NeuroRehabilitation - Volume 47, issue 4

Authors: Song, Jessica Z. | Catizzone, Margot | Arbour-Nicitopoulos, Kelly P. | Luong, Dorothy | Perrier, Laure | Bayley, Mark | Munce, Sarah E.P.

Article Type: Review Article

Abstract: BACKGROUND: People with childhood-onset disabilities face unique physical and social challenges in adulthood. Exercise interventions may improve physical performance in children, but there is a lack of research on adults. OBJECTIVE: To describe studies that investigate exercise interventions and to evaluate the quality of physical performance outcome measures for adults with childhood-onset disabilities. METHODS: Eligible studies reported on exercise interventions for adults (ages 16+) with cerebral palsy, spina bifida, or acquired brain injuries. Only randomized controlled trials published in English from 2008 to 2019 were included. MEDLINE, CINAHL, PEDro, EMBASE, and Cochrane Central Register of Controlled …Trials were searched. Two reviewers independently screened studies and abstracted data. RESULTS: This scoping review included 4 trials reporting on cerebral palsy only. Three strength training programs found significant improvements in gait, and one mixed training program found significant improvements in strength and fitness. Only two outcome measures used are valid/reliable for adults (6 Minute Walk Test and Borg-20 Grades ). CONCLUSION: Certain interventions may improve physical performance, but there is a lack of research on appropriate exercise interventions and physical performance outcome measures for adults with childhood-onset disabilities. Different exercise interventions should be investigated using larger sample sizes and outcome measures should be standardized. Show more

Keywords: Childhood-onset disabilities, adults, spina bifida, cerebral palsy, acquired brain injury, exercise interventions, outcome measures, reliability and validity

DOI: 10.3233/NRE-203250

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 359-380, 2020

Authors: Moggio, Lucrezia | Petraroli, Annalisa | Marotta, Nicola | Demeco, Andrea | Pino, Ilaria | Marinaro, Cinzia | Barletta, Marianna | Ammendolia, Antonio

Article Type: Case Report

Abstract: BACKGROUND: Primary lateral sclerosis (PLS) is an upper motor neurons disease that on rare occasions may determine bradykinesia and motor fatigue. To date, no rehabilitative treatment has been described as useful for these patients. CASE PRESENTATION: A 68-year-old male developed dysarthria, spastic laugh, impairments of handwriting and fine motor, gait and dysphagia disorders for both solids and liquids over the period from 2015 to December 2018, with normal DaT scans and no clinical benefits from therapy with levodopa, pramipexole and baclofen. The patient underwent exercises for gait training and balance control with sensory treadmill and stabilometric platform and …kinesiotherapy to improve fine motor skills of both hands and postural changes, five days a week for two weeks. Based on our data, the patient showed an improvement in balance and gait parameters in T2 compared to T1. CONCLUSION: Thanks to the synergistic action of a combined treatment of physical and instrumental therapy, despite the rare pathology and complex disability, the patient had important benefits in terms of performance and independence in daily activity. Show more

Keywords: Primary lateral sclerosis, parkinsonism, rehabilitation, motor neuron disease

DOI: 10.3233/NRE-201527

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 381-386, 2020

Authors: Frenkel, Maya | Eckstein, Nava | Frenkel-Toledo, Silvi

Article Type: Research Article

Abstract: BACKGROUND: BEITI is a comprehensive test of a wide range of basic and extended daily functioning. It was developed for physiotherapists in the community to enable increased sensitivity in detecting changes in the functioning of patients with different diagnoses. BEITI was found to be valid, reliable and valuable in terms of the time and effort involved. Its clinical properties as a measurement in inpatients with brain lesions is yet to be determined. OBJECTIVE: To translate BEITI from Hebrew into English, and explore its psychometric properties in inpatients with brain lesions in the subacute phase. METHODS: The …admission and discharge records of 131 patients hospitalized in a neurological rehabilitation department were reviewed retrospectively. The internal consistency, responsiveness, and floor and ceiling effects of BEITI were assessed. RESULTS: Excellent internal consistency was found for BEITI at admission and discharge (Cronbach’s α  ≥ 0.964). BEITI had high effect sizes (effect size = 1.11, standardized response mean = 1.54). Significant changes over time were found for the BEITI (p  < 0.001). No floor or ceiling effects were observed. CONCLUSIONS: BEITI is a reliable and responsive scale for assessing basic and extended daily functioning in inpatients with brain injuries in the subacute phase. Show more

Keywords: Measure of daily functioning, brain lesions, rehabilitation, physiotherapy, BEITI

DOI: 10.3233/NRE-203122

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 387-392, 2020

Authors: Jones, Kate Fiona | Pryor, Julie | Care-Unger, Candice | Descallar, Joseph | Simpson, Grahame Kenneth

Article Type: Research Article

Abstract: BACKGROUND: Spirituality may play an important role in neurorehabilitation, however research findings indicate that rehabilitation professionals do not feel well equipped to deliver spiritual care. OBJECTIVE: To evaluate a spiritual care training program for rehabilitation professionals. METHODS: An exploratory controlled trial was conducted. Participants enrolled in a two-module spiritual care training program. Spiritual care competency was measured with the Spiritual Care Competency Scale. Confidence and comfort levels were measured using the Spiritual Care Competency Scale domains. The Spirituality and Spiritual Care Rating Scale assessed participant attitudes and knowledge. Measures were administered three times: pre-program, post-program and …six weeks follow-up. RESULTS: The training (n  = 41) and control (n  = 32) groups comprised rehabilitation professionals working in spinal cord or traumatic brain injury units. No between-group differences were observed on the study variables at the pre-program time point. Multilevel models found that levels of spiritual care competency, confidence, comfort, and ratings on existential spirituality increased significantly for the training group (versus control) post-program (p  < 0.05) and these significant differences were maintained at follow-up. CONCLUSIONS: A brief spiritual care training program can be effective in increasing levels of self-reported competency, confidence and comfort in delivery of spiritual care for rehabilitation professionals. Show more

Keywords: Spirituality, spiritual care, health professionals, spinal cord injury, traumatic brain injury, rehabilitation

DOI: 10.3233/NRE-203221

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 393-403, 2020

Authors: Chow, Beverley | Feloiu, Florin | Berardocco, Assunta | Ceglie, David | Nesathurai, Shanker

Article Type: Research Article

Abstract: BACKGROUND: Parkinson’s disease (PD) is a progressive neurodegenerative disorder with manifestations such as tremors, rigidity and bradykinesia. OBJECTIVE: The objective of this study was to evaluate the efficacy of outpatient multidisciplinary rehabilitation. METHODS: 179 patients participated in the six-week program. The following outcomes were measured: Timed Up and Go (TUG), sit to stand five times (STSx5) and in 30 seconds (STS30), six minute walk distance (6MWD) and gait velocity (6MWV), MOCA, bilateral grip strength, 360-degree turn (360 R, 360 L) and bilateral nine hole peg test. Pre- and post- data was analyzed via paired t -tests. …Multiple regression was used to determine age- or gender-affected outcomes. RESULTS: Patients showed a statistically significant improvement (p  < 0.05) in all outcomes. Mean TUG improved by 1.63 seconds (s), STSx5 by 4.19s, STS30 by 2.37 repetitions, 6MWD by 66.8 metres, 6MWV by 0.15 m/s, MOCA by 1.50 points, 360 R by 1.17s, 360 L by 1.60s, Grip R by 0.78 kg, Grip L by 0.95 kg, 9HP R by 1.71s and 9HP L by 1.58s. Gender had no influence. Age was a statistically significant predictor in STSx5 and 6MW. CONCLUSIONS: An outpatient multidisciplinary program successfully decreased motor impairment and increased overall functional independence in PD. Show more

Keywords: Parkinson’s disease rehabilitation, outpatient rehabilitation, neurorehabilitation, motor outcomes

DOI: 10.3233/NRE-203218

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 405-414, 2020

Authors: Chang, Hsiu-Chen | Chen, Chiung-Chu | Weng, Yi-Hsin | Chiou, Wei-Da | Chang, Ya-Ju | Lu, Chin-Song

Article Type: Research Article

Abstract: BACKGROUND: Recent studies have suggested that cognitive-motor dual-task (DT) training might improve gait performance, locomotion automaticity, balance, and cognition in patients with Parkinson’s disease (PD). OBJECTIVE: We aimed to investigate the efficacy of cognitive-cycling DT training in patients with early-stage PD. METHODS: Participants were scheduled to perform cognitive tasks simultaneously with the cycling training twice per week for eight weeks for a total of 16 sessions during their on-states. Clinical assessments were conducted using the unified Parkinson’s disease rating scale (UPDRS), modified Hoehn and Yahr stage, Timed Up and Go (TUG) test, gait and cognitive performances …under dual-task paradigm, the new freezing of gait questionnaire, Schwab and England Activities of Daily Living scale, 39-item Parkinson’s disease questionnaire, and cognitive performance. RESULTS: Thirteen eligible patients were enrolled in the study. The mean age was 60.64±5.32 years, and the mean disease duration was 7.02±3.23 years. Twelve PD patients completed 16 serial cognitive-cycling sessions for two months. After 16 sessions of training (T2), the UPDRS III scores improved significantly in both the off- and on-states, and TUG were significantly less than those at pretraining (T0). During both the single-task and the DT situations, gait performance and spatial memory cognitive performance significantly improved from T0 to T2. CONCLUSION: The present study demonstrated that cognitive-cycling DT training improves the motor functions, gait and cognitive performances of PD patients. Show more

Keywords: Parkinson’s disease, cycling, cognitive, dual-task, gait

DOI: 10.3233/NRE-203090

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 415-426, 2020

Authors: El-Tamawy, Mohammed S. | Darwish, Moshera H. | Elkholy, Saly H. | Moustafa, Engy BadrEldin S. | Abulkassem, Shimaa T. | Khalifa, Heba A.

Article Type: Research Article

Abstract: BACKGROUND: Cortical reorganization between both cerebral hemispheres plays an important role in regaining the affected upper extremity motor function post-stroke. OBJECTIVES: The purpose of the current study was to investigate the recommended number of contra-lesion low frequency repetitive transcranial magnetic stimulation (LF-rTMS) sessions that could enhance cortical reorganization post-stroke. METHODS: Forty patients with right hemiparetic subacute ischemic stroke with an age range between 50–65 yrs were randomly assigned into two equal groups: control (GA) and study (GB) groups. Both groups were treated with a selected physical therapy program for the upper limb. Sham and real contra-lesion LF-rTMS …was conducted for both groups daily for two consecutive weeks. Sequential changes of cortical excitability were calculated by the end of each session. RESULTS: The significant enhancement in the cortical excitability was observed at the fourth session in favor of the study group (GB). Sequential rate of change in cortical excitability was significant for the first eight sessions. From the ninth session onwards, no difference could be detected between groups. CONCLUSION: The pattern of recovery after stroke is extensive and not all factors could be controlled. Application of LF-rTMS in conjugation with a selected physical therapy program for the upper limb from four to eight sessions seems to be efficient. Show more

Keywords: Cortical excitability, cortical reorganization, sequential changes, single pulse TMS, transcranial magnetic stimulation, upper limb motor performance.

DOI: 10.3233/NRE-203156

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 427-434, 2020

Authors: Lee, Jiyeon | Jeon, Jeongwoo | Lee, Dongyeop | Hong, Jiheon | Yu, Jaeho | Kim, Jinseop

Article Type: Research Article

Abstract: BACKGROUND: Trunk stability has been identified as an important prerequisite of functional movement. OBJECTIVE: To investigate the effectiveness of core muscle contraction training on abdominal muscle thickness, balance, and gait ability in stroke patients. METHODS: Thirty patients with stroke were randomly assigned to two experimental groups and a control group. All groups received conventional therapeutic exercise program for six weeks. The experimental groups additionally trained trunk stability exercise with abdominal hollowing or bracing maneuvers within training time. Primary outcome measures were evaluated abdominal muscle thickness using the sonography. Secondary outcome measures were evaluated by the Functional …Reach Test (FRT), Berg Balance Scale (BBS), 10-meter walk test (10MWT), and Timed Up and Go test (TUG). RESULTS: Compared with the control group, the effect of trunk stability training for the experimental groups on the abdominal muscles thickness change was observed (p  < 0.05). The values in balance and gait measures, BBS, FRT, 10MWT, and TUG, showed significant improvement after the intervention periods (p  < 0.05), although no significant differences were found in scores of gait and balance scales among groups. CONCLUSIONS: Trunk stability training with selective abdominal muscles activation has beneficial effects on abdominal muscles, balance, and mobility in stroke patients. Our findings might provide support for introducing stroke rehabilitation. Show more

Keywords: Stroke, rehabilitation, abdominal muscles, balance, gait

DOI: 10.3233/NRE-203133

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 435-442, 2020

Authors: Moftah, Emad | Vennu, Vishal | Abdulrahman, Tariq A. | Alnahdi, Ali H. | Balubaid, Hashim | Alghamdi, Ghalib | Alonazi, Sultana | Abunassif, Sondos | Bindawas, Saad M.

Article Type: Research Article

Abstract: BACKGROUND: Although several studies have shown an association of muscle weakness with gait speed (GS), no study has explored the relationship of muscle strength with swing phase duration and GS after stroke among the elderly in Saudi Arabia. OBJECTIVE: To examine the association of affected ankle dorsiflexor and hip flexor muscle strength with swing phase duration and GS in the elderly with different stroke chronicity. METHODS: In this cross-sectional study, we included a total of 60 post-stroke patients aged ≥55 years who were admitted in neurorehabilitation units between May 2017 and August 2018. Linear regression was …employed to examine the association of muscle strength (measured using a handheld dynamometer) with swing phase duration and GS (both measured using the computerized Zebris–Mat). RESULTS: The chronicity of the stroke was negatively associated (p  < 0.05 ) with swing phase duration. The ankle dorsiflexor muscle strength was significantly associated with GS (β= 0.656, p  = 0.041 ). In contrast, hip flexor muscle strength was significantly associated with GS (β= 0.574, p  < 0.0001 ) even after adjusting for stroke chronicity (β= 0.561, p  < 0.0001 ). CONCLUSIONS: Stroke chronicity was the predictor that reduced swing phase duration. The ankle dorsiflexor muscle strength was associated with GS. However, the hip flexor muscle strength was associated with GS even after adjusting for stroke chronicity. Show more

Keywords: Ankle dorsiflexion, hip flexion, muscle torque, rehabilitation, stroke

DOI: 10.3233/NRE-203150

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 443-450, 2020

Authors: Martins, Júlia Caetano | Nadeau, Sylvie | Aguiar, Larissa Tavares | Scianni, Aline Alvim | Teixeira-Salmela, Luci Fuscaldi | De Morais Faria, Christina Danielli Coelho

Article Type: Research Article

Abstract: BACKGROUND: Impaired mobility is related to low physical activity (PA) levels observed after stroke. Therapeutic approaches, such as task-specific circuit training (TSCT), used to improve mobility in individuals with stroke, could also improve PA levels. OBJECTIVE: To investigate the efficacy of TSCT, focused on both upper (UL) and lower (LL) limbs, in improving PA levels and mobility (primary outcomes), as well as muscle strength, exercise capacity, and quality of life (secondary outcomes) in subjects with stroke. METHODS: A randomized controlled trial with 36 subjects with chronic stroke was conducted. Experimental group: TSCT, involving both UL and …LL. Control group: global stretching, memory exercises, and education sessions. Both groups received 60 minute sessions/week over 12 weeks. Outcomes were measured at baseline, post-intervention and 16 week follow-up. RESULTS: No changes were found for primary and secondary outcomes (0.11≤p≤0.99), except for quality of life, which improved in the experimental group post-intervention and 16 week follow-up (p  = 0.02). CONCLUSION: TSCT focused on both UL and LL was not effective on PA levels and mobility of individuals with chronic stroke, however, improvements in quality of life were observed. Since this is the first study to investigate this combined training aimed at improving PA levels, future studies are necessary to better understand the impact of this type of intervention. Show more

Keywords: Stroke, physical activity, mobility, task-specific training, quality of life

DOI: 10.3233/NRE-203207

Citation: NeuroRehabilitation, vol. 47, no. 4, pp. 451-462, 2020