NeuroRehabilitation - Volume 53, issue 2

Authors: Peters, Matthew E. | Gurin, Lindsey J. | Quinn, Davin K. | Roy, Durga

Article Type: Editorial

Keywords: Neuropsychiatry, neuropsychology, traumatic brain injury, functional neurological disorder, progressive supranuclear palsy, neurorehabilitation

DOI: 10.3233/NRE-236003

Citation: NeuroRehabilitation, vol. 53, no. 2, pp. 173-176, 2023

Authors: Kalra, Inder D. | Watanabe, Thomas K.

Article Type: Research Article

Abstract: BACKGROUND: Post-traumatic agitation is a common and problematic complication after traumatic brain injury. It may present with features consistent with psychiatric disorders, which may provide clues as to management. OBJECTIVE: This is a narrative review of pertinent literature and a description of a collaborative clinical approach utilizing psychiatric and brain injury rehabilitation strategies to optimize outcomes in the management of post-traumatic agitation. METHODS: Describe and provide evidence for a transdisciplinary clinical approach supported by existing literature and clinical experience. RESULTS: Given the heterogeneity of the problem and limitations in the current literature there is …no standardized approach to manage post-traumatic agitation; nevertheless, a strategy is proposed that clinicians may utilize to guide treatment and assess efficacy of the chosen intervention(s). CONCLUSION: A clinical approach that uses quantitative assessment of targeted behavior to objectively evaluate pharmacological interventions that are generated by a collaborative approach may yield improved outcomes for managing post-traumatic agitation. Show more

Keywords: Traumatic brain injury, post-traumatic agitation, aggression, pharmacological intervention, agitation, neurobehavioral disability

DOI: 10.3233/NRE-230009

Citation: NeuroRehabilitation, vol. 53, no. 2, pp. 177-185, 2023

Authors: D’Alonzo, Bernadette A. | Wiebe, Douglas J. | Master, Christina L. | Castellana, Matthew C. | Willer, Barry S. | Leddy, John J.

Article Type: Research Article

Abstract: BACKGROUND: Affective symptoms, specifically, anxiety, are often overlooked after sport-related concussion (SRC), and may contribute to prolonged recovery. OBJECTIVE: To examine the impact of anxiety during clinical recovery among adolescents (13–18y) enrolled in a randomized trial of aerobic exercise for SRC. METHODS: Patients at three sites were randomized into aerobic exercise or stretching arms, and enrolled in the 4-week intervention. The relationship between PROMIS Anxiety score at initial visit and time to symptom resolution was evaluated with survival analysis. The relationship between weekly PROMIS Anxiety score and Post-concussion Symptom Inventory (PCSI) score was evaluated with Linear …Mixed Models. Analyses adjusted for study arm and baseline covariates. RESULTS: Among 54 adolescents (median age = 15.8y, initial visit PCSI score = 32, pre-injury PROMIS Anxiety score = 2), median time to symptom resolution was 10 days (25th-75th percentiles: 6-24) in the Low-PROMIS Anxiety group and 12 days (25th-75th percentiles: 5-21) in the High-PROMIS Anxiety group (p  = 0.62). Each additional unit of PROMIS Anxiety score corresponded to a 1.52-unit higher PCSI total score (p  <  0.01). Neither effect varied by aerobic exercise/stretching group. CONCLUSION: Higher initial PROMIS Anxiety score was not significantly associated with delayed symptom resolution. However, over time, PROMIS Anxiety score was significantly associated with elevated PCSI score, regardless of exercise/stretching group. Show more

Keywords: Concussion, adolescent, pediatric, anxiety, symptoms, anxiety disorder, concussion, head injury, rehabilitation

DOI: 10.3233/NRE-220221

Citation: NeuroRehabilitation, vol. 53, no. 2, pp. 187-198, 2023

Authors: Jobin, Kaiden | Wang, Meng | du Plessis, Sané | Silverberg, Noah D. | Debert, Chantel T.

Article Type: Research Article

Abstract: BACKGROUND: Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion. OBJECTIVE: To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS. METHODS: Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and …logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates. RESULTS: We found that total RPQ score ( β ˆ = 0.27; 95% CI = [0.16, 0.38]), GAD-7 score ( β ˆ = 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score ( β ˆ = 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]). CONCLUSION: The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions. Show more

Keywords: Post-concussion symptoms, functional neurological disorder, rehabilitation, concussion, anxiety, depression, avocational rehabilitation, concussion, Post-concussion syndrome (PCS), Traumatic brain injury (TBI)

DOI: 10.3233/NRE-237002

Citation: NeuroRehabilitation, vol. 53, no. 2, pp. 199-208, 2023

Authors: Mertens, Nickolas | Cavanagh, James | Brandt, Emma | Fratzke, Violet | Story-Remer, Jacqueline | Rieger, Rebecca | Wilson, J. Kevin | Gill, Darbi | Campbell, Richard | Quinn, Davin K.

Article Type: Research Article

Abstract: BACKGROUND: Transcranial direct current stimulation (tDCS) may provide a potential therapy for cognitive deficits caused by traumatic brain injury (TBI), yet its efficacy and mechanisms of action are still uncertain. OBJECTIVE: We hypothesized that anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) would boost the influence of a cognitive training regimen in a mild-to-moderate TBI (mmTBI) sample. Cognitive enhancement was measured by examining event-related potentials (ERPs) during cognitive control tasks from pre- to post-treatment. METHODS: Thirty-four participants with mmTBI underwent ten sessions of cognitive training with active (n  = 17) or sham (n  = 17) anodal tDCS …to the left DLPFC. ERPs were assessed during performance of an auditory oddball (3AOB), N-back, and dot pattern expectancy (DPX) task before and after treatment. RESULTS: P3b amplitudes significantly decreased from baseline to post-treatment testing, regardless of tDCS condition, in the N-back task. The active tDCS group demonstrated a significantly increased P3a amplitude in the DPX task. No statistically significant stimulation effects were seen during the 3AOB and N-back tasks. CONCLUSION: Active anodal tDCS paired with cognitive training led to increases in P3a amplitudes in the DPX, inferring increased cognitive control. P3b decreased in the N-back task demonstrating the effects of cognitive training. These dissociated P3 findings suggest separate mechanisms invoked by different neuroplasticity-inducing paradigms (stimulation versus training) in brain networks that support executive functioning. Show more

Keywords: Traumatic brain injury, transcranial direct current stimulation, cognitive control, electroencephalography

DOI: 10.3233/NRE-230014

Citation: NeuroRehabilitation, vol. 53, no. 2, pp. 209-220, 2023

Authors: Krasna, Daniel | Colebank, Brittaney | King, Sophia | Bechtold, Kathleen T.

Article Type: Case Report

Abstract: BACKGROUND: Neurorehabilitation is interdisciplinary and cross-sectorial, requiring the coordinated effort of diverse sectors, professions, patients and communities to manage complex condition-related disabilities. A more holistic approach to experimental rehabilitation can incorporate individualized treatment plans into rehabilitation research to improve overall clinical care. OBJECTIVE: This case aims to highlight the benefit of collaboration between neurology, psychiatry, physiatry and rehabilitation therapists to successfully rehabilitate complex patients. CASE PRESENTATION: A 72-year-old gentleman with history of depression, anxiety and sleep difficulties presented to our institution one year after a stroke for help managing exacerbations of his premorbid conditions. The patient …had a hemorrhagic stroke which required craniectomy and led to seizures. Past history was unclear regarding what workups had been done but was suggestive of rapid eye movement (REM) sleep behavior disorder (RBD). RESULTS: Given the numerous medications patient had tried in the past and since his stroke, a true multidisciplinary team was needed and his case required close coordination to successfully diagnose the reason for each of his symptoms and to provide treatments and rehabilitation. CONCLUSION: The correct diagnosis was only achieved by clear communication among team members which allowed for optimal treatment and improvement with therapies. Show more

Keywords: Case report, brain injury, psychiatry

DOI: 10.3233/NRE-220284

Citation: NeuroRehabilitation, vol. 53, no. 2, pp. 221-226, 2023

Authors: Goldstein, Alexa N. | Paredes-Echeverri, Sara | Finkelstein, Sara A. | Guthrie, Andrew J. | Perez, David L. | Freeburn, Jennifer L.

Article Type: Case Report

Abstract: BACKGROUND: While expert consensus recommendations support the use of speech and language therapy (SLT) for patients with functional speech disorder (FND-speech), there are limited published data on clinical outcomes. OBJECTIVE: To retrospectively report the treatment outcomes and clinical characteristics of patients with FND-speech that attended outpatient SLT as part of a multidisciplinary program for functional neurological disorder (FND). METHODS: In this case series, we included adult patients with FND-speech that consecutively participated in outpatient SLT at our institution between October 2014 and September 2021. Baseline demographic and neuropsychiatric characteristics were extracted from the medical records, along …with data on FND-speech phenotypes, number of treatment sessions received, and clinician-determined outcomes. Only descriptive statistics were used to report findings. RESULTS: Twenty patients met inclusion criteria; ages ranged from 21–77, with a mean of 51.6±16.2 years. 85% of the cohort presented with mixed FND-speech symptoms. Patients attended a range of 2–37 visits, with an average of 9.2±8.0 visits over 4.4±3.5 months. At the last treatment session, 3 patients were asymptomatic, 15 had improved, and 2 had not improved; 8 individuals that improved received video telehealth interventions. CONCLUSION: This case series lends additional support for outpatient SLT in the assessment and management of individuals with FND-speech, and may help clarify patient and provider treatment expectations. Additional prospective research is needed to investigate baseline predictors of treatment response and further define the optimal frequency, intensity, duration, and clinical setting for SLT delivery in this population. Show more

Keywords: Functional speech disorder, functional neurological disorder, speech and language therapy, speech and language pathology, treatment, communication, improvement, neurorehabilitation

DOI: 10.3233/NRE-220182

Citation: NeuroRehabilitation, vol. 53, no. 2, pp. 227-238, 2023

Authors: Reisch, Anne | Gerety, Gregory | Ding, Andrew | Narapareddy, Laren | Narapareddy, Bharat R.

Article Type: Case Report

Abstract: BACKGROUND: Progressive Supranuclear Palsy (PSP) is an incurable neurodegenerative disorder. One variant of PSP is a frontal lobe cognitive or behavioral presentation (PSP-F). Currently, the primary management of this disease is rooted in neurological rehabilitation, therefore, early, and accurate diagnosis is key. CASE REPORT: Here we present a 60-year-old man with a 2–3-year history of functional decline and behavioral changes. He was misdiagnosed with a late-onset psychiatric disorder. During his second inpatient admission, a full workup for neurodegenerative diseases was performed, and the patient was ultimately diagnosed with probable PSP-F. We describe his neurological rehabilitation plan, examining recommendations …before and after diagnosis. RESULTS: After the neurodegenerative disorder diagnosis, the neurological rehabilitation plan, particularly PT and OT, changed drastically despite no change in clinical presentation emphasizing the value of an appropriate and early diagnosis. Furthermore, in an OT session, the patient demonstrated longitudinal improvement, emphasizing the importance of rehabilitation in these patient’s lives. CONCLUSION: Increased recognition of PSP variants amongst healthcare providers will allow more patients to receive early and appropriate diagnoses, so that they can benefit maximally from their neurological rehabilitation plans, maintain quality of life and experience longer periods of functioning. Furthermore, developing PSP-specific rehabilitation guidelines are crucial for improved outcomes. Correct diagnosis will also reduce the use of inappropriate and potentially harmful medications in these populations. Show more

Keywords: Progressive supranuclear palsy, dementia, neurorehabilitation, frontotemporal dementia, behavioral variant frontotemporal dementia, occupational rehabilitation, physical therapy

DOI: 10.3233/NRE-220235

Citation: NeuroRehabilitation, vol. 53, no. 2, pp. 239-247, 2023

Authors: Rathore, Farooq Azam | Nazir, Shaikh Nabi Bukhsh

Article Type: Other

Abstract: BACKGROUND: In post stroke patients, seizures can complicate the recovery process and lead to poor outcomes. It is unclear whether antiepileptic drugs (AEDs) can prevent seizures after a stroke. OBJECTIVE: To summarize the evidence on the effects of AEDs on the primary and secondary prevention of post stroke seizures. METHODS: The authors searched the Cochrane Register of Studies and MEDLINE (last search on 9 March 2021), checked the reference lists of articles retrieved and contacted the corresponding authors of the study where needed. Only randomized controlled trials were included (RCT). There were no language and time …limits. RESULTS: Two RCTs with 856 adult participants with a clinical diagnosis of stroke were included. There was moderate-certainty evidence that the AEDs were not effective for primary prevention of post stroke seizures (Relative effect, 95% CI = RR 0.65, 95% CI 0.34 to 1.26). They also did not affect the mortality rate (RR 1.03, 95% CI 0.78 to 1.36). Both studies were at low risk of bias and certainty of the evidence was low to moderate. CONCLUSION: The evidence for routine use of AED for the primary and secondary prophylaxis of post stroke seizures is unclear. There is a need for high-quality trials to address this question using a larger sample size. Show more

Keywords: Rehabilitation, stroke, epilepsy, mortality

DOI: 10.3233/NRE-236004

Citation: NeuroRehabilitation, vol. 53, no. 2, pp. 249-251, 2023