NeuroRehabilitation - Volume Pre-press, issue Pre-press

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. Pre-press, no. Pre-press, pp. 1-10, 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. Pre-press, no. Pre-press, pp. 1-22, 2023

Authors: Maguire, Clare | Betschart, Martina | Pohl, Johannes | Primani, Francesca | Taeymans, Jan | Hund-Georgiadis, Margret

Article Type: Research Article

Abstract: BACKGROUND: Brain-derived neurotrophic factor (BDNF) promotes activity-dependent neuroplasticity and is released following aerobic-exercise. OBJECTIVE: Feasibility and efficacy of 1.Moderate-Intensity Cycle-Ergometer-Training (MI-ET) and 2.Low-Intensity Circuit-Training (LI-CT) on BDNF-serum-concentration in chronic-stroke and consequently efficacy of motor-learning in varying BDNF-concentrations (neuroplasticity being the substrate for motor-learning) via upper-limb robotic-training (RT) in both groups. METHODS: Randomised-control feasibility-study. 12-week, 3x/week intervention, 17 chronic-stroke-survivors randomized into: (1) MI-ET&RT or (2) LI-CT&RT. Both groups completed 40 mins MI-ET or LI-CT followed by 40 mins RT. Feasibility outcomes: (1) screening and enrollment-rates, (2) retention-rates, (3) adherence: (i) attendance-rates, (ii) training-duration, (4) adverse events. Primary clinical outcomes: …1. serum-BDNF changes pre-post training (immediate) and pre-training basal-levels over 12-weeks (long-term). 2.upper-limb performance with Action-Research-Arm-Test (ARAT). Additionally, feasibility of an embedded health economic evaluation (HEE) to evaluate health-costs and cost-effectiveness. Outcomes: cost-questionnaire return-rates, cost-of-illness (COI) and Health-Utitility-Index (HUI). RESULTS: 21.5% of eligible and contactable enrolled. 10 randomized to MI-ET and 7 to LI-CT. 85% of training-sessions were completed in MI-ET (306/360) and 76.3% in LI-CT-group (165/216). 12-weeks: Drop-outs MI-ET-10%, LI-CT-43%. Clinical outcomes: No significant changes in immediate or long-term serum-BDNF in either group. Moderate-intensity aerobic-training did not increase serum-BDNF post-stroke. Individual but no group clinically-relevant changes in ARAT-scores. HEE outcomes at 12-weeks: 100% cost-questionnaires returned. Group-costs baseline and after treatment, consistently favouring MI-ET group. COI: (1-year-time-frame): MI-ET 67382 SD (43107) Swiss-Francs and LI-CT 95701(29473) Swiss-Francs. CONCLUSION: The study is feasible with modifications. Future studies should compare high-intensity versus moderate-intensity aerobic-exercise combined with higher dosage arm-training. Show more

Keywords: Stroke, aerobic training, BDNF, circuit training, upper-limb robotic training, health economic evaluation

DOI: 10.3233/NRE-220239

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-22, 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. Pre-press, no. Pre-press, pp. 1-11, 2023

Authors: Pereira, Vitor Costa | Fontão, Luís | Engenheiro, Gonçalo | Gouveia, Filipa | Pinto, Luísa | Leal, Joana | Moreira, Jorge | Aguiar-Branco, Catarina | Roriz, José Mário

Article Type: Research Article

Abstract: BACKGROUND: Dysphagia is a common manifestation after stroke and seems to play a major role in clinical and functional outcomes. OBJECTIVES: To identify clinical predictors of higher degrees of dysphagia, as well as assess its burden in our hospital, in order to understand how to improve the approach to this symptom. METHODS: We included 311 patients admitted in an acute stroke unit in a year-long period. The relationship of dysphagia with different outcomes, both in acute phase and within the first year after stroke, were investigated. RESULTS: Using the Pearson Correlation Coefficient, NIHSS score …at admission was positively correlated with the degree of dysphagia (r  = 0,783; p  <  0,001) and total anterior circulation infarcts and age (>  70 years) were also associated with higher risk of dysphagia (p  <  0.001). During hospitalization both respiratory infections and mortality occurred at significantly higher rates for dysphagic patients (p  <  0.001) and we observed an increasing trend towards a higher mortality rate, the higher the degree of dysphagia. These patients stayed longer in the stroke unit, with less chance to be discharged home and more frequently transferred to inpatient rehabilitation care. One year after admission, dysphagic patients were more frequently readmitted due to pneumonia and we observed a higher mortality rate compared to patients without dysphagia (p  <  0.001). CONCLUSION: The presence of the above-mentioned dysphagia predictive factors should alert us to the need for an early approach, starting in the stroke unit, but also after discharge, taking into account its impact on clinical outcomes, mortality and healthcare costs. Show more

Keywords: Dysphagia, swallowing impairment, stroke, risk factors, outcomes, rehabilitation

DOI: 10.3233/NRE-220242

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-8, 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 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. Pre-press, no. Pre-press, pp. 1-12, 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. Pre-press, no. Pre-press, pp. 1-9, 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. Pre-press, no. Pre-press, pp. 1-15, 2023