NeuroRehabilitation - Volume 32, issue 2

Authors: Jo, Hae Min | Song, Jun-chan | Jang, Sung Ho

Article Type: Research Article

Abstract: We investigated the effect of a static stretching device on spasticity and motor function for people with chronic hemiparesis following stroke. Ten participants with chronic hemiparesis following stroke who had severe spasticity and incomplete weakness of the affected wrist and hand were recruited. The stretching device consisted of a resting hand splint, a finger and thumb stretching system, and a frame. The stretched state was maintained for 10 minutes/session, and the static stretching program was performed for 2 sessions/day and 7 days/week for 4 weeks. Spasticity and motor function of the affected wrist and hand were assessed three times with …intervals of 4 weeks (twice [Pre-1, Pre-2] before and once [Post-1] after starting the static stretching program). The effect of the static stretching device was assessed using modified Ashworth scale (MAS) scores, by measuring active range of motion (AROM), and using the wrist and hand subsection of the Fugl-Meyer motor assessment (FMA). The main effects of the static stretching program on MAS scores for wrist and metacarpophalangeal (MCP) joints and FMA scores were significant. AROMs of MCPs and wrist showed an increase, however, no significant main effects of the static stretching program were observed. MAS in flexor muscles of MCP joints showed a significant decreased from Pre-2 (mean ± standard deviation (SD): 2.56 ± 0.55; median and interquartile range (IQR): 2.42, 2.12–3.08) to Post-1 (mean ± SD: 1.05 ± 0.49; median and IQR: 1.08, 0.87–1.50) (P < 0.001), and MAS in wrist flexor muscles also showed a significant decrease from Pre-2 (mean ± SD: 3.20 ± 0.78; median and IQR: 3.0, 2.75–4.0) to Post-1 (mean ± SD: 1.90 ± 0.73; median and IQR: 2.0, 1.0–2.5) (P < 0.001). FMA score also showed a significant increase from Pre-2 (11.3 ± 6.09) to Post-1 (14.5 ± 6.20) (P < 0.001). It was found that the static stretching device effectively relieved spasticity and improved motor function in subjects with severe spasticity and incomplete weakness following stroke. Show more

Keywords: Motor function, spasticity, stretch, hemiparesis, stroke

DOI: 10.3233/NRE-130857

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 369-375, 2013

Authors: Hwang, Young-In | Yoo, Won-Gyu | An, Duk-Hyun | Heo, Hyo-Jin

Article Type: Research Article

Abstract: We investigated the effectiveness of an AFO-shaped band as an assistive walking device in patients with neurological lesions. The participants included 11 patients with a recent history of a CVA and one multiple sclerosis patient. In each patient, the order of conditions (AFO, AFO-shaped band, barefoot) was randomized. Participants were required to walk on the GAITRite mat twice during each condition. The average gait velocity among patients using the AFO-shaped elastic band was significantly higher than those under barefoot conditions (p = 0.015). Participants using the AFO-shaped elastic band also showed a significantly higher average number of steps per …minute (cadence) as compared with the barefoot and AFO conditions (p = 0.007). Significant differences in stride length on the unaffected side were found between the AFO-shaped band and barefoot conditions (p = 0.029). Our results indicated that the AFO-shaped elastic band could be useful for patients with central neurological lesions with respect to gait, especially walking velocity, cadence, and stride length on the affected side. Thus, the AFO-shaped elastic band could be a practical tool for clinicians to train patients with central neurological lesions to walk. Show more

Keywords: Ankle foot orthosis, gait, multiple sclerosis, orthotic devices, rehabilitation, stroke

DOI: 10.3233/NRE-130858

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 377-383, 2013

Authors: Lee, Na Kyung | Kwon, Jung Won | Son, Sung Min | Nam, Seok Hyun | Choi, Yong Won | Kim, Chung Sun

Article Type: Research Article

Abstract: Objective: The aim of this study is to investigate whether progressive resistive training with closed-kinetic chain (CKC) and open-kinetic chain (OKC) exercises could change plantar pressure distribution during walking in patients with stroke. Methods: Thirty-nine stroke patients were recruited and randomly divided into a CKC exercise group (n = 13), an OKC exercise group (n = 13), and a control group (n = 13). Both CKC and OKC exercise groups performed their own respective training programs 5 times per week for 6 weeks, whereas no training was done in the control group. Barefoot plantar pressure …distribution was measured during walking in terms of contact area (CA), peak contact force (PCF), and contact impulse (CI) on each of three foot regions (i.e. forefoot (FF), midfoot (MF), and hindfoot (HF)). Results: In the CKC exercise group, there were significant changes in only the CA and PCF of HF. In the OKC exercise and control groups, no significant differences were found for all variables of plantar pressure distributions. Conclusion: We found that resistive training with closed kinetic chain exercises could be an effective treatment method for improving normal gait patterns in stroke patients. These findings may be attributed to the fact that CKC exercise induced use of the ankle and knee muscles and provided repetitive sensory input from the affected foot. Show more

Keywords: Closed-kinetic chain exercise, open-kinetic chain exercises, plantar pressure distribution, gait pattern

DOI: 10.3233/NRE-130859

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 385-390, 2013

Authors: Zhang, Jianli | Yin, Changhao | Zhang, Yu | Zhao, Libo | Fu, HongJuan | Feng, Jiachun

Article Type: Research Article

Abstract: Aim: To explore the role of rs11053646 polymorphism of oxidized low-density lipoprotein receptor 1 (OLR-1) gene in the susceptibility and prognosis of ischemic stoke (IS). Methods: A total of 304 IS patients and 377 age and sex-matched healthy controls were recruited. Patients were followed up for 6 months for recovery evaluation of stroke. Genotyping analyses of the rs11053646 G > C polymorphisms of OLR1 gene were performed. Results: The genotype frequencies and alleles frequencies at rs11053646 were significantly differed between stroke subjects and control subjects (both P < 0.001). The presence of CC genotype was …significantly higher in IS subjects than in controls (38% vs. 25%, P = 0.001). Similarly, the C allele carriage in IS was significantly higher than controls (59% vs. 49%, P < 0.001). Regression analysis showed the CC homozygote had a significantly increased risk for stroke (adjusted OR = 2.080; P = 0.001). The genotype of rs11053646 were not associated with the IS subtype and severity at admission, but determine the clinical outcome at 6 months after discharge from hospital. Conclusion: The rs11053646 polymorphism of OLR1 gene be used as a molecular marker for the susceptibility and prognosis of IS in Chinese population. Show more

Keywords: Ischemic stroke, susceptibility, prognosis, oxidized LDL receptor gene 1

DOI: 10.3233/NRE-130860

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 391-396, 2013

Authors: Mendez, Mario F. | Owens, Emily M. | Reza Berenji, Gholam | Peppers, Dominique C. | Liang, Li-Jung | Licht, Eliot A.

Article Type: Research Article

Abstract: Introduction: Primary blast forces may cause dysfunction from mild traumatic brain injury (mTBI). Objective: To investigate the effects of primary blast forces, independent of associated blunt trauma and post-traumatic stress disorder, on sensitive post-concussive measures. Methods: This study investigated post-concussive symptoms, functional health and well-being, cognition, and positron emission tomography (PET) neuroimaging among 12 Iraq or Afghanistan war veterans who sustained pure blast-force mTBI, compared to 12 who sustained pure blunt-force mTBI. Results: Both groups had significantly lower scores than published norms on the Rivermead Post-Concussion Questionnaire (RPQ) and the SF36-V Health Survey. Compared …to the Blunt Group, the Blast Group had poorer scores on the Paced Auditory Serial Addition Test (PASAT) and greater PET hypometabolism in the right superior parietal region. Only the Blast Group had significant correlations of their RPQ, SF36-V Mental Composite Score, and PASAT scores with specific regional metabolic changes. Conclusion: This pilot study suggests that pure blast force mTBI may have greater post-concussive sequelae including deficits in attentional control and regional brain metabolism, compared to blunt mTBI. A disturbance of a right parietal-frontal attentional network is one potential explanation for these findings. Show more

Keywords: Mild traumatic brain injury, blast forces, post-concussion, positron emission tomography imaging

DOI: 10.3233/NRE-130861

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 397-407, 2013

Authors: McIntyre, Amanda | Mehta, Swati | Janzen, Shannon | Aubut, JoAnne | Teasell, Robert W.

Article Type: Review Article

Abstract: Objective: The objective of this study was to determine rates of functional outcomes, based on Glasgow Outcome Scale scores, among older adults (>60 years) after a traumatic brain injury. Methods: An extensive database search was conducted. To be included all articles were published in English, included individuals 60 years or older, explicitly stated in-hospital GCS scores and GOS scores within one year post-TBI. Data was pooled on patient characteristics, mortality rates, time to death, and study design. Results: A total of 11 studies were included in this review. Among individuals with severe TBI, favourable, unfavourable, and …fatal outcomes were observed in 7.9% (CI 5.3%–11.8%), 13.8% (CI 10.0%–18.8%) and 79.3% (CI 73.2%–84.4%), respectively. Among those with moderate TBI, favourable, unfavourable, and fatal outcomes were observed in 32.2% (CI 18.0%–50.7%), 29.5% (CI 16.5%–47.0%), and 42.5% (CI 26.1%–60.7%), respectively. Among those with mild TBI, favourable, unfavourable, and fatal outcomes were observed in 80.5% (CI 53.2%–93.7%), 7.0% (CI 1.9%–22.7%), and 10.7% (CI 3.1%–30.9%), respectively. Conclusion: This study has demonstrated the significant interaction between GCS and GOS among older adults. Although older adults may require aggressive and comprehensive treatment to achieve these favourable outcomes, high rates of unfavourable outcome should not justify the use of conservative treatment. Show more

Keywords: Aging, traumatic brain injury, Glasgow coma scale, Glasgow outcome scale

DOI: 10.3233/NRE-130862

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 409-414, 2013

Authors: Kiselka, Anita | Greisberger, Andrea | Heller, Mario

Article Type: Research Article

Abstract: Background: Resistance exercise is effective in improving muscle strength and preventing muscle weakness in multiple sclerosis (MS) patients. Control of resistance training intensity based on perceived muscular effort is applicable to healthy individuals, yet there is no evidence of its utility for MS patients. Objective: To compare perception of muscular effort in MS patients to healthy controls. Methods: Based on their perception of muscular effort, twenty-five MS patients and twenty-eight controls adjusted static elbow extension tasks according to five levels on the OMNI-Resistance Exercise Scale. Elbow extension strength and muscle activity were measured via load cell …dynamometer and surface electromyography (EMG) and related to each participant’s maximal voluntary contraction (MVC) strength and muscle activity. Two-way analysis of variance was used to evaluate statistical significance. Results: There were no statistically significant differences between MS patients and healthy controls, they produced similar relative torque values (F1 = 0.196; p > 0.05) and extensor muscle activities (F2,617 = 1.556; p > 0.05) across all effort levels. Conclusion: No differences were found in the perception of muscular effort in MS patients and the age-matched control group. Future studies should explore, whether rating of perceived exertion is an effective instrument to control resistance training intensity in MS patients. Show more

Keywords: Multiple sclerosis, perception, effort, exertion, rating scale, muscle strength, surface electromyography, upper extremity

DOI: 10.3233/NRE-130863

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 415-423, 2013

Authors: Oh, Duck-Won | Park, Hyun-Ju

Article Type: Research Article

Abstract: Purpose: This study aimed to describe a community-based ambulation training for ambulatory patients with incomplete spinal cord injury (SCI) and then to report the results of the training. Method: Four patients with incomplete SCI participated in this study. The indoor and outdoor walking function was assessed at four intervals: pre-training, post-training, and at 4-week and 1-year follow-ups after successful completion of the community-based ambulation training. Training consisted of the four-staged ambulation protocol with weekly-increased environmental demands, which consisted of 1-hour sessions six times a week for a 4-week period (i.e., a total of 24 sessions). Results: …The walking function of all patients was remarkably improved after the training, and these effects were favorably maintained at the 4-week and 1-year follow-ups. Conclusion: These findings suggest that the use of community-based ambulation training is a beneficial therapeutic option to improve the walking function of ambulatory patients with incomplete SCI and to offer better opportunities for reintegration into community life. Show more

Keywords: Spinal cord injury, community-based ambulation training, walking

DOI: 10.3233/NRE-130864

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 425-432, 2013