NeuroRehabilitation - Volume 46, issue 4

Authors: Zwolińska, Jolanta | Gąsior, Monika

Article Type: Review Article

Abstract: BACKGROUND: Physical therapy modalities are often applied in treatment of neurological conditions in children and adolescents. OBJECTIVE: Evaluation of the methodological quality of research focusing on the application of physical therapy modalities in children and adolescents with neurological conditions. METHODS: Papers published between 2007 and 2018 were included in the review. 149 papers were analyzed and finally 26 studies investigating the use of physical therapy modalities in children and adolescents with neurological conditions were included in the review. Jadad scale (0–5) was used to assess the methodological value of the studies. RESULTS: The mean …Jadad score was 1.46 (researcher 1) and 1.38 (researcher 2). A score of 0 was awarded to nine (r1) and eight papers (r2). A score of 5 points was awarded to three (r1) and two papers (r2). CONCLUSION: 1. The evidence showing the effectiveness of the use of physical therapy modalities is mainly of low quality. 2. The Jadad scale is a valuable tool to assess the quality of research, although it does not always reflect the real value in the case children participate in studies. 3. The analyzed studies show that physical therapy modalities are effective in the treatment of children and adolescents with neurological disorders. Show more

Keywords: Neurological diseases, physical therapy modalities, developmental age, Jadad scale, physiotherapy

DOI: 10.3233/NRE-203045

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 437-453, 2020

Authors: Alashram, Anas R. | Annino, Giuseppe | Raju, Manikandan | Padua, Elvira

Article Type: Review Article

Abstract: BACKGROUND: Balance deficits are common impairments in individuals with post-traumatic brain injury (TBI). Balance deficits can restrict the activities of daily living and productive participation in social life. To date, no systematic reviews have examined the impact of physical therapy intervention on balance post-TBI. OBJECTIVE: To examine the effects of physical therapy interventions on balance impairments in individuals with TBI. METHODS: We systematically searched in PubMed, EMBASE, Scopus, PEDro, MEDLINE, REHABDATA, and Web of Science for randomized controlled trials (RCTs), clinical control trials, and pilot studies that examined the effects of physical therapy interventions on balance …deficits in individuals post-TBI. The methodological quality was estimated using the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Eight studies published from 2003 to 2019 were included in this study. A total of 259 TBI participants post-TBI were included in this review, 71 (27.41%) of which were females. The methodological quality of the selected studies ranged from low to high. There were no significant differences between experimental interventions, virtual reality (VR), vestibular rehabilitation therapy (VRT), control group interventions, and other traditional physical therapy interventions. CONCLUSIONS: The evidence about the effects of the physical therapy interventions in improving the balance ability post-TBI was limited. Further randomized controlled trials are strongly warranted to understand the role of physical therapy in patients with TBI who complain about balance deficits. Show more

Keywords: Brain injuries, trauma, postural balance, rehabilitation, therapeutics, systematic review, neurological rehabilitation

DOI: 10.3233/NRE-203047

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 455-466, 2020

Authors: Mann, Jessie

Article Type: Review Article

Abstract: BACKGROUND: One of the most interesting emerging medical devices is the medical avatar - a digital representation of the patient that can be used toward myriad ends, the full potential of which remains to be explored. Medical avatars have been instantiated as telemedical tools used to establish a representation of the patient in tele-space, upon which data about the patient’s health can be represented and goals and progress can be visually tracked. Manipulation of the medical avatar has also been explored as a means of increasing motivation and inducing neural plasticity. OBJECTIVE: The article reviews the literature on …body representation, simulation, and action-observation and explores how these components of neurorehabilitation are engaged by an avatar-based self-representation. METHODS: Through a review of the literature on body representation, simulation, and action-observation and a review of how these components of neurorehabilitation can be engaged and manipulated with an avatar, the neuroplastic potential of the medical avatar is explored. Literature on the use of the medical avatar for neurorehabilitation is also reviewed. RESULTS: This review demonstrates that the medical avatar has vast potentialities in neurorehabilitation and that further research on its use and effect is needed. Show more

Keywords: Telerehabilitation, avatar, neurorehabilitation

DOI: 10.3233/NRE-203063

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 467-482, 2020

Authors: Kim, Dae Hyun | Kang, Chang Soon | Kyeong, Sohyun

Article Type: Research Article

Abstract: BACKGROUND: Robot-assisted gait training (RAGT) can improve walking ability after stroke but the underlying mechanisms are unknown. OBJECTIVE: We evaluated the changes in the injured brain after RAGT and compared the effects of early start and late start of RAGT. METHODS: Eleven patients with hemiplegia after stroke undergoing inpatient rehabilitation were examined within 3 months of stroke onset and were randomly assigned into two groups. Group 1 started RAGT with conventional physiotherapy immediately after enrollment, whereas Group 2 underwent conventional physiotherapy for 4 weeks before starting RAGT. We acquired diffusion tensor imaging data after enrollment and …at 4 and 8 weeks after treatment. Fractional anisotropy (FA) and mean diffusivity (MD) maps were used to analyze the neural changes. RESULTS: Repeated measures analysis of variance of the data at 4 weeks after treatment showed a significant interaction between time and groups (RAGT versus control) for the FA and MD values in the non-lesioned hemisphere, indicating that the non-lesioned hemisphere was significantly reorganized by RAGT compared with conventional physiotherapy. Analysis of the data at 8 weeks after treatment showed a significant interaction between time and groups (early and late start of RAGT) for the MD values in the motor-related areas bilaterally, indicating that early start of RAGT significantly accelerated bi-hemispheric reorganization as compared with late start of RAGT. CONCLUSIONS: Our findings indicate that RAGT can facilitate reorganization in the intact superior temporal, cingulate, and postcentral gyri. Furthermore, early start of RAGT can accelerate bi-hemispheric reorganization in the motor-related brain regions. Show more

Keywords: Stroke, gait, robot-assisted therapy, rehabilitation, plasticity, functional recovery

DOI: 10.3233/NRE-203054

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 483-489, 2020

Authors: Handelzalts, Shirley | Gray, Ganit | Steinberg-Henn, Flavia | Soroker, Nachum | Melzer, Itshak

Article Type: Research Article

Abstract: BACKGROUND: Persons with stroke (PwS) demonstrate impaired reactive balance control placing them at increased risk of falls. Yet, tests used in clinical practice to assess this risk usually rely on proactive balance control. OBJECTIVE: To investigate differences in proactive balance in PwS with varying reactive balance capacity. METHODS: Reactive balance control was assessed in 48 first-event subacute PwS by measuring multiple-step threshold and fall threshold in response to unannounced surface perturbations. They were classified as low-, medium- high- threshold fallers and non-fallers in accordance with the perturbation magnitude at which they were unable to maintain balance …(fall threshold). Proactive balance control and gait performance were tested using the Berg Balance test, 10-meter walk test, 6-minute walk test and the Activities-specific Balance Confidence Scale (ABC). RESULTS: PwS who demonstrated poor reactive balance capacity were also more impaired in their proactive balance and gait. Proactive balance and gait performance were significantly different between the 4 groups while ABC was not. The associations between reactive and proactive measures of balance were moderate (r  = 0.53–0.67). CONCLUSIONS: The moderate correlations between reactive and proactive balance control suggest the recruitment of different neural mechanisms for these two operations, highlighting the importance of assessing and treating reactive balance in clinics. Show more

Keywords: Stroke, falls, balance reactive control, balance proactive control, fall threshold, gait

DOI: 10.3233/NRE-203039

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 491-500, 2020

Authors: Sayaca, Cetin | Sapcíoglu, Taha Yasin | Kaya, Defne

Article Type: Research Article

Abstract: BACKGROUND: Stroke is one of the most important causes of swallowing difficulty. It is seen in one of every two patients with stroke. Although the swallowing function is controlled by both hemispheres, it is unknown which hemisphere is more dominant than another for controlling the swallowing function. However, the aspiration and pharyngeal phase dysfunction can be seen in right hemisphere involvement while oral phase dysfunction can be seen in left hemisphere involvement. OBJECTIVE: The aim of this study was to investigate whether water swallowing performance, deep cervical flexor muscle endurance, and maximum phonation time were affected in right …handed patients with hemiplegia. STUDY DESIGN: The study was designed as a cross-sectional study. METHODS: Patients with unilateral strokes that damaged the right (Group I: n  = 37) and left (Group II: n  = 20) hemispheres were included. Swallowing difficulties were evaluated with the Turkish version of the Eating Assessment Tool. The water swallowing performance was measured with the 100 ml water swallow test. The muscle endurance (ME) of deep neck flexors was measured in the chin-tuck position. The laryngeal function was measured indirectly with maximum phonation time (MPT). RESULTS: The mean age of patients was 73.54±7.28 years in Group I and the mean age of patients was 73.15±6.94 years in Group II. There were no differences in maximum phonation time, water swallowing performance (swallow volume, capacity, and speed), and swallowing difficulty (p  > 0.05). The neck flexor muscular endurance of patients with unilateral strokes that damaged the left hemisphere was better than the patients with unilateral strokes that damaged the right hemisphere (p  < 0.05). There was a relationship between MPT and ME, MPT and swallowing difficulty, ME and swallowing difficulty (r:0.637, p:0.000; r:–0.465, p:0.004; r:–0.473, p:0.003 respectively) in the right hemisphere involvement patients. There was a relationship between swallowing difficulty to swallowing volume and swallowing capacity (respectively, r:–0.402 and p:0.014; r:–0.473 and p:0.003) in the patients with unilateral strokes that damaged the right hemisphere. There was no relationship between other parameters in Group I (p  > 0.05). There was no relationship between all parameters in Group II (p  > 0.05). CONCLUSIONS: This study is the first study to investigate whether water swallowing performance, deep cervical flexor muscle endurance, and maximum phonation time were affected in right handed patients with unilateral strokes that damaged the right or left hemispheres. In light of the findings of the study, it was thought that swallowing should be evaluated in detail especially in hemiplegic patients with right hemisphere involvement. There is a need for studies examining the results of swallowing rehabilitation on right or left hemisphere in hemiplegic individuals. Show more

Keywords: Stroke, hemisphere involvement, deglutition disorders, 100 ml water swallow test, deep neck flexor muscle endurance, maximum phonation time

DOI: 10.3233/NRE-203089

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 501-509, 2020

Authors: Rubin, Evan | Klonoff, Pamela | Perumparaichallai, Ramaswamy Kavitha

Article Type: Research Article

Abstract: BACKGROUND: Caregiver burden is experienced by a significant number of caregivers of survivors of acquired brain injury (ABI). It is known that self-awareness can impact functioning following ABI. However, the impact of self-awareness on caregiver burden has not been established. OBJECTIVE: To investigate the relationship between self-awareness and caregiver burden following ABI. METHODS: We studied 57 patient-caregiver pairs up to 28 years post-discharge from a post-acute comprehensive holistic milieu-oriented neurorehabilitation program. The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed by survivors of ABI and their caregivers. Discrepancies in reports between survivors of ABI and their caregivers were …used to determine self-awareness. Additionally, caregivers completed the Zarit Burden Interview (ZBI). RESULTS: Survivors of ABI with impaired self-awareness reported significantly higher levels of functioning than survivors of ABI with unimpaired self-awareness (p  < 0.001). Unimpaired self-awareness (p  < 0.001) and lower survivor self-reported MPAI-4 Total Score (p  < 0.001) significantly predicted caregiver burden. CONCLUSIONS: Survivors of ABI’s level of functioning and their level of self-awareness significantly impacted caregiver burden. Survivors of ABI with impaired self-awareness not only lack insight into their functional abilities but also tend to overestimate their capabilities; this likely contributes to the need for greater levels of supervision and worsened caregiver burden. Show more

Keywords: Anosognosia, awareness, brain injuries, neurological rehabilitation, caregivers

DOI: 10.3233/NRE-203093

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 511-518, 2020

Authors: Munari, Daniele | Serina, Anna | Disarò, Jacopo | Modenese, Angela | Filippetti, Mirko | Gandolfi, Marialuisa | Smania, Nicola | Picelli, Alessandro

Article Type: Research Article

Abstract: BACKGROUND: Backward walking is recommended to improve the components of physiological gait in neurological disease. Botulinum toxin type A is an effective safe first line-treatment for post-stroke spasticity. OBJECTIVE: To compare the effects of backward treadmill training (BTT) versus standard forward treadmill training (FTT) on motor impairment in patients with chronic stroke receiving botulinum toxin type A therapy. METHODS: Eighteen chronic stroke patients were randomly assigned to receive BTT (n  = 7) or FTT (n  = 11) as adjunct to botulinum toxin type A therapy. A total of twelve 40-minute sessions (3 sessions/week for 4 weeks) of either …BTT or FTT were conducted. A blinded assessor evaluated the patients before and after treatment. The primary outcome was the 10-meter Walking Test (10 MWT). Secondary outcomes were the modified Ashworth Scale, gait analysis, and stabilometric assessment. RESULTS: Between-group comparison showed a significant change on the 10 MWT (P  = 0.008) and on stabilometric assessment [length of centre of pressure CoP (P  = 0.001) and sway area (P  = 0.002) eyes open and length of CoP (P  = 0.021) and sway area (P  = 0.008) eyes closed] after treatment. CONCLUSIONS: Greater improvement in gait and balance was noted after BTT than after FTT as an adjunct to botulinum toxin therapy in patients with chronic stroke. Show more

Keywords: Postural balance, locomotion, muscle spasticity, rehabilitation, stability, cerebral stroke

DOI: 10.3233/NRE-203067

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 519-528, 2020

Authors: Zarucchi, A. | Vismara, L. | Frazzitta, G. | Mauro, A. | Priano, L. | Maestri, R. | Bergna, A. | Tarantino, A.G.

Article Type: Research Article

Abstract: BACKGROUND: Pisa syndrome (PS) is a clinical condition frequently associated with Parkinson’s disease (PD). It is characterized by a trunk lateral flexion higher than 10 degrees and reversible when lying. One pathophysiological hypothesis is the altered verticality perception, due to a somatosensory impairment. Osteopathic Manipulative Treatment (OMT) manages fascial-system alterations, linked to somatic dysfunctions. Fascial system showed to be implicated in proprioceptive sensibility. OBJECTIVE: The aim of the study was to assess OMT efficacy on postural control in PD-PS patients by stabilometry. METHODS: In this single-blinded trial we studied 24 PD-PS patients, 12 of whom were …randomly assigned to receive a multidisciplinary physical therapy protocol (MIRT) and sham OMT, while the other 12 received four OMT plus MIRT, for one month. The primary endpoint was the eye closed sway area assessment after the intervention. Evaluation of trunk lateral flexion (TLF) with DIERS formetrics was also performed. RESULTS: At one month, the sway area of the OMT group significantly decreased compared to placebo (mean delta OMT – 326.00±491.24 mm2 , p  = 0.01). In the experimental group TLF showed a mean inclination reduction of 3.33 degrees after treatment (p  = 0.044, mean d  = 0.54). Moreover, a significant positive association between delta ECSA and delta TLF was observed (p  = 0.04, r  = 0.46). DISCUSSION: Among PD-PS patients, MIRT plus OMT showed preliminary evidence of postural control and TLF improvement, compared to the control group. Show more

Keywords: Fascia, osteopathic medicine, complementary therapies, Parkinson, proprioception

DOI: 10.3233/NRE-203068

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 529-537, 2020

Authors: Hadoush, Hikmat | Lababneh, Tamara | Banihani, Saleem A. | Al-Jarrah, Muhammed | Jamous, Mohammed

Article Type: Research Article

Abstract: BACKGROUND: Parkinson’s disease (PD) is a multisystem-progressive neurodegenerative disease characterized by dopaminergic neurons, however, the role of the non-dopaminergic system (such as melatonin hormone) in the pathogenesis of PD is now emerging. OBJECTIVE: To identify any potential correlation between the dopamine and melatonin serum levels, and motor, cognitive, and sleep dysfunctions in patients with PD. METHOD: Cross-sectional piloting study conducted with a sample of 34 patients with PD (aged 50–72 yrs old). Correlation tests performed to identify any potential correlations between the biomarkers’ serum levels and motor, cognitive, and sleep dysfunctional levels in “on-medication” status. …RESULTS: Spearman’s test showed significant correlations between the melatonin serum level and sleep dysfunctions including overall sleep quality (P  = 0.010) and subjective sleep quality sub-score (P  = 0.001). On the other hand, spearman’s test showed significant correlations between the dopamine serum level and motor dysfunctions including Berg Balance Scale (P  = 0.026), 10-Meter Walk Test (P  = 0.016), and Fear of Falling Index (P  = 0.007), as well as comparisons between the dopamine serum level and cognitive dysfunction (P  = 0.048). CONCLUSIONS: Melatonin serum level would serve as a potential biomarker in understanding the PD pathogenesis, and the melatonin serum level should be considered in future studies related to PD besides the dopamine serum level. Show more

Keywords: Parkinson’s disease, dopamine, melatonin, motor function, cognitive, sleep

DOI: 10.3233/NRE-203075

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 539-549, 2020