NeuroRehabilitation - Volume 34, issue 4

Authors: Feeney, Timothy J. | Achilich, Jason

Article Type: Research Article

Abstract: Background: A significant number of individuals with brain injury demonstrate behavioral challenges that negatively affect their ability to live successfully in community settings. While there are a number of treatment approaches that have demonstrable effects in well controlled clinical settings, it is very difficult to implement these approaches in natural settings. Objectives: The goal of this study was to report the results of an investigation of the effects of a multicomponent behavioral intervention on the challenging behavior of an adolescent and young adult with growing behavioral concerns after acquired brain injury (TBI). Methods: The participants were …an 16 year old adolescent male and a 24 year old female, with escalating behavior problems after severe TBI. Multiple baseline designs were used to document the effects of an intervention package that integrated cognitive and executive function intervention to address severe challenging behaviors in natural settings. The following dependent variables were used to establish the effectiveness of the interventions: frequency and intensity of aggressive behaviors and participation in scheduled activities. The intervention included integrated components of positive behavior supports, cognitive supports and specific executive function scripts. Results: These single subject experiments demonstrated the effectiveness of a multicomponent intervention on the reduction of the frequency of problem behaviors and the increase of pro-social behaviors. Conclusion: These two successful interventions extended the findings of previously published data for the successful treatment of behavioral challenges using a flexible support-oriented intervention that combines behavioral, cognitive, and executive function components. Show more

Keywords: Behavior disorders, neurorehabilitation, traumatic brain injury, positive behavior support, cognitive-behavioral intervention, functional assessment, context sensitive treatment, multi-component intervention

DOI: 10.3233/NRE-141088

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 709-723, 2014

Authors: Suzuki, Toshiaki | Bunno, Yoshibumi | Onigata, Chieko | Tani, Makiko | Uragami, Sayuri

Article Type: Research Article

Abstract: Background: No scientific basis exists for the effect of motor imagery with eyes open. Objective: To investigate spinal neural function during motor imagery and at rest with eyes open or closed by analyzing F-waves generated by the left thenar muscles after left median nerve stimulation. Methods: Sixteen healthy volunteers performed motor imagery while achieving 50% maximal voluntary contraction by isometrically contracting the opponens pollicis muscle. For subjective comparisons after the test, patients were asked whether imaging was easier with eyes open or closed and were then asked to imagine the contraction while holding the sensor between …thumb and index finger with eyes open or closed. Results: Persistence during motor imagery under both visual conditions tended to increase compared with that at rest. F/M amplitude ratio was significantly higher during motor imagery under both visual parameters than at rest. Most subjects (14/16) found imaging easier with eyes open, but no relationship was found between F-wave data and subjective evaluations to determine the easier condition for motor imagery. Conclusion: Motor imagery with eyes open or closed increased the excitability of spinal neural output to the thenar muscles. However, subjective evaluation to determine the easier visual condition for motor imagery revealed insignificant results. Show more

Keywords: Motor imagery, eye condition, F-wave

DOI: 10.3233/NRE-141085

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 725-729, 2014

Authors: Swinnen, Eva | Baeyens, Jean-Pierre | Pintens, Seppe | Van Nieuwenhoven, Johan | Ilsbroukx, Stephan | Buyl, Ronald | Ron, Clijsen | Goossens, Maggie | Meeusen, Romain | Kerckhofs, Eric

Article Type: Research Article

Abstract: Background: Although body weight supported (BWS) treadmill training (TT) leads to some improvements in walking ability, it has not been proven that it is more effective than other walking therapies in persons with multiple sclerosis (PwMS). One possible explanation could be that BWSTT focuses on the cyclic movement of the lower extremities while the trunk is passively suspended in the harness. Objective: This study aimed to assess the 3 dimensional trunk and pelvis movements during BWS treadmill walking. Methods: 14 PwMS and 14 healthy persons (8 male/20 female; age 23 to 59 years) walked with 0%, …10%, 20%, 30%, 50% and 70% BWS. After a familiarization period, kinematic electromagnetic tracking (Polhemus Liberty™ 240/16) of the trunk and pelvis movements was applied. Statistical analysis consisted of a repeated measures ANOVA with simple contrasts (SPSS 20). Results: This study shows that BWS walking leads in general to smaller maximum trunk and pelvis movement amplitudes compared with walking without BWS, this with exception of the pelvis anterior-posterior movement in healthy subjects. conclusion: These data help to identify and isolate the effect of different BWS levels in PwMS and in healthy persons and suggest to use BWS lower than 30% for treadmill training. Show more

Keywords: Body weight support, gait, gait analysis, kinematics, multiple sclerosis, pelvis, rehabilitation, treadmill, trunk, walking

DOI: 10.3233/NRE-141089

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 731-740, 2014

Authors: King, Nigel

Article Type: Research Article

Abstract: Background: Older age and female gender are known factors in the development of persisting post concussion symptoms (PCS) following mild head injury (MHI). Very few studies however have examined these variables in permanent PCS. Objective: This systematic review empirically examines the extent to which such factors pertain to this group. Methods: Systematic electronic data base searches identified all long-term studies of two types: first, those with correlations between age or gender and outcome; second, those providing the mean ages or gender mixes of samples selected for poor outcome and samples not selected for such. …Results: Twenty studies from 1341 abstracts were ultimately analysed. Correlation studies showed poorer outcome to be associated with both older age (3/4 studies) and female gender (2/4 studies). Those with poor long-term outcome had a significantly higher mean age (40.6) than non-selected patients (32.5). The proportion of men in selected samples (54.8%) was significantly lower than those in non-selected ones (66.5%). Conclusions: Older age is a strong vulnerability factor in the development of permanent PCS and female gender is a significant one. Show more

Keywords: Mild head injury, permanent post concussion symptoms

DOI: 10.3233/NRE-141072

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 741-748, 2014

Authors: Lancioni, Giulio E. | Singh, Nirbhay N. | O'Reilly, Mark F. | Sigafoos, Jeff | Oliva, Doretta | Buonocunto, Francesca | Sacco, Valentina | D'Amico, Fiora | Navarro, Jorge | Lanzilotti, Crocifissa | De Tommaso, Marina | Megna, Marisa

Article Type: Research Article

Abstract: Background: Interventions for post-coma persons, who have emerged from a minimally conscious state but present with extensive neuro-motor impairment and lack of or minimal verbal skills, need to promote occupation and communication through the use of assistive technology. Objective: These two studies were aimed at assessing two technology-aided programs to promote leisure engagement and communication for three post-coma participants with multiple disabilities. Methods: Study I assessed a program to allow a woman and a man with extensive neuro-motor impairment and lack of speech to switch on music and videos, make requests to caregivers, and send messages …to (communicate with) relevant partners and receive messages from those partners. Study II assessed a program to allow a post-coma woman with extensive motor impairment and reduced verbal behavior to activate music, videos and requests, send and receive messages, and make telephone calls. Results: Data showed that both programs were successful. The participants of Study I managed leisure engagement, requests, as well as text messaging. The participant of Study II showed consistent leisure engagement, text messaging, and telephone calls. Conclusions: Assistive technology can be profitably used to provide post-coma persons with multiple disabilities relevant leisure and communication opportunities. Show more

Keywords: Leisure engagement, communication, post-coma persons with consciousness, multiple disabilities, assistive technology

DOI: 10.3233/NRE-141075

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 749-758, 2014

Authors: Larson, Eric B. | Feigon, Maia | Gagliardo, Pablo | Dvorkin, Assaf Y.

Article Type: Research Article

Abstract: Background: Recent advancement in the technology of virtual reality (VR) has allowed improved applications for cognitive rehabilitation. Objectives: The aim of this review is to facilitate comparisons of therapeutic efficacy of different VR interventions. Methods: A systematic approach for the review of VR cognitive rehabilitation outcome research addressed the nature of each sample, treatment apparatus, experimental treatment protocol, control treatment protocol, statistical analysis and results. Using this approach, studies that provide valid evidence of efficacy of VR applications are summarized. Applications that have not yet undergone controlled outcome study but which have promise are introduced. …Results: Seventeen studies conducted over the past eight years are reviewed. The few randomized controlled trials that have been completed show that some applications are effective in treating cognitive deficits in people with neurological diagnoses although further study is needed. Conclusion: Innovations requiring further study include the use of enriched virtual environments that provide haptic sensory input in addition to visual and auditory inputs and the use of commercially available gaming systems to provide tele-rehabilitation services. Recommendations are offered to improve efficacy of rehabilitation, to improve scientific rigor of rehabilitation research and to broaden access to the evidence-based treatments that this research has identified. Show more

Keywords: Brain injury, rehabilitation, virtual reality, outcome

DOI: 10.3233/NRE-141078

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 759-772, 2014

Authors: Hayward, Kathryn S. | Kuys, Suzanne S. | Barker, Ruth N. | Brauer, Sandra G.

Article Type: Research Article

Abstract: Background: A good motor outcome after stroke is often equated with independence in functional performance. However, for patients with severe motor disability a good outcome is unlikely, but an important change may be achievable. Objective: Determine if patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function. Methods: A prospective observational study of 239 patients with stroke admitted to inpatient rehabilitation in Brisbane, Australia was conducted. On admission and discharge, participants were assessed using the motor items of the Functional Independence Measure (m-FIM). The importance of change achieved on …the m-FIM was evaluated according to: 1) a statistical significant outcome; 2) achievement of a MCID based on a physician-anchored rating of change; and 3) shift in disability status e.g., severe to moderate disability. Results: Patients with severe motor disability achieved a significant improvement in motor function (p < 0.001), which saw up to 83% achieve a MCID and 85% shift out of ‘severe’ to either moderate or mild motor disability on discharge from inpatient rehabilitation. Conclusion: This study demonstrates that patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function on discharge from inpatient rehabilitation. Show more

Keywords: Stroke, inpatient rehabilitation, functional recovery, severe, motor

DOI: 10.3233/NRE-141076

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 773-779, 2014

Authors: Forslund, Marit V. | Arango-Lasprilla, Juan C. | Roe, Cecilie | Perrin, Paul B. | Andelic, Nada

Article Type: Research Article

Abstract: Objectives: The aims of this study were to examine (a) predictors of partnered relationship probability trajectories and relationship stability across 1, 2, and 5 years after traumatic brain injury, and (b) influences on the slopes of these trajectories. Materials & methods: Individuals (n = 105) from Norway with acute TBI were assessed during admission to an urban trauma center and again at 1, 2 and 5 years after injury. The outcome measures were partnered relationship status (partnered vs. single) at 1, 2 and 5 years post-injury investigated through multilevel modelling, and relationship stability (stable, unstable, and single) investigated …through multinomial logistic regression. Independent variables were sex, age at injury, partnered relationship at injury, having dependent children, education, employment and occupation status at time of injury, acute Glasgow Coma Scale score, posttraumatic amnesia, and length of stay in hospital. Results: Partnered relationship status at injury and the interaction of relationship status at injury by time, employment at injury and the interaction of TBI severity by time were significant predictors of participants' relationship trajectories. Having dependent children at the time of injury, higher education, and being in a blue collar occupation at time of injury were significant predictors of relationship stability. Conclusions: The identification of these influences on partnered relationship probability trajectories and stability could help clinicians and researchers develop and refine early interventions to reduce relationship dissolution in the first several years after brain injury. Show more

DOI: 10.3233/NRE-141084

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 781-788, 2014

Authors: Dutta, Arindam | Chugh, Sanjay | Banerjee, Alakananda | Dutta, Anirban

Article Type: Research Article

Abstract: Background: Non-invasive brain stimulation (NIBS) is a promising tool for facilitating motor function. NIBS therapy in conjunction with training using postural feedback may facilitate physical rehabilitation following posture disorders (e.g., Pusher Syndrome). Objectives: The objectives of this study were, 1) to develop a low-cost point-of-care-testing (POCT) system for standing posture, 2) to investigate the effects of anodal tDCS on functional reach tasks using the POCT system. Methods: Ten community-dwelling elderly (age >50 years) subjects evaluated the POCT system for standing posture during functional reach tasks where their balance score on Berg Balance Scale was compared with …that from Center-of-Mass (CoM) – Center-of-Pressure (CoP) posturography. Then, in a single-blind, sham-controlled study, five healthy right-leg dominant subjects (age: 26.4 ± 5.3 yrs) were evaluated using the POCT system under two conditions – with anodal tDCS of primary motor representations of right tibialis anterior muscle and with sham tDCS. Results: The maximum CoP-CoM lean-angle was found to be well correlated with the BBS score in the elderly subjects. The anodal tDCS strongly (p = 0.0000) affected the maximum CoP excursions but not the return reaction time in healthy. Conclusion: It was concluded that the CoM-CoP lean-line could be used for posture feedback and monitoring during tDCS therapy in conjunction with balance training exercises. Show more

Keywords: Wii balance board, microsoft kinect, balance disorders, non-invasive brain stimulation

DOI: 10.3233/NRE-141077

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 789-798, 2014

Authors: Swanenburg, Jaap | Hegemann, Stefan C.A. | Zurbrugg, Aron | Palla, Antonella | de Bruin, Eling D.

Article Type: Research Article

Abstract: Background: The aim of his study was to evaluate the reliability and validity of the Expanded Timed Get-up-and-Go (ETGUG) test in patients with bilateral vestibular loss (BVL). Methods: 21 BVL patients (58 ± 14 years) were recruited and measured twice by two raters. After a one hour break ETGUG was repeated by the first rater. 21 age matched controls (CON; 58 ± 14 years) were measured once by the first rater. All time scores of the ETGUG for the separate tasks and gait speed calculated from tasks 3 and 5 were analysed to determine relative and absolute reliability, …smallest detectable change (SDC) and discriminatory capabilities. Results: The ETGUG scores showed good to excellent inter-rater (ICC2,1 = 0.85–0.97) and test-retest reliability (ICC3,1 = 0.86–0.98) following log-transformation for tasks 2–6. Task1 scored fair r = 0.46–0.68. The SDCs were small (SDC = 0.05–0.21 seconds). Bland-Altman plots demonstrated good agreement between the measurements. There were significant differences between BVL and CON in ETGUG scores for tasks 1, 3, 4, 5, 6 & overall time. Task 2 showed no difference between the groups. BVL patients walked slower compared to the age-matched controls. Discussion: Good reliability of the ETGUG in BVL and an indication for the discriminatory capabilities for the separate tasks suggest that the ETGUG could facilitate the study of functional deficits in BVL patients. Good reliability, small measurement error and values of SDC warrant the further utilisation of the ETGUG for the evaluation of physical functioning in BVL patients. Show more

Keywords: Reliability, validity, gait speed, bilateral vestibular loss

DOI: 10.3233/NRE-141083

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 799-807, 2014