NeuroRehabilitation - Volume 35, issue 2

Authors: Wood, Richard M. | Griffiths, Jeff D. | Williams, Janet E. | Brouwers, Jakko

Article Type: Research Article

Abstract: Background: To date, little research has been published regarding the effective and efficient management of resources (beds and staff) in neurorehabilitation, despite being an expensive service in limited supply. Objective: To demonstrate how mathematical modelling can be used to optimise service delivery, by way of a case study at a major 21 bed neurorehabilitation unit in the UK. Methods: An automated computer program for assigning weekly treatment sessions is developed. Queue modelling is used to construct a mathematical model of the hospital in terms of referral submissions to a waiting list, admission and treatment, and ultimately …discharge. This is used to analyse the impact of hypothetical strategic decisions on a variety of performance measures and costs. The project culminates in a hybridised model of these two approaches, since a relationship is found between the number of therapy hours received each week (scheduling output) and length of stay (queuing model input). Results: The introduction of the treatment scheduling program has substantially improved timetable quality (meaning a better and fairer service to patients) and has reduced employee time expended in its creation by approximately six hours each week (freeing up time for clinical work). The queuing model has been used to assess the effect of potential strategies, such as increasing the number of beds or employing more therapists. Conclusions: The use of mathematical modelling has not only optimised resources in the short term, but has allowed the optimality of longer term strategic decisions to be assessed. Show more

Keywords: Health resources, personnel management, systems theory, operations research, personnel staffing and scheduling, database management systems

DOI: 10.3233/NRE-141114

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 171-179, 2014

Authors: Iyengar, Y.R. | Vijayakumar, K. | Abraham, J.M. | Misri, Z.K. | Suresh, B.V. | Unnikrishnan, B.

Article Type: Research Article

Abstract: Background & objective: This study was executed to find out correlation between postural alignment in sitting measured through photogrammetry and postural control in sitting following stroke. Methods: A cross-sectional study with convenient sampling consisting of 45 subjects with acute and sub-acute stroke. Postural alignment in sitting was measured through photogrammetry and relevant angles were obtained through software MB Ruler (version 5.0). Seated postural control was measured through Function in Sitting Test (FIST). Correlation was obtained using Spearman's Rank Correlation co-efficient in SPSS software (version 17.0). Results: Moderate positive correlation (r = 0.385; p < 0.01) was …found between angle of lordosis and angle between acromion, lateral epicondyle and point between radius and ulna. Strong negative correlation (r = −0.435; p < 0.01) was found between cranio-vertebral angle and kyphosis. FIST showed moderate positive correlation (r = 0.3446; p < 0.05) with cranio-vertebral angle and strong positive correlation (r = 0.4336; p < 0.01) with Brunnstrom's stage of recovery in upper extremity. Conclusion: Degree of forward head posture in sitting correlates directly with seated postural control and inversely with degree of kyphosis in sitting post-stroke. Postural control in sitting post-stroke is directly related with Brunnstrom's stage of recovery in affected upper extremity in sitting. Show more

Keywords: Sitting, posture, postural alignment, postural control, photogrammetry

DOI: 10.3233/NRE-141118

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 181-190, 2014

Authors: Appel, Caroline | Perry, Lin | Jones, Fiona

Article Type: Research Article

Abstract: Background: Shoulder impairments are common after stroke, resulting in reduced upper limb function. Shoulder strapping may be beneficial as an adjunct to conventional therapy and warrants further investigation. Objectives: To determine i) the efficacy and ii) any adverse effects of shoulder strapping used to reduce stroke-related upper limb and shoulder impairments and to improve function. Methods: Three reviewers independently searched CINAHL, Ovid MEDLINE, EMBASE, AMED and PEDro databases and extracted data. Results were synthesized using descriptive methods and meta-analysis and interpreted in relation to potential risk of bias. Results: Eight studies met inclusion criteria, …recruiting 340 stroke participants. Studies predominantly included people with shoulder paralysis and examined shoulder strapping within four weeks of stroke onset for outcomes of increased upper limb function, reduced subluxation and pain. Strapping interventions, outcomes and measures were diverse, some studies encountered high risk of bias and findings were generally inconclusive with some indication of benefit in terms of delaying onset of shoulder pain. Conclusions: There is insufficient evidence of efficacy or inefficacy with shoulder paralysis but shoulder strapping demonstrated minimal adverse effects and should be rigorously tested with shoulder paresis as well as paralysis after stroke. Show more

Keywords: Shoulder, stroke, strapping, upper limb, rehabilitation

DOI: 10.3233/NRE-141108

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 191-204, 2014

Authors: Sorinola, I.O. | Powis, I. | White, C.M.

Article Type: Research Article

Abstract: Background: The restoration of trunk function following stroke is a key component of rehabilitation, however there is limited evidence of the efficacy of additional trunk training. Objectives: To evaluate the efficacy of trunk exercises added to conventional rehabilitation on functional outcomes. Methods: Relevant randomised controlled trials (RCTs), published up to July 2012, evaluating the effect of the addition of trunk exercises to conventional rehabilitation on functional outcomes were identified in Medline, Cinahl, Embase, Pubmed, PEDro, Web of Science and Scopus databases. Findings were summarised across studies as mean or standardised mean differences (MD or SMD) …with 95% confidence intervals. Results: Six RCTs with 155 participants and a mean PEDro score of 6.5 (range 6 to 8) were included. Data from two to five studies were pooled in meta-analyses that showed a moderate, non-significant effect of additional trunk exercise on trunk performance, (SMD = 0.50; 95% CI −0.25, 1.25; P = 0.19); large effects on standing balance, SMD = 0.72 (95% CI −0.01, 1.45 P = 0.05); and walking ability, (SMD = 0.81; 95% CI 0.30, 1.33. P = 0.002) and a small, non-significant effect, MD = 10.03 (95% CI −15.70, 35.75. P = 0.44) on functional independence. Conclusions: There is moderate evidence that the addition of specific trunk exercise to conventional early stroke rehabilitation significantly improve standing balance and mobility after stroke; however the evidence was weak for the effect of additional trunk exercise on trunk performance and in functional independence. Show more

Keywords: Meta-analysis, stroke, rehabilitation, trunk exercise, functional recovery, mobility

DOI: 10.3233/NRE-141123

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 205-213, 2014

Authors: Pappalardo, A. | Ciancio, M.R. | Patti, F.

Article Type: Research Article

Abstract: Background: Basic trunk movement control is often impaired after stroke and its recovery is a “miliary stone” in rehabilitation. Objective: In this prospective, observational, parallel-group study, we investigated whether there are differences in terms of post-stroke recovery of basic trunk control between patients with left or with right hemiparesis. Methods: We recruited 94 patients with loss of postural trunk control due to stroke. Patients were divided into Group A (48 patients with left hemiparesis) and Group B (46 patients with right hemiparesis). We administered the Trunk Control Test (TCT) and the 13 motor items included on …the Functional Independence Measure. Evaluation was performed at admission (To) and discharge (T1). Results: TCT increased respectively from 46.7 ± 23.3 to 62.6 ± 19.5 (mean ± standard deviation-SD, p < 0.0001) in Group A and from 49.4 ± 23.2 to 79.1 ± 14.4 (mean ± SD, p < 0.0001) in Group B. TCT resulted significantly higher in Group B than in Group A, at T1 (p < 0.0001). No significant difference was found for motFIM at T1. Conclusion: Side of hemiparesis could affect the degree of recovery of basic trunk control after stroke. Patients with right hemiparesis benefit more than those with left hemiparesis. Improvement of basic trunk control was not responsible for an advantage on functional independence. Show more

Keywords: Stroke, recovery, trunk control

DOI: 10.3233/NRE-141109

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 215-220, 2014

Authors: Kong, Keng-He | Lee, Jeanette

Article Type: Research Article

Abstract: Background: The ability to perform basic activities of daily living (ADL) independently is a marker of functional recovery after a stroke. However, there few studies documenting their long-term recovery. Objective: To document temporal recovery of activities of daily living (ADL) and establish predictors of ADL in a cohort of ischemic stroke patients in the first year after stroke. Methods: Prospective cohort study of 163 patients with first-ever ischemic stroke admitted to a rehabilitation centre. The Modified Barthel Index (MBI) was used to measure the patient's ability to perform the following 10 ADLs: feeding, grooming, dressing, bathing, …toileting, bladder and bowel continence, transfers, ambulation and stair climbing. It was assessed on rehabilitation admission, discharge, and at 3, 6 and 12 months after stroke. The Motricity Index was used to measure motor power of the hemiplegic limb. Results: The mean age was 63.8 (10.7) years, with 111 males and 52 females. The mean total MBI scores on rehabilitation admission, rehabilitation discharge, 3, 6 and 12 months after stroke were 41.3 (24.6), 72.9 (20.5), 88.4 (18.6), 90.5 (17.2) and 84.2 (20.4) respectively. Median scores of feeding, grooming, toileting, bladder/bowel continence, transfers and ambulation plateaued by 3 months after stroke. Median scores of dressing and stair climbing plateaued at 6 months and that for bathing, 12 months after stroke. None of the patients were functionally independent (defined as MBI score of 100) on rehabilitation admission, but this improved to 8.6% on discharge, and 32.1%, 41.4% and 50.3% at 3, 6 and 12 months after stroke respectively. The MBI and Motricity scores were strongly correlated at all periods of follow up (r = 0.67 to 0.69, p < 0.0001). Univariate analysis showed that age, neglect, a cortical stroke, admission MBI, NIHSS, Motricity Index and Abbreviated Mental Score scores were predictors of functional independence at 12 months after stroke. On logistic regression, only age remained significant, younger patients being more likely than older patients to be functionally independent. Conclusion: Most recovery of ADL occurs by 3 months after stroke. For individual ADLs, dressing, stair climbing and bathing appear to take a longer time to recover. Older age was a negative predictor of functional dependence at 12 months after stroke. Show more

Keywords: Stroke, rehabilitation, outcome

DOI: 10.3233/NRE-141110

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 221-226, 2014

Authors: Lohse-Busch, H. | Marlinghaus, E. | Reime, U. | Möwis, U.

Article Type: Research Article

Abstract: Background: Incidental observations led to the question whether ESWT could alleviate the still difficult-to-improve symptoms of DSPNP. Methods: In a pilot study, out of an original 24 patients with DSPNP, 10 patients with diabetes mellitus were excluded because of their inhomogeneous performances. Of the 14 patients remaining, 6 received one sham treatment at the beginning. All 14 patients were then treated with ESWT to the soles of the feet using the Duolith® shock wave generator (Storz Medical) 3 times weekly for 2 weeks. The assessments were carried out before and after the sham treatment, the first ESWT …(question: before and after the first ESWT or only after?) and after 2, 4 and 8 weeks. Results: The placebo treatment did not influence pain or paraesthesia. After the 2 weeks of ESWT, intensity decreased from 100% to 23.6%, rising again after 8 weeks to 45.7% of the original state (p < 0.01). The placebo treatment did however have a great effect on walking abilities. The results of ESWT did not become significant until the 8th week. Step length improved by 14.6% (p < 0.001), walking speed by 24.8% (p < 0.001) and time of dual support during the stance phase of the gait declined by 12.2% (p < 0.009). Conclusions: Despite the small number of cases, it appears that ESWT can alleviate some of the symptoms of DSPNP. Show more

Keywords: Extracorporeal shock wave therapy, polyneuropathy, pain, walking kinematics, paraesthesia

DOI: 10.3233/NRE-141116

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 227-233, 2014

Authors: Lohse-Busch, H. | Reime, U. | Falland, R.

Article Type: Research Article

Abstract: Objective: Can stimulation of nerve growth factors by focused transcranial extracorporeal shock wave therapy (TESWT) be made effective for persons within unresponsive wakefulness syndrome (apallic syndrome)? Design: Between eight and 18 years after the brain lesion, five patients with unresponsive wakefulness syndrome of differing severity received TESWT with the device Duolith (Storz Medical) during four-week physicomedical complex therapies. In the previous years they had been treated with the same complex therapies without TESWT. The vigilance did not change. Results: After two-four years and an average of 5.2 treatment series, the patients' abilities improved by 135.9% on …the German Coma Remission Scale (KRS) and by 43.6% on the Glasgow Coma Scale. In the motor area of the KRS, the patients improved by 64.3%. Three PEG feeding tubes could be removed, nonverbal communication initiated four times. Conclusion: In this longitudinal observation study, focused TESWT stimulated vigilance in patients with unresponsive wakefulness syndrome. The precise neurophysiological effects remain to be verified by a study of the clinical results. Show more

Keywords: Unresponsive wakefulness syndrome, apallic, extracorporeal shock wave therapy

DOI: 10.3233/NRE-141115

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 235-244, 2014

Authors: Lu, William | Cantor, Joshua | Aurora, R. Nisha | Nguyen, Michael | Ashman, Teresa | Spielman, Lisa | Ambrose, Anne | Krellman, Jason W. | Gordon, Wayne

Article Type: Research Article

Abstract: Background: Obstructive sleep apnea (OSA) is commonly found in individuals with traumatic brain injury (TBI) and may exacerbate TBI-related symptoms. Nocturnal polysomnography (NPSG) is considered the gold standard for detecting the presence of sleep apnea. However, there is a limitation with its use known as the “first-night effect” (aberrant polysomnography findings on the first night in a sleep lab). Objective: The primary objectives were to investigate the night-to-night consistency of diagnosing and classifying obstructive sleep apnea in individuals with TBI, and ascertain if individuals with TBI are prone to a first-night effect. Methods: 47 community-dwelling adults …with self-reported mild-to-severe TBI underwent two nights of in-laboratory NPSG to examine variability between the first and second night with regards to OSA diagnosis and severity as well as sleep architecture. Results: OSA detection and severity were consistent from night-to-night in 89% of participants with TBI. Participants with TBI demonstrated longer REM latency on the first night compared to the second night of sleep study. Conclusions: These findings indicate that two nights of in-laboratory NPSG are generally consistent in reliably diagnosing OSA in individuals with TBI and that first-night effects are minimal. One night of NPSG has diagnostic utility in the evaluation of sleep disorders in individuals with TBI. Show more

Keywords: Traumatic brain injury, sleep, obstructive sleep apnea, polysomnography

DOI: 10.3233/NRE-141117

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 245-251, 2014

Authors: Stasolla, Fabrizio | De Pace, Claudia

Article Type: Research Article

Abstract: Background: Post-coma persons with multiple disabilities may represent a challenge to rehabilitation centers, due to their clinical conditions. Moreover, they can failed to engage adaptive responses aimed at the self-management of environmental stimuli. Objectives: To assess the impact and social rating of a new assistive technology set-up for promoting constructive engagement by two post-coma boys emerged from a minimal conscious state. Method: During baseline sessions, the participants were provided with a mouse to manage the computer system. During intervention phases, a new technology was implemented, allowing both participants to manage environmental stimuli with a microswitch instead …of the mouse. Furthermore, a social validation assessment was carried out, involving students as raters. Results: Data showed an increasing of constructive engagement by both participants during intervention phases. Sixty psychology students (social raters) favoured the new technology on a six items questionnaire (i.e. enjoyment, suitability, rehabilitation, independence, daily context and support). Conclusions: The new technology was suitable, affordable, effective and socially preferable. Show more

Keywords: Assistive technology, acquired brain injury, consciousness disorders, extensive motor disabilities, social validation, rehabilitation psychology

DOI: 10.3233/NRE-141112

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 253-259, 2014