NeuroRehabilitation - Volume 51, issue 3

Authors: Cheung, Lovisa | Chan, Katherine | Heffernan, Matthew G. | Pakosh, Maureen | Hitzig, Sander L. | Marzolini, Susan | Kalsi-Ryan, Sukhvinder | Musselman, Kristin E.

Article Type: Review Article

Abstract: BACKGROUND: Spinal cord injury (SCI) leads to various physical, psychological, and social challenges. Sport is a holistic physical activity that may target these challenges. No literature systematically summarizes the overall impact of sport participation for those with SCI. OBJECTIVE: To comprehensively report the findings of quantitative studies investigating the impact of sport on the physical, psychological, and social health of individuals with SCI. METHODS: Six databases were searched: APA PsycInfo, CINAHL, Embase, Emcare, Ovid Medline, and PubMed (non-Medline). Studies were included if (a) participants were adults with SCI for ≥12 months, (b) outcomes resulting from ≥3 …months of sport participation were investigated, (c) sport occurred in the community setting, and (d) comparisons of sport and non-sport conditions were analyzed. Details regarding study characteristics, participants, sport(s), and outcomes were extracted. Methodological quality was assessed using the Modified Downs and Black checklist. RESULTS: Forty-nine studies were included. Study quality ranged from poor to moderate. Sport participation showed favourable results for outcomes including function, quality of life, and community integration. Mixed results were found for outcomes including cardiac function, depressive symptoms, and employment. No significant associations were found for postural control, resilience, and education. CONCLUSIONS: The review findings suggest sport may be a promising intervention for addressing some challenges associated with SCI. Show more

Keywords: Exercise, para-athletes, quantitative research, spinal cord injuries, sport

DOI: 10.3233/NRE-220037

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 353-395, 2022

Authors: Arango-Lasprilla, Juan Carlos | Watson, Jack D. | Rodriguez, Miriam J. | Ramos-Usuga, Daniela | Mascialino, Guido | Perrin, Paul B.

Article Type: Research Article

Abstract: BACKGROUND: Research has found that Hispanics with traumatic brain injury (TBI) have reduced functional outcomes compared to non-Hispanic Whites, including lower probabilities of post-injury employment. However, previous studies were cross-sectional, combined racial/ethnic minority groups, and did not examine the factors that predict return to work of Hispanics longitudinally. OBJECTIVE: To determine the demographic and injury-related predictors of employment probability trajectories during the first 10 years after TBI. METHODS: 1,346 Hispanics in the TBI Model Systems Database were included. Hierarchical linear modeling was used to examine baseline predictors of employment probability trajectories across this time period. …RESULTS: Employment probability demonstrated a quadratic movement over time, with an initial increase followed by a plateau or slight decrease. Hispanics with TBI had higher employment probability trajectories if they had been younger at the time of injury, spent less time in posttraumatic amnesia, had greater years of education, had been employed at the time of injury, had higher annual earnings at the time of injury, and had experienced a non-violent mechanism of injury. CONCLUSION: Culturally adapted treatment programs with a focus on early intervention incorporating vocational rehabilitation and employment programs for Hispanics with TBI who present with these risk factors are needed. Show more

Keywords: TBI, Hispanics, employment, rehabilitation

DOI: 10.3233/NRE-220066

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 397-405, 2022

Authors: Kim, Sun-Min | Jang, Sang-Hun

Article Type: Research Article

Abstract: BACKGROUND: The effects of trunk stabilization exercise programs and exercises applying weight loads for stroke patients are well presented. However, there is not enough objective research to prove the effects of trunk stabilization exercise programs using weight loads for stroke patients. OBJECTIVE: In this study, a trunk stabilization exercise program using weight loads was performed to investigate its impact on the balance and gait ability of stroke patients. METHODS: Thirty patients with stroke were randomly divided into three groups. Experiment group 1 followed a trunk stabilization exercise program using weight loads, experiment group 2 followed a …trunk stabilization exercise program, and the control group followed general physiotherapy. Patients’ balance ability was assessed using balance measurement equipment BT-4 (postural sway area (PSA), postural sway length (PSL), limit of stability (LOS)), Berg Balance Scale (BBS), and Time Up and Go test (TUG). Gait speed was measured to examine gait ability. RESULT: After the intervention, the PSA, PFSL in experimental groups 1 and 2 decreased but that of the control group increased. BBS, TUG, and LOS scores of experimental group 1 were significantly improved compared to experimental group 2 and the control group. Also, gait speed was significantly improved in experimental group 1 compared to experimental group 2 and the control group. CONCULSION: This study may be used as a basic material for an effective trunk stabilization exercise method for stroke patients and might be of significance as an intervention method for stroke patients requiring long-term treatment. Show more

Keywords: Trunk stabilization exercise, weight load, balance, gait, stroke

DOI: 10.3233/NRE-220143

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 407-419, 2022

Authors: Aloraini, Saleh M.

Article Type: Research Article

Abstract: BACKGROUND: Stroke often leads to lower extremity impairments that significantly hinders functional recovery. OBJECTIVE: To investigate the effectiveness of constraint-induced movement therapy for the lower extremity (CIMT-LE) for improving balance and ambulation among people post-stroke. METHODS: A randomized controlled, single-blinded clinical trial was conducted. Participants were recruited and randomized into one of two groups: CIMT-LE group and control. Outcome measures were the Fugl-Meyer assessment of lower extremity, Berg balance scale, ten-meter walk test and six-minute walk test. Outcome measures were collected at baseline, following the conclusion of the therapeutic programs and after three months. …RESULTS: 38 participants were enrolled in the study (19 in each group). No significant differences were found between groups at baseline. At the conclusion of therapeutic programs, both groups showed significant changes compared to baseline. However, changes seen in the CIMT-LE were clinically significant. Further, at three months following the conclusion of the program, the recorded improvements were retained by participants. CONCLUSION: A CIMT-LE program compared to an intensity-matched conventional program yielded significant clinical improvements among people post-stroke. These improvements were seen in lower extremity motor recovery, postural balance and gait speed. Furthermore, these improvements were retained three months following the conclusion of the therapeutic program. Show more

Keywords: Stroke, rehabilitation, mobility, gait, movement therapy, balance, ambulation

DOI: 10.3233/NRE-220139

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 421-431, 2022

Authors: Yao, Lulu | Liang, Wei | Du, Xin | Chen, Yujing | Huang, Xiaobo

Article Type: Research Article

Abstract: BACKGROUND: Acupuncture has been used to treat patients with post-stroke neurological dysfunction. OBJECTIVE: The purpose of our observational study was to observe the long-term efficacy of acupuncture and investigate whether the acupuncture treatment could short the recovery time of patients with post-stroke dysphagia. METHODS: Medical records were reviewed to select patients who met the inclusion criteria for post-stroke dysphagia. Exposure factor was defined as received acupuncture during inpatient. Clinical data were obtained at the 6-month follow-up. The primary outcome was the time to improve the score of Food Intake Level Scale (FILS, 0–10) by 3 grades. …Cox regression models were used to assess the relationship between acupuncture and recovery of dysphagia. RESULTS: In acupuncture group, the median time to achieve clinical improvement of dysphagia was 97 days (95% CI, 93–124) compared with 119 days (95% CI, 108–145) in control group, with a statistically significant difference between the two groups (HR = 1.48; 95% CI 1.14–1.92; P  = 0.003). At 6 months, 78 patients (60.5%) in acupuncture group reached excellent function and 61 patients (47.3%) in control group (RR = 1.28; 95% CI, 1.02–1.62; P  = 0.045). 106 patients (82.2%) in acupuncture group achieved favorable function and 91 patients (70.5%) in control group (RR = 1.17; 95% CI, 1.02–1.35; P  = 0.039). The outcome of adjusted multivariable Cox regression models showed that there was a difference in the recovery time of dysphagia between groups, HR = 1.79, 95% CI 1.34–2.39. The rates of adverse events were similar in both groups. CONCLUSIONS: Acupuncture can promote the recovery of post-stroke dysphagia, and has a better long-term efficacy. Besides, it can reduce the degree of disability and improve the quality of life. Show more

Keywords: Acupuncture, stroke, dysphagia, swallowing function, observational study

DOI: 10.3233/NRE-220113

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 433-441, 2022

Authors: Shin, Jin | Chung, Yijung

Article Type: Research Article

Abstract: BACKGROUND: Many stroke patients show reduced walking abilities, characterized by asymmetric walking patterns. For such patients, restoration of walking symmetry is important. OBJECTIVE: This study investigates the effect of treadmill training with visual feedback and rhythmic auditory cue (VF+RAC) for walking symmetry on spatiotemporal gait parameters and balance abilities. METHODS: Thirty-two patients with chronic stroke participated in this study. Participants were randomized to either the VF+RAC (n  = 16) or the Control (n  = 16) group. The VF+RAC group received treadmill training with VF and RAC, and the Control group underwent treadmill training without any visual and auditory …stimulation. VF+RAC and Control groups were trained three times per week for eight weeks. After eight weeks of training, the spatiotemporal gait parameters, Timed up and go test, and Berg balance scale were measured. RESULTS: The VF+RAC group significantly improved balance and spatiotemporal parameters except for non-paretic single limb support compared to the Control group. CONCLUSIONS: This study demonstrated that treadmill training with VF+RAC significantly improved spatiotemporal gait symmetry, including other gait parameters, and enhanced balance abilities in stroke patients. Therefore, treadmill training with VF+RAC could be a beneficial intervention in clinical settings for stroke patients who need improvement in their gait and balance abilities. Show more

Keywords: Gait symmetry, visual feedback, rhythmic auditory cue, balance, stroke

DOI: 10.3233/NRE-220099

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 443-453, 2022

Authors: Xin, Xiyan | Duan, Fang | Kranz, Georg S. | Shu, Dong | Fan, Ruiwen | Gao, Ying | Yan, Zheng | Chang, Jingling

Article Type: Research Article

Abstract: BACKGROUND: Ischemic stroke is a common type of stroke associated with reorganization of functional network of the brain. OBJECTIVE: This pilot study aimed to investigate the characteristics of functional brain networks based on EEG in patients with acute ischemic stroke. METHODS: Seven patients with ischemic stroke within 72 hours of onset and seven healthy controls were enrolled in the study. Dynamic EEG monitoring and clinical information were repeatedly collected within 72 hours (T1), on the 5th day (T2), and on the 7th day (T3) of stroke onset. A directed transfer function was employed to construct functional …brain connection patterns. Graph theoretical analysis was performed to evaluate the characteristics of functional brain networks. RESULTS: First, we found that the brain networks of ischemic stroke patients were quite different from the healthy controls. The clustering coefficient (0.001 < Threshold < 0.2) in Delta, Theta, and Alpha bands for the patients were significantly lower (P  < 0.01) and the shortest path length in all bands (0.001 < Threshold < 0.2) for the patients were significantly longer (P  < 0.01). Moreover, the peaks of the shortest path length for the patients seemed to be higher in all bands with larger thresholds. Secondly, the brain networks for the patients showed a characterized time-variation pattern. The clustering coefficient (0.001 < Threshold < 0.2) of T1 was higher than that of T2 in alpha band (P  < 0.01). The shortest path length (0.001 < Threshold < 0.2) of T3 was shorter than that of T2 (P  < 0.01) in all bands, and the peak of T3 was numerically higher than that of T2 in all bands with narrower thresholds. CONCLUSION: Functional brain networks in patients with acute ischemic stroke showed impaired global functional integration and decreased efficiency of information transmission compared with healthy subjects. The shortening of the shortest path length during the recovery indicates neural plasticity and reorganization. Show more

Keywords: Acute ischemic stroke, functional connectivity, EEG, The clustering coefficient, The shortest path length

DOI: 10.3233/NRE-220107

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 455-465, 2022

Authors: Sun, Yingying | Li, Lihong | Chen, Yao | Wang, Lei | Zhai, Lihao | Sheng, Jili | Liu, Tao | Jin, Xiaoqing

Article Type: Research Article

Abstract: BACKGROUND: A variety of acupuncture therapies have shown efficacy in Parkinson’s disease (PD). OBJECTIVE: To evaluate scalp acupuncture (SA) effects on motor and cerebral activity by using gait equipment and resting-state functional magnetic resonance imaging (rs-fMRI). METHODS: Twelve patients with PD received SA. They underwent the first functional-imaging scan after tactile stimulation and the second scan following needle removal. Gait test and local sensation assessment were performed immediately after each functional scan. Gait parameter differences between pre- and post-SA were analyzed using a paired t -test and altered brain areas in degree centrality (DC) and fractional …amplitude of low-frequency fluctuation (fALFF) were identified between the two scans. RESULTS: Eight patients completed the experiment. Stride length, maximum ankle height, maximum ankle horizontal displacement, gait speed, and range of shank motion significantly increased post-treatment (P  < 0.05). fALFF in left middle frontal gyrus and DC in left cerebellum (corrected) increased, while fALFF in left inferior parietal lobule (corrected) during SA decreased, compared with those in tactile stimulation. A positive correlation was observed between right limb swings and both fALFF areas. CONCLUSIONS: Differences in gait and brain analyses presented modulation to motor and brain activity in PD, thus, providing preliminary evidence for SA efficacy. Show more

Keywords: Scalp acupuncture, Parkinson’s disease, tactile stimulation, functional magnetic resonance imaging (fMRI)

DOI: 10.3233/NRE-220048

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 467-479, 2022

Authors: Gialanella, Bernardo | Gaiani, Marta | Comini, Laura | Olivares, Adriana | Di Pietro, Davide | Vanoglio, Fabio | Cenicola, Alice | Vezzadini, Giuliana

Article Type: Research Article

Abstract: BACKGROUND: To date little is known about factors affecting walking rehabilitation in Parkinson’s disease (PD) patients. OBJECTIVE: This prospective observational cohort study evaluated the walking distance covered in 6 minutes (6 MWD) before and after conventional rehabilitation and verified which among PD motor disorders was the most important determinant of walking distance in PD patients undergoing rehabilitation. METHODS: Data were collected from 55 PD patients, performing a conventional outpatient motor rehabilitation program. The 6MWD at the end of rehabilitation and gain in 6MWD were the outcome measures. The Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr …scale, Nine Hole Peg Test, Grip and Pinch test, ROM wrist motility, and Berg Balance Scale (BBS) were used to assess PD patients at admission and were considered as dependent variables. Backward multiple regression analyses identified the determinants of 6MWD outcomes. RESULTS: The 6MWD was 246.58±115 meters at admission and 286.90±116 at the end of rehabilitation. At end of rehabilitation, the 6MWD was 42.32±47 meters greater than admission (p  < 0.001), corresponding to an increase of +17.16%. At the end of rehabilitation, the 6MWD was significantly longer in PD patients with stages 1–3 of the Hoehn and Yahr scale. Berg Balance Scale (β= 0.47, p  < 0.001) and right Grip and Pinch at admission (β= 0.36, p  = 0.001) were the only determinants of final 6MWD. The R2 value of the model was 0.47 (R2 adjusted 0.45). No variable was a determinant of gain in 6MWD. CONCLUSIONS: The study indicates that balance and generalized muscle strength are important determinants of walking rehabilitation in PD patients, in whom it is essential to maintain high levels of balance and muscle strength for a time as long as possible. These findings suggest planning more intensive rehabilitation treatments in PD patients with low levels of balance and muscle strength. Show more

Keywords: Balance, conventional rehabilitation, motor coordination, muscle strength, passive range of motion

DOI: 10.3233/NRE-220103

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 481-488, 2022

Authors: Bjork, James M. | Perrin, Paul B. | Plonski, Paul E. | Vassileva, Jasmin | Goetz, Lance L.

Article Type: Research Article

Abstract: BACKGROUND: Low Quality of Life (QoL) in persons with paraplegia may stem from impulsive behaviors. Impulsivity in persons with paraplegia and persistently low QoL has seldom been probed but could be targeted with cognitive behavioral therapies. OBJECTIVE: Determine how task-assessed and self-report impulsivity relate to quality of life (QoL) in adults with paraplegia. METHODS: In a preliminary study, 33 adults with paraplegia after traumatic SCI were administered verbal interviews on QoL from the PROMIS item bank at baseline and at six-month follow-up, along with several computerized metrics of impulsivity at baseline. RESULTS: A cluster …of (n  = 10) participants characterized by high levels of negative affect and low levels of resilience and life satisfaction across both baseline and follow-up showed significantly greater negative urgency impulsivity (p  = 0.007) as well as significantly lower mindfulness and self-care in some domains (all p  < 0.05), compared to the cluster of participants (n  = 23) who showed higher life satisfaction and resilience. Behavioral metrics of delay discounting and rapid-response (motoric) impulsivity did not significantly differ (all p  > 0.05) between the two clusters of participants. CONCLUSIONS: These data suggest that novel interventions that reduce trait impulsivity in other disorders could be applied to potentially reduce risk for reduced self-care and QoL in individuals with paraplegia. Show more

Keywords: Paraplegia, quality of life, impulsivity, spinal cord injury

DOI: 10.3233/NRE-220115

Citation: NeuroRehabilitation, vol. 51, no. 3, pp. 489-497, 2022