NeuroRehabilitation - Volume 35, issue 2

Authors: Finn, Maurice | McDonald, Skye

Article Type: Research Article

Abstract: The results of a multiple baseline single case study using computerised cognitive training in older adults with Amnestic Mild Cognitive Impairment (aMCI) are reported. Two participants each completed 40 sessions of training in two phases: an initial phase that trained attention, processing speed and cognitive flexibility, followed by a mixed memory and execution functions phase. It was hypothesised that participants would improve with practice on the trained tasks, that the benefits of training would generalise to non-trained neuropsychological probe measures, and that training would result in improved perceptions of memory and mood. Results indicated that one participant showed improved performance …on untrained measures of attention and reasoning. On pre/post measures both participants reported less frequent cognitive failures in everyday life and improved mood following training. The results are discussed along with suggestions for future research. Show more

Keywords: Aged, cognitive training, mild cognitive impairment, single case study

DOI: 10.3233/NRE-141121

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 261-270, 2014

Authors: Jeon, Seo Young | Han, Soo Jeong | Jeong, Jee Hyang | Fregni, Felipe

Article Type: Research Article

Abstract: Background: Individuals with definite cognitive impairment and mild cognitive impairment (MCI) show motor dysfunction. Objective: This study aimed to investigate whether exercise changes balance and whether the effects of exercise on balance are different in patients with MCI as compared to the control group. Methods: Posturography was used to assess balance by measuring the mediolateral and anteroposterior sway distance and sway speed. After the baseline balance test (T1), subjects received exercise instruction. Follow-up balance tests were performed at 6 months (T2) and 12 months (T3). Results: When comparing persons with MCI (n = 17) …with control group (n = 12), four indices of posturography showed differences between groups (p < 0.05). Also, there were improvements in more indices between T1 and T3, rather than between T1 and T2, in both MCI and control groups (p < 0.05). After receiving guidance concerning exercises, the sway values at 12 months were lower than values at the 6-month follow-up (p < 0.05). However, this trend in the sway values did not show a difference between the groups (p > 0.05). Conclusion: Persons with MCI had poorer balance control ability as compared with normal healthy persons. More than one year of steady exercise can be helpful for the improvement of balance in both MCI and normal persons. Show more

Keywords: Mild cognitive impairment, balance, posturography, exercise

DOI: 10.3233/NRE-141120

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 271-278, 2014

Authors: McKee, Kathleen E. | Hackney, Madeleine E.

Article Type: Research Article

Abstract: Background: In Parkinson's disease (PD), motor and cognitive impairments interact to affect functional performance adversely. A valid mobility test, the Four Square Step Test (FSST) involves multidirectional stepping over obstacles. FSST performance may also be associated with cognitive performance. Objectives: This study determined the feasibility and reliability of an obstacle-based FSST in older individuals with versus without PD, and evaluated the association of PD performance of FSST with tests of cognition. Methods: Thirty-one individuals with mild-moderate PD, evaluated while ON medications, completed the obstacle-based FSST, other mobility and cognitive measures. FSST performance was compared between a …PD participant sub-set (n = 24) and 24 age-matched older adults. Data were analyzed with independent t-tests, correlations, and linear regression. Results: Obstacle-based FSST was feasible and reliable within sessions in those with PD. Median best FSST time among individuals with PD was 11.72 s (9.99, 13.98) and FSST had concurrent validity with tests of mobility, and cognitive dual-tasking. Among cognitive tests, Trails Making Test B, which evaluates executive function, emerged as a sole contributor (49%) of variance. FSST performance did not differ between those with PD and older adults. Conclusion: The obstacle-based FSST is feasible and reliable in those with PD. The relationship between cognitive status and performance on the FSST did not appear to be strongly disease-stage dependent. Using FSST in the clinic may help assess the health status of a motor-cognitive interaction in individuals with PD. Show more

Keywords: Parkinson's disease, mobility limitation, cognition, accidental falls

DOI: 10.3233/NRE-141122

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 279-289, 2014

Authors: Morberg, Bo M. | Jensen, Joakim | Bode, Matthias | Wermuth, Lene

Article Type: Research Article

Abstract: Background: Parkinson's disease (PD) is a neurodegenerative disease caused by loss of dopaminergic nigrostriatal neurons. Several studies have investigated various physical interventions on PD. The effects of a high intensity exercise program with focus on resistance; cardio; equilibrium; and flexibility training have not been evaluated previously. Objective: The aim of this study was to investigate the effects of a complex, high intensity physical training program, with a long duration, on motor and non-motor symptoms in patients with PD. Method: 24 patients with PD Hoehn and Yahr stage 1–3 were non-randomly allocated to an intervention group (n …= 12) and a control group (n = 12). The intervention group underwent 32 weeks of high intensity personalized physical training twice a week, with an optional extra training session once a week. The control group received general recommendations regarding physical activity. The primary outcomes were the change in Unified Parkinson's Disease Rating Scale Subscores (UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39). Results: At week 32, the training significantly improved both UPDRS motor subscores (p = 0.045), activities of daily living subscores (ADL) (p = 0.006), mentation subscores (p = 0.004) and complication subscores (p = 0.019). The effect on the PDQ39 total score was not statistically significant. The intervention group however experienced a substantial improvement of the PDQ39 items emotional well-being (−11.0) and bodily discomfort (−7.14). Conclusion: The results suggest that a personal high intensity exercise program may favorably influence both motor and non-motor symptoms in patients with mild to moderate PD. More studies with both higher methodology in study design and a follow-up examination are recommended. Show more

Keywords: Parkinson's disease, exercise, resistance training, cardiovascular training, UPRDS, quality of life

DOI: 10.3233/NRE-141119

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 291-298, 2014

Authors: Pilkar, Rakesh | Yarossi, Mathew | Nolan, Karen J.

Article Type: Research Article

Abstract: Background: Functional Electrical Stimulation (FES) applied through a foot drop stimulator (FDS) is a rehabilitation intervention that can stimulate the common peroneal nerve to provide dorsiflexion at the correct timing during gait. Objective: To determine if FES applied to the peroneal nerve during walking through a FDS would effectively retrain the electromyographic temporal activation of the tibialis anterior in individuals with stroke. Methods: Surface electromyography (EMG) were collected bilaterally from the tibialis anterior (TA) while participants (n = 4) walked with and without the FDS at baseline and 4 weeks. Comparisons were made between stimulation timing …and EMG activation timing to produce a burst duration similarity index (BDSI). Results: At baseline, participants displayed variable temporal activation of the TA. At 4 weeks, TA activation during walking without the FDS more closely resembled the pre-programmed FDS timing demonstrated by an increase in BDSI scores in all participants (P = 0.05). Conclusions: Continuous use of FDS during a task specific movement can re-train the neuromuscular system. After 4 weeks of utilization the FDS trained the TA to replicate the programmed temporal activation patterns. These findings begin to establish the FDS as a rehabilitation intervention that may facilitate recovery rather than just compensate for stroke related gait impairments due to foot drop. Show more

Keywords: Stroke, foot drop, hemiplegic gait, EMG, functional electrical stimulation, rehabilitation

DOI: 10.3233/NRE-141126

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 299-305, 2014

Authors: Jahanmiri-Nezhad, Faezeh | Hu, Xiaogang | Suresh, Nina L. | Rymer, William Z. | Zhou, Ping

Article Type: Research Article

Abstract: Background and purpose: The relationship between surface electromyography (EMG) and muscle force is essential to assess muscle function and its deficits. However, few studies have explored the EMG-force relation in patients with amyotrophic lateral sclerosis (ALS). The purpose of this study was to examine the EMG-force relation in ALS subjects and its alteration in comparison with healthy control subjects. Methods: Surface EMG and force signals were recorded while 10 ALS and 10 age-matched healthy control subjects produced isometric voluntary contractions in the first dorsal interosseous (FDI) muscle over the full range of activation. A linear fit of the …EMG-force relation was evaluated through the normalized root mean square error (RMSE) between the experimental and predicted EMG amplitudes. The EMG-force relation was compared between the ALS and the healthy control subjects. Results: With a linear fit, the normalized RMSE between the experimental and predicted EMG amplitudes was 9.6 ± 3.6% for the healthy control subjects and 12.3 ± 8.0% for the ALS subjects. The slope of the linear fit was 2.9 ± 2.2 μVN−1 for the ALS subjects and was significantly shallower (p < 0.05) than the control subjects (5.1 ± 1.8 μVN−1 ). However, after excluding the four ALS subjects who had very weak maximum force, the slope for the remaining ALS subjects was 3.5 ± 2.2 μVN−1 and was not significantly different from the control subjects (p > 0.05). Conclusions: A linear fit can be used to well describe the EMG-force relation for the FDI muscle of both ALS and healthy control subjects. A variety of processes may work together in ALS that can adversely affect the EMG-force relation. Show more

Keywords: ALS, EMG-force relation, FDI, isometric contraction

DOI: 10.3233/NRE-141125

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 307-314, 2014

Authors: Goverover, Yael | Genova, Helen | Griswold, Hali | Chiaravalloti, Nancy | DeLuca, John

Article Type: Research Article

Abstract: Background: Recent models of self-awareness draw a distinction between intellectual awareness (metacognitive knowledge of disabilities) and online awareness of errors (emergent and anticipatory awareness). Objective: The present study compared these two types of self-awareness (metacognitive knowledge of disabilities and online awareness) in individuals with multiple sclerosis (MS) and healthy participants. The relationship between self-awareness and functional performance was also examined. Methods: Participants included 18 individuals with MS and 16 healthy controls (HC) between the ages of 27 and 60. Intellectual awareness was assessed via discrepancy scores on the Functional Behavior Profile (FBP) between participants and their …informants. Online Awareness was examined using self-prediction and self-assessment of performance on a functional task. Results: Participants with MS had significantly lower levels of intellectual awareness relative to HCs. The MS group demonstrated worse prediction online awareness than HCs. However, assessment online awareness did not differ between groups, indicating that experience with a task can improve online awareness in persons with MS. Conclusion: This study highlights the necessity of adopting a multidimensional approach to assessing the multifaceted phenomenon of self-awareness in MS. In addition, it provides initial evidence to support a self-awareness treatment model for persons with MS. Show more

Keywords: Impaired self-awareness, error-monitoring, activities of daily living, cognition, quality of life, multiple sclerosis

DOI: 10.3233/NRE-141113

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 315-323, 2014

Authors: Karimi, Mohammad | Omar, Abdul Hafidz Haji | Fatoye, Francis

Article Type: Research Article

Abstract: Background: Spinal cord injury (SCI), damage to spinal cord, influences the ability of the subjects to stand and walk. Moreover, they have some problems such as osteoporosis, muscle spasm, joint contracture and bowel and bladder function. These subjects use various orthoses and undergo different rehabilitation programmes to restore their ability. It is controversial whether use of aforementioned methods improves the physiological health of SCI individuals and improves their ability to ambulate or not. Therefore, the aim of this review was to investigate the effectiveness of assistive devices to restore their physiological health and their functional ability in patients with SCI. …Method: A search was done in some databases such as Medline, Embasco, and ISI Web of sciences between 1960 and 2013. The quality of studies was assessed using the Down and Black tool. Results: Two hundred articles were found based on the selected key words. Sixty papers were selected for final analysis, of which 35 and 45 focused on benefits of standing and walking, performance of SCI during standing and walking with various systems, respectively. Conclusion: Although there was lots of variation between the studies based on the number of subjects, level of lesion, type of lesion and time post injury, it can be concluded that use of various orthoses neither improve the abilities of subjects to stand and walk nor improve their physiological health. It may be concluded that the use of other methods of exercise may have more physiological benefits for SCI subjects. Show more

Keywords: Spinal cord injury, physiological health, walking ability, orthosis, hybrid, functional electrical stimulation, robotic

DOI: 10.3233/NRE-141124

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 325-340, 2014

Authors: Abdul-Sattar, Amal B.

Article Type: Research Article

Abstract: Objective: To identify the possible factors influencing motor functional outcome of patients with traumatic spinal cord injury (T-SCI) after inpatient rehabilitation. Methods: 90 patients with T-SCI consecutively admitted for inpatient SCI rehabilitation unit was studied. Demographic characteristics, level and completeness of SC injury using American Spinal Injury Association (ASIA) Impairment Scale, disability level using Functional Independence Measure (FIM), psychological state using Hospital Anxiety and Depression Scale (HADS), and SCI-related medical complications were assessed and recorded at admission. The main measure of functional outcome was the motor FIM gain score at discharge. The univariate and multiple linear regression analyses …were performed. Results: The Mean admission motor FIM score was 35.3 (20.1), the mean discharge motor FIM score was 65.3 (22.5), and the mean motor FIM gain score was 30.0 (20.9). Univariate analyses indicated that the significant factors influencing motor functional outcome included age, motor FIM score at admission, level and severity of injury, anxiety/depression score, time between injury and admission to rehabilitation, length of stay, destination at discharge, and family caregiver. However, in multiple linear regression analyses, age, destination at discharge, family caregiver were not significant predictors. Conclusion: Age was not predictor of motor functional outcome and rehabilitation can be effective in elderly SCI patients. Rehabilitation intervention should begin as soon as possible. The admission motor FIM score, level and severity of injury, interval between onset and admission, anxiety/depression score, and length of stay can be used to predict functional outcomes of rehabilitation in SCI patients. Show more

Keywords: Traumatic spinal cord injury, rehabilitation, predictors, functional outcome

DOI: 10.3233/NRE-141111

Citation: NeuroRehabilitation, vol. 35, no. 2, pp. 341-347, 2014