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

Authors: Saxton, Melissa E. | Younan, Shameran Slewa | Lah, Suncica

Article Type: Research Article

Abstract: Objective: This theoretically driven study aimed to determine contribution of emotional perception impairments to social behaviour following traumatic brain injury (TBI). Methods: Adults with severe TBI (n = 24) participated. Emotion perception predictors included: (i) appraisal: Montreal Set of Facial Displays of Emotion, The Adapted Story Task, (ii) affective state: Depression, Anxiety and Stress Scale (DASS-21), Interpersonal Reactivity Index (IRI) and (iii) regulation: Delis Kaplan Executive Function System - Colour Word Interference and Word Fluency. Social behavioural outcomes were (i) interpersonal: Key Behaviors Change Inventory (KBCI) - Interpersonal Difficulties and (ii) communication: KBCI - Communication Problems. …Results: Social behaviours correlated with affective state, but not appraisal or regulation. Simultaneous regression analyses revealed significant independent contributions of affective state: (i) the IRI Perspective Taking to the KBCI Interpersonal Difficulties and (ii) the DASS-21 (composite) and IRI Perspective Taking to the KBCI Communication Problems. The models explained 52% and 72% of the variance of the KBCI Interpersonal Difficulties and Communication Problems respectively. Conclusions: This study provides evidence that impairments in certain aspects of emotion perception: affective state [empathy (perspective taking) and mood], but not appraisal and regulation, contribute to social behaviour difficulties in patients with severe TBI, which has important implications for rehabilitation. Show more

Keywords: Brain injuries, emotions, social behaviour, rehabilitation

DOI: 10.3233/NRE-130954

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 263-271, 2013

Authors: Stevens, Lillian F. | Perrin, Paul B. | Hubbard, Rebecca | Díaz Sosa, Dulce María | Espinosa Jove, Irma Guadalupe | Arango-Lasprilla, Juan Carlos

Article Type: Research Article

Abstract: Purpose: To examine differences in ratings of family dynamics between individuals with traumatic brain injury (TBI) and their family caregivers in Mexico, as well as differences in the prediction of caregiver and patient mental health outcomes from those ratings. Method: Forty-two patient-caregiver dyads (n = 84) from the National Institute of Rehabilitation in México City participated in a comprehensive evaluation of their family dynamics and mental health. Results: Patients' and caregivers' ratings of family dynamics were significantly correlated and did not differ across five of six types of family dynamics, but caregivers rated their family's level …of empathy higher than patients, p < 0.001. Additionally, all patient and caregiver ratings of family dynamics were significantly correlated. Patients', caregivers', and combined (using structural equation modeling latent constructs) ratings of family dynamics robustly predicted four times as many caregiver mental health outcomes as patient mental health outcomes. Conclusions: Family dynamics influence both TBI patient and caregiver mental health but much more so in caregivers. Research on families of individuals with TBI in Mexico should incorporate both patient and caregiver perspectives to more comprehensively depict the environment in which TBI rehabilitation occurs. Show more

Keywords: TBI, caregivers, family functioning, mental health outcomes

DOI: 10.3233/NRE-130955

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 273-283, 2013

Authors: Salhofer-Polanyi, Sabine | Windt, Judith | Sumper, Harald | Grill, Hermine | Essmeister, Maria | Diermayr, Gudrun | Zebenholzer, Karin | Leutmezer, Fritz | Zulehner, Gudrun | Vass, Karl | Asenbaum-Nan, Susanne

Article Type: Research Article

Abstract: Background: Rehabilitation is often recommended to MS-patients but data on its efficacy is limited. Objective: To evaluate the benefit of inpatient multidisciplinary rehabilitation. Methods: A rater-blinded, randomized, waiting list controlled exploratory study. 19 participants completed the study with ten allocated to the intervention and nine to the waiting list group. Assessment of outcome-parameters was done at baseline and after 3 months. Time Walking Tests (TWTs) and 9 Hole Peg Test were used to objectively assess the level of activity, Functional-Assessment-in-MS and MS-Self Efficacy-Scale to assess participation and quality of life and Expanded Disability Status Scale (EDSS) …to assess bodily function. Additionally Rivermead Mobility Index, Berg Balance Scale, Tinetti-Test, MS-Functional Composite and a rater-blinded evaluation of a video-analysis on walking performance was done. Results: Mean change scores of Timed 50 meter Walk (p = 0.014), walking speed (p = 0.034), 2- (p = 0.204) and 6-Minute Walk (p = 0.027) indicated an improvement favoring inpatient multidisciplinary rehabilitation. We could not demonstrate a benefit for upper limb function and some improvement was seen in other outcome-parameters without reaching statistical significance. EDSS remained unchanged. Conclusion: Inpatient multidisciplinary rehabilitation is effective in MS patients with positive impact on the level of activity as measured by TWTs covering both short and long distance ambulation. Show more

Keywords: Multiple sclerosis, inpatient, rehabilitation, level of activity, 6-Minute walk, 2-Minute walk

DOI: 10.3233/NRE-130956

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 285-292, 2013

Authors: Citaker, Seyit | Guclu-Gunduz, Arzu | Yazici, Gokhan | Bayraktar, Deniz | Nazliel, Bijen | Irkec, Ceyla

Article Type: Research Article

Abstract: Background: Muscle strength and standing balance decrease in patients with Multiple Sclerosis (MS). Objective: The aim of the present study was to investigate the relationship between the lower extremity isometric muscle strength and standing balance in patients with MS. Methods: Forty-seven patients with MS and 10 healthy volunteers were included. Neurological disability level was assessed using Expanded Disability Status Scale (EDSS). Isometric strength of seven lower extremity muscles (hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor) was assessed using hand-held dynamometer. Duration of static one-leg standing balance was measured using digital chronometer. Results: Hip …flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength, and duration of one-leg standing balance were decreased in patients with MS when compared with controls (p < 0.05). All assessed lower extremity isometric muscle strength and EDSS level was related duration of one-leg standing balance in patients with MS. All assessed lower extremity isometric muscle strength (except ankle dorsal flexor) was related with EDSS. Conclusions: Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength decreases in ambulatory MS patients. Lower extremity muscle weakness and neurological disability level are related with imbalance in MS population. Hip and knee region muscles weakness increases the neurological disability level. For the better balance and decrease neurological disability level whole lower extremity muscle strengthening should be included in rehabilitation programs. Show more

Keywords: Muscle strength, balance, multiple sclerosis, EDSS

DOI: 10.3233/NRE-130958

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 293-298, 2013

Authors: Frazzitta, Giuseppe | Abbruzzese, Giovanni | Bertotti, Gabriella | Boveri, Natalia | Pezzoli, Gianni | Maestri, Roberto

Article Type: Research Article

Abstract: Goal and objectives: Parkinsonian patients can be classified in two main subgroups: tremor dominant and akinetic-rigid. The aim of this study was to evaluate whether intensive rehabilitation treatment has the same efficacy in the two subtypes. Material and methods: Patients were classified according to tremor: 65 patients with absence of tremor in “on” and “off” state were assigned to Group_1 and 65 patients with tremor were assigned to Group_2. All patients underwent a 4-week intensive multidisciplinary rehabilitation treatment. The primary outcome measures were: the Unified Parkinson's Disease Rating Scale (UPDRS) II, III, UPDRS akinetic-rigid score and UPDRS tremor …score. The secondary outcome measures were: the Berg Balance Scale, 6-minute walking test, self-assessment Parkinson's Disease Disability Scale, Abnormal Involuntary Movement Scale, Freezing of Gait Questionnaire. Results: Patients in Group_1 tended to be more affected than patients in Group_2 by dyskinesias (45% vs 29% p = 0.069) and freezing (46% vs 29%, p = 0.046). Levodopa-equivalent dosages were higher in Group_1 (802 vs 670 mg/day, p = 0.008). Considering the effect of rehabilitation, an homogeneous improvement was observed in all variables in both groups of patients (p < 0.0001). Conclusion: Intensive rehabilitation treatment is effective in improving motor performance in both groups. The anatomical and biochemical differences existing between the two subgroups appear to not determine different clinical outcomes. Show more

Keywords: Parkinson's disease, akinetic-rigid, tremor, rehabilitation

DOI: 10.3233/NRE-130959

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 299-303, 2013

Authors: Stegemöller, Elizabeth L. | Vallabhajosula, Srikant | Haq, Ihtsham | Hwynn, Nelson | Hass, Chris J. | Okun, Michael S.

Article Type: Research Article

Abstract: Background: High frequency stimulation (HFS) of the subthalamic nucleus is one of the most effective treatments for advanced Parkinson's disease (PD). HFS has provided beneficial improvements in the cardinal features of PD, but has not been proven as effective for addressing the axial predominant levodopa resistant symptoms, such as speech disturbances, gait disturbances, and postural instability. Recent studies have suggested that changes in stimulation parameters may influence differing PD symptoms. Objective: The purpose of this study was to compare the effects of low frequency stimulation (LFS) versus HFS on the Unified Parkinson's Disease Rating Scale (UPDRS), gait, balance, …and verbal fluency. Methods: Eight tremor dominant and nine non-tremor dominant participants with bilateral deep brain stimulation of the subthalamic nucleus were tested off stimulation, during LFS, and during HFS. Results: Results revealed that HFS significantly reduced UPDRS tremor score in the tremor dominant group; however no differences emerged within the non-tremor dominant group. No differences between groups or stimulation conditions were found for gait, balance, and verbal fluency measures. Conclusion: These results may suggest that HFS is better than LFS for reducing tremor in tremor dominant patients. However, patients with mild or no tremor show no acute differences in benefit from LFS as compared to HFS. Show more

Keywords: Low frequency stimulation, Parkinson's disease, gait, balance, speech

DOI: 10.3233/NRE-130960

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 305-312, 2013

Authors: Corbett, Duane B. | Peer, Kimberly S. | Ridgel, Angela L.

Article Type: Research Article

Abstract: Background: Parkinson's disease (PD) is a neurological disorder which often results in joint rigidity, bradykinesia and decreased range of motion (ROM). Segmental biomechanical muscle stimulation (BMS) can increase ROM in healthy young adults. However, acute effects on ROM in PD have not been examined. Objective: To examine whether BMS and active-assisted cycling (AAC) of the legs results in acute changes in ROM in PD. Methods: Seventeen individuals with PD completed four sessions. Subjects first came to the lab ‘on’ PD medications and completed baseline assessments. During session 2, subjects were ‘off’ PD medications and watched a …video describing the interventions. In the 3rd and 4th visits, subjects were ‘off’ medications and the order of AAC or BMS was counterbalanced. Shoulder and hip ROM was measured prior to and immediately after each intervention and hip kinematics were examined during over-ground walking. Results: There was a significant improvement in hip and shoulder ROM after BMS and AAC. Hip velocity during over-ground walking improved after BMS but not after AAC. Conclusions: Single bouts of BMS and AAC have a positive effect on ROM and hip velocity during over-ground walking. This suggests that BMS and AAC may be altering central motor control processes. Show more

Keywords: Segmental vibration, range of motion, flexibility, exercise

DOI: 10.3233/NRE-130961

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 313-322, 2013

Authors: Paker, Nurdan | Bugdayci, Derya | Goksenoglu, Goksen | Sen, Aysu | Kesiktas, Nur

Article Type: Research Article

Abstract: Background: Decreased mobility and walking capacity occur frequently in Parkinson's disease (PD). Robotic treadmill training is a novel method to improve the walking capacity in rehabilitation. Objectives: The primary aim of this study was to investigate the effects of robotic treadmill training on functional mobility and walking capacity in PD. Secondly, we aimed to assess the effects of the robotic treadmill training the motor symptoms and quality of life in patients with PD. Methods: Seventy patients with idiopathic Parkinson's disease who admitted to the outpatient clinic of the rehabilitation hospital were screened and 12 ambulatory volenteers …who met the study criteria were included in this study. Patients were evaluated by Hoehn Yahr (HY) scale clinically. Two sessions robotic treadmill training per week during 5 weeks was planned for every patient. Patients were evaluated by the Timed Up and Go (TUG) test, 10 meter walking test (10 MWT), Unified Parkinson's Disease Rating Scale (UPDRS) motor section and Parkinson's Disease Questionnaire-39 (PDQ-39) at the baseline, at the 5 and 12 weeks. Cognitive and emotional states of the patients were assessed by Mini Mental State Examination (MMSE) test and Hospital Anxiety and Depression Scale (HADS) at the baseline. All patients were under medical treatment for the PD in this study and drug treatment was not changed during the study. Results: Ten patients completed the study. The mean age was 65.6 ± 6.6 years. Five patients (50%) were women. Disease severity was between the HY stage 1–3. Two patients did not continue the robotic treadmill training after 7 sessions. They also did not want to come for control visits. TUG test, 10 MWT and UPDRS motor subscale scores showed statistically significant improvement after robotic treadmill training (p = 0.02, p = 0.001, p = 0.016). PDQ-39 scores improved significantly after robotic treadmill training (p = 0.03), however, the scores turned back to the baseline level at the 12. week control. Conclusion: As a result of this preliminary study, robotic treadmill training was useful to improve the functional mobility, walking capacity and motor symptoms in mild to moderate PD. Robotic treadmill training provided a transient improvement in the quality of life during the treatment. Show more

Keywords: Parkinson's disease, robotic treadmill training, Timed Up and Go test, 10 meter walk test, functional status, quality of life

DOI: 10.3233/NRE-130962

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 323-328, 2013

Authors: Reitz, André

Article Type: Research Article

Abstract: Background: Critical illness polyneuropathy is a frequent complication of critical illness in intensive care units. Reports on autonomic systems like lower urinary tract and bowel functions in patients with CIP are not available in medical literature. Objective: This study performed during primary rehabilitation of patients with critical illness polyneuropathy explores if sensory and motor pathways controlling the lower urinary tract function are affected from the disease. Methods: Neurourological examinations, urodynamics, electromyography and lower urinary tract imaging were performed in 28 patients with critical illness polyneuropathy. Discussion: Sacral sensation was impaired in 1 patient (4%). …Sacral reflexes were absent in 8 patients (30%). Anal sphincter resting tone was reduced in 3 (12%), anal sphincter voluntary contraction was absent or reduced in 8 patients (30%). Urodynamic findings were detrusor overactivity and detrusor overactivity incontinence in 9 (37.5%), incomplete voiding in 8 (30%), abnormal sphincter activity in 4 (16%), abnormal bladder sensation in 4 (16%) and detrusor acontractility in 2 patients (8.3%). Morphological abnormalities of the lower urinary tract had 10 patients (41.6%). Conclusion: Sensory and motor pathways controlling the lower urinary tract might be affected from CIP. During urodynamics dysfunctions of the storage as well as the voiding phase were found. Morphological lower urinary tract abnormalities were common. Show more

Keywords: Critical illness polyneuropathy, urinary bladder, neurogenic, detrusor overactivity, urinary incontinence, urinary retention

DOI: 10.3233/NRE-130963

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 329-336, 2013

Authors: Paker, Nurdan | Bugdayci, Derya | Midik, Melike | Celik, Berna | Kesiktas, Nur

Article Type: Research Article

Abstract: Background: Emotional problems are common in spinal cord injury (SCI). Self report questionnaires are easy and useful for screening the emotional status in clinical practice. Objectives: The aim of this study was to assess the reliability of the Turkish version of the Hospital Anxiety and Depression Scale (HADS) as well as to investigate the frequency of anxiety and depression in a group with SCI admitted to the outpatient clinic of a rehabilitation hospital. Methods: One hundred seventy-five persons with traumatic SCI were included in this study. The American Spinal Injury Association Impairment Scale, Functional Independence Measure …(FIM) and HADS were used for assessments. Results: The mean age of the participants was 35 ± 13 years, and the mean time elapsed since injury was 13 ± 29 months. The mean motor FIM score was 41 ± 21. The Cronbach's alpha coefficient was 0.90 and 0.77 for the anxiety and depression subscales of the HADS, respectively. Forty percent of the participants had anxiety and 28% had depression. Anxiety was positively correlated with time since injury (r = 0.2). Depression was negatively correlated with the education level (r = 0.25), and positively correlated with age (r = 0.17). There was a positive correlation with completeness and anxiety and depression (r = 0.49, r = 0.55). Conclusion: The Turkish version of the HADS is a reliable psychological screening test for anxiety and depression in people with SCI. Rehabilitation team should gather maximum information about the emotional status of the person with SCI, and plan the appropriate treatment for anxiety and depression. Show more

Keywords: Anxiety, depression, hospital anxiety and depression scale, reliability, spinal cord injury

DOI: 10.3233/NRE-130964

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 337-341, 2013

Authors: Block, Cady | Cianfrini, Leanne

Article Type: Research Article

Abstract: Background: The pervasive disease of chronic pain is a common challenge for the clinical rehabilitation professional. Concurrent with physical and emotional symptoms, pain-related cognitive impairment has been reported. Although opioid analgesics are frequently prescribed, concern exists that opioids possess adverse cognitive effects of their own. Objectives: To review the neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population, and to provide recommendations for clinical practice and future research. Methods: This non-systematic review sought to provide a comprehensive synthesis of relevant neurobiology, …neuroimaging, neuropsychological, and rehabilitation research literatures. We included citations from seminal and current texts as well as relevant original and review articles from 1980–2012 in PubMed and PubMedCentral online research databases. Discussion and summary/conclusions: To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations. Show more

Keywords: Pain, chronic, analgesics, opioid, cognition, neuropsychology, automobile driving

DOI: 10.3233/NRE-130965

Citation: NeuroRehabilitation, vol. 33, no. 2, pp. 343-366, 2013