NeuroRehabilitation - Volume 34, issue 1

Authors: Becker, Frank | Kirmess, Melanie | Tornås, Sveinung | Løvstad, Marianne

Article Type: Research Article

Abstract: Background: Measures of cognitive rehabilitation should include comprehensive holistic rehabilitation as well as interventions targeting specific cognitive functions; it is however not clear how this knowledge should be put into practice. Objective: To describe services provided at the cognitive rehabilitation unit at Sunnaas Rehabilitation Hospital (SRH), a regional rehabilitation centre in Norway. Methods: Cognitive rehabilitation programs offered at SRH are described. For all patients served in 2011 and 2012, epidemiological and hospitalization related data were retrieved. Results from a patient satisfaction survey are presented. Results: The services include individual holistic cognitive rehabilitation as well …as group programs. 307 individual patients were served in 355 hospitalizations; 68.1% were male; age ranged from 18 to 78 years. The largest patient groups were stroke (46.6%) and traumatic brain injury (33.0%). Mean length of stay was 36.9 days. Median time post injury was 0.8 years (range 16 days – 14 years). More than 90% of the patients were satisfied with the services they received to a large or very large extent. Conclusions: Providing cognitive rehabilitation that encompasses both a holistic approach and targets specific cognitive functions is challenging. More research is warranted to illuminate further how cognitive rehabilitation services should be designed and conducted in practice. Show more

Keywords: Cognitive rehabilitation, stroke, traumatic brain injury

DOI: 10.3233/NRE-131015

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 87-100, 2014

Authors: Devan, Bryan D. | Pistell, Paul J. | Duffy, Kara B. | Kelley-Bell, Bennett | Spangler, Edward L. | Ingram, Donald K.

Article Type: Research Article

Abstract: Background: Previous studies have shown that cyclic nucleotide phosphodiesterase type 5 (PDE5) inhibition with the drugs sildenafil and vardenafil can enhance spatial performance and object recognition in rodent models of learning and memory. Objective: We review recent studies on PDE5 inhibition and report novel data that specifically tests the systemic effects of both pharmacological agents in aged rats using two different spatial learning/memory paradigms. Methods: The 14-unit T-maze was used as a test of egocentric spatial processing that requires rats to learn a series of left/right turns to avoid mild footshock. The Morris water maze is …a test of allocentric spatial learning that requires the acquisition of place information to localize a hidden platform relative to distal room cues. Results: In both cases, acquisition (i.e., learning performance) was not improved, however after a one week drug washout period, aged animals demonstrated improved spatial memory retention compared to aged controls, ruling out simple performance effects. Conclusions: These findings are discussed in relation to recent reports on the use of PDE inhibitors to treat Alzheimer's disease (AD) dementia and age-related memory impairments. While some report promising pre-clinical results, others note that PDE5 may not be an appropriate target in AD due to a lack of localization within critical brain structures where therapeutic activity is needed. Despite these limitations, PDE5 inhibition may produce beneficial effects via several mechanisms that target predisposing risk factors leading to increased incidence of memory impairment in aged individuals and influence memory consolidation mechanisms that preserve long-term retention of cognitive information. Show more

Keywords: Alzheimer's disease, animal models, phosphodiesterase inhibition, cognitive enhancement

DOI: 10.3233/NRE-131022

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 101-111, 2014

Authors: Paolucci, Teresa | Morone, Giovanni | Fusco, Augusto | Giuliani, Marco | Rosati, Elisa | Zangrando, Federico | Saraceni, Vincenzo Maria | Paolucci, Stefano | Iosa, Marco

Article Type: Research Article

Abstract: Background: Subjects affected by Parkinson's disease have substantially impaired static and dynamic balance, leading to diminished functional ability. Conventional and innovative exercises have been suggested, but most of them were focused on motor features of posture and gait, deserving poor attention to perceptive aspects of balance. Objective: To evaluate the efficacy of the perceptive rehabilitation, based on perceptual surfaces, for postural balance (primary aim) and pain, depression and activity daily living. Methods: In this pilot study, we have treated 9 patients with Parkinson's disease undergone rehabilitation aiming to restoring their correct body midline perception, according a …schema treatment – no treatment – treatment. Results: During the rehabilitative intervention, both Tinetti balance score (p = 0.007 in both phases) and Tinetti gait score (p = 0.011 and p = 0.016, respectively), such as pain relief assessed by Visual Analogue Scale (p = 0.011, p = 0.010) were improved. Conversely in the phase of no-intervention, lasting the same amount of time, it was showed a significant reduction of Tinetti Balance score (p = 0.010) and no significant changes in terms of Tinetti Gait score and Visual Analogue Scale. Conclusions: These preliminary results highlighted the importance of introducing perceptive training into the exercises proposed to patients with Parkinson's disease for reducing both their static and dynamic balance impairments. Show more

Keywords: Perceptive Rehabilitation, balance, trunk midline, motor outcomes, low back pain

DOI: 10.3233/NRE-131024

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 113-120, 2014

Authors: Ferrucci, Roberta | Vergari, Maurizio | Cogiamanian, Filippo | Bocci, Tommaso | Ciocca, Matteo | Tomasini, Emanuele | De Riz, Milena | Scarpini, Elio | Priori, Alberto

Article Type: Research Article

Abstract: Background: The debilitating fatigue that patients with multiple sclerosis (MS) commonly experience during day-to-day living activities responds poorly to current therapeutic options. Direct currents (DC) delivered through the scalp (transcranial DC stimulation or tDCS) at weak intensities induce changes in motor cortical excitability that persist for almost an hour after current offset and depend on current polarity. tDCS successfully modulates cortical excitability in various clinical disorders but no information is available for MS related fatigue. Objective: In this study we aimed to assess fatigue symptom after five consecutive sessions of anodal tDCS applied over the motor cortex in …patients with MS. Methods: We enrolled 25 patients with MS all of whom experienced fatigue. We delivered anodal and sham tDCS in random order in two separate experimental sessions at least 1 month apart. The stimulating current was delivered for 15 minutes once a day for 5 consecutive days. In each session the Fatigue Impact Scale (FIS) and the Back Depression Inventory (BDI) were administered before the treatment (baseline), immediately after treatment on day five (T1), one week (T2) and three weeks (T3) after the last tDCS session. Results: All patients tolerated tDCS well without adverse events. The fatigue score significantly decreased after anodal tDCS in 65% of the patients (responders). After patients received tDCS for 5 days their FIS scores improved by about 30% and the tDCS-induced benefits persisted at T2 and T3. Conclusion: Our preliminary findings suggest that anodal tDCS applied over the motor cortex, could improve fatigue in most patients with MS. Show more

Keywords: Multiple sclerosis, fatigue, tDCS, treatments, motor cortex

DOI: 10.3233/NRE-131019

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 121-127, 2014

Authors: Thiagarajan, Preethi | Ciuffreda, Kenneth J. | Capo-Aponte, Jose E. | Ludlam, Diana P. | Kapoor, Neera

Article Type: Research Article

Abstract: Background: Considering the extensive neural network of the oculomotor subsystems, traumatic brain injury (TBI) could affect oculomotor control and related reading dysfunction. Objective: To evaluate comprehensively the effect of oculomotor-based vision rehabilitation (OBVR) in individuals with mTBI. Methods: Twelve subjects with mTBI participated in a cross-over, interventional study involving oculomotor training (OMT) and sham training (ST). Each training was performed for 6 weeks, 2 sessions a week. During each training session, all three oculomotor subsystems (vergence/accommodation/version) were trained in a randomized order across sessions. All laboratory and clinical parameters were determined before and after OMT and …ST. In addition, nearvision-related symptoms using the Convergence Insufficiency Symptom Survey (CISS) scale and subjective visual attention using the Visual Search and Attention Test (VSAT) were assessed. Results: Following the OMT, over 80% of the abnormal parameters significantly improved. Reading rate, along with the amplitudes of vergence and accommodation, improved markedly. Saccadic eye movements demonstrated enhanced rhythmicity and accuracy. The improved reading-related oculomotor behavior was reflected in reduced symptoms and increased visual attention. None of the parameters changed with ST. Conclusions: OBVR had a strong positive effect on oculomotor control, reading rate, and overall reading ability. This oculomotor learning effect suggests considerable residual neuroplasticity following mTBI. Show more

Keywords: Traumatic brain injury, mTBI, reading dysfunction, oculomotor deficiency, nearvision symptoms, oculomotor rehabilitation, neuroplasticity, oculomotor learning, eye movements

DOI: 10.3233/NRE-131025

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 129-146, 2014

Authors: Chong, Hyun Ju | Cho, Sung-Rae | Kim, Soo Ji

Article Type: Research Article

Abstract: Background: As a sequential, programmed movement of fingers, keyboard playing is a promising technique for inducing execution and a high level of coordination during finger movements. Also, keyboard playing can be physically and emotionally rewarding for adolescents in rehabilitation settings and thereby motivate continued involvement in treatment. Objective: The purpose of this study is to evaluate the effects of keyboard playing using Musical Instrument Digital Interface (MIDI) on finger movement for adolescents with brain damage. Methods: Eight adolescents with brain damage, ages 9 to 18 years (M = 13 years, SD = 2.78), in physical rehabilitation …settings participated in this study. Measurements included MIDI keyboard playing for pressing force of the fingers and hand function tests (Grip and Pinch Power Test, Box and Block Test of Manual Dexterity [BBT], and the Jebsen Taylor Hand Function Test). Results: Results showed increased velocity of all fingers on the MIDI-based test, and statistical significance was found in the velocity of F2 (index finger), F3 (middle finger), and F5 (little finger) between pre- and post-training tests. Correlation analysis between the pressing force of the finger and hand function tests showed a strong positive correlation between the measure of grip power and the pressing force of F2 and F5 on the Grip and Pinch Strength Test. All fingers showed strong correlation between MIDI results and BBT. For the Jebsen Taylor Hand Function Test, only the moving light objects task at post-training yielded strong correlation with MIDI results of all fingers. Conclusions: The results support using keyboard playing for hand rehabilitation, especially in the pressing force of individual finger sequential movements. Further investigation is needed to define the feasibility of the MIDI program for valid hand rehabilitation for people with brain damage. Show more

Keywords: Keyboard playing, MIDI, hand rehabilitation, adolescents, brain damage

DOI: 10.3233/NRE-131026

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 147-155, 2014

Authors: Fleming, Jennifer | Liddle, Jacki | Nalder, Emily | Weir, Nicole | Cornwell, Petrea

Article Type: Research Article

Abstract: Background: Return to driving is a goal and milestone in the recovery process following acquired brain injury (ABI). Knowledge of whether and when a person is likely to return to driving is important to people with ABI, family members and clinicians. Objective: To determine the rates, timing, correlates, and predictors of return to driving in the first 6 months after discharge from hospital following ABI. Methods: Survey of 212 participants with ABI and 121 family members at discharge and 3 and 6 months later. Participants with ABI were grouped according to driving status (not driving, returned …within 3 months, returned within 6 months). Groups were compared on demographics, injury severity, quality of life, functioning, psychosocial integration, depression, and carer well-being. Results: By 6 months post-discharge 62.3% had resumed driving. Between group differences existed on measures of injury severity, and psychosocial integration at 6 months, and carer depression and strain at discharge and 6 months. Whether and when someone returned to driving could be predicted by length of hospital stay, and level of community integration, and pain at discharge. Conclusions: Educating clients about their likelihood and timing of return to driving, and supporting non-drivers and their carers may improve psychosocial outcomes. Show more

Keywords: Community integration, rehabilitation, longitudinal studies, brain injuries, traumatic, automobile driving

DOI: 10.3233/NRE-131012

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 157-166, 2014

Authors: Leibach, Gillian G. | Trapp, Stephen K. | Perrin, Paul B. | Everhart, Robin S. | Cabrera, Teresita Villaseñor | Jimenez-Maldonado, Miriam | Arango-Lasprilla, Juan Carlos

Article Type: Research Article

Abstract: Background: Traumatic brain injury (TBI) is a leading cause of death in Mexico, and Mexican TBI caregivers have been shown to experience significant mental health problems and high levels of family needs. Objective: This study investigated the associations between family needs and Mexican TBI caregiver mental health. Methods: Ninety TBI caregivers from Guadalajara, Mexico completed measures assessing their own mental health (depression, anxiety, burden, satisfaction with life, and self-esteem) and family needs (physical health, informational, financial, social support, and household). Results: Family health needs were uniquely associated with all indices of caregiver mental health, …and household needs were uniquely associated with caregiver depression, burden, and anxiety. Additionally, social support needs were related to caregiver satisfaction with life, informational needs to burden, and financial needs to self-esteem. Conclusions: Interventions for TBI caregivers in Mexico—and likely in other global regions with high levels of familism—should include an emphasis on overall family health, the delineation of family roles regarding household responsibilities, the improvement of social support networks and the social presence of family members, and the provision of complete and relevant information regarding TBI. When these needs are more comprehensively met, caregiver mental health will likely improve. Show more

Keywords: TBI caregivers, Latin America, mental health, family needs

DOI: 10.3233/NRE-131013

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 167-175, 2014

Authors: Naghdi, Soofia | Ansari, Noureddin Nakhostin | Abolhasani, Hamid | Mansouri, Korosh | Ghotbi, Nastaran | Hasson, Scott

Article Type: Research Article

Abstract: Background: Spasticity is a common impairment following upper motor neuron lesions such as stroke. The appropriate measurement of muscle spasticity using validated tools to evaluate the outcome of therapies is important in clinical and research settings. Objective: To determine the concurrent criterion-related validity of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor muscle spasticity based on its correlation with H-reflex tests. Methods: A total of 20 adult patients poststroke underwent clinical and electrophysiological assessment of wrist flexor muscle spasticity on the affected side. The primary outcome measures were: R2−R1 of the MTS; and the …H-reflex indices of Hmax /Mmax ratio and Hslp /Mslp ratio. The Hslp and the latency of H-reflex were also measured. Results: Correlations tests did not reveal significant associations between the clinical and H-reflex tests. Conclusions: This study suggests that the MTS may not be a valid tool to evaluate muscle spasticity in this sample of patients after stroke. Show more

Keywords: Stroke, spasticity, Modified Tardieu Scale, H-reflex, validity

DOI: 10.3233/NRE-131016

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 177-184, 2014

Authors: Cioncoloni, David | Taddei, Sabrina | Bielli, Silvia | Annunziata, Pasquale | Mazzocchio, Riccardo

Article Type: Research Article

Abstract: Background: Botulinum neurotoxin A (BoNT-A) may reduce lower limb spasticity but its role in improving walking ability remains to be established. Objective: To investigate the efficacy of simultaneous BoNT-A injections into several targeted spastic muscles of different joints on gait speed and on functional gains in gait performance in chronic stroke and MS patients. Methods: Twenty patients affected by stroke or multiple sclerosis were tested before, one and three months after BoNT-A administration. Gait was evaluated by the 10 Meter Walk Test; patients were stratified into functional ambulation classes accordingly. Spasticity was assessed using the modified …Ashworth Scale. Results: At final assessment, spasticity was reduced in hip adductors and ankle plantar-flexors, gait speed improved and, 1/3rd of patients transitioned to a higher ambulation class. The pre-post difference in Level of Spasticity of the hips was a predictor for an increase in gait speed. Conclusions: A meaningful improvement in walking performance can be obtained in chronic spastic patients after BoNT-A injection into several muscles, specifically the hip adductors. Show more

Keywords: Botulinum Neurotoxin A, BoNT-A, spasticity, gait

DOI: 10.3233/NRE-131021

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 185-192, 2014