NeuroRehabilitation - Volume 46, issue 3

Authors: Yoon, Hyun Sik | Cha, Young Joo | You, Joshua (Sung) Hyun

Article Type: Research Article

Abstract: BACKGROUND: Neurodevelopmental treatment (NDT) and Dynamic neuromuscular stabilization (DNS)-based exercise is effective for improving core stability and postural control in stroke patients. OBJECTIVE: To compare the effects of DNS and conventional NDT exercises on diaphragm movement, abdominal muscle thickness, and postural control in stroke patients. METHODS: The participants were randomly allocated into DNS (n  = 16) and NDT (n  = 15) for 30 minutes each per day, 3 days a week for 4 weeks. Diaphragm movement and abdominal muscle thickness were determined using ultrasonography. The trunk impairment scale (TIS) and Berg Balance Scale (BBS) were used to measure …postural control. The functional ambulation category (FAC) was used to evaluate gait ability. Analysis of covariance (ANCOVA) was used to evaluate post-test differences in the DNS and NDT exercise groups. RESULTS: ANCOVA revealed the superior effects of DNS in diaphragm movement and abdominal muscle thickness (transversus abdominis, internal oblique), as well as clinical BBS and FAC tests, compared with those of NDT (p  < 0.05). CONCLUSIONS: This novel clinical trial suggests that DNS training was more effective than NDT training in improving postural movement control and gait ability via a balanced co-activation of the diaphragm and TrA/IO in stroke patients. Show more

Keywords: Diaphragm movement, dynamic neuromuscular stabilization, subacute stroke, core stabilization

DOI: 10.3233/NRE-192983

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 381-389, 2020

Authors: Aguiar, Larissa Tavares | Nadeau, Sylvie | Britto, Raquel Rodrigues | Teixeira-Salmela, Luci Fuscaldi | Martins, Júlia Caetano | Samora, Giane Amorim Ribeiro | da Silva Júnior, João Antônio | Faria, Christina Danielli Coelho de Morais

Article Type: Research Article

Abstract: BACKGROUND: Individuals with stroke have low physical activity levels and spend high amount of time in low-energy expenditure activities. OBJECTIVE: To investigate the effects of aerobic treadmill training on physical activity levels and time spent in low-energy expenditure activities (primary outcomes), as well as on cardiorespiratory fitness, endurance, depression, mobility, quality of life and participation (secondary outcomes) after stroke. METHODS: A randomized controlled trial, with 22 adults with chronic stroke was performed. Experimental group: aerobic treadmill training at 60–80% of heart rate reserve. Control group: outdoor-overground walking below 40% of heart rate reserve. Both groups: three …40 min sessions/week over 12 weeks. Outcomes were measured at baseline, post-training, and 16-week follow-up. RESULTS: No changes in the primary outcomes were found for any of the groups. The experimental group showed greater improvements in quality of life at 16-week follow-up (13 points;95% CI:3.5–23). Both groups improved depression (2.2 points;95% CI:0.01–4.3), endurance (Six-minute walk test:31 m;95% CI:5.6–57, Incremental shuttle-walk test:55 m;95% CI:3.8–107), and mobility (0.12 m/s;95% CI:0.02–0.2). CONCLUSION: Aerobic treadmill training improved quality of life. Aerobic treadmill training or outdoor-overground walking improved depression, endurance and mobility. Further studies are needed to clarify the effects of aerobic training on physical activity levels and time spent in low-energy expenditure activities after stroke. Show more

Keywords: Stroke, aerobic exercise, physical activity, sedentary lifestyle, walking

DOI: 10.3233/NRE-193013

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 391-401, 2020

Authors: MacDonald, Shannon L. | Journeay, W. Shane | Uleryk, Elizabeth

Article Type: Review Article

Abstract: BACKGROUND: Obesity is a known risk factor for stroke, but its impact on functional recovery is less clear. Understanding the effect of obesity on functional recovery during inpatient rehabilitation will aid clinicians in patient counselling and help administrators with program planning. OBJECTIVE: To determine if obesity affects the functional outcomes of adults undergoing inpatient stroke rehabilitation. METHODS: MEDLINE, Embase, CINAHL, and Cochrane databases were searched using the subject headings and text word terms for stroke, rehabilitation, and obesity. Two independent reviewers screened the articles against pre-defined eligibility criteria and extracted the data. Outcomes of interest included …FIM, mRS, Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke, and Barthel Index. RESULTS: Seven studies from five countries with a total of 3070 participants were included. There was significant heterogeneity among the studies in the BMI cut-off points and functional outcome measures used. Two studies found a positive association between obesity and functional outcome, two studies found no association, and three studies reported a negative relationship. CONCLUSIONS: No conclusions could be drawn regarding whether the functional outcome of adults undergoing inpatient stroke rehabilitation differ between individuals with and without obesity. Show more

Keywords: Obesity, recovery of function, rehabilitation, stroke, stroke rehabilitation

DOI: 10.3233/NRE-192979

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 403-415, 2020

Authors: Obayashi, Shigeru | Takahashi, Rina | Onuki, Mitsugu

Article Type: Research Article

Abstract: BACKGROUND: Few patients with severe upper extremity (UE) paresis after stroke achieved full recovery, because of the lack of a definitive approach to improve severe UE paresis immediately after onset. OBJECTIVE: to investigate the effects of coupled EMG-triggered and cyclic neuromuscular electrical stimulation (NMES) on UE paresis during early acute phase of stroke. METHODS: Seventeen participants with severe UE disability met the criteria. 8 subjects received 20 minutes of NMES prior to standard care per session, while 9 age- and severity-matched subjects received two times 20 minutes of standard care. Outcome measures included UE motor section …of the Fugl-Meyer Motor Assessment Scale (FMA-UE), Wolf motor function test (WMFT), and box and block test (BBT). RESULTS: The NMES group received treatment (average session: 10.87) after a median 7 days from stroke (16.5 sessions after 5 days for control). To adjust the different treatment durations, we defined “progress rate” as the gains of UE function scores divided by treatment duration. The progress rate was significantly different in FMA-UE, but not in WMFT and BBT. CONCLUSIONS: The present study suggested beneficial effects of coupled NMES on UE paresis during early acute phase of stroke. Show more

Keywords: Cortical reorganization, electrical stimulation, motor recovery, stroke, upper extremity

DOI: 10.3233/NRE-203024

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 417-422, 2020

Authors: Yoshida, Akihito | Iwatsuki, Katsuyuki | Hoshiyama, Minoru | Hirata, Hitoshi

Article Type: Research Article

Abstract: BACKGROUND: Several studies on carpal tunnel syndrome have reported pain that exists beyond the median nerve territory of the affected hand. However, the mechanism is unknown. PURPOSE: We investigated the cause of extra-territorial pain by the analysis of clinical assessments and cortical activity using magnetoencephalography. METHODS: To compare patients with and without extra-territorial pain, fourteen patients with carpal tunnel syndrome were assessed using clinical examination, such as patients’ profile, paresthesia, physical tests, and psychological tests. The physical assessment included tactile threshold and static and moving two-point discrimination sensations on digital pulp. Neural activation in the cerebral …cortex was also measured using z-scores calculated by magnetoencephalography. RESULTS: Among fourteen patients, ten patients had pain in the affected median nerve territory only and four patients had extra-territorial pain. When comparing the groups, the static and moving two-point discrimination sensation values in patients with extra-territorial pain were larger than those of patients without the pain (p  < 0.05). The supra-marginal gyrus, mid-part of the precentral sulcus, angular gyrus in the left hemisphere, bilateral sensorimotor areas for legs, and bilateral isthmus-cingulate areas showed larger z-scores in patients with extra-territorial pain than in patients without the pain (p  < 0.05). CONCLUSIONS: The static and moving two-point discrimination sensations signify the ability of tactile spatial acuity. Bilateral sensorimotor areas were activated in sites that were not the hand. Furthermore, the inferior parietal lobule in the left hemisphere, which synthesizes and integrates multiple sensations showed high activation. Our findings suggested that the mechanism of extra-territorial pain was associated with dysfunction of spatial cognition. Show more

Keywords: Pain, carpal tunnel syndrome, magnetoencephalography, spatial cognition, inferior parietal lobule

DOI: 10.3233/NRE-193007

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 423-431, 2020

Authors: Platz, Thomas

Article Type: Other

Abstract: BACKGROUND: Emotionalism, i.e. uncontrolled episodes of crying (or less commonly laughing) post stroke that are not triggered by situations that would have previously provoked such behavior occur in stroke survivors, may persist in some, and can be socially embarrassing. OBJECTIVE: To evaluate whether pharmacological interventions are beneficial, acceptable, and safe in the treatment of emotionalism post stroke. METHODS: A Cochrane review by Allida et al. was summarized with comments. RESULTS: From a total of 7 eligible trials with a total of 239 participants included in the review, five with 213 participants could be used …for data extraction. Very low to moderate quality evidence pointed to some beneficial effects of antidepressants in the treatment of emotionalism after stroke. CONCLUSIONS: The available data suggest that antidepressants may reduce the frequency and severity of crying or laughing episodes in stroke survivors with emotionalism. Show more

Keywords: Stroke, affective symptoms, antidepressive agents, crying, laughter, randomized controlled trial, review

DOI: 10.3233/NRE-209003

Citation: NeuroRehabilitation, vol. 46, no. 3, pp. 433-435, 2020