NeuroRehabilitation - Volume 33, issue 4

Article Type: Introduction

Abstract: International Conference on Recent Advances in Neurorehabilitation (ICRAN 2013) was held in Valencia, Spain. ICRAN 2013 focused on neuroimaging, robotics and virtual rehabilitation which was presented through conferences of the most well-known figures debates, oral communications and poster presentations. NeuroRehabilitation has included in this issue the leading posters that were presented at ICRAN 2013.

DOI: 10.3233/NRE-130988

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 503-503, 2013

Authors: Dores, A.R. | Almeida, I. | Barbosa, F. | Castelo-Branco, M. | Monteiro, L. | Reis, M. | de Sousa, L. | Caldas, A. Castro

Article Type: Research Article

Abstract: Background: Examining changes in brain activation linked with emotion-inducing stimuli is essential to the study of emotions. Due to the ecological potential of techniques such as virtual reality (VR), inspection of whether brain activation in response to emotional stimuli can be modulated by the three-dimensional (3D) properties of the images is important. Objective: The current study sought to test whether the activation of brain areas involved in the emotional processing of scenarios of different valences can be modulated by 3D. Therefore, the focus was made on the interaction effect between emotion-inducing stimuli of different emotional valences (pleasant, unpleasant …and neutral valences) and visualization types (2D, 3D). However, main effects were also analyzed. Methods: The effect of emotional valence and visualization types and their interaction were analyzed through a 3 × 2 repeated measures ANOVA. Post-hoc t-tests were performed under a ROI-analysis approach. Results: The results show increased brain activation for the 3D affective-inducing stimuli in comparison with the same stimuli in 2D scenarios, mostly in cortical and subcortical regions that are related to emotional processing, in addition to visual processing regions. Conclusions: This study has the potential of clarify brain mechanisms involved in the processing of emotional stimuli (scenarios' valence) and their interaction with three-dimensionality. Show more

Keywords: Emotional valence (pleasant, unpleasant, neutral), 3D/2D visual stimuli, functional Magnetic Resonance Imaging (fMRI)

DOI: 10.3233/NRE-130987

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 505-512, 2013

Authors: Luna-Oliva, Laura | Ortiz-Gutiérrez, Rosa María | Cano-de la Cuerda, Roberto | Piédrola, Rosa Martínez | Alguacil-Diego, Isabel M. | Sánchez-Camarero, Carlos | Martínez Culebras, María del Carmen

Article Type: Research Article

Abstract: Background: Limited evidence is available about the effectiveness of virtual reality using low cost commercial consoles for children with developmental delay. Objective: The aim of this preliminary study is to evaluate the usefulness of a videogame system based on non-immersive virtual reality technology (Xbox 360 KinectTM) to support conventional rehabilitation treatment of children with cerebral palsy. Secondarily, to objectify changes in psychomotor status of children with cerebral palsy after receiving rehabilitation treatment in addition with this last generation game console. Methods: 11 children with cerebral palsy were included the study. A baseline, a post-treatment and a …follow-up assessment were performed related to motor and the process skills, balance, gait speed, running and jumping and fine and manual finger dexterity. All the participants completed 8 weeks of videogame treatment, added to their conventional physiotherapy treatment, with Xbox 360 Kinect™ (Microsoft) game console. Results: The Friedman test showed significant differences among the three assessments for each variable: GMFM (p = 0.001), AMPS motor (p = 0.001), AMPS process (p = 0.010), PRT (p = 0.005) and 10 MW (p = 0.029). Wilcoxon test showed significant statistically differences pre and post-treatment, in all the values. Similarly, results revealed significant differences between basal and follow-up assessment. There were not statistical differences between post-treatment and follow-up evaluation, indicating a long-term maintenance of the improvements achieved after treatment. Conclusions: Low cost video games based on motion capture are potential tools in the rehabilitation context in children with CP. Our Kinect Xbox 360 protocol has showed improvements in balance and ADL in CP participants in a school environment, but further studies are need to validate the potential benefits of these video game systems as a supplement for rehabilitation of children with CP. Show more

Keywords: Cerebral palsy, child, rehabilitation, video games, virtual reality

DOI: 10.3233/NRE-131001

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 513-521, 2013

Authors: Merlo, A. | Longhi, M. | Giannotti, E. | Prati, P. | Giacobbi, M. | Ruscelli, E. | Mancini, A. | Ottaviani, M. | Montanari, L. | Mazzoli, D.

Article Type: Research Article

Abstract: Background: Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient's ability, but the temporal evolution of motion related to motor control is disregarded. Objective: To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function. Methods: Twenty-five healthy individuals performed the Armeo® Spring device “Vertical Capture” task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number …of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided. Results: 4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness. Conclusions: We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients. Show more

Keywords: Upper limb, robotic device, robotic rehabilitation, normative values, Armeo®Spring

DOI: 10.3233/NRE-130998

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 523-530, 2013

Authors: Bravo-Esteban, E. | Taylor, J. | Abián-Vicén, J. | Albu, S. | Simón-Martínez, C. | Torricelli, D. | Gómez-Soriano, J.

Article Type: Research Article

Abstract: Background: Although the spasticity syndrome is an important sensorimotor disorder, the impact of grade of lower limb muscle hypertonia, spasm and clonus activity on voluntary muscle function, gait and daily activities has not been systematically analysed during subacute and chronic spinal cord injury (SCI). Objective: To determine the prevalence of spasticity signs and symptoms during SCI, and to assess their impact on motor function and activities. Methods: A descriptive transverse study of sixty-six subjects with SCI was performed by assessing injury characteristics, spasticity (modified Ashworth scale, Penn scale, SCATS scale) and motor function (lower limb manual …muscle scores, WISCI II, spinal cord injury spasticity evaluation tool). Results: Most subjects with the spasticity syndrome presented lower limb hypertonia and spasms during both subacute and chronic SCI, interfering with daily life activities. Subjects with incomplete SCI and hypertonia revealed a loss of voluntary flexor muscle activity, while extensors spasms contributed strongly to loss of gait function. The Penn spasms scale no correlated with muscle function or gait. Conclusions: Specific diagnosis of spasm activity during subacute SCI, and its impact on lower limb voluntary muscle activity, gait function and daily activities, is required to develop a more effective neurorehabilitation treatment strategy. Show more

Keywords: Spinal cord injury, spasticity syndrome, hypertonia, spasms, flexor and extensor muscle, subacute and chronic spinal cord injury, spasticity severity, AIS, manual muscle score, WISCI II, SCI-SET, SCATS, penn scale, modified ashworth scale

DOI: 10.3233/NRE-131000

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 531-543, 2013

Authors: Ortiz Gutiérrez, Rosa | Galán del Río, Fernando | Cano de la Cuerda, Roberto | Alguacil-Diego, Isabel M. | Arroyo González, Rafael | Miangolarra Page, Juan Carlos

Article Type: Research Article

Abstract: Background: Balance and postural control (PC) disorders are frequent motor disorder symptoms associated with multiple sclerosis (MS). Objective: To demonstrate the potential improvements in balance and PC among patients with MS who complete a virtual reality telerehabilitation program that represents a feasible alternative to physical therapy for situations in which conventional treatment is not available. Methods: 50 patients was recruited. Control group (n = 25) received physiotherapy treatment twice a week (40 min per session). Experimental group (n = 25) received telerehabilitation treatment using the Xbox 360® console monitored via videoconference. Experimental group attended 40 …sessions, four sessions per week (20 min per session). The treatment schedule lasted 10 weeks for both groups. A computerised dynamic posturography and clinical outcomes (Berg Balance and Tinettti scales) were used at baseline and at the end of the treatment. Results: Results showed an improvement over general balance in both groups. Visual preference, the contribution of vestibular information, mean response time and Tinetti test yielded significant differences in the experimental group. An ANOVA revealed significant between-group post-treatment differences in the composite equilibrium score, Berg and Tinetti scales in the experimental group. Conclusion: We suggest that our virtual reality program enables anticipatory PC and response mechanisms and might serve as a successful therapeutic alternative in situations in which conventional therapy is not readily available. Show more

Keywords: Balance, multiple sclerosis, telerehabilitation, video games, virtual reality

DOI: 10.3233/NRE-130995

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 545-554, 2013

Authors: Straudi, S. | Benedetti, M.G. | Venturini, E. | Manca, M. | Foti, C. | Basaglia, N.

Article Type: Research Article

Abstract: Background: Gait disorders are common in multiple sclerosis (MS) and lead to a progressive reduction of function and quality of life. Objective: Test the effects of robot-assisted gait rehabilitation in MS subjects through a pilot randomized-controlled study. Methods: We enrolled MS subjects with Expanded Disability Status Scale scores within 4.5–6.5. The experimental group received 12 robot-assisted gait training sessions over 6 weeks. The control group received the same amount of conventional physiotherapy. Outcomes measures were both biomechanical assessment of gait, including kinematics and spatio-temporal parameters, and clinical test of walking endurance (six-minute walk test) and mobility …(Up and Go Test). Results: 16 subjects (n = 8 experimental group, n = 8 control group) were included in the final analysis. At baseline the two groups were similar in all variables, except for step length. Data showed walking endurance, as well as spatio-temporal gait parameters improvements after robot-assisted gait training. Pelvic antiversion and reduced hip extension during terminal stance ameliorated after aforementioned intervention. Conclusions: Robot-assisted gait training seems to be effective in increasing walking competency in MS subjects. Moreover, it could be helpful in restoring the kinematic of the hip and pelvis. Show more

Keywords: Rehabilitation, robot-driven gait orthosis, gait analysis, multiple sclerosis

DOI: 10.3233/NRE-130990

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 555-563, 2013

Authors: Kim, Jung-Hee | Lee, Byoung-Hee

Article Type: Research Article

Abstract: Objective: The objective of this study was to compare the effects of action observation training and motor imagery training on recovery from chronic stroke. Methods: Thirty patients who were more than six months post stroke participated in this study and were randomly allocated to three groups. The action observation training group practiced additional action observation training for five 30-minute sessions over a four-week period. The motor imagery training group practiced additional motor imagery training for five 30-minute sessions over a four-week period. The following clinical measures were used for assessment of dynamic balance and gait abilities: Timed Up …and Go Test, Functional Reaching Test, Walking Ability Questionnaire, and Functional Ambulation Category. Spatiotemporal gait parameters were also collected using a GAITRite system. Result: Compared with the physical training group, the action observation training group showed significant improvement in the Timed Up and Go test, gait speed, cadence, and single limb support of the affected side. No significant differences in any of the outcome measures were observed between the action observation training group and the motor imagery training group. Conclusion: Action observation training and motor imagery training results in improvement of dynamic balance and gait ability. These results suggest the feasibility and suitability of action observation training for patients with chronic stroke. Show more

Keywords: Stroke, action observation, mirror neuron, balance, gait

DOI: 10.3233/NRE-130991

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 565-574, 2013

Authors: Cabanas-Valdés, Rosa | Cuchi, Gerard Urrutia | Bagur-Calafat, Caritat

Article Type: Research Article

Abstract: Background: Trunk control has been identified as an important early predictor of functional outcome after stroke but there is insufficient evidence that proximal stability of the trunk is a pre-requisite for sitting and standing balance, walking, and functional activities. Objective: We systematically reviewed the literature on trunk training exercises (TTE) in adult patients with stroke. To establish if TTE can improve trunk performance and sitting balance. Methods: CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, REHABDATA Database, Scielo, Scopus, Web of Science, Trip Database, and Epistemonikos were searched and reference lists screened to identify randomised controlled trials (RCTs) of …trunk training exercises in stroke survivors. Two reviewers independently screened references, selected relevant studies, extracted data, and assessed trial quality. The primary outcomes were trunk performance and sitting balance. Due to the heterogeneity of included studies meta-analysis was not possible. Results: A total of 11 studies with 317 participants were analysed. Trunk training exercises showed a moderate evidence to improve trunk performance and dynamic sitting balance. Conclusions: Trunk training exercises, performed with either stable or unstable surface, could be a good rehabilitation strategy and might help improving trunk performance and dynamic sitting balance after stroke. Show more

Keywords: Exercise therapy, stroke, sitting balance, trunk, systematic review

DOI: 10.3233/NRE-130996

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 575-592, 2013

Authors: Wang, Jing | Fritzsch, Claire | Bernarding, Johannes | Krause, Thomas | Mauritz, Karl-Heinz | Brunetti, Maddalena | Dohle, Christian

Article Type: Research Article

Abstract: Background: Mirror therapy (MT) was found to improve motor function after stroke, but its neural mechanisms remain unclear, especially in single stroke patients. Objectives: The following imaging study was designed to compare brain activation patterns evoked by the mirror illusion in single stroke patients with normal subjects. Methods: Fifteen normal volunteers and five stroke patients with severe arm paresis were recruited. Cerebral activations during movement mirroring by means of a video chain were recorded with functional magnetic resonance imaging (fMRI). Single-subject analysis was performed using SPM 8. Results: For normal subjects, ten and thirteen …subjects displayed lateralized cerebral activations evoked by the mirror illusion while moving their right and left hand respectively. The magnitude of this effect in the precuneus contralateral to the seen hand was not dependent on movement speed or subjective experience. Negative correlation of activation strength with age was found for the right hand only. The activation pattern in stroke patients is comparable to that of normal subjects and present in four out of five patients. Conclusions: In summary, the mirror illusion can elicit cerebral activation contralateral to the perceived hand in the majority of single normal subjects, but not in all of them. This is similar even in stroke patients with severe hemiparesis. Show more

Keywords: Movement, mirror illusion, imaging, mirror therapy, stroke

DOI: 10.3233/NRE-130999

Citation: NeuroRehabilitation, vol. 33, no. 4, pp. 593-603, 2013