NeuroRehabilitation - Volume 33, issue 2

Authors: Massie, Crystal L. | Tracy, Brian L. | Paxton, Roger J. | Malcolm, Matthew P.

Article Type: Research Article

Abstract: Objective: To determine the impact of a single-session of repetitive transcranial magnetic stimulation (rTMS) and an rTMS intervention on neurophysiology and motor control in survivors of stroke. Methods: Twelve stroke survivors were randomized into functional-rTMS or passive-rTMS conditions. Measures of short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF), and force steadiness (coefficient of variation, CV) at 10 and 20% of maximum voluntary contraction were assessed at baseline and after a single-session of rTMS (post single-session), and again following an intervention of 8 rTMS sessions (2 sessions per day; post-intervention). Functional-rTMS required subjects to exceed a muscle activation threshold …assessed by surface electromyography to trigger each rTMS train; the passive-rTMS group received rTMS while relaxed. Results: ICF scores significantly increased following the single-session of functional-rTMS compared to the decrease following passive-rTMS. The increase in APB SICI and ICF scores following the intervention was significantly greater for the functional-rTMS group compared to the decreases following passive-rTMS. The groups were significantly different in the CV of force (20%) following the single-session of rTMS, and in the 10 and 20% tasks following the intervention. The functional-rTMS group increased steadiness overtime, whereas the passive group demonstrated a return to baseline following the intervention session. No differences were observed in first dorsal interosseus (FDI) measures (SICI and ICF) between groups. Conclusions: The functional-rTMS protocol enhanced cortical excitability following a single-session and after repeated sessions and improved steadiness, whereas the passive stimulation protocol tended to decrease excitation and no improvements in steadiness were observed. Show more

Keywords: Rehabilitation, motor control, transcranial magnetic stimulation, repetitive transcranial magnetic stimulation, force

DOI: 10.3233/NRE-130944

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 185-193, 2013

Authors: Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: We report on a chronic stroke patient who showed motor recovery by improvement of limb-kinetic apraxia (LKA) after undergoing intensive rehabilitation for a period of one month, which was demonstrated by diffusion tensor tractography (DTT) and transcranial magnetic stimulation (TMS). Methods: A 50-year-old male patient presented with severe paralysis of the left extremities at the onset of thalamic hemorrhage. At thirty months after onset, the patient exhibited moderate weakness of his left upper and lower extremities. In addition, he exhibited a slow, clumsy, and mutilated movement pattern during grasp-release movements of his left hand. During a one-month …period of intensive rehabilitation, which was started at thrity months after onset, the patient showed 22% motor recovery of the left extremities. The slow, clumsy, and mutilated movement pattern of the left hand almost disappeared. Results: DTTs of the corticospinal tract (CST) in both hemispheres originated from the cerebral cortex, including the primary motor cortex, and passed along the known CST pathway. The DTT of the right CST was located anterior to the old hemorrhagic lesion. TMS study performed at thirty and thirty-one months after onset showed normal and similar findings for motor evoked potential in terms of latency and amplitude of the left hand muscle. Conclusions: We think that the motor weakness of the left extremities in this patient was mainly ascribed to LKA and that most of the motor recovery during a one-month period of rehabilitation was attributed to improvement of LKA. Show more

Keywords: Motor recovery, stroke, diffusion tensor tractography, transcranial magnetic stimulation, apraxia, limb-kinetic apraxia

DOI: 10.3233/NRE-130945

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 195-200, 2013

Authors: San Luis, Christa O'Hana V. | Staff, Ilene | Ollenschleger, Martin D. | Fortunato, Gilbert J. | McCullough, Louise D.

Article Type: Research Article

Abstract: Background: Prolonged dysphagia after middle cerebral artery (MCA) territory strokes may require percutaneous endoscopic gastrostomy (PEG) tube feeding. Objective: We examined the predictors of PEG placement among patients with MCA stroke. It was hypothesized that stroke laterality was a predictor. Methods: A retrospective cohort study of existing data from Hartford Hospital Stroke Database was done. A total of 157 patients with acute ischemic MCA stroke were included. Patients were divided into the “PEG” group (n = 24) and “no PEG” group (n = 133). Existing demographic, clinical and swallowing data were compared between the 2 groups. …Results: Demographic data were similar between the groups. The “PEG” group had a higher admission National Institute of Health Stroke Scale (NIHSS) score, higher proportion of patients who had thrombolytic administration, in- hospital aspiration pneumonia and inability to be assessed on first swallow evaluation. Multivariate analysis revealed that all, except thrombolytic administration may predict PEG placement. Conclusion: Admission NIHSS score, in-hospital aspiration pneumonia and inability to undergo first swallow evaluation may predict PEG placement in patients with acute MCA stroke. Stroke laterality was not associated. This knowledge facilitates early identification of patients that may require PEG tube placement for early nutrition provision and discharge to rehabilitation. Show more

Keywords: Gastrostomy, middle cerebral artery infarction, functional laterality, endoscopy, dysphagia

DOI: 10.3233/NRE-130946

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 201-208, 2013

Authors: Abdul-sattar, Amal B. | Godab, Tarek

Article Type: Research Article

Abstract: Purpose: To identify the possible factors influencing functional outcome of stroke patients after inpatient rehabilitation. Methods: One hundred and eighty patients with stroke consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke characteristics, impairment (National Institutes of Health Stroke Scale), disability level (Functional Independence Measure [FIM]), psycho-emotional state (Geriatric Depression Scale-15 [GDS-15]), cognitive function (Mini Mental State Evaluation [MMSE]), and preexisting medical conditions were recorded at admission. The main measure of functional outcome was the discharge FIM score. The univariate and multiple linear regression analyses were performed. Result: The Mean admission total FIM score …was 64.8 ± 22.4 and the mean discharge total FIM score was 84.0 ± 23.0, with this gain being highly significant (P < 0.001). Univariate analyses indicated that the significant factors influencing functional outcome of stroke patients at discharge from rehabilitation included age, total FIM score at admission, severity of stroke, recurrent stroke, cognitive impairment, and depression. However, in multiple linear regression analyses, age was not significant predictor. Conclusion: Age predicts the function outcome to lesser extent than other covariate. The admission total FIM score, cognitive condition, depression, and stroke severity are predictors of functional outcome of stroke patients after inpatient rehabilitation. Show more

Keywords: Predictors, stroke, rehabilitation, functional outcome

DOI: 10.3233/NRE-130947

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 209-216, 2013

Authors: Cioncoloni, David | Martini, Giuseppe | Piu, Pietro | Taddei, Sabrina | Acampa, Maurizio | Guideri, Francesca | Tassi, Rossana | Mazzocchio, Riccardo

Article Type: Research Article

Abstract: Background and purpose: There is a need for individuating those post-stroke patients who may benefit from an optimal and customised rehabilitation plan aiming at early reintegration in community life participation. This study investigated whether the gain of independence in complex Activities of Daily Living (ADL) may be predicted before the discharge from the stroke unit using simple bedside determinants. Methods: In 104 first-ever stroke patients with no previous disability, ten determinants at 10 days after stroke were selected. Multivariable logistic regression analysis was applied to identify the prognostic determinants able to predict independence in complex ADL, as measured …by modified Rankin Scale grade ≤2. Results: The model shows that having a Barthel Index ≥9, a Motricity Index- Upper Limb ≥75, an age ≤70 and being a male resulted in 100% probability of achieving independence in complex ADL. If three of the four determinants were present, the probability was more than 90%. With the presence of two of the four determinants, the probability ranged from 87% to 28%. With the presence of only one determinant, the probability was 13%. Conclusions: Accurate prediction of independence in complex ADL can be made before the discharge from the stroke unit. The strength of the paretic upper limb, age, gender, and the ability of performing basic ADL are the significant variables. The probability of favorable prognosis depends on the presence and on the robustness of each single determinant. Show more

Keywords: Stroke, prognosis, recovery of function

DOI: 10.3233/NRE-130948

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 217-223, 2013

Authors: Andringa, Aukje S. | Van de Port, Ingrid G.L. | Meijer, Jan-Willem G.

Article Type: Research Article

Abstract: Purpose: To evaluate tolerance of a new dynamic hand-wrist orthosis and effectiveness on the prevention of progressive wrist contracture and spasticity after stroke. Method: Chronic stroke patients (N = 6) with upper limb spasticity, who had not been able to endure a static orthosis, were provided with a custom-made dynamic orthosis. Tolerance of the orthosis was evaluated by the daily wearing time, and self-reported pain and spasticity. Effectiveness was measured by contracture of wrist and finger flexor muscles, upper limb spasticity and use of spasticity treatment. Outcome measures were collected at time of fitting of the dynamic orthosis …(baseline) and after three and six months. Results: Five patients could endure the dynamic orthosis without discomfort for 6 hours daily during the 6-month period. Self-reported spasticity and pain decreased significantly (p < 0.05) compared to wearing the static orthosis. In comparison to baseline, the maximum passive wrist extension increased significantly from −29° to −12° (p < 0.05). Although, no significant change in spasticity was measured, the use of Botulinum Toxin injections decreased for two patients. Conclusions: The majority of the included chronic stroke patients tolerated the new dynamic orthosis for at least 6 hours daily and the use significantly reduced wrist contractures in a 6-month period. Show more

Keywords: Stroke, upper extremity, contracture, spasticity, dynamic, orthosis

DOI: 10.3233/NRE-130949

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 225-231, 2013

Authors: Ellis, Charles | Focht, Kendrea L. | Grubaugh, Anouk L.

Article Type: Research Article

Abstract: Background: Perceptions of stroke recovery can differ substantially between stroke survivors and their healthcare providers. Concordance between the two is important for collaborative goal setting to facilitate optimal outcomes. Objective: To explore stroke survivors' perceptions of their own recovery and residual impairments with specific emphasis on communication and cognition. Methods and procedures: A qualitative analytic approach was used in the study. Nine stroke survivors participated in a focus group discussion as part of a larger study designed to examine post-stroke outcomes. Results: Early in the focus group proceedings, a discussion emphasizing how stroke survivors …perceive their overall recovery emerged. Six of the nine participants (67%) perceived their overall stroke recovery to be greater than 90%, and only physical impairments were reported. Later in the course of the interview, eight of the nine participants (89%) reported either word retrieval or memory loss deficits which negatively influenced their daily functional activities. Conclusions: Stroke survivors in this sample did not include communication and cognitive deficits in their perception of their overall recovery despite later reporting these symptoms and related impairment. Failure of patients to include such persisting deficits in their reports of recovery can cause a mismatch between stroke survivor and provider goals. Show more

Keywords: Stroke, recovery, cognition, communication

DOI: 10.3233/NRE-130950

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 233-239, 2013

Authors: Owolabi, Mayowa Ojo

Article Type: Research Article

Abstract: Objective: There is lack of a German-language holistic stroke-specific health-related quality of life (HRQOL) measure with therapeutically-oriented domains. The objective of this study was to investigate the psychometric properties of the HRQOL in stroke patients (HRQOLISP) questionnaire in German stroke survivors. Methods: Following standard procedure for cross-cultural validation, the HRQOLISP was translated into German. It was completed by 103 German stroke patients and 50 apparently healthy controls. Acceptance, ceiling and floor effects, reliability, as well as content, construct, factorial and known-group's validity were analysed. Stratification was according to modified Rankin, stroke levity and National Institute of Health stroke …scales. Results: The HRQOLISP was acceptable and holistic with neither ceiling nor floor effect. One-factor solution explained >40% of the variance for most domains. Two-factor solution explained 82% of the variance for the global HRQOL consistent with the conceptual framework distributing the therapeutically-oriented domains into two spheres. Cronbach's α ranged from 0.77 to 0.92 for the domains. The HRQOLISP, though lengthy, covered the entire spectrum of stroke-related HRQOL with no additional item suggested by the German stroke patients. The HRQOLISP demonstrated good convergent and discriminant validity as well as excellent ‘known groups’ validity across disability and stroke severity strata. Conclusions: The German version of the HRQOLISP is the first holistic, stroke-specific HRQOLISP measures with therapeutically-oriented domains to be validated in Germany. It is acceptable, reliable and valid but needs to be validated in proxies to facilitate its utility among stroke patients with severe communication problems. Show more

Keywords: Stroke rehabilitation, quality of life, HRQOL, HRQOLISP, validity, reliability

DOI: 10.3233/NRE-130951

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 241-250, 2013

Authors: Alimović, Sonja | Katušić, Ana | Mejaški-Bošnjak, Vlatka

Article Type: Research Article

Abstract: Background: Children with perinatal brain damage have a high prevalence of visual impairment. Stimulation of vision at a critical period can encourage brain plasticity and the recovery of impaired function. Objective: The aim of our study was to investigate when is the critical period for visual stimulation in children with perinatal brain damage. Methods: We compared 35 children within the first eight months of life (median age = 4 months) to 35 children aged between eight and thirty months (median age = 15 months), all with perinatal brain damage. All the children were attending an early …intervention program at Mali dom, Zagreb, a rehabilitation centre for children with visual impairment. We compared the results from baseline and follow-up assessments of visual functions (grating acuity and contrast sensitivity). We also compared differences in change scores between the two groups. Results: Our results have shown that children who commence a visual stimulation program within the first eight months of life had more improvement in both visual functions. This improvement is statistically significant in visual acuity (p = 0.048). Conclusions: These results indicate the importance of starting a visual stimulation program within the first eight months after birth. Show more

Keywords: Visual stimulation, critical period, early infancy, perinatal brain damage, visual functions, visual impairment

DOI: 10.3233/NRE-130952

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 251-255, 2013

Authors: Seo, Jeong Pyo | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: Little is known about neural recovery of an injured cingulum following brain injury. We report on a patient with brain injury who showed apparent neural recovery of an injured cingulum on follow up diffusion tensor tractography (DTT). Methods: A 53-year-old female patient had suffered hypoxic ischemic brain injury for a period of approximately nine hours following spontaneous subarachnoid hemorrhage and intraventricular hemorrhage, and underwent coiling of a left ruptured aneurysm of the posterior communicating artery. She showed severe cognitive impairment, so that she could not be evaluated on the Mini-Mental State Examination, however, her cognition showed improvement …to 21 at five months after onset and 24 at 14 months after onset on the Mini-Mental State Examination. Results: On seven-day DTT for the fornix in the patient, we observed a discontinuation in the left crus and thinning of the right crus. However, on 14-month DTT, the thinned right fornical crus had disappeared. Regarding the cingulum, on seven-day DTTs, discontinuations of both cingulums anterior to the genu of the corpus callosum were observed. However, on 14-month follow up DTT, the right cingulum was elongated to the right basal forebrain and no change in the discontinuation of the left cingulum was observed. Conclusions: These changes observed on DTT in both cingulums appeared to indicate recovery of the injured cingulum in this patient. The results of this study may suggest a mechanism for recovery of injured cingulum following brain injury. Show more

Keywords: Cingulum, diffuse axonal injury, memory, diffusion tensor imaging, brain plasticity

DOI: 10.3233/NRE-130953

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 257-261, 2013