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

Authors: Ponfick, Matthias | Wiederer, Ralf | Bösl, Kathrin | Neumann, Günter | Lüdemann-Podubecka, Jitka | Gdynia, Hans-Jürgen | Nowak, Dennis A.

Article Type: Research Article

Abstract: Background: We investigated if longer weaning is associated with inferior rehabilitative outcome in critical illness polyneuropathy (CIP) and cerebrovascular diseases (CVD). Methods: We analysed retrospectively weaning protocols and medical histories of 171 tracheotomized patients with CIP and CVD. We assessed weaning durations (WD), independence in activities of daily living, as assessed by the functional independence measure (FIM), mortality rates and discharge modalities in each cohort. Weaning was performed using synchronized intermittent mandatory ventilation (SIMV) with Autoflow® and assisted spontaneous ventilation (ASV). Results: WD was significantly longer in CIP compared to CVD (p < 0.001). Despite …shorter in-patient treatment and longer WD, patients with CIP acquired significantly greater gains of improvement than CVD (p = 0.015). Independent living at home was possible in 43% of patients with CIP and in 26% of CVD. Mortality was equal in both groups (13% vs. 6%, p > 0.05). Chronic obstructive pulmonary disease (COPD) showed a trend towards longer weaning durations in both entities (p = 0.06). Higher age significantly correlated with longer WD (p = 0.038, r = 0.16). Longer rehabilitation duration (RD) positively correlated with higher Delta-FIM (DFIM) in both entities (p = 0.006, r = 0.21). Conclusion: Longer weaning and its partly negative influence on rehabilitative outcome can be compensated by longer in-patient rehabilitation in CIP and CVD. Show more

Keywords: Weaning, rehabilitation, critical illness polyneuropathy, stroke, functional independence measure, outcome

DOI: 10.3233/NRE-141066

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 493-498, 2014

Authors: Finch, Emma | Copland, David A.

Article Type: Research Article

Abstract: Background: Language function is susceptible to the effects of brain tumours during both the tumour growth phase and during neurosurgical resection. Aim: This paper aimed to systematically review existing literature to determine the current status of knowledge about language outcomes following neurosurgery. Methods: A systematic review was conducted involving a detailed literature search using online databases, quality assessment of relevant articles and data extraction. Results: Of the 1449 articles retrieved, nine articles satisfied the study criteria. Overall, these studies reported variable patterns of language function post-surgery, however, there was a trend towards an early …post-surgical decline in language function that greatly improved by 3 months. The likelihood of developing post-surgical communication impairments was influenced by a number of factors including pre-operative aphasia and the identification of sub-cortical language tracts inside the tumour margin, however, further research is required to fully elucidate pertinent predictors. Conclusion: These findings have implications for rehabilitation programs following brain tumour surgery and suggest that there are a number of key gaps warranting further investigation. Show more

Keywords: Brain tumour, aphasia, language, language impairment, neurosurgery, systematic review

DOI: 10.3233/NRE-141053

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 499-514, 2014

Authors: Intiso, Domenico | Simone, Valentina | Di Rienzo, Filomena | Iarossi, Andrea | Pazienza, Luigi | Santamato, Andrea | Maruzzi, Giuseppe | Basciani, Mario

Article Type: Research Article

Abstract: Background: Spasticity can be a severe disabling disorder requiring high-dose injections of botulinum toxin type A (BoNT-A). Efficacy and safety of high BoNT-A doses in reducing multi-level spasticity of subjects with brain injury and cerebral palsy were investigated. Pain and functional outcome were also assessed. Method: High doses (up to 840 IU) of incobotulinumtoxinA were injected in adult subjects with severe spasticity of the upper and lower limbs due to brain injury (BI) and cerebral palsy (CP). The Modified Ashworth Scale, Visual Analogue scale, Glasgow Outcome Scale, Franchay Arm Test (FAT) and Barthel Scale were employed to assess …spasticity, pain and functional outcome at baseline, and 4 and 16 weeks after BoNT-A injection. Results: Twenty-two (12 M, 10 F; mean age 38.1 ± 13.7 years) subjects – 16 subjects with BI and 6 with CP – were enrolled. Elbow, wrist, fingers and ankle muscles showed significant spasticity reduction after BoNT-A injections. The mean FAT score improved, but the benefit was not significant. Three (13.6%) subjects complained of mild adverse events. Conclusion: High-dose BoNT-A injections were effective and safe in reducing spasticity of BI and CP subjects. A significant reduction of the pain was also observed, but global functionality and arm dexterity were unchanged. Show more

Keywords: Botulinum toxin, efficacy, high dose, spasticity, brain injury, cerebral palsy

DOI: 10.3233/NRE-141052

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 515-522, 2014

Authors: Medina-Perez, Carlos | de Souza-Teixeira, Fernanda | Fernandez-Gonzalo, Rodrigo | de Paz-Fernandez, Jose Antonio

Article Type: Research Article

Abstract: Background: Although resistance training adaptations in multiple sclerosis (MS) patients have been described, the detraining response in this population is largely unknown. Objective: This study was designed to evaluate the effects of a 12-week detraining period on muscle strength (isometric and endurance) and muscle power of multiple sclerosis (MS) patients that had previously carried out a 12-week resistance training program (RTP). Methods: Forty-two MS patients were randomly assigned into two groups: an exercise group (EG) that performed a 12-week RTP for the knee extensors muscles; and a control group (CG), that did not perform any specific …training. Knee extension maximal voluntary isometric contraction (MVIC), muscle power and muscle endurance were evaluated before and after the RTP, as well as 12 weeks after training completion. A strain gauge was used to measure the maximal voluntary isometric contraction and muscle power was assessed with a linear encoder. Muscle endurance was interpreted as the number of repetitions that a patient could perform in a single set of knee extension exercise. Results: The EG increased MVIC and muscle power after the training period, although the training did not affect muscle endurance. After 12 weeks of detraining, MVIC returned to pre-training values but muscle power was still greater than pre-training values in the EG. The CG did not present any change in the variables measured during the intervention. Conclusions: A 12-week RTP improved MVIC and muscle power in MS patients. Additionally, 12 weeks of detraining blunted strength training adaptations in MS patients, although muscle power training adaptations were still evident after the detraining period. Show more

Keywords: Multiple sclerosis, exercise rehabilitation, progressive resistance training, detraining, muscle strength, muscle power, lower extremity

DOI: 10.3233/NRE-141062

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 523-530, 2014

Authors: Noyes, Katia | Bajorska, Alina | Wasserman, Erin B. | Weinstock-Guttman, Bianca | Mukamel, Dana

Article Type: Research Article

Abstract: Objectives: To assess patient characteristics and risk factors associated with care transitions between skilled nursing facility (SNF) and home care for patients with multiple sclerosis (MS) in an effort to improve outcomes and optimize patient care pathways. Background: MS is a chronic neurologic illness of younger adults that is associated with physical disability, cognitive impairment and a high need for supportive services. Methods: The study was based on the 2005 Nursing Home Minimum Data Set and the Outcome and Assessment Information Set data (n = 10,064). We performed multivariate evaluation of patient risk factors for skilled …nursing facility (SNF) admission and disposition while controlling for potential patient self-selection and other characteristics that affect care utilization. Results: MS patients with recent history of home care use were less likely to be admitted to an acute care hospital and had higher physical disability at SNF admission than SNF patients who did not use home care. Insurance type (Medicaid) and availability of informal caregivers were associated with the use of homecare services after a SNF stay, while patient demographic and clinical characteristics did not explain SNF disposition. Conclusions: Future studies should explore the association between the local availability and affordability of home-based services and physician attitude about community-based care management of disabled patients. Show more

Keywords: Multiple Sclerosis (MS), disability, cognitive impairment, home health care (HHC), Skilled nursing facility (SNF)

DOI: 10.3233/NRE-141056

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 531-540, 2014

Authors: Harro, C.C. | Shoemaker, M.J. | Frey, O. | Gamble, A.C. | Harring, K.B. | Karl, K.L. | McDonald, J.D. | Murray, C.J. | VanDyke, J.M. | Tomassi, E.M. | VanHaitsma, R.J.

Article Type: Research Article

Abstract: Objectives: The purpose of this single-blinded, randomized controlled study was to examine and compare the immediate and retention effects of progressive speed-dependent treadmill training (SDTT) and rhythmic auditory-cued (RAC) training on balance function, fall incidence, and quality of life (QOL) in individuals with PD. Methods: Twenty participants (mean age 66.1 yrs) with idiopathic PD were randomized into either SDTT (n = 10) or RAC (n = 10) progressive, interval-based locomotor training for 6 weeks. Measures included the Berg Balance Scale (BBS), Rapid Step-Up Test (RST), Activities-specific Balance Confidence Scale, Parkinson's Disease Questionnaire-39 (PDQ), and the NeuroCom Sensory Organization …Test (SOT), Motor Control Test, and Limits of Stability (LOS). Fall incidence was assessed prospectively post-training based on six monthly self-report fall calendars. Results: Significant gains in balance measures were observed post-training in BBS, RST and SOT for the RAC group and in RST, SOT and LOS for the SDTT group. Gains were retained at 3 months post-training in all measures for RAC group, but only the RST for the SDTT group. No clear trend in reduction in fall frequency was evident. Conclusion: Externally-cued locomotor training paradigms with progressive speed challenges produced significant improvements in dynamic balance function in persons with PD, with stronger retention of gains in RAC group. Show more

Keywords: Parkinson's disease, locomotor training, rehabilitation

DOI: 10.3233/NRE-141048

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 541-556, 2014

Authors: Harro, Cathy C. | Shoemaker, Michael J. | Frey, Oksana J. | Gamble, April C. | Harring, Kendra B. | Karl, Katherine L. | McDonald, Jeffrey D. | Murray, Carolyn J. | Tomassi, Erika M. | Van Dyke, Jasmine M. | VanHaistma, Rachel J.

Article Type: Research Article

Abstract: Objectives: The purpose of this randomized controlled study was to examine and compare the immediate and retention effects of speed-dependent treadmill training (SDTT) and rhythmic auditory-cued (RAC) overground walking on gait function and fall risk in individuals with Parkinson's disease (PD). Methods: Twenty participants (mean age 66.1 yrs) with idiopathic PD were randomized into either SDTT (n = 10) or RAC (n = 10) progressive, interval-based locomotor training protocols. Immediate and retention training effects on gait function and fall risk were measured by comfortable and fast gait speed (CGS, FGS), 6-Minute Walk Test (6MWT), and Functional Gait Assessment …(FGA). Results: Immediate within-group training effects revealed significant gains in CGS, 6MWT, and FGA for the RAC group, and in FGS, 6-MinuteWalk Test, and FGA for the SDTT group. Retention effects were found at 3-month follow-up for all gait measures in the RAC group, and for FGS and FGA in the SDTT group. No statistically significant differences in immediate or retention training effects on gait measures were found between groups. Conclusions: Externally-cued locomotor training with progressive and interval-based speed challenges, either with RAC overground or on a treadmill, produced significant improvements in walking speed, endurance, and dynamic balance during walking. Show more

Keywords: Parkinson's disease, locomotor training, rehabilitation

DOI: 10.3233/NRE-141051

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 557-572, 2014

Authors: Bertisch, Hilary | Rath, Joseph | Long, Coralynn | Ashman, Teresa | Rashid, Tayyab

Article Type: Research Article

Abstract: Background: The field of positive psychology has grown exponentially within the last decade. To date, however, there have been few empirical initiatives to clarify the constructs within positive psychology as they relate to rehabilitation medicine. Character strengths, and in particular resilience, following neurological trauma are clinically observable within rehabilitation settings, and greater knowledge of the way in which these factors relate to treatment variables may allow for enhanced treatment conceptualization and planning. Objective: The goal of this study was to explore the relationships between positive psychology constructs (character strengths, resilience, and positive mood) and rehabilitation-related variables (perceptions of …functional ability post-injury and beliefs about treatment) within a baseline data set, a six-month follow-up data set, and longitudinally across time points. Methods: Pearson correlations and supplementary multiple regression analyses were conducted within and across these time points from a starting sample of thirty-nine individuals with acquired brain injury (ABI) in an outpatient rehabilitation program. Results: Positive psychology constructs were related to rehabilitation-related variables within the baseline data set, within the follow-up data set, and longitudinally between baseline positive psychology variables and follow-up rehabilitation-related data. Conclusions: These preliminary findings support relationships between character strengths, resilience, and positive mood states with perceptions of functional ability and expectations of treatment, respectively, which are primary factors in treatment success and quality of life outcomes in rehabilitation medicine settings. The results suggest the need for more research in this area, with an ultimate goal of incorporating positive psychology constructs into rehabilitation conceptualization and treatment planning. Show more

Keywords: Rehabilitation, brain injury, positive psychology, resilience, function, positive psychotherapy inventory

DOI: 10.3233/NRE-141059

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 573-585, 2014

Authors: Hong, Seung Pyo | Park, HaeYean | Kwon, Jae-Sung | Yoo, Eunyoung

Article Type: Research Article

Abstract: Background: Eccentric viewing training can be successfully applied in the clinical setting based on positive evidence. Nonetheless, published research should be integrated to provide a conclusive perspective of the efficacy of eccentric viewing training. Objective: Meta-analysis was conducted to examine effectiveness of eccentric viewing training on daily visual activities for individuals with age-related macular degeneration (AMD). Methods: The papers used in this study were located through PubMed, Ovid, ProQuest, EBSCOhost, RISS, and KMbase on studies published between January, 1990 and December, 2012. The keywords for searching were “age-related macular degeneration” and “eccentric viewing”, “eccentric fixation”, “peripheral …vision” or “preferred retinal loci”. The effect sizes were calculated using Comprehensive Meta-Analysis 2.0 and interpreted according to Cohen's criteria. Results: A total of 258 studies were found, among which five papers suited the main selection criteria for final analysis. The entire effect size was 0.660 (95% CI, 0.232 ~ 1.088), indicating a moderate effect size of the eccentric viewing training for individuals with AMD in their daily visual activities (p < 0.05). Conclusions: The results of this study demonstrated the clinical effectiveness of eccentric viewing training for individuals with AMD. This result should be interpreted cautiously, though, given the possibility of publication bias. Show more

Keywords: Age-related macular degeneration, eccentric viewing training, meta-analysis, occupational therapy

DOI: 10.3233/NRE-141055

Citation: NeuroRehabilitation, vol. 34, no. 3, pp. 587-595, 2014