NeuroRehabilitation - Volume 52, issue 3

Authors: Ramsay, Scott | Dahinten, V. Susan | Ranger, Manon | Babul, Shelina

Article Type: Review Article

Abstract: BACKGROUND: Concussions are a significant health issue for children and youth. After a concussion diagnosis, follow-up visits with a health care provider are important for reassessment, continued management, and further education. OBJECTIVE: This review aimed to synthesize and analyse the current state of the literature on follow-up visits of children with a concussive injury and examine the factors associated with follow-up visits. METHODS: An integrative review was conducted based on Whittemore and Knafl’s framework. Databases searched included PubMed, MEDLINE, CINAHL, PsycINFO, and Google Scholar. RESULTS: Twenty-four articles were reviewed. We identified follow-up visit rates, …timing to a first follow-up visit, and factors associated with follow-up visits as common themes. Follow-up visit rates ranged widely, from 13.2 to 99.5%, but time to the first follow-up visit was only reported in eight studies. Three types of factors were associated with attending a follow-up visit: injury-related factors, individual factors, and health service factors. CONCLUSION: Concussed children and youth have varying rates of follow-up care after an initial concussion diagnosis, with little known about the timing of this visit. Diverse factors are associated with the first follow-up visit. Further research on follow-up visits after a concussion in this population is warranted. Show more

Keywords: Concussion, follow-up visits, health services, children, youth

DOI: 10.3233/NRE-220216

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 315-328, 2023

Authors: Sánchez-Cuesta, Francisco José | González-Zamorano, Yeray | Arroyo-Ferrer, Aída | Moreno-Verdú, Marcos | Romero-Muñoz, Juan Pablo

Article Type: Review Article

Abstract: BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) over the primary motor cortex (M1) has been used to treat stroke motor sequelae regulating cortical excitability. Early interventions are widely recommended, but there is also evidence showing interventions in subacute or chronic phases are still useful. OBJECTIVE: To synthetize the evidence of rTMS protocols to improve upper limb motor function in people with subacute and/or chronic stroke. METHODS: Four databases were searched in July 2022. Clinical trials investigating the effectiveness of different rTMS protocols on upper limb motor function in subacute or chronic phases post-stroke were included. PRISMA guidelines …and PEDro scale were used. RESULTS: Thirty-two studies representing 1137 participants were included. Positive effects of all types of rTMS protocols on upper limb motor function were found. These effects were heterogeneous and not always clinically relevant or related to neurophysiological changes but produced evident changes if evaluated with functional tests. CONCLUSION: rTMS interventions over M1 are effective for improving upper limb motor function in people with subacute and chronic stroke. When rTMS protocols were priming physical rehabilitation better effects were achieved. Studies considering minimal clinical differences and different dosing will help to generalize the use of these protocols in clinical practice. Show more

Keywords: Repetitive transcranial magnetic stimulation, stroke, upper limb motor function, subacute, chronic, motor cortex

DOI: 10.3233/NRE-220306

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 329-348, 2023

Authors: Brusola, Gregory | Garcia, Erica | Albosta, Meagan | Daly, Audrey | Kafes, Konstandinos | Furtado, Michael

Article Type: Review Article

Abstract: BACKGROUND: Post-stroke spasticity is often one of the primary impairments addressed in rehabilitation. However, limited guidance exists on the effectiveness of physical therapy (PT) interventions for post-stroke spasticity. OBJECTIVE: To evaluate the quality of evidence of PT interventions for post-stroke spasticity. METHODS: Ovid (Medline), Cochrane Library, CINAHL, Scopus, PEDro, and PROSPERO were searched to identify reviews based on the following criteria: 1) published between 2012 and 2021, 2) participants older than 18 years old, 3) post-stroke spasticity, 4) PT interventions, 5) clinical or neurophysiological measures of spasticity as primary outcomes. Assessment of Multiple Systematic Reviews 2 …and the Grades of Recommendations Assessment, Development, and Evaluation assessed methodological quality. RESULTS: Eight articles were included in the analysis. No high-quality evidence was found. Moderate quality evidence exists for transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, resistance training, and lower extremity ergometer training with or without functional electrical stimulation. Low quality evidence exists for dynamic stretching, botulinum toxin with constraint-induced movement therapy, and static stretching using positional orthoses. CONCLUSION: Findings suggest that PT should prioritize a combination of active strategies over passive interventions, but further studies are needed prioritizing analyses of the movement system in managing post-stroke spasticity in conjunction with medical therapies. Show more

Keywords: Muscle spasticity, stroke, physical therapy, physical therapy modalities, electric stimulation, exercise

DOI: 10.3233/NRE-220275

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 349-363, 2023

Authors: de Sire, Alessandro | Moggio, Lucrezia | Marotta, Nicola | Curci, Claudio | Lippi, Lorenzo | Invernizzi, Marco | Mezian, Kamal | Ammendolia, Antonio

Article Type: Review Article

Abstract: BACKGROUND: Spinal cord injury (SCI) leads to spinal nerve fiber tract damage resulting in functional impairments. Volumetric muscle loss (VML), a skeletal muscle volume abnormal reduction, is represented by atrophy below the injury level. The strategies for VML management included personalized approaches, and no definite indications are available. OBJECTIVE: To identify the rehabilitation effects of VML in subjects with SCI (humans and animals). METHODS: PubMed, Scopus, and Web of Science databases were systematically searched to identify longitudinal observational studies with individuals affected by traumatic SCI as participants; rehabilitation treatment as intervention; no control, sham treatment, and …electrical stimulation programs as control; total lean body and lower limb lean mass, cross-sectional area, functional gait recovery, muscle thickness, and ultrasound intensity, as outcome. RESULTS: Twenty-four longitudinal observational studies were included, evaluating different rehabilitation approaches’ effects on the VML reduction in subjects affected by SCI. The data showed that electrical stimulation and treadmill training are effective in reducing the VML in this population. CONCLUSION: This systematic review underlines the need to treat subjects with traumatic SCI (humans and animals) with different rehabilitation approaches to prevent VML in the subacute and chronic phases. Further clinical observations are needed to overcome the bias and to define the intervention’s timing and modalities. Show more

Keywords: Rehabilitation, volumetric muscle loss, spinal cord injury, functional electrical stimulation, neuromuscular electrical stimulation

DOI: 10.3233/NRE-220277

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 365-386, 2023

Authors: Abuoaf, Romaisa | AlKaabi, Rooh | Mohamed Saleh, Aisha | Zerough, Umkalthoum | Hartley, Tasneem | van Niekerk, Sjan-Mari | Khalil, Hanan | Morris, Linzette Deidre

Article Type: Review Article

Abstract: BACKGROUND: Anxiety is a prominent disabling non-motor neuropsychiatric complication of Parkinson’s disease (PD). Pharmacological treatments for PD and anxiety have drug interactions and negative side effects. Therefore, non-pharmacological interventions such as exercise has been proposed to reduce anxiety in people with PD (PwP). OBJECTIVE: This systematic review aimed to explore the relationship between physical exercise and anxiety in PwP. METHOD: Four databases (PubMed, Embase, Scopus, Ebscohost) were searched without date restrictions. English randomized control trials (RCT) including adults with PD, exposed to physical exercise interventions with anxiety as an outcome variable, were included. Quality was assessed …by means of an adapted 9-point PEDro scale. RESULTS: Five of the identified 5547 studies met the inclusion criteria. Sample size ranged between 11–152 participants, totaling 328 participants with majority being male. PD stage ranged from early to moderate, with disease duration ranged between 2.9 and 8.0 years. All studies measured anxiety at baseline and post-intervention. On average studies scored 7/9 (76%) on the PEDro scale. CONCLUSION: There is insufficient evidence to support or refute the effect of exercise on anxiety in PwP due to noted limitations of included studies. There is an urgent need for high-quality RCTs on physical exercise and anxiety in PwP. Show more

Keywords: Anxiety, exercise, parkinson’s disease

DOI: 10.3233/NRE-220264

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 387-402, 2023

Authors: Oh, Wonjun | Kim, Tae Hui | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: Effective and sustainable interventions are clearly needed for mild cognitive impairment (MCI) patients. Despite the clinical importance of the multimodal intervention approach, only one study using a multimodal approach demonstrated promising improvements in memory, attention, and executive functions, which also correlated with functional magnetic resonance imaging (MRI) blood oxygenation level dependent (BOLD) changes in cerebral activation in 50 MCI patients. OBJECTIVE: To investigate the self-perception and anticipated efficacy of each element of the BRAIN-FIT multimodal intervention program (robotic-assisted gait training (RAGT), computerized cognitive therapy, music, light, transcranial direct current stimulation (tDCS), and diaphragmatic breathing exercises) and …the correlation between memory, concentration, depression, and sleep in older adults with MCI. METHODS: One hundred participants (mean±standard deviation: 8.63±78.4 years; 47 women) with MCI were recruited from a major university medical center and community dementia relief center. The survey questionnaire comprised four domains with 21 questions, including four pertaining to general demographic characteristics, eight related to exercise and activity, three related to sleep, and nine related to the BRAIN-FIT program. Chi-squared test was used to analyze the Likert scale data. The descriptive frequencies were calculated. Additionally, Spearman’s rho statistics measure the rank-order association. The statistical significance was at P  < 0.05. RESULTS: A strong correlation was observed between memory and concentration (r  = 0.850, P  = 0.000), memory and depression (r  = 0.540, P  = 0.000), memory and sleep (r  = 0.502, P  = 0.000), concentration and depression (r  = 0.602, P  = 0.000), concentration and sleep (r  = 0.529, P  = 0.000) and sleep and depression (r  = 0.497, P  = 0.000). The correlation between medical services and sleep (r  = 0.249, P  = 0.012) was moderate. The chi-square test revealed a significant difference in memory and low-intensity duration of exercise (χ2[3,N = 100] = 11.69, P  = 0.01), concentration and high-intensity exercise duration (χ2[3,N = 100] = 10.08, P  = 0.02), concentration with low-intensity exercise duration (χ2[3,N = 100] = 21.11, P  = 0.00), depression with high-intensity (χ2[3,N = 100] = 10.36, P  = 0.02), high-intensity duration of exercise (χ2[3,N = 100] = 10.48, P  = 0.02); low-intensity (χ2[3,N = 100] = 7.90, P  = 0.48), and low-intensity duration of exercise (χ2[3,N = 100] = 9.69, P  = 0.02). Additionally, significant differences were observed between sleep and high-intensity (χ2[3, N  = 100] = 10.36, P  = 0.02), low-intensity (χ2[3, N  = 100] = 18.14, P  = 0.00), and low-intensity duration of exercise (χ2[3, N  = 100] = 18.30, P  = 0.00). Among the participants 5% answered RAGT, and 20% responded that they had experienced computerized cognitive therapy. Music therapy (20 %), diaphragmatic breathing exercises (45 %), and light therapy (10 %) were used. No patient had experienced tDCS. Conversely, 11% of the participants answered RAGT for programs they wanted to experience and 21% responded to computerized cognitive therapy. 25% of music therapy, 22% of diaphragmatic breathing exercises, 5% of light therapy, and 16% of tDCS participants said they wanted to experience it. Finally, 63% of the participants wanted to participate in the BRAIN-FIT program. CONCLUSION: The present study’s results provide clinical evidence-based insights into the utilization of BRAIN-FIT in MCI to maximize cognitive score improvement of memory, concentration, depression, and sleep. Therefore, when designing the BRAIN-FIT , six intervention items were set in proportion to the preference based on the survey, to reduce participants’ feeling of repulsion. The program was configured according to exercise intensity. Show more

Keywords: Mild cognitive impairment, BRAIN-FIT multimodal intervention program, RAGT, computerized cognitive therapy, music, light, tDCS, diaphragmatic breathing exercises

DOI: 10.3233/NRE-220253

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 403-412, 2023

Authors: Zheng, Jinyu | He, Wanying | Ma, Qiqi | Cai, Wenqian | Li, Sujiao | Yu, Hongliu

Article Type: Research Article

Abstract: BACKGROUND: There are few isometric training systems based on upper limb rehabilitation robots. Its efficacy and neural mechanism are not well understood. OBJECTIVE: This study aims to investigate the cortex activation of dynamic resistance and static (isometric) training based on upper limb rehabilitation robot combined with virtual reality (VR) interaction by using functional near-infrared spectroscopy (fNIRS). METHODS: Twenty subjects were included in this study. The experiment adopts the block paradigm design. Experiment in dynamic and static conditions consisted of three trials, each consisting of task (60 s)-rest (40 s). The neural activities of the sensorimotor cortex (SMC), premotor …cortex (PMC) and prefrontal cortex (PFC) were measured. The cortex activation and functional connectivity (FC) were analyzed. RESULTS: Both the dynamic and static training can activate SMC, PMC, and PFC. In SMC and PMC, the activation of static training was stronger than dynamic training, there were significant differences between the two modes of each region of interest (ROI) (p  < 0.05) (SMC: p  = 0.022, ES = 0.72, PMC: p  = 0.039, ES = 0.63). Besides, the FC between all ROIs of the static training was stronger than that of the dynamic training. CONCLUSION: The static training based on upper limb rehabilitation robot may better facilitate the cortical activation associated with motor control. Show more

Keywords: Rehabilitation robot, isometric resistance, functional near-infrared spectroscopy, cortical activation, functional connectivity

DOI: 10.3233/NRE-220292

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 413-423, 2023

Authors: Lewis, Frank D. | Horn, Gordon J.

Article Type: Research Article

Abstract: BACKGROUND: With the effectiveness of post-hospital brain injury rehabilitation clearly demonstrated, research focus has shifted to durability of treatment gains over time. OBJECTIVE: Study objectives were threefold: (1) examined the stability of outcomes following post-hospital rehabilitation for persons with acquired brain injury, (2) compare differences in short and long-term outcome for TBI and CVA groups, and (3) identify predictors of long-term outcomes. METHODS: Subjects (n  = 108) were selected from 2,177 neurologically impaired adults with consecutive discharges from 18 post-hospital programs in 12 states from 2011 through 2019. The study sample included TBI, CVA, and Mixed neurological …groups. All persons were evaluated using the Mayo Portland Adaptability Inventory –4 Participation Index at four assessment intervals: admission, discharge, and 3 and 12 month follow-up. Additional analyses included repeated measures 2x4 design addressing TBI and CVA by the four measurement periods, and hierarchical multiple regression to identify outcome predictors. RESULTS: The total sample demonstrated a reduction in Participation T-scores (indicating less disability) from admission to discharge. Reductions in disability were maintained at the 3 and 12 month follow-up assessments (Greenhouse-Geisser F (2.37) = 76.87, p  < 0.001, partial eta2 = 0.418, power to detect = 0.99). The CVA group demonstrated greater disability at each assessment interval, however, those differences were not statistically significant. Significant predictors of outcome at 12 months post-discharge were length of stay in program and type of injury. TBIs with longer length of stay experienced better outcome at 12 months than non-TBIs with shorter length of stays (hierarchical multiple regression adjusted R2  = 0.085, p  < 0.05). CONCLUSION: Post-hospital residential neurorehabilitation programs provide a return on investment. Gains are realized from admission to discharge, and maintained one year following discharge from rehabilitation. Show more

Keywords: TBI, CVA, post-hospital rehabilitation, long-term outcome, MPAI-4

DOI: 10.3233/NRE-220261

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 425-433, 2023

Authors: Mischler, Brigitte | Hilfiker, Roger | Hund-Georgiadis, Margret | Maguire, Clare

Article Type: Research Article

Abstract: BACKGROUND: Daily step-count is important post-insult in the subacute phase to influence neuroplasticity, functional recovery and as a predictive factor for activity level one-year post event. OBJECTIVE: Measure daily step-count in subacute patients follow-ing brain injury in an inpatient neurorehabilitation setting and compare these to evi-dence-based recommendations. METHODS: 30 participants measured of daily step-count over a seven-day period, throughout the day to assess when and how activity varied. Step-counts were analyzed in sub-groups based on walking ability using the Functional Ambulation Categories (FAC). Correlations between steps-count and FAC level, walking speed, light touch, joint position sense, …cognition, and fear of falling were calculated. RESULTS: Median (IQR) daily steps for all patients was 2512 (568.5,4070.5). Not independently walkers took 336 (5–705), the value is below the recommendation. Participants walking with assistance took 700 (31–3080), significantly below recommended value (p  = 0.002), independent walkers took 4093 (2327–5868) daily steps, significantly below recommended value (p  = < 0.001). Step-count showed moderate to high and statistically-significant correlations: positive for walking speed, joint position sense, negative for fear of falling, and number of medications. CONCLUSIONS: Only 10% of all participants reached the recommended daily steps. Interdisciplinary team-work and strategies to increase daily activity between therapies may be crucial to achieve recommended step-levels in subacute inpatient settings. Show more

Keywords: Neurorehabilitation, stroke, traumatic brain injury, steps, stepcount

DOI: 10.3233/NRE-220248

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 435-450, 2023

Authors: Liou-Johnson, Victoria | Merced, Kritzia | Klyce, Daniel W. | Agtarap, Stephanie | Finn, Jacob A. | Chung, Joyce S. | Campbell, Thomas | Harris, Odette A. | Perrin, Paul B.

Article Type: Research Article

Abstract: BACKGROUND: Almost one-third of the U.S. military population is comprised of service members and veterans (SMVs) of color. Research suggests poorer functional and psychosocial outcomes among Black and Hispanic/Latine vs. White civilians following traumatic brain injury (TBI). OBJECTIVE: This study examined racial/ethnic differences in 5-year functional independence and life satisfaction trajectories among SMVs who had undergone acute rehabilitation at one of five Veterans Affairs (VA) TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). METHODS: Differences in demographic and injury-related factors were assessed during acute rehabilitation among White (n  = 663), Black (n  = 89), and Hispanic/Latine (n  = 124) …groups. Functional Independence Measure (FIM) Motor, FIM Cognitive, and Satisfaction with Life Scale (SWLS) scores were collected at 1, 2, and 5 years after injury. Racial/ethnic comparisons in these outcome trajectories were made using hierarchical linear modeling. RESULTS: Black SMVs were less likely than White and Hispanic/Latine SMVs to have been deployed to a combat zone; there were no other racial/ethnic differences in any demographic or injury-related variable assessed. In terms of outcomes, no racial/ethnic differences emerged in FIM Motor, FIM cognitive, or SWLS trajectories. CONCLUSION: The absence of observable racial/ethnic differences in 5-year outcome trajectories after TBI among SMVs from VA TBIMS PRCs contrasts sharply with previous research identifying disparities in these same outcomes and throughout the larger VA health care system. Individuals enrolled in VA PRCs are likely homogenized on key social determinants of health that would otherwise contribute to racial/ethnic disparities in outcome trajectories. Show more

Keywords: Traumatic brain injury, racial/ethnic disparities, Service Members and Veterans, functional independence, life satisfaction

DOI: 10.3233/NRE-220225

Citation: NeuroRehabilitation, vol. 52, no. 3, pp. 451-462, 2023