NeuroRehabilitation - Volume 34, issue 3

Authors: Caglar, Nil Sayiner | Akin, Turkan | Erdem, Ibrahim Halil | Ozgonenel, Levent | Aytekin, Ebru | Tutun, Sule | Akar, Nezihe | Aysar, Ozcan

Article Type: Research Article

Abstract: Background: Stroke is acute vascular deterioration of cerebral functions and 2nd leading cause of death. As population gets older, as well as the increasing prevalence of stroke and disability from chronic disease, the demand for rehabilitation care will continue to rise. There is need for evidence based rehabilitation approaches and rehabilitation outcomes should be proved by objective questionnairres to qualify the process. Objective: To present the functional outcomes of stroke rehabilitation process among functional impairment measure evaluation. Determine the contributing factors on functional gain. Material-methods: Retrospectively assessment of data of 142 posttroke patients performed. In addition …to demographical and clinical properties, functional outcomes with functional impairment measurement (FIM) and motor evaluation by Brunnstrom Motricitiy Index were recorded. Risk factors for stroke were questionned also. Results: The mean of ages was 64.30 ± 11.9 years, male/female ratios were 47.2%/ 52.8%. The functional gain was 20.4% in M-FIM, 14.7% in C-FIM. Better outcomes gained by the patients who stayed longer than 15 days (ANOVA, p: 0.000) and who had hemorrhagic etiology (MannWhitney U, p: 0.048), meanwhile there was no significant difference in gender and plegic side groups on both Motor-FIM and Cognitive-FIM gains (p > 0.05, MannWhitney U). Regression models exhibited highest impact on the M-FIM gain were the admission M-FIM scores and DM (adjusted Rsquare: 0.173, p: 0.000). Admission C-FIM scores had positive correlation with discharge C-FIM scores (r: 0.917, p: 0.000). Although older age was the negative determinant of C-FIM gain (r: −0.202, p: 0.016). We obtained the risk factor distribution 71.8% for HT, 29.6% for CAD, 25.6% for smoking, 16.2% for TIA and 33.1% for DM. All had negative impact on functional outcomes but DM had significantly (regression analysis p < 0.05). Conclusion: Improvement by rehabilitation programme determined by FIM scores. Data provided about the poststroke patients and present risk factors. Still there exists similar ratios of risk factors as studies before eventhough prevention recommendations. Show more

Keywords: Stroke, rehabilitation, functional independence measure

DOI: 10.3233/NRE-141060

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 391-399, 2014

Authors: Boss, H.M. | Van Schaik, S.M. | Deijle, I.A. | de Melker, E.C. | van den Berg, B.T.J. | Scherder, E.J.A. | Bosboom, W.M.J. | Weinstein, H.C. | Van den Berg-Vos, R.M.

Article Type: Research Article

Abstract: Background: Despite the beneficial effect of cardiac rehabilitation after myocardial infarction, a rehabilitation program to improve cardiorespiratory fitness and influence secondary prevention has not been implemented for ischemic stroke and transient ischemic attack (TIA). Objective: To investigate the safety and feasibility of a post-stroke care including an exercise program after minor ischemic stroke or TIA. Methods: In a randomised controlled trial, 20 patients with a recent minor stroke or TIA without cardiac contraindications were randomly assigned to one of the two interventions; post-stroke care without exercise or post-stroke care with exercise. Patients were evaluated at baseline, …6 and 12 months. Results: Eighteen patients completed the intervention. In none of the patients cardiopulmonary contraindications for the maximal exercise test and exercise program were found. No cardiovascular events occurred during the maximal exercise tests and exercise program. After one year, significantly more patients in the post-stroke care with exercise group achieved the composite endpoint of optimal medical therapy. Conclusions: Post-stroke care including an exercise program is safe and feasible in the acute phase after minor stroke or TIA and might be a way to increase effectiveness of secondary stroke prevention. We are currently conducting a larger trial to validate these results. Show more

Keywords: Ischemic stroke, TIA, secondary prevention, physical exercise

DOI: 10.3233/NRE-141049

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 401-407, 2014

Authors: Broetz, Doris | Del Grosso, Nicholas A. | Rea, Massimiliano | Ramos-Murguialday, Ander | Soekadar, Surjo R. | Birbaumer, Niels

Article Type: Research Article

Abstract: Background: Standard assessment instruments cannot differentiate patients with minimal residual hand function after stroke. As a result, changes in motor recovery are difficult to document using currently-available tests. In a controlled study with chronic stroke patients without residual finger extension, a new hand function test has been developed. This instrument, called Broetz Hand Test (BzH), allows to assess small variations in hand function in severely paralyzed stoke patients. The instrument is easy to use, and was developed using principles of motor learning and behavioral assessment. Methods: The instrument consists of seven daily life-oriented tasks, each of which asks …for movement of the paralyzed hand. BzH of 20 patients after stroke was evaluated before and after a behavioral physiotherapy treatment. Sensitivity, inter-observer reliability, test-retest reliability and construct validity was calculated. Results: Two-tailed paired-samples t-test before and after treatment demonstrated sufficient sensitivity. Mean agreement between the raters resulted in an excellent interrater-reliability. Test-retest reliability between the pre- and post-treatment scores was 0.9. The correlation between BzH and standard test scores was statistically significant and demonstrated sufficient validity. Conclusion: The BzH is a valid and reliable tool to assess changes in hand function in severely paralyzed patients after stroke. Show more

Keywords: Stroke, assessment, hand function, physiotherapy, rehabilitation

DOI: 10.3233/NRE-141063

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 409-427, 2014

Authors: Kim, Yushin | Kim, Woo-Sub | Yoon, BumChul

Article Type: Research Article

Abstract: Background: The stroke patients have difficulties in both voluntary muscle contraction and individual movements. However, there is a lack of quantitative analysis focusing on decreased finger control in stroke patients. Objectives: The purpose of the study was to identify the changes in motor selectivity in stroke patients during a finger force production task. Methods: Fifteen stroke patients and fifteen control subjects were asked to perform maximum voluntary force (MVF) production during single- and multi-finger force tasks. Finger interaction indices such as force independence (FI) and force sharing deviation (FSD) were analyzed using measured individual finger forces. …Results: MVF analysis in the impaired hand of stroke patients showed that they produced 31% or 41% lower force than their unimpaired hand or the control hand, respectively. For the finger interaction indices, the stroke patients' impaired hand had lower FI and higher FSD than their unimpaired hand or the normal subjects' hand. Conclusion: The lower FI and higher FSD show that stroke patients have a limited ability to produce force independently and to synchronize produced multi-finger force, respectively. These results have a negative impact on the selectivity of their motor control. In terms of rehabilitation, we expect that the finger interaction indices used in the present study can quantify motor selectivity in the damaged central nervous system. Show more

Keywords: Selectivity, stroke, hand, finger, control, motor

DOI: 10.3233/NRE-141050

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 429-435, 2014

Authors: Viana, R.T. | Laurentino, G.E.C. | Souza, R.J.P. | Fonseca, J.B. | Silva Filho, E.M. | Dias, S.N. | Teixeira-Salmela, L.F. | Monte-Silva, K.K.

Article Type: Research Article

Abstract: Background: Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies. Objective: This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals. Methods: Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham …tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data. Results: Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID. Conclusions: These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further. Show more

Keywords: Virtual reality therapy, non-invasive brain stimulation, transcranial stimulation, rehabilitation, stroke, wii gaming system

DOI: 10.3233/NRE-141065

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 437-446, 2014

Authors: Erdoğan Uçar, Demet | Paker, Nurdan | Buğdaycı, Derya

Article Type: Research Article

Abstract: Background: Treadmill training with partial body weight support has been suggested as a useful strategy for gait rehabilitation after stroke. Objectives: This prospective, randomized, controlled study of gait training tested the feasibility and potential efficacy of using a robotic-assisted gait device, Lokomat, for treadmill training with partial body weight support in subjects with chronic hemiplegia; the device was also compared with conventional home exercise. Methods: Twenty-two male ambulatory ischemic or hemorrhagic induced stroke patients with chronic hemiplegia lasting at least 12 months were enrolled in this prospective study. The patients were assigned to either the Lokomat …group or the conventional exercise group. The Lokomat group underwent active robotic training for ten sessions (five sessions per week for two weeks). Each session lasted 30 minutes. If a patient missed three consecutive training sessions, he was removed from the study. The Timed Up and Go Test is used to assess mobility and requires both static and dynamic balance. The 10-m Timed Walking Speed Test is designed to determine the patient's overground walking speed. The Mini-Mental State Examination and Hospital Anxiety and Depression Scale were used for mental and psychological evaluation; the Functional Ambulation Categories was used to assess ambulatory status. Results: Within each eight-week interval, the patients undergoing the Lokomat training demonstrated significantly greater improvement on the Timed Up and Go Test and 10-m Timed Walking Speed Test than those undergoing conventional training. Conclusion: Despite the small number of patients in the study, the present data suggests that the robotic-assisted device, Lokomat, provides innovative possibilities for gait training in chronic hemiplegia rehabilitation by training at higher intensity levels for longer durations than traditional home exercise. Show more

Keywords: Rehabilitation, lokomat, hemiplegia, gait training

DOI: 10.3233/NRE-141054

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 447-453, 2014

Authors: Ojagbemi, Akin | Akinyemi, Rufus | Baiyewu, Olusegun

Article Type: Research Article

Abstract: Background: The frequency and predictors of post-stroke depression diagnosed according to codified criteria remain unknown in Nigeria. Objectives: We report on the predictors of post-stroke major depressive disorder (MDD) in Nigeria using standardized assessment methods. Method: Using a case-control design, we consecutively recruited 260 participants. Among them were 130 stroke survivors attending rehabilitation. Along with historical details, an exploration for MDD meeting criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders was carried out using a semi-structured interview. Cognition was assessed using both the Mini Mental State Examination and the modified …Indiana University Token test, while disability was assessed using the modified Rankin Scale. Associations were explored using univariate and multivariate analyses. Results: The diagnosis of MDD was more frequently present in the stroke survivors (41.5%, p < 0.001). It was strongly associated with female gender (p < 0.001, O.R = 3.77, 95% C.I = 1.78–8.00), disability (p = 0.001, O.R = 3.27, 95% C.I = 1.57–6.83), and cognitive dysfunction (p < 0.001, O.R = 5.28, 95% C.I = 2.25–12.41). Female gender (p = 0.037, O.R = 2.65, 95% C.I = 1.06–6.62) and cognitive dysfunction (P = 0.03, O.R = 4.58, 95% C.I = 1.68–12.46) were independent predictors of post-stroke MDD. Conclusion: Post stroke MDD is common in Nigerian survivors attending rehabilitation. The high rates reported in this population may be the result of factors affecting the efficient management of stroke in developing countries. Show more

Keywords: Stroke, survivors, depression, DSM IV, rehabilitation, disability, cognition

DOI: 10.3233/NRE-141061

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 455-461, 2014

Authors: Pagliarin, Karina Carlesso | Ortiz, Karin Zazo | de Mattos Pimenta Parente, Maria Alice | Arteche, Adriane | Joanette, Yves | Nespoulous, Jean-Luc | Fonseca, Rochele Paz

Article Type: Research Article

Abstract: Background: In Brazil, no standardized instruments are available to assess language in patients with aphasia. Objective: The aim of the current study was to search for reliability and validity evidence for the Montreal-Toulouse Language Assessment Battery (MTL-BR). Methods: The sample was composed of 537 adults, of whom 463 were healthy individuals and 74 had neurological lesions (25 participants had right hemisphere brain damage, 21 had left hemisphere damage (LHD) with aphasia and 28 had LHD without aphasia). Reliability was assessed by internal consistency (Cronbach's alpha) and test-retest analyses. Test-retest reliability was calculated using the Pearson correlation …coefficient, and a repeated measures analysis of variance, with years of education as a covariate. Construct validity was verified by correlations between scores in MTL-BR subtest and similar tasks from other language assessment instruments. Results: Internal consistency was satisfactory (Cronbach's alpha between 0.79 and 0.90), as were correlations between test and retest scores (mean 0.52), and between the MTL-BR and scores in similar instruments. Conclusions: The present results suggested that the MTL-BR battery had adequate reliability and validity as a method for diagnosing and monitoring aphasia. Show more

Keywords: Language, assessment, test validity, adults

DOI: 10.3233/NRE-141057

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 463-471, 2014

Authors: Bin Ayaz, Saeed | Ikram, Muhammad | Matee, Sumeera | Ahmad, Khalil

Article Type: Case Report

Abstract: Objective: To report an unusual case of cervical spinal cord injury. Study design: Case report of a 23 year old soldier who sustained spinal cord injury in front rolls during a military training program. Settings: Spinal Cord Injuries Unit, Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan. Case report: A 23 year old soldier, who voluntarily joined a military training program, suffered spinal cord injury in doing front rolls resulting in tetraplegia and incontinence for bowel and bladder corresponding to the injury level of C5 ASIA Impairment Scale C with Functional Independence …Measure Score of 40/126. His Magnetic Resonance Imaging showed posterior displacement of CV3 resulting in cord compression and swelling at CV3 and CV4 levels. He was managed conservatively by comprehensive rehabilitation and improved to spinal cord injury C5 ASIA Impairment Scale D with Functional Independence Measure Score of 76/126. Conclusion: This case report describes spinal cord injury secondary to front-rolls. As front-rolls are part and parcel of military training, awareness and coaching to ensure safety must be exercised from the beginning of any training program. Show more

Keywords: Cervical spinal cord injury, military training, tetraplegia, Pakistan

DOI: 10.3233/NRE-141064

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 473-477, 2014

Authors: Jantz, Paul B. | Bigler, Erin D.

Article Type: Research Article

Abstract: Advanced neuroimaging contributes to a greater understanding of brain pathology following a traumatic brain injury (TBI) and has the ability to guide neurorehabilitation decisions. When integrated with the school-based psychoeducational assessment of a child with a TBI, neuroimaging can provide a different perspective when interpreting educational and behavioral variables relevant to school-based neurorehabilitation. School psychologists conducting traditional psychoeducational assessments of children with TBI seldom obtain and integrate neuroimaging, despite its availability. This article presents contextual information on the medical assessment of TBI, major types of neuroimaging, and networks of the brain. A case study illustrates the value of incorporating neuroimaging …into the standard school-based psychoeducational evaluations of children with traumatic brain injury. Show more

Keywords: School psychologist, psychoeducational, TBI, neuroimaging, brain networks

DOI: 10.3233/NRE-141058

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 479-492, 2014