group showed poorer performance in executive function and higher agitation than the non-frontal lesion group. Patients with bilateral frontal lesion showed greater deficits in executive function and were more depressed than unilateral frontal lesion groups. Especially in those unilateral frontal lesion groups, right side frontal lesion group was worse on executive function than left side frontal lesion group. CONCLUSIONS: Duration of LOC and lesion location are main parameters affecting executive function, everyday memory, and emotion in neuropsychological outcomes following TBI, suggesting that these parameters need to be considered for cognitive rehabilitation interventions. Show more

Keywords: Traumatic brain injury, executive function, memory, emotion

DOI: 10.3233/NRE-192893

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 369-379, 2020