NeuroRehabilitation - Volume 49, issue 3

Authors: Cumplido, Carlos | Delgado, Elena | Ramos, Jaime | Puyuelo, Gonzalo | Garcés, Elena | Destarac, Marie André | Plaza, Alberto | Hernández, Mar | Gutiérrez, Alba | García, Elena

Article Type: Review Article

Abstract: BACKGROUND: Cerebral Palsy (CP) and Spinal Muscular Atrophy (SMA) are common causes of motor disability in childhood. Gait exoskeletons are currently being used as part of rehabilitation for children with walking difficulties. OBJECTIVE: To assess the safety and efficacy and describe the main characteristics of the clinical articles using robot-assisted gait training (RAGT) with exoskeleton for children with CP or SMA. METHODS: A computer search was conducted in five bibliographic databases regarding clinical studies published in the last ten years. In order to be included in this review for further analysis, the studies had to meet …the following criteria: (1) assess efficacy or safety of interventions; (2) population had to be children with CP or SMA aged between 3 and 14; (3) exoskeleton must be bilateral and assist lower limbs during walking. RESULTS: Twenty-one articles were selected, of which only five were clinical trials. 108 participants met the inclusion criteria for this study, all with a diagnosis of CP. The evidence level of the selected papers was commonly low. CONCLUSIONS: RAGT therapy seems to be safe for children with CP. However, further investigation is needed to confirm the results related to efficacy. There is no evidence of RAGT therapy for SMA children. Show more

Keywords: Cerebral Palsy, exoskeleton, paediatric, rehabilitation, robot-assisted gait training, Spinal Muscular Atrophy

DOI: 10.3233/NRE-210135

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 333-348, 2021

Authors: Page, Teneille A. | Gordon, Sarah | Balchin, Ross | Tomlinson, Mark

Article Type: Review Article

Abstract: INTRODUCTION: Traumatic brain injury (TBI) has wide-ranging neuropsychological, physical, social and financial implications. The impact on caregivers of moderate to severe TBI survivors, particularly in low- and middle-income countries, is under-investigated. AIM: Identify and describe the experiences of caregivers’ of moderate to severe TBI survivors postdischarge from healthcare facilities. METHODS: A scoping review was conducted utilising seven electronic databases. Two reviewers screened articles using eligibly criteria related to setting (postdischarge), caregiving (informal), age of TBI survivors (> 18 years) and injury severity (moderate-severe). Studies published in English between 1999 –2018 were included. RESULTS: Fourteen articles …met the inclusion criteria. Articles reporting on the same sample were merged during data charting. The final analyses included 11 articles comprised of qualitative, quantitative and mixed-methods studies. Ten themes were identified: psychological distress, social functioning, financial burden, family experiences, coping strategies, access to services, time burdens and physical, cognitive and behavioural difficulties. Characteristics of caregivers and TBI survivors were also reported. CONCLUSION: Caregivers of moderate to severe TBI survivors experience challenges in various life domains, and there is limited research concerning caregivers in low- and middle-income countries. Future research should focus on understanding more nuanced experiences across various environments, which may increase comprehensive, flexible and long-term support. Show more

Keywords: Traumatic brain injury, caregiver experiences, postdischarge

DOI: 10.3233/NRE-210099

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 349-362, 2021

Authors: Zak, Marek | Sikorski, Tomasz | Wasik, Magdalena | Krupnik, Szymon | Andrychowski, Jaroslaw | Brola, Waldemar

Article Type: Review Article

Abstract: BACKGROUND: Pisa syndrome (PS) is a postural disorder characterised by lateral flexion of the spine (> 10°), predisposing the affected individuals to falls, and contributing to increased mortality in neurodegenerative diseases. OBJECTIVE: An overview of currently applied therapeutic management options, primarily focused on specifically structured rehabilitation exercises, in conjunction with falls-risk assessment in the individuals affected by PS. METHODS: A narrative literature review, augmented with the authors’ own experience in physical rehabilitation management. RESULTS: As individuals affected by PS are evidenced to be intrinsically exposed to higher falls-risk through acquired postural deformities, they often fall …victims of traumatic accidents, occasionally also facing relocation into 24-hour nursing facilities due to the injuries sustained/resultant disability, consequently having overall quality of their life appreciably reduced. CONCLUSIONS:s A comprehensive approach is postulated in designing optimal therapeutic management, comprised of the exercises controlling postural stability, whilst reducing lower back pain, and the ones also promoting specific skills essential for coping unassisted after an accidental fall effectively. Rehabilitation of individuals affected by PS should be a fully integrated service, eliminating all identified risk factors for falls. As clinical PS symptoms tend to recur after completion of a full course of therapeutic management, all PS patients should continue the pursuit of therapeutic exercises on an individual basis, to effectively retard their recurrence. In view of overall scarcity of clinical studies completed on the large population samples of PS patients, further in-depth research is still required to ensure higher credence to overall efficacy of the presently proposed therapeutic solutions. Show more

Keywords: Pisa syndrome, neurodegenerative disorders, falls risk, rehabilitation

DOI: 10.3233/NRE-210167

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 363-373, 2021

Authors: Klobucká, Stanislava | Klobucký, Robert | Kollár, Branislav

Article Type: Research Article

Abstract: BACKGROUND: No general recommendations are yet available for the application of robot-assisted treadmill therapy for children with cerebral palsy regarding the length and intensity of the intervention. OBJECTIVE: The aim of the study was to evaluate patient-specific determinants of responsiveness to robot-assisted gait training (RAGT) in patients with bilateral spastic cerebral palsy. METHOD: During 12 months, the patients underwent 1–4 blocks of RAGT, representing 16–82 TUs. The following parameters were evaluated before (V0) and after each therapeutic block (V1–V4): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and …jumping) of the Gross Motor Function Measure (GMFM-88). We evaluated the change in motor functions in relation to the severity of disability, age, gender and number of therapeutic units. RESULTS: Ninety-seven patients aged between 3.7 and 27 years (mean age 10.02 years (SD±5.29); Gross Motor Function Classification System level I [n  = 5], II [n  = 25], III [n  = 48], IV [n  = 19]) underwent 16–82 TUs (overall average number 34.06 TUs, SD±16.41) of RAGT. In the patient group, we recorded clinically meaningful improvement and statistically significant improvement (p  < 0.001) in gross motor functions with gradual increase in the effect size after each therapeutic block. Using correlation and regression analysis, we found a statistically significant associations between the number of therapeutic units, severity of disability, and improvement in motor functions after RAGT. CONCLUSION: We have identified two determinants –the severity of disability and the number of therapeutic units –which could have a decisive and predictive character in setting rehabilitation/designing programmes. The duration of the applied RAGT period, frequency and intensity could be a crucial factor for the potential of improvement in children with BS-CP. Show more

Keywords: Neurorehabilitation, Lokomat, cerebral palsy, gross motor function

DOI: 10.3233/NRE-210130

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 375-389, 2021

Authors: Ahmed, Umair | Karimi, Hossein | Gilani, Syed Amir | Ahmad, Ashfaq

Article Type: Research Article

Abstract: BACKGROUND: The Stroke Impact Scale version 3.0 (SIS 3.0) is a self-reported outcome measure designed to assess quality of life (QoL) following a stroke. Although the psychometric properties of the SIS 3.0 are identified as superior to the generic QoL scales, it has not been translated and tested in Pakistan. OBJECTIVE: To validate the Urdu version of the SIS 3.0 (USIS 3.0) for Pakistan. METHODS: A prospective cohort of 116 patients with mild to moderate stroke reported their recovery using the USIS 3.0. The patients were concurrently assessed on the established tools to assess the validity …and were re-evaluated to determine the test-retest reliability, precision, minimal detectable change (MDC), and minimal clinically important difference (MCID). RESULTS: The reliability and internal consistency of USIS were satisfactory except for the emotion domain. The correlations of USIS with the established tools were strong. The discriminant validity was also significant across the levels of the modified Rankin scale (MRS). Only hand function and communication domains exhibited significant floor and ceiling effects, respectively. Regarding weighted K , values ranged from 0.53 to 0.88. CONCLUSIONS: The USIS 3.0 has satisfactory psychometric properties and can be used in clinical and research settings for stroke survivors. Show more

Keywords: Stroke, stroke impact scale, outcome measures, quality of life

DOI: 10.3233/NRE-210064

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 391-402, 2021

Authors: Hernández-Méndez, Beatriz | Martín-Silva, Isabel | Tapias-Vilanova, Martí | Moreno-Gallo, Yolanda | Sanjuan-Menendez, Estela | Lorenzo-Tamayo, Eva | Ramos-González, Montserrat | Montufo-Rosal, Marina | Zuriguel-Pérez, Esperanza

Article Type: Research Article

Abstract: BACKGROUND: The evidence of early mobilization after stroke is conflicting, and the recovery period is an important concern. OBJECTIVE: To analyse the functionality, quality of life and disability at 90 days and 1 year post-stroke of patients who received a Very Early Mobilization Protocol. METHODS: Prospective cohort study in a tertiary stroke unit. Consecutive patients aged≥18 years and without prior significant disability, who presented motor deficit after acute stroke, were included. A symmetry test was performed to compare the changes in the main variables: Barthel Index (BI), Functional Ambulation Category (FAC), modified Rankin Scale (mRS) and …EuroQol five-dimensions three-level (EQ-5D-3L) between 90 days and 1 year post-stroke. RESULTS: A total of 123 patients were recruited. The BI reflected an improvement at 1 year in transfer to chair/bed in 25.8%(p  < 0.01) of patients and in toilet use in 25.8%(p  = 0.02). The FAC showed an improvement at 1 year in 44.4%(p  < 0.01) of patients and the mRS in 19.1%(p  = 0.01). The usual activities dimension of the EQ-5D-3L showed a clinically relevant improvement after 1 year in 15.9%(p  = 0.23) of patients. CONCLUSIONS: A significant percentage of patients show improvements in some functional areas and in disability between 90 days and 1 year post-stroke. Show more

Keywords: Activities of daily living, disability evaluation, early mobilization, quality of life, stroke

DOI: 10.3233/NRE-210118

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 403-414, 2021

Authors: García-Rudolph, Alejandro | Bernabeu, Montserrat | Cegarra, Blanca | Saurí, Joan | Madai, Vince Istvan | Frey, Dietmar | Opisso, Eloy | Tormos, Josep María

Article Type: Research Article

Abstract: BACKGROUND: Many efforts have been devoted to identify predictors of functional outcomes after stroke rehabilitation. Though extensively recommended, there are very few external validation studies. OBJECTIVE: To externally validate two predictive models (Maugeri model 1 and model 2) and to develop a new model (model 3) that estimate the probability of achieving improvement in physical functioning (primary outcome) and a level of independence requiring no more than supervision (secondary outcome) after stroke rehabilitation. METHODS: We used multivariable logistic regression analysis for validation and development. Main outcome measures were: Functional Independence Measure (FIM) (primary outcome), Functional Independence …Staging (FIS) (secondary outcome) and Minimal Clinically Important Difference (MCID). RESULTS: Patients with stroke admitted to a rehabilitation center from 2006 to 2019 were retrospectively studied (N = 710). Validation of Maugeri models confirmed very good discrimination: for model 1 AUC = 0.873 (0.833–0.915) and model 2 AUC = 0.803 (0.749–0.857). The Hosmer–Lemeshow χ2 was 6.07(p  = 0.63) and 8.91(p  = 0.34) respectively. Model 3 yielded an AUC = 0.894 (0.857–0.929) (primary outcome) and an AUC = 0.769 (0.714–0.825) (MCID). CONCLUSIONS: Discriminative power of both Maugeri models was externally confirmed (in a 20 years younger population) and a new model (incorporating aphasia) was developed outperforming Maugeri models in primary outcome and MCID. Show more

Keywords: Stroke rehabilitation, activities of daily living, predictors, aphasia

DOI: 10.3233/NRE-201619

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 415-424, 2021

Authors: Gottlieb, Anna | Boltzmann, Melanie | Schmidt, Simone B. | Gutenbrunner, Christoph | Krauss, Joachim K. | Stangel, Martin | Höglinger, Günter U. | Wallesch, Claus-W. | Rollnik, Jens D.

Article Type: Research Article

Abstract: BACKGROUND: Upper limb dysfunction is a frequent complication after stroke impairing outcome. Inhibitory repetitive transcranial magnetic stimulation (rTMS) applied over the contralesional hemisphere is supposed to enhance the positive effects of conventional rehabilitative treatment. OBJECTIVE: This double-blind randomized placebo-controlled trial investigated whether inhibitory rTMS as add-on to standard therapy improves upper limb spasticity. METHODS: Twenty-eight patients (aged 44 to 80 years) with unilateral stroke in the middle cerebral artery territory were analyzed. Participants were randomly assigned to inhibitory, low-frequency (LF-) rTMS (n  = 14) or sham-rTMS (n  = 14). The primary outcome measure was the spasticity grade, which …was assessed with the Modified Ashworth Scale (MAS). In addition, the Fugl-Meyer-Assessment (FMA) for the upper extremity (UE) and a resting-state fMRI were performed to measure motor functions and the sensorimotor network, respectively. RESULTS: The MAS score was reduced in the LF-rTMS group only, whereas the FMA score improved in both groups over time. Regarding the fMRI data, both groups activated typical regions of the sensorimotor network. In the LF-rTMS group, however, connectivity to the left angular gyrus increased after treatment. CONCLUSION: Changes in functional connectivity in patients receiving inhibitory rTMS over the contralesional motor cortex suggest that processes of neuronal plasticity are stimulated. Show more

Keywords: Stroke, upper limb paresis, spasticity, repetitive transcranial magnetic stimulation, resting-state functional connectivity, neurological rehabilitation, rTMS

DOI: 10.3233/NRE-210088

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 425-434, 2021

Authors: Kang, Wonil | Chung, Jane | Lee, Jeongeun | Jung, Kwang-Ik | Yoo, Woo-Kyoung | Ohn, Suk Hoon

Article Type: Research Article

Abstract: BACKGROUND: Laryngeal penetration, which is a less serious form of aspiration, should be considered in patients with stroke to ensure early detection of risk of laryngeal aspiration and prevention of pneumonia. OBJECTIVE: As a follow-up to a previous study that demonstrated the association of pharyngeal width to laryngeal aspiration, the present study sought to determine whether the pharyngeal width was related to not only laryngeal aspiration but also laryngeal penetration in patients with deglutition disorder following stroke. METHODS: The pharyngeal width on the roentgenogram was measured and compared based on the severity of aspiration. Moreover, the …optimal cut-off points were determined for predicting the penetration and aspiration so that the difference between the penetration and the aspiration could be elucidated. RESULTS: The pharyngeal width of the patients was wider than the controls. The increase of the pharyngeal width by aspiration severity was more evident in the patients with chronic and right cerebral stroke. The optimal cut-off point of the pharyngeal width was approximately 1 mm lesser for the prediction of penetration than for aspiration. CONCLUSIONS: The pharyngeal width could be an ancillary method for detecting penetration and aspiration in stroke patients. Show more

Keywords: Stroke, deglutition disorders, pharynx, penetration, aspiration

DOI: 10.3233/NRE-210120

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 435-444, 2021

Authors: Bartolome, G. | Starrost, U. | Schröter-Morasch, H. | Schilling, B. | Fischbacher, L. | Kues, L. | Graf, S. | Ziegler, W.

Article Type: Research Article

Abstract: BACKGROUND: The Munich Swallowing Score (MUCSS) is a clinician rated scale for the assessment of the functional level of swallowing saliva/secretions, food and liquids. The MUCSS consists of two eight-point subscales, MUCSS-Saliva and MUCSS-Nutrition. In a previous article, content validity and interrater reliability were described. OBJECTIVE: The aim of the present study was to investigate criterion validity and sensitivity to change of the MUCSS. METHODS: The research was conducted at a tertiary care academic hospital. Data were collected retrospectively in a cohort of 100 acute and subacute neurologic patients. Criterion validity was judged by comparison to …the Gugging Swallowing Screen (GUSS), the Barthel Index (BI), Early Rehabilitation Barthel Index (ERI), Extended Barthel Index (EBI) and also by comparison to three physiological scales drawn from FEES videos: The Penetration - Aspiration Scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale (YPR) and the Murray Secretion Scale (MSS). Changes in oral intake and saliva swallowing were followed up for three months. RESULTS: Between MUCSS and scores directly reflecting dysphagic symptoms (GUSS, PAS, YPR, MSS, ERI), strong to moderate correlations were found, weaker but statistically significant associations were seen with global measures of disability (BI isolated, EBI-subscale cognitive functions). MUCSS was sensitive to positive change of saliva swallowing and oral intake during the recovery period. CONCLUSIONS: These preliminary data suggest that the MUCCS is a valid scale and may be appropriate for documenting clinical change in swallowing abilities of patients with neurogenic dysphagia. Show more

Keywords: Neurogenic dysphagia, clinical swallowing rating scale, swallowing rehabilitation

DOI: 10.3233/NRE-210011

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 445-457, 2021