NeuroRehabilitation - Volume 35, issue 1

Authors: Kane, Heather | Halpern, Michael T. | Teixeira-Poit, Stephanie | Frost, Corey | Keating, Michael | Olmsted, Murrey | Johnson, Shana

Article Type: Research Article

Abstract: Background: Rehabilitation care is an important part of comprehensive care for MS patients. Little is known about the number of physiatry residents who are interested in providing care to individuals with multiple sclerosis [MS]. Objective: This study examines factors that influence physiatry residents' interest in providing care to MS patients. Methods: We randomly sampled half of all Accreditation Council for Graduate Medical Education-certified physical medicine and rehabilitation residency programs in the continental United States and Puerto Rico. Surveys were received from 74% of programs (Stage 1 response rate) and from 221 residents (45% Stage 2 response …rate). Results: Residents expressing interest in providing MS care were more likely to be female, Asian, and to select statements emphasizing multidisciplinary care approaches and a community of dedicated professional colleagues as positive features of MS patient care. Residents interested in teaching and with more education debt were marginally more likely to express interest in MS care. Conclusions: Medical education should emphasize the need for physical medicine and rehabilitative care among individuals with MS, the ability of physiatrists to improve the functional status and quality of life for MS patients, and the team-based nature of MS care. Show more

Keywords: Multiple sclerosis, physical and rehabilitation medicine, physiatry, education, medical

DOI: 10.3233/NRE-141095

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 89-95, 2014

Authors: Kerling, A. | Keweloh, K. | Tegtbur, U. | Kück, M. | Grams, L. | Horstmann, H. | Windhagen, A.

Article Type: Research Article

Abstract: Background: Physical capacity (PC) and quality of life (QoL) are both reduced in multiple sclerosis (MS). Objective: Aim of our study was to investigate limitations in PC and QoL in response to the severity of MS. Methods: The study involved 60 patients (PG) (Expanded Disability Status Scale EDSS 0–3:38, EDSS 3.5–6:22) and 48 healthy controls (CG). Endurance capacity was assessed as peak oxygen uptake (VO2peak ) and ventilatory anaerobic threshold (VAT). Maximum force was measured in isokinetic testing. QoL was assessed using the SF-36-questionnaire and HALEMS. Results: Patients with MS showed reduced VO2peak …and QoL in comparison with CG. Patients with an EDSS >3 showed reduced VO2peak , and maximum force, however at the VAT there was no significant difference independent of the EDSS. The MS-specific QoL HALEMS and subscales 1, 4, 6, 8 and the physical sum score of the SF-36-questionnaire were evaluated to be better in patients with an EDSS ≤3. Conclusions: There are limitations within PC in patients with MS in comparison with a healthy CG; within the PG there are notes on a similar aerobic capacity but worsened anaerobic capacity in patients with an EDSS >3. This should be taken into account in future treatment strategies for training therapy. Show more

Keywords: Multiple sclerosis, quality of life, VO2peak, EDSS, ventilatory anaerobic threshold (VAT)

DOI: 10.3233/NRE-141099

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 97-104, 2014

Authors: Ploughman, Michelle | Shears, Jennifer | Harris, Chelsea | Hogan, Stephen H. | Drodge, Olivia | Squires, Sherry | McCarthy, Jason

Article Type: Research Article

Abstract: Purpose: To determine the effectiveness of a community re-integration exercise initiative on function, mood, participation, and exercise adherence for persons with moderate to severe neurological conditions (stroke, multiple sclerosis, etc.). Methods: We recruited 29 adults (able to walk at least 3 m with assistance) discharged from an outpatient rehabilitation program for the 10 week intervention which was comprised of two components: circuit training and guided transition to a standard gym setting. We evaluated participants before and after the intervention and at four month follow up, including functional balance and mobility using the Timed Up and Go Test, walking …endurance using the 6 Minute Walk Test, health related quality of life (HR QoL) using a visual analogue scale, activity and participation using the Frenchay Activities Index and mood using the Hospital Anxiety and Depression Scale. Results: Twenty-seven participants completed the intervention. The only significant improvement was in HR QoL. Forty-four percent of participants continued to exercise after cessation of the program. Those who continued to exercise (Exercisers n = 12) experienced more improvement in HR QoL than Non-Exercisers (n = 15). Conclusions: This re-integration initiative for people with neurological impairments improved HR QoL and facilitated independent exercise for 44% of participants. The novel component of the program, which facilitated transition to standard gym equipment, likely contributed to improved exercise adherence in the longer term. Show more

Keywords: Community-based, multiple sclerosis, Parkinson's disease, stroke, neurological disorders, participation, quality of life

DOI: 10.3233/NRE-141090

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 105-112, 2014

Authors: Amichai, Taly | Katz-Leurer, Michal

Article Type: Research Article

Abstract: Objective: A systematic review which aims to assess the evidence regarding the function of the autonomic heart rate regulation system among children with cerebral palsy (CP). Methods: The target population included children with CP of diverse severity, aged 1.5 to 18 years. Databases searched for English language studies from 1960 to 2013: PubMed, EMBASE, CINAHL, Cochrane Library, The Physiotherapy Evidence Database (PEDro), and ClinicalTrials.gov site. Search terms included ‘cerebral palsy’ or ‘spastic diplegia’ or ‘hemiplegia’ or ‘quadriplegia’ and ‘autonomic nervous system’ or ‘heart rate variability’ or ‘sympathetic’ or ‘para sympathetic’. Twenty five articles were identified and included if …(1) participants were less than 18 years of age, (2) diagnosis of CP was made after the age of 18 months (3) more than 80% of cases had a diagnosis of CP and (4) autonomic cardiac heart rate regulation system state or response to a stimuli was described for all the participants. Six articles met the criteria for inclusion. Results: Evidence suggests that reduced Heart Rate Variability (HRV) time domain parameters close to birth are associated with a CP diagnosis at the age of three years. In addition, HRV parameters' mean values, are significantly lower among children with CP compared to typically developed (TD) control. While performing head up, tilt or standing position, HRV was significantly reduced only among TD control, but no effect was seen in those variables among children with CP. Conclusion: Further studies are needed to assess the potential to predict CP by assessing HRV parameters among newborn children. In addition, assessing HRV among children with CP may improve our understanding of the heart rate autonomic system and its response to different stimulus such as muscle contraction, paced breathing and aerobic training. Show more

DOI: 10.3233/NRE-141097

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 113-122, 2014

Authors: Boyaci, Ahmet | Tutoglu, Ahmet | Boyaci, Nurefsan | Koca, Irfan | Calik, Mustafa | Sakalar, Ali | Kilicaslan, Nihat

Article Type: Research Article

Abstract: Objective: To investigate changes in stiffness in the gastrocnemius (GCM) muscle following rehabilitation therapy and botulinum toxin type A (BTX-A) injections in patients with spastic cerebral palsy (CP). Methods: The study included 16 children with spastic CP (Group 1) and 17 healthy children (Group 2). The children with CP received BTX-A injections and underwent rehabilitation therapy. The GCM and soleus muscles of the CP group were evaluated according to the modified Ashworth scale (MAS). The thicknesses of the muscles were measured, and the elasticity score (ELX 2/1) index was calculated. Results: The ELX 2/1 indices of …the gastromedialis (GM) and gastrolateralis (GL) were significantly higher in Group 1 than in Group 2 (p < 0.05). The ELX 2/1 indices in the GM and GL muscles in the CP group were found to have decreased 4 weeks after the procedure (p < 0.05). Furthermore, the mean MAS score of the ankle decreased, from 3.4 to 2.6 (p < 0.05). GM ELX 2/1 in Group 1 (post-treatment) was significantly different from Group 2 (p < 0.05). Conclusions: The combined use of clinical scales and sonoelastography can provide valuable information for determining structural changes in the GCM muscle following rehabilitation therapy and BTX-A injections. Show more

Keywords: Cerebral palsy, elasticity score index, gastrocnemius muscle, rehabilitation, spasticity

DOI: 10.3233/NRE-141107

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 123-129, 2014

Authors: Lee, Dong Ryul | Kim, Yun Hee | Kim, Dong A. | Lee, Jung Ah | Hwang, Pil Woo | Lee, Min Jin | You, Sung (Joshua) Hyun

Article Type: Research Article

Abstract: Background: In children with cerebral palsy (CP), the never-learned-to-use (NLTU) effect and underutilization suppress the normal development of cortical plasticity in the paretic limb, which further inhibits its functional use and increases associated muscle weakness. Objective: To highlight the effects of a novel comprehensive hand repetitive intensive strengthening training system on neuroplastic changes associated with upper extremity (UE) muscle strength and motor performance in children with spastic hemiplegic CP. Method: Two children with spastic hemiplegic CP were recruited. Intervention with the comprehensive hand repetitive intensive strengthening training system was provided for 60 min a day, three …times a week, for 10 weeks. Neuroplastic changes, muscle size, strength, and associated motor function were measured using functional magnetic resonance imaging (MRI), ultrasound imaging, and standardized motor tests, respectively. Results: The functional MRI data showed that the comprehensive hand repetitive intensive strengthening training intervention produced measurable neuroplastic changes in the neural substrates associated with motor control and learning. These neuroplastic changes were associated with increased muscle size, strength and motor function. Conclusions: These results provide compelling evidence of neuroplastic changes and associated improvements in muscle size and motor function following innovative upper extremity strengthening exercise. Show more

Keywords: Neuroplasticity, cerebral palsy, functional magnetic resonance imaging, strength training, muscle size

DOI: 10.3233/NRE-131036

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 131-136, 2014

Authors: Tánczos, Tímea | Zádori, Dénes | Jakab, Katalin | Hnyilicza, Zsuzsanna | Klivényi, Péter | Keresztes, László | Engelhardt, József | Németh, Dezső | Vécsei, László

Article Type: Case Report

Abstract: Background: Lightning-related injuries most often involve impairment of the functions of the central and peripheral nervous systems, usually including cognitive dysfunctions. We evaluated the cognitive deficit of a patient who had survived a lightning strike and measured the improvement after her cognitive training. This therapeutic method appears to be a powerful tool in the neurorehabilitation treatment. Objective: The aim of this case study was to prove the beneficial effects of cognitive training as part of the neurorehabilitation after a lightning strike. Methods: Six neuropsychological functions were examined in order to test the cognitive status of the …patient before and after the 2-month cognitive training: phonological short-term memory (digit span test and word repetitions test), visuo-spatial short-term memory (Corsi Block Tapping Test), working memory (backward digit span test and listening span test), executive functions (letter and semantic fluencies), language functions (non-word repetition test, Pléh-Palotás-Lörik (PPL) test and sentence repetition test) and episodic memory (Rivermead Behavioral Memory Test and Mini Mental State Examination). We also utilized these tests in aged-matched healthy individuals so as to be able to characterize the domains of the observed improvements more precisely. Results: The patient exhibited a considerable improvement in the backward digit span, semantic fluency, non-word repetition, PPL, sentence repetition and Rivermead Behavioral Memory tests. Conclusions: The cognitive training played an important role in the neurorehabilitation treatment of this lightning injury patient. It considerably improved her quality of life through the functional recovery. Show more

Keywords: Lightning injury, neurorehabilitation, neuropsychological tests, cognitive training

DOI: 10.3233/NRE-141106

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 137-146, 2014

Authors: Ness, Bryan M. | Rocke, Maya R. | Harrist, Christopher J. | Vroman, Kerryellen G.

Article Type: Research Article

Abstract: Background: Enrolling in post-secondary education is common among military service members returning from combat deployments, but recent research shows service members who present with neurobehavioral symptoms consistent with traumatic brain injury (TBI) and/or post-traumatic stress disorder (PTSD) are at risk for psychosocial and academic difficulty. Objective: This exploratory study was conducted to examine the academic experiences of service members through in-depth qualitative analysis. Methods: An initial survey was conducted at a public university to measure self-reported academic achievement and neurobehavioral symptoms experienced by service members (n = 48). Then, follow-up interviews were solicited from a sub-sample …(n = 5) of participants to gain an in-depth understanding of their transition, social, and academic experiences. Results: The results revealed both the day-to-day challenges participants faced while adjusting to post-secondary life and how neurobehavioral symptoms associated with combat trauma interacted with their learning experiences. The findings indicated participants did not perceive neurobehavioral symptoms as particularly deleterious to their learning thereby highlighting the potentially integral role of coping strategies and motivation in post-secondary success. Conclusions: This study underscores the importance of understanding not only the adverse impact of neurobehavioral symptoms but the factors that promote resilience among military service members in post-secondary education. Show more

Keywords: Neurobehavioral symptoms, post-secondary experience, service member/veteran, combat, TBI/PTSD

DOI: 10.3233/NRE-141098

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 147-158, 2014

Authors: Zimmermann, Nicolle | Netto, Tania Maria | Amodeo, Maria Teresa | Ska, Bernadette | Fonseca, Rochele Paz

Article Type: Research Article

Abstract: Background: Neuropsychological interventions have been mainly applied with clinical populations, in spite of the need of preventing negative changes across life span. Among the few studies of cognitive stimulation in elderly, surprisingly there is no enough research comparing direct and indirect active stimulation programs. Objective: This study aims to verify wheter there are differences between two cognitive interventions approaches in older adults: a structured Working Memory (WM) Training Program versus a Poetry-based Stimulation Program. Methods: Fourteen older adults were randomly assigned to participate into one of the two intervention groups. The assessed neurocognitive components were attention, …episodic and working memory, communicative and executive functions. WM Training activities were based on Baddeley's model; Poetry-based Stimulation Program was composed by general language activities. Data were analyzed with one-way ANCOVA with Delta scores and pre and post-training tests raw scores. Results: WM group improved performance on WM, inhibition, and cognitive flexibility measures, while Poetry group improved on verbal fluency and narrative discourse tasks. Discussion: Both approaches presented benefits; however WM Training improved its target function with transfer effects to executive functions, being useful for future studies with a variety of dementias. Poetry-based Stimulation also improved complex linguistic abilities. Both approaches may be helpful as strategies to prevent dysfunctional aging changes. Show more

Keywords: Cognitive training, older adults, transfer, working memory

DOI: 10.3233/NRE-141104

Citation: NeuroRehabilitation, vol. 35, no. 1, pp. 159-170, 2014