NeuroRehabilitation - Volume 48, issue 1

Authors: Park, SuHo | Lee, DongGeon | Hong, SoungKyun | Cho, KiHun | Lee, GyuChang

Article Type: Case Report

Abstract: BACKGROUND: With the recent developments in science, full-immersion virtual reality devices have been developed, which may have feasibility for stroke rehabilitation. OBJECTIVE: This case report investigated the feasibility of training using a full-immersion virtual reality video game for improving motor function, balance, and gait in a young stroke survivor. METHOD: The case was a 27-year-old woman with stroke. A training using full-immersion virtual reality video game (Sony PlayStation® VR) was performed for 30 minutes per session, 3 sessions per week, for 6 weeks, with a total of 18 sessions. Before training and at each training for …6 weeks, with a total of 19 times, the motor function, balance, and gait were assessed using the Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and Tinetti Balance Assessment, 10 Meter Walk Test (10MWT), Tinetti Gait Assessment, and Dynamic Gait Index (DGI). RESULTS: During the training, there were no adverse events reported. The case achieved 14 points higher than the pre-assessment with 34 points on the MAS, 16 points higher than the pre-assessment with 48 points on BBS, 6.85 sec lower than the pre-assessment, with 13.58 sec on TUG, 5 points higher than the pre-assessment with 13 points on the Tinetti Balance Assessment, 5.36 sec lower than the pre-assessment, with 8.15 sec on the 10MWT, 4 points higher than the pre-assessment with 10 points on the Tinetti Gait Assessment, and 10 points higher than the pre-assessment with 21 points on the DGI. CONCLUSION: This case report suggests that training using a full-immersion virtual reality video game may be a safe and effective method to improve motor function, balance, and gait in a young stroke survivor. Show more

Keywords: Full-immersion virtual reality, video game, young stroke, motor function, balance, gait

DOI: 10.3233/NRE-201501

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 1-8, 2021

Authors: Yoo, I.G.

Article Type: Review Article

Abstract: BACKGROUND: Neurofeedback training targets the relevant brain response under minimal stress. It could be a promising approach for the treatment of patients with brain injury. OBJECTIVE: This review aimed to examine the existing literature to confirm the effectiveness of applied electroencephalogram (EEG)-based neurofeedback training in the area of occupational therapy for upper limb stroke rehabilitation. METHOD: All relevant literature published until July 1, 2020 in five prominent databases (PubMed, CINAHL, PsycINFO, MEDLINE Complete, and Web of Science) was reviewed, based on the five-step review framework proposed by Arksey and O’Malley. RESULTS: After a thorough …review, a total of 14 studies were included in this review. Almost studies reported significant improvements as a result of EEG-based neurofeedback training, but this had not always account for the differences in effectiveness between groups. However, the results of these studies suggested that neurofeedback training was effective as compared to the traditional treatment and more effective in combination with EEG than that with simple equipment application. CONCLUSION: This review demonstrated the effectiveness of the combination of occupational therapy and EEG-based neurofeedback training. Most of these treatments are intended for inpatients, but they may be more effective for outpatients, especially if customized to their requirements. Also, such explorations to assess the suitability of the treatment for patient rehabilitation will help reduce barriers to effective interventions. An analysis of the opinions of participants and experts through satisfaction surveys will be helpful. Show more

Keywords: EEG-based neurofeedback training, occupational therapy, scoping review, stroke

DOI: 10.3233/NRE-201579

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 9-18, 2021

Authors: Swiggum, Mary Scott | Knowlton, Jane | Powers, Denise

Article Type: Case Report

Abstract: BACKGROUND: Neuro-Developmental Treatment (NDT) currently embraces evidence-based concepts of motor control, motor learning and neuroplasticity. However, most research has been performed on outdated models of NDT. OBJECTIVE: This case series examines the short- and long-term outcomes of a three-week intensive using contemporary NDT interventions. METHODS: Six children, 2–10 years old with neurologic disorders and Gross Motor Function Classification System (GMFCS) levels I-III participated in the intervention. The three-week intensive included 60 minutes of physical, occupational and speech therapy 3–5 times weekly. RESULTS: All children demonstrated Gross Motor Function Measure-66 gains of medium to large …effect sizes. These gains were maintained or improved upon 3 months’ post conclusion of the intensive intervention. CONCLUSIONS: This study supports emerging research regarding the effectiveness of intensive intervention and further study of current NDT interventions. Show more

Keywords: Intensive intervention, cerebral palsy, NDT

DOI: 10.3233/NRE-201525

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 19-27, 2021

Authors: Veerubhotla, Akhila | Pilkar, Rakesh | Ehrenberg, Naphtaly | Nolan, Karen J.

Article Type: Research Article

Abstract: BACGROUND: Interventions addressing balance dysfunction after traumatic brain injury (TBI) only target compensatory aspects and do not investigate perceptual mechanisms such as sensory acuity. OBJECTIVE: To evaluate the efficacy of a novel intervention that integrates sensory acuity with a perturbation-based approach for improving the perception and functional balance after TBI. METHODS: A two-group design was implemented to evaluate the effect of a novel, perturbation-based balance intervention. The intervention group (n  = 5) performed the intervention with the sinusoidal (0.33, 0.5, and 1 Hz) perturbations to the base of support with amplitudes derived using our novel outcome of sensory …acuity - perturbation perception threshold (PPT). The efficacy is evaluated using changes in PPT and functional outcomes (Berg Balance Scale (BBS), Timed-up and Go (TUG), 5-meter walk test (5MWT), and 10-meter walk test (10MWT)). RESULTS: There was a significant post-intervention change in PPT for 0.33 Hz (p  = 0.021). Additionally, clinically and statistically significant improvements in TUG (p  = 0.03), 5MWT (p  = 0.05), and 10MWT (p  = 0.04) were observed. CONCLUSIONS: This study provides preliminary efficacy of a novel, near-sensory balance intervention for individuals with TBI. The use of PPT is suggested for a comprehensive understanding and treatment of balance dysfunction. The promising results support the investigation in a larger cohort. Show more

Keywords: Sensory threshold detection, perturbation-based intervention, biofeedback, sensory acuity, rehabilitation, traumatic brain injury

DOI: 10.3233/NRE-201502

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 29-37, 2021

Authors: da Rosa Pinheiro, Douglas Rafael | Cabeleira, Maria Eduarda Parcianello | da Campo, Luigi Antonio | Corrêa, Philipe Souza | Blauth, Ariane Haydeé Estrada Gamarra | Cechetti, Fernanda

Article Type: Research Article

Abstract: BACKGROUND: Studies demonstrate the benefits of aerobic cycling training in subacute and chronic stroke subjects, but there is a lack in the literature about its effects on the acute phase. OBJECTIVE: Verify the effects of aerobic cycling training on lower limbs muscle strength, gait speed, balance, mobility and functionality of acute stroke subjects. METHODS: Control group (CG) performed conventional physiotherapy twice a day and the intervention group (IG) performed a conventional physiotherapy and a cycle ergometer session, for five consecutive days. Subjects were assessed for muscle strength by a digital dynamometer, gait speed by the 10-meter-walk-test, …balance by the Berg Balance Scale, mobility by the ICU-Mobility-Scale and functionality by the Perme Score. RESULTS: Twenty subjects were enrolled in the study, 10 in the CG and 10 in the IG. Lower limbs muscle strength, the main endpoint, was better in the IG compared to the CG. The same was found in the secondary endpoints. The intragroup analysis was also positive for the CG in the mobility and functionality. CONCLUSIONS: Conventional physiotherapy combined with cycling exercise showed better results in the improvement of muscle strength of lower limbs, mobility and functionality of subjects who suffered from acute stroke. Show more

Keywords: Ergometry, exercise therapy, hospitalization, lower extremity, stroke, stroke rehabilitation

DOI: 10.3233/NRE-201585

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 39-47, 2021

Authors: de Sire, Alessandro | Invernizzi, Marco | Ferrillo, Martina | Gimigliano, Francesca | Baricich, Alessio | Cisari, Carlo | De Marchi, Fabiola | Foglio Bonda, Pier Luigi | Mazzini, Letizia | Migliario, Mario

Article Type: Research Article

Abstract: BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting upper and lower motor neurons. The current practice of caring for patients affected by ALS involves a multidisciplinary team without any indication about oral health care. OBJECTIVE: We sought to investigate the functional status and oral health in patients with ALS to define a specific multidisciplinary management. METHODS: In this cross-sectional study, we included patients affected by ALS, evaluating their functional status, using the Revised ALS Functional Rating Scale (ALSFRS-R) and their oral health status through specific parameters, including Brief Oral Health Status Examination (BOHSE), …Winkel Tongue Coating Index (WTCI), and Oral Food Debris Index (OFDI). RESULTS: All 37 patients (mean age: 61.19±11.56 years) showed a poor oral status, independent from the functional status and strictly correlated to the severity of sialorrhea (p  = 0.01). OFDI index was negatively correlated with the ALSFRS-R upper limb (p  = 0.03). Patients with bulbar onset had significantly lower ability to perform adequate tongue movements in terms of protrusion (p  = 0.006) and lateralization (p  < 0.001). Significant negative correlations between survival rate and BOHSE (p  = 0.03) was found. CONCLUSIONS: Taken together, our findings showed that a poor oral health status might be correlated to a worse functional status and survival time. Thus, an adequate oral health care and rehabilitation should be considered as crucial in the multidisciplinary management of patients with ALS. Show more

Keywords: Amyotrophic lateral sclerosis, oral hygiene, functioning, rehabilitation, oral rehabilitation

DOI: 10.3233/NRE-201537

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 49-57, 2021

Authors: Sato, Keisuke | Maeda, Keisuke | Ogawa, Takahiro | Shimizu, Akio | Nagami, Shinsuke | Nagano, Ayano | Murotani, Kenta | Inoue, Tatsuro | Suenaga, Masaki

Article Type: Research Article

Abstract: BACKGROUND: The Functional Assessment for Control of Trunk (FACT) was developed to evaluate trunk function after stroke. However, only a few studies used FACT to show functional outcome. OBJECTIVE: This study aimed to validate the FACT predictive ability for functional outcome following stroke and create an English version of the FACT. METHODS: This retrospective, observational study was conducted with patients aged≥65 years with stroke. Patients were divided into two groups according to the median FACT score at admission: trunk impairment or high trunk function group. Multiple regression analysis was performed for Functional Independence Measure (FIM) gain …and FIM efficiency to examine the relationship between trunk function assessed by FACT at admission and functional prognosis. RESULTS: 105 participants (mean age, 80.2±7.6, 57.1%were men) were included. Of these, 48 (45.7%) and 57 (54.3%) were categorized to the trunk impairment group and high trunk function group, respectively. FACT score at admission was associated with FIM gain (coefficient = 0.875, P  = 0.001) and FIM efficiency (coefficient = 0.015, P  = 0.016) after adjusting for confounders. CONCLUSIONS: Trunk impairment at admission assessed by FACT could predict functional prognosis. The English version of FACT was created and further demonstrated the validity of FACT. Show more

Keywords: Trunk function, rehabilitation, functional prognosis, stroke, cerebral infarction

DOI: 10.3233/NRE-201533

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 59-66, 2021

Authors: Little, Alice | Byrne, Christopher | Coetzer, Rudi

Article Type: Review Article

Abstract: BACKGROUND: Anxiety is a common neuropsychological sequela following traumatic brain injury (TBI). Cognitive Behaviour Therapy (CBT) is a recommended, first-line intervention for anxiety disorders in the non-TBI clinical population, however its effectiveness after TBI remains unclear and findings are inconsistent. OBJECTIVE: There are no current meta-analyses exploring the efficacy of CBT as an intervention for anxiety symptoms following TBI, using controlled trials. The aim of the current study, therefore, was to systematically review and synthesize the evidence from controlled trials for the effectiveness of CBT for anxiety, specifically within the TBI population. METHOD: Three electronic databases …(Web of Science, PubMed and PsycInfo) were searched and a systematic review of intervention studies utilising CBT and anxiety related outcome measures in a TBI population was performed through searching three electronic databases. Studies were further evaluated for quality of evidence based on Reichow’s (2011) quality appraisal tool. Baseline and outcome data were extracted from the 10 controlled trials that met the inclusion criteria, and effect sizes were calculated. RESULTS: A random effects meta-analysis identified a small overall effect size (Cohen’s d) of d  = –0.26 (95%CI –0.41 to –0.11) of CBT interventions reducing anxiety symptoms following TBI. CONCLUSIONS: This meta-analysis tentatively supports the view that CBT interventions may be effective in reducing anxiety symptoms in some patients following TBI, however the effect sizes are smaller than those reported for non-TBI clinical populations. Clinical implications and limitations of the current meta-analysis are discussed. Show more

Keywords: Traumatic brain injury, anxiety, cognitive behaviour therapy, meta-analysis

DOI: 10.3233/NRE-201544

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 67-82, 2021

Authors: Chen, Qingmei | Shen, Dan | Sun, Haiwei | Ke, Jun | Wang, Hongxia | Pan, Shenjie | Liu, Haoyu | Wang, Dapeng | Su, Min | Fang, Qi

Article Type: Research Article

Abstract: BACKGROUND: The treatment for patients suffering from motor dysfunction following stroke using continuous repetitive transcranial magnetic stimulation (rTMS) has the potential to be beneficial for recovery. However, the impact of explicit results on the coupling of various rTMS protocols on motor treatment in patients following acute cerebral infarction remain unexplored. OBJECTIVE: The current study aims to design a sham-controlled randomized report to explore the capability of consecutive suppressive-facilitatory rTMS method to increase the motor results following acute stroke. METHODS: A hundred ischemic stroke patients suffering from motor disorder were randomly assigned to obtain 4 week sessions …of (1)10 Hz over the ipsilesional primary motor cortex (M1) and next 1 Hz over the contralesional M1; (2) contralesional sham stimulation and next ipsilesional real 10 Hz; (3) contralesional real 1 Hz rTMS and next ipsilesional sham stimulation; or (4) bilateral sham-control procedures. At 24 hours before and after the intervention, we obtained cortical excitability data from study subjects. At baseline, after treatment and 3 months follow up, we additionally evaluated patients with the clinical assessments. RESULTS: At post-intervention, group A showed greater motor improvements in FMA, FMA-UL, NIHSS, ADL and mRS values than group B, group C and group D, that were continued for at least 3 months after the completion of the treatment time. Specifically, it is shown in the cortical excitability study that the motor-evoked potential (MEP) amplitude and resting motor threshold (rMT) more significantly improved in group A than other groups. The improvement in motor function and change in motor cortex excitability exhibit a significant correlation in the affected hemisphere. The combined 1 Hz and 10 Hz stimulation treatment showed a synergistic effect. CONCLUSIONS: Facilitatory rTMS and coupling inhibitory produced extra satisfactory results in facilitating the motor’s recovery in the subacute and acute phase following stroke compared to that acquired from alone single-course modulation. Show more

Keywords: Facilitatory repetitive magnetic stimulation, inhibitory repetitive transcranial magnetic stimulation, motor function, stroke, treatment

DOI: 10.3233/NRE-201606

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 83-96, 2021

Authors: Eschweiler, Mareike | Bohr, Lara | Kessler, Josef | Fink, Gereon R. | Kalbe, Elke | Onur, Oezguer A.

Article Type: Research Article

Abstract: BACKGROUND: The negative impact of cognitive dysfunction on motor rehabilitation as a relearning-process is well known in stroke patients. However, evidence for combined cognitive and motor training (CMT) is lacking. OBJECTIVE: To evaluate the effects of combined CMT in early stroke rehabilitation. METHODS: In a controlled pilot study, 29 moderately affected stroke patients with low-level motor performance and cognitive impairment received motor therapy plus either cognitive (experimental group, EG) or low-frequency ergometer training (control group, CG) for eight days. RESULTS: Both groups improved their motor functioning significantly. After training, between-group comparison revealed significant differences …for cognitive flexibility and trends for set-shifting, working memory, and reaction control in favor of the EG. Within-group effects showed improvement across all cognitive domains in the EG, which correlated with gains in bed-mobility, while the CG showed no significant improvement in cognition. Rather, a trend towards reaction control decline was observed, which correlated with less functional progression and recovery. Furthermore, a decline in cognitive flexibility, set-shifting, and working memory was descriptively observed. CONCLUSIONS: Combined CMT may enhance cognition and motor relearning early after stroke and is superior to single motor training. Further studies are needed to replicate these results and investigate long-term benefits. Show more

Keywords: Cerebrovascular event, rehabilitation, physiotherapy, cognition recovery of function

DOI: 10.3233/NRE-201583

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 97-108, 2021

Authors: Lequerica, Anthony H. | Arango-Lasprilla, Juan Carlos | Krch, Denise | Corrigan, John D.

Article Type: Research Article

Abstract: BACKGROUND: With structured interviews being an established method for assessing one’s exposure to traumatic brain injury across their lifetime, effective assessment tools are needed to serve the large population of Spanish speakers in the U.S. and abroad. OBJECTIVE: To obtain preliminary evidence of validity for a Spanish version of a web-based, structured interview designed to assess lifetime exposure to TBI. METHODS: A sample of 720 Spanish-speaking individuals between the ages of 18 through 65 from the continental U.S. (34.3%), South America (30.8%), the Caribbean (12.6%), Spain (12.4%), and Mexico and Central America (9.9%) completed an online …survey containing the Ohio State University Traumatic Brain Injury Identification Method (Self-Administered-Brief; OSU TBI-ID SAB), Neurobehavioral Symptom Inventory, and PROMIS Cognitive Concerns Scale. RESULTS: Indices of severity of worst TBI, time since most recent TBI, and multiple injuries demonstrated expected relationships with neurobehavioral symptoms such that greater symptom reporting was observed among those who had more severe injuries, more recent injuries, and multiple injuries over a period of time. CONCLUSIONS: Findings provide preliminary evidence of validity for three of the indices derived from OSU TBI-ID SAB among Spanish-speaking individuals. Further study is needed to assess other aspects of this instrument to pave the way for further epidemiological studies involving lifetime exposure to TBI among Spanish-speaking individuals across the U.S., Spain, and Latin America. Show more

Keywords: Traumatic brain injury, measurement, validity, cross-cultural

DOI: 10.3233/NRE-201539

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 109-117, 2021

Authors: Radecka, Aleksandra | Knyszyńska, Anna | Łuczak, Joanna | Lubkowska, Anna

Article Type: Research Article

Abstract: BACKGROUND: The available literature lacks data about the influence of whole body cryotherapy (WBC) on muscle activity in patients with sclerosis multiplex (MS). OBJECTIVE: Assessment of the influence of the 20 WBC series on the surface electromyography (sEMG) signal and the relationship between it and the functional state in patients with MS. METHODS: The study group was 114 of MS patients (aged 45.24±11.88yr.,) which 74 of them received 20 of WBC. An assessment was made of: the hand grip (HGS), Timed 25-Foot Walk, Fatigue Severity Scale, sEMG signal from the dominant limb. RESULTS: After …a series of 20 WBC: in the rest electromyograms, an increase of extensor carpi radialis (ECR) and a decrease of flexor carpi radialis (FCR) amplitude were demonstrated (non-normalized signal ECR p  = 0.0001); significant differences in sEMG rest signals between ECR and FCR have decreased; for voluntary contraction in both assessed antagonistic muscle amplitude was significantly decreased (p  = 0.0005; p  = 0.0316, p  = 0.0185); an increase of HGS (p  < 0.001); gait improvement (p  = 0.001); decrease fatigue (p  = 0.024). No significant changes were observed in the control group. CONCLUSIONS: Series of 20 WBC improves the functional state and reduces fatigue in patients with MS, which may be due to adaptive changes in bioelectrical muscle activity. Show more

Keywords: Surface electromyography, whole-body cryotherapy, multiple sclerosis, hand grip strength, fatigue severity scale, timed 25-foot walk

DOI: 10.3233/NRE-201535

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 119-131, 2021

Authors: Kyeong, Sunghyon | Kim, Dae Hyun

Article Type: Research Article

Abstract: OBJECTIVE: The aim of this study was to determine common structural and functional networks associated with asymmetric step length after unilateral ischemic stroke. METHODS: Thirty-nine chronic stroke patients were divided into two groups, based on the presence or absence of asymmetric step length. In each group, each lesion was mapped onto a brain magnetic resonance image. The structural and functional networks of brain regions connected to each lesion were identified using a public diffusion tensor and resting state function magnetic resonance image dataset. To identify brain regions associated with asymmetric step length, we conducted voxel-wise independent sample t …-tests for structural and function lesion network maps. RESULTS: At least 85% of lesions showed functional network overlap in the bilateral frontal lobe. Functional connectivity of the dorsolateral prefrontal cortex in the contralesional hemisphere was significantly decreased in group 1 compared to that in group 2. CONCLUSIONS: The dorsolateral prefrontal cortex may have an important role in compensating for an asymmetric step length after a unilateral stroke. Show more

Keywords: Lesion network mapping, lesion network, step length asymmetry, functional connectivity, structural connectivity

DOI: 10.3233/NRE-201555

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 133-138, 2021

Authors: Toledo, Felippe | Thaler, Markus

Article Type: Research Article

Abstract: BACKGROUND: Action observation describes a concept where the subsequent motor behavior of an individual can be modulated though observing an action. This occurs through the activation of neurons in the action observation network, acting on a variety of motor learning processes. This network has been proven highly useful in the rehabilitation of patients with acquired brain injury, placing “action observation” as one of the most effective techniques for motor recovery in physical neurorehabilitation. OBJECTIVE: The aim of this paper is to define an EEG marker for motor learning, guided through observation. METHODS: Healthy subjects (n  = 41) …participated voluntarily for this research. They were asked to repeat an unknown motor behavior, immediately after observing a video. During the observation, EEG raw signals where collected with a portable EEG and the results were later compared with success and fail on repeating the motor procedure. The comparison was then analyzed with the Mann-Whitney U test for non-parametrical data, with a confidence interval of 95%. RESULTS: A significant relation between motor performance and neural activity was found for Alpha (p  = 0,0149) and Gamma (0,0005) oscillatory patterns. CONCLUSION: Gamma oscillations with frequencies between 41 and 49,75 Hz, seem to be an adequate EEG marker for motor performance guided through the action observation network. The technology used for this paper is easy to use, low-cost and presents valid measurements for the recommended oscillatory frequencies, implying a possible use on rehabilitation, by collecting data in real-time during therapeutic interventions and assessments. Show more

Keywords: EEG-Marker, action observation network, motor learning, neurorehabilitation

DOI: 10.3233/NRE-201508

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 139-148, 2021

Authors: Arienti, Chiara

Article Type: Other

Abstract: BACKGROUND: Several medicines have been shown to be effective in treating neuropathic pain, but they can have damaging side effects, therefore people are now trying herbal products to help relieve pain. OBJECTIVE: The aim of the Cochrane Review was to evaluate whether herbal products/preparations have an analgesic effectiveness in neuropathic pain and whether any side effects are associated with their use. METHODS: The population addressed were adults aged ≥18 years, suffering from chronic neuropathic pain. Studies that investigated the effects of herbal products/preparations for the relief of neuropathic pain compared to any or no interventions were …included. RESULTS: Included studies did not show that herbal products/preparations have reduced pain intensity of 30% or above and there was no observable reduction in the total pain score. CONCLUSIONS: There is insufficient evidence to suggest that herbal products/preparations have any efficacy in any neuropathic pain conditions. The current evidence is of very low quality resulting in serious uncertainties about the estimates of effect observed. Show more

Keywords: Herbal medicine, neuropathic pain, rehabilitation

DOI: 10.3233/NRE-209009

Citation: NeuroRehabilitation, vol. 48, no. 1, pp. 149-152, 2021