NeuroRehabilitation - Volume 51, issue 2

Authors: Vuu, Sally | Barr, Christopher J. | Killington, Maggie | Jill, Garner | van den Berg, Maayken E.L.

Article Type: Review Article

Abstract: BACKGROUND: Recent research recommends physical exercise rather than rest following a mild traumatic brain injury (mTBI). OBJECTIVE: To determine the effect of physical exercise on persistent symptoms in people with mTBI. METHODS: A search of randomized controlled trials was conducted in CINAHL, Cochrane Library, EMBASE, MEDLINE, SportDiscus and Web of Science, from 2010 to January 2021. Studies were included if they described the effects of a physical exercise intervention in people with mTBI on persistent symptoms. Study quality, intervention reporting, and confidence in review findings were assessed with the CASP, TIDieR and GRADE respectively. …RESULTS: 11 eligible studies were identified for inclusion. Study interventions broadly comprised of two categories of physical exercise, i.e., aerobic (n  = 8) and vestibular (n  = 3). A meta-analysis (n  = 3) revealed the aerobic exercise group improvement was significantly larger compared to the usual care group –0.39 (95% CI: –0.73 to –0.05, p  = 0.03). Only three studies using vestibular exercise reported on persistent symptoms and yielded mixed results. CONCLUSIONS: This study demonstrated that the use of aerobic exercise is supported by mixed quality evidence and moderate certainty of evidence, yet there is limited evidence for the use of vestibular exercise for improving persistent symptoms in people with mTBI. Show more

Keywords: Mild traumatic brain injury, concussion, post concussion syndrome, exercise, systematic review

DOI: 10.3233/NRE-220044

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 185-200, 2022

Authors: Mangone, Massimiliano | Agostini, Francesco | de Sire, Alessandro | Cacchio, Angelo | Chiaramonte, Angelo | Butterini, Giulia | Martano, Andrea | Paoloni, Marco | Bernetti, Andrea | Paolucci, Teresa

Article Type: Review Article

Abstract: BACKGROUND: Parkinson’s disease (PD) is a neurodegenerative disease characterized by loss of substantia nigra neurons with deficiency of dopamine. The main symptoms are tremor, rigidity and bradykinesia. Rehabilitation has an important role in the treatment of this condition and virtual reality (VR) is one of the most recent tools. OBJECTIVE: The purpose of this umbrella review is to evaluate the effectiveness of VR systems on gait control for return to work in patients with PD. METHODS: The electronic search, for reviews and meta-analysis studies that investigated the effectiveness of VR on gait control in PD patients, …was performed through December 2021 using the following databases: PubMed, Scopus, PEDro, and Google Scholar. Mesh terms used were: Job integration/reintegration OR return-to-work AND Parkinson’s disease AND virtual reality OR exergame. No limit on the year of publication of the article was used. CONCLUSIONS: A total of 14 articles were included in our analysis. The included evidence shows a stride length improvement in patients treated with VR compared to conventional active treatments. No difference was found in walking speed. Also, the included articles show an improvement on various measures of balance, motor function and severity of PD motor symptoms. In addition, the literature shows an improvement in the quality of life and neuropsychiatric symptoms in patients undergoing VR rehabilitation training. RESULTS: he results of our study suggest that VR rehabilitation improves gait performance, particularly stride length, thus being able to provide an improvement in the quality of life and a more effective return to work training in patients with PD. Show more

Keywords: Parkinson’s disease, virtual reality, rehabilitation, gait, return to work

DOI: 10.3233/NRE-220029

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 201-211, 2022

Authors: Lorusso, Matteo | Tagliamonte, Nevio Luigi | Tramontano, Marco | Fresch, Anna | Granelli, Giulia | Smania, Nicola | Tamburella, Federica

Article Type: Review Article

Abstract: BACKGROUND: Balance is a crucial function of basic Activities of Daily Living (ADL) and is often considered the priority in Spinal Cord Injury (SCI) patients’ rehabilitation. Technological devices have been developed to support balance assessment and training, ensuring an earlier, intensive, and goal-oriented motor therapy. OBJECTIVE: The aim of this systematic review is to explore the technology-assisted strategies to assess and rehabilitate balance function in persons with SCI. METHODS: A systematic review was conducted in the databases PubMed, Scopus, IEEE Xplore, Cochrane Library, and Embase. Full reports on Randomized Clinical Trials (RCTs) of parallel-group or cross-over …design and non-RCTs were included according to the following criteria: i) publication year from 1990 to 2021; ii) balance considered as a primary or secondary outcome; iii) population of individuals with SCI with age over 18 years old, regardless of traumatic or non-traumatic lesions, Time Since Injury, lesion level, Asia Impairment Scale score and gender. The methodological quality was determined for each included study according to the recognized Downs and Black (D&B) tool. RESULTS: Nineteen articles met the inclusion criteria and were included in the analysis. Four articles focused on balance assessment while 15 targeted rehabilitation interventions to improve balance by using Treadmill-Based Devices (TBD), OverGround Devices (OGD) and Tilt Table Devices (TTD). Statistically significant effects on balance can be found in TBD subcategory, in the hip-knee guidance subcategory of OGD and in the study of TTD category. CONCLUSION: Although different studies reported positive effects, improvements due to technology-assisted rehabilitation were not greater than those obtained by means of other rehabilitation therapies. The heterogeneity, low methodological quality, and the small number of the studies included do not allow general conclusions about the usefulness of technology-assisted balance assessment and training in individuals with SCI, even if significant improvements have been reported in some studies. Show more

Keywords: Spinal cord injury, balance rehabilitation, balance assessment, rehabilitation technologies

DOI: 10.3233/NRE-220060

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 213-230, 2022

Authors: Sang, Bomo | Deng, Shizhe | Zhai, Jingbo | Hao, Ting | Zhuo, Bifang | Qin, Chenyang | Zhang, Menglong | Zhao, Xiaofeng | Meng, Zhihong

Article Type: Review Article

Abstract: BACKGROUND: Aphasia is one of the most common complications in patients with ischemic stroke. Studies have shown that acupuncture can improve the symptoms of aphasia patients. However, the effect of acupuncture on language function in patients with ischemic stroke is still controversial. OBJECTIVE: This study aimed to critically assess the efficacy and safety of acupuncture for aphasia following ischemic stroke. METHODS: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, China National Knowledge Infrastructure, Wanfang Digital Periodicals, and Chinese Science and Technology Periodicals database were searched. All randomized controlled trials (RCTs) that …met the criteria were included. RESULTS: Meta-analyses showed that mean difference in change of auditory comprehension score (MD = 7.71, 95% CI: 1.83 to 13.59, P  = 0.01), spontaneous speech (MD = 2.77, 95% CI: 0.59 to 4.95, P  = 0.01), repetition score (MD = 14.48, 95% CI: 11.04 to 17.91, P  < 0.00001) and naming score (MD = 14.60, 95% CI: 11.33 to 17.88, P  < 0.00001) measured by WAB scale were statistically significant. Subgroup analyses demonstrated that there were statistically significant mean differences in four items of WAB scale in patients with sub-acute stroke, and no statistically significant differences in patients with acute stroke. CONCLUSION: The present study suggests that acupuncture may improve the language function of patients with aphasia following ischemic stroke, especially during the sub-acute phase. However, due to insufficient sample sizes and information on the safety, more high-quality RCTs are still needed Show more

Keywords: Acupuncture, aphasia, ischemic stroke, speech therapy, systematic review

DOI: 10.3233/NRE-220007

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 231-245, 2022

Authors: Elnaggar, Ragab K. | Alghadier, Mshari | Abdrabo, Mohamed S. | Abonour, Asmaa A.

Article Type: Research Article

Abstract: BACKGROUND: Individuals with hemiparetic cerebral palsy (h-CP) encounter postural control issues that largely interfere with activity and participation. So, there might be a need for improved, clearly effective rehabilitation protocols that target postural control dysfunction, which may, then, reduce activity limitations and participation restrictions. OBJECTIVE: This trial was undertaken to examine the effect of a structured, 12-week aqua-plyometric (Aqua-PLYO) exercise program on postural control and functional ability in children with h-CP. METHODS: Fifty-six children with h-CP took part in a two-arm, randomized single-blind controlled trial. They were randomly assigned to either receive the standard …physical therapy (Control group; n  = 28) or the Aqua-PLYO training program (Aqua-PLYO group; n  = 28), three times/week over 12 consecutive weeks. The dynamic limit of stability [i.e., movement directional control (M-DC), reaction time (ReT), movement velocity (M-Vel), endpoint excursion (EP-Exc), and maximum excursion (M-Exc)] and functional ability [i.e., 30-second sit-to-stand test (30sec-STS), timed up and down stairs test (TUDS), and the dynamic gait index (DGI)] were assessed pre- and post-treatment. RESULTS: From the pre- to post-treatment occasion, the Aqua-PLYO group achieved greater improvement for the M-DC (P  = 0.013), ReT (P  = 0.004), M-Vel (P  = 0.03), EP-Exc (P  = 0.002), and M-Exc (P  = 0.006), compared to controls. Besides, the Aqua-PLYO group showed more conducive changes in functional ability [as evidenced by the 30sec-STS (P  = 0.005), TUDS (P  = 0.002), and DGI (P  = 0.004) scores]. CONCLUSION: Aqua-PLYO training is likely an effective training paradigm for enhancing postural control and functional ability in children with h-CP. Further studies are, however, recommended to substantiate the current evidence. Show more

Keywords: Cerebral palsy, plyometric exercise, strength training, postural control, functional performance

DOI: 10.3233/NRE-220020

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 247-258, 2022

Authors: Cho, Ji-Eun | Shin, Joon-Ho | Kim, Hogene

Article Type: Research Article

Abstract: BACKGROUND: Individuals with stroke have impaired sensorimotor function of ankle. OBJECTIVE: To investigate the effects of passive biaxial ankle movement training synchronized with electrical stimulation therapy (AMT-EST) on ankle proprioception, passive range of motion (pROM), and strength, balance, and gait of chronic stroke patients. METHODS: Thirty-five stroke patients were randomized. The experimental group received a total of 20 AMT-EST sessions. The control group received only EST. Primary outcome measures were ankle functions. Secondary outcome measures were clinical assessments of motor, balance, and gait-related functions. All assessments were compared before and after the intervention. RESULTS: …The experimental group had significantly improved ankle dorsiflexor strength (p  = 0.015) and ankle pROM during foot supination (p  = 0.026) and pronation (p  = 0.004) and clinical assessment (Fugl–Meyer Assessment of the lower extremities [FM-L], Berg Balance Scale, Timed Up and Go test, Fall Efficacy Scale, walking speed, and step length; all p  < 0.05) values. The regression model predicting ankle proprioception showed significantly large effects (adjusted R2  = 0.493; p  < 0.01) of the combined FM-L score and time since stroke. CONCLUSION: Biaxial AMT-EST resulted in better ankle pROM and strength than conventional EST. Ankle proprioception was not significantly improved after AMT-EST and was predicted by the FM-L score and time since stroke. Show more

Keywords: Ankle, electrical stimulation, proprioception, range of motion, stroke

DOI: 10.3233/NRE-220018

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 259-269, 2022

Authors: Alaca, Nuray | Öcal, Numan Melik

Article Type: Research Article

Abstract: BACKGROUND: The Modified Constraint-Induced Movement Therapy (mCIMT) method is a unilateral training that respectively avoids and activates less affected and affected sides of upper extremities; however, the selected options are not typically ideal. Proprioceptive based training (PT) includes bilateral training methods and influencing proprioceptive receptors. OBJECTIVE: The primary purpose was to determine if conventional therapy and PT or conventional therapy and mCIMT therapy show similar improvement in patients with chronic stroke. The secondary purpose was to investigate the effectiveness of conventional therapy and PT or mCIMT therapy in patients with chronic stroke and to compare which of the …two interventions is more effective. METHODS: Forty patients with chronic stroke were randomly allocated to only conventional therapy (PTR, n  = 14), conventional therapy plus proprioception training (PTR-PT, n  = 13), and mCIMT (PTR-mCIMT, n  = 13) groups. Evaluations were assessed before and 6 weeks after treatment. RESULTS: Intragroup evaluations revealeda significant improvement in the all scores in the PTR-PT and PTR-mCMIT groups (p  = 0.006 < 0.001). Intergroup comparisons demonstrated that the PTR-mCIMT group had a significant improvement in spasticity and motor function scores compared to the PTR (p  < 0.001) and the PTR-PT groups (p  = 0.006–0.015). CONCLUSIONS: PT and mCMIT applied in addition to conventional therapy in patients with chronic stroke were more effective than only conventional therapy. Additionally, mCMIT showed greater improvement in spasticity and motor function scales than PT. Show more

Keywords: Constraint-induced movement therapy, motor functions, proprioception training, spasticity, stroke

DOI: 10.3233/NRE-220009

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 271-282, 2022

Authors: Yang, Zhen | Qiao, Linru | He, Jianhua | Zhao, Xue | Zhang, Minyan

Article Type: Research Article

Abstract: BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has been widely used for hand function recovery in patients with subacute and chronic stroke. OBJECTIVE: To observe the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with functional electrical stimulation (FES) on hand function recovery during convalescence of stroke. METHODS: Patients were divided into3 groups of 20 patients in each. All patients received routine training. rTMS group was treated with low-frequency repetitive transcranial magnetic stimulation (rTMS). FES group received functional electrical stimulation (FES) therapy. Observation group was treated with low-frequency rTMS …and FES. The changes of TMS-MEP in the 3 groups were observed at the time of enrollment and after 2 courses of treatment, respectively, and the total active activity of fingers (TAM) and Fugl-Meyer assessment (FMA) rating scale were evaluated in wrist and hand parts. RESULTS: The amplitude of TMS-MEP was significantly higher than that of FES group. FMA score and TAM score in the observation group were significantly better than that of rTMS group and FES group. CONCLUSION: Low-frequency rTMS combined with FES treatment can effectively improve the range of motion of fingers, and significantly improve the grasp, pinching and other functions of hands. Show more

Keywords: Low-frequency repetitive transcranial magnetic stimulation, functional electrical stimulation, stroke, hand function

DOI: 10.3233/NRE-220074

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 283-289, 2022

Authors: Seneviratne, Harshana | Mann, Georgina | Troeung, Lakkhina | Martini, Angelita

Article Type: Research Article

Abstract: BACKGROUND: Following acquired brain injury (ABI), cognitive and physical barriers can prevent access to a previously enjoyed lifestyle, reducing quality of life. OBJECTIVE: This study aimed to examine predictors of health-related quality of life (HRQoL) in adults with ABI receiving post-acute community-based rehabilitation and disability support services, using tools developed for this population. METHODS: Retrospective cross-sectional design. Main outcome measures were the Quality of Life after Brain Injury Inventory (QOLIBRI) and Functional Independence and Assessment Measure (FIM + FAM) for adults with ABI (n  = 67) undergoing post-acute rehabilitation in Western Australia, 2015–2021. RESULTS: Mean QOLIBRI total …score (±standard deviation) was 57.2±17.4, indicating impaired HRQoL, with mood disorders likely prevalent. Regression analysis demonstrated no differences in HRQoL between different age groups, sexes or brain injury types. Shorter time since injury and lower total FIM + FAM score significantly predicted poorer HRQoL in the model. CONCLUSION: This population appears vulnerable to psychological illness, although HRQoL is addressed for a minority of clients during routine post-acute care (19%). As improvement in quality of life is a fundamental goal of rehabilitation post-ABI, understanding the relationship between potentially modifiable factors such as functional independence and HRQoL is critical to improve outcomes and provide the best chance at a satisfying life. Show more

Keywords: Quality of life, rehabilitation, functional independence, brain injury, disability

DOI: 10.3233/NRE-220062

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 291-302, 2022

Authors: Yen, Hsiao-Ching | Han, Yin-Yi | Hsiao, Wei-Ling | Hsu, Po-Min | Pan, Guan-Shuo | Li, Min-Hao | Chen, Wen-Shiang | Chuang, Hung-Jui

Article Type: Research Article

Abstract: BACKGROUND: Brain plasticity evoked by environmental enrichment through early mobilization may improve sensorimotor functions of patients with moderate-to-severe traumatic brain injury (TBI). Increasing evidence also suggests that early mobilization increases verticalization, which is beneficial to TBI patients in critical care. However, there are limited data on early mobilization interventions provided to patients with moderate-to-severe TBI. OBJECTIVE: We investigated the possible enhancing effects of revised progressive early mobilization on functional mobility and the rate of out-of-bed mobility attained by patients with moderate-to-severe TBI. METHODS: This is a quantitative study with a retrospective and prospective …pre–post intervention design. We implemented a revised progressive early mobilization protocol for patients with moderate-to-severe TBI admitted to the trauma intensive care unit (ICU) within the previous seven days. The outcome parameters were the rate of patients attaining early mobilization (sitting on the edge of the bed) and the Perme ICU Mobility Score at discharge from the ICU. The outcome parameters in the intervention cohort were compared with those from a historical control cohort who received standard medical care a year previously. Differences in the Perme ICU Mobility Score between the two cohorts were assessed using univariate analysis of covariance. RESULTS: Forty-two patients were included in the progressive early mobilization program and were compared with 44 patients who underwent standard medical care. In the intervention cohort, 100% and 57.2% of the patients completed early rehabilitation and early mobilization, respectively, compared to 0% in the control cohort. The intervention cohort at ICU discharge showed significantly improved the Perme ICU Mobility Scores. CONCLUSIONS: The implementation of the revised progressive early mobilization program for patients with moderate-to-severe TBI resulted in significantly improved mobility at ICU discharge; however, the length of overall stay in the ICU may be not affected. Show more

Keywords: Traumatic brain injury, intensive care, early mobilization

DOI: 10.3233/NRE-220023

Citation: NeuroRehabilitation, vol. 51, no. 2, pp. 303-313, 2022