NeuroRehabilitation - Volume 35, issue 3

Authors: Eidenberger, Margit | Nowotny, Silvia

Article Type: Review Article

Abstract: Background: Amyotrophic Lateral Sclerosis is a neurodegenerative disease with rapid involvement of the inspiratory muscles, leading to respiratory insufficiency. Death often occurs by aspiration and pneumonia. Endurance- and strength therapy within ALS are discussed controversially. Objective: To review the current literature to assess the efficacy of inspiratory muscle training for ALS. Method: Systematic review, using databases as PubMed, PEDro, Cochrane and Google Scholar. Intervention: Inspiratory muscle training vs. sham training or inspiratory muscle training alone. Outcome measures: Inspiratory muscle strength, dyspnoea, quality of life and survival time. Results: Four studies …could be included in this review, two RCT's, one pre-experimental study and one with a historical control group. In total 73 patients underwent inspiratory muscle training. Conclusion: Studies varied in onset of the training, the training protocol and the outcomes measured. At time, there is limited evidence that inspiratory muscle training leads to strengthening of inspiratory muscles in ALS. Improvements made were minor, in only a few parameters and also in control groups. Survival time was significantly longer in the experimental group in one study. Interesting suppositions (diaphragm training vs. other IM training, improvement of chest wall and lung compliance) need to be examined in robustly designed future trials, defining exact therapeutic windows and interventions. Show more

Keywords: Amyotrophic Lateral Sclerosis, inspiratory muscle strength, diaphragm, training

DOI: 10.3233/NRE-141148

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 349-361, 2014

Authors: Koyama, Soichiro | Tanabe, Shigeo | Warashina, Hiroaki | Kaneko, Tomoaki | Sakurai, Hiroaki | Kanada, Yoshikiyo | Nagata, Junji | Kanno, Tetsuo

Article Type: Research Article

Abstract: Background: Motor dysfunction after stroke might be improved by neuromuscular electrical stimulation (NMES) combined with 1 Hz repetitive transcranial magnetic stimulation (rTMS) in patients with moderate and severe motor dysfunction. Objective: This preliminary study tested the effect of this treatment combination. Methods: Fifteen patients (60.5 ± 10.3 years old) participated in the study. All patients had been affected by cerebral artery infarction or hemorrhage and had moderate or severe motor dysfunction in their affected hand. The patients received NMES at paretic wrist extensor muscles combined with rTMS over the unaffected M1 hemisphere twice a day, six …days/week over two weeks. All participants underwent the following battery of tests to evaluate the motor function of the affected hand: Upper limb Fugl-Meyer Assessment (UFMA), Wolf Motor Function Test (WMFT), and Box and Block Test (BBT). Results: UFMA, WMFT, and BBT scores improved significantly after the study. Conclusions: These results suggest that NMES combined with rTMS could be useful for recovery of moderate and severe motor function after stroke. Show more

Keywords: Neuromuscular electrical stimulation, repetitive transcranial magnetic stimulation, severe stroke patients

DOI: 10.3233/NRE-141127

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 363-368, 2014

Authors: Boudarham, J. | Pradon, D. | Roche, N. | Bensmail, D. | Zory, R.

Article Type: Research Article

Abstract: Background: A dynamic-ankle-foot orthosis has recently emerged and consists of an elastic band allowing the variation of stiffness degree and adjusts dorsiflexion assistance in swing. The aim of this study was to quantify the biomechanical adaptations induced by this orthosis during gait in hemiplegic patients. Methods: Twelve hemiplegic patients performed two gait analyses (without and with the ankle-foot orthosis). Spatiotemporal, kinematic, kinetic and electromyographic gait parameters were quantified using an instrumented gait analysis system during the stance and swing phases. Results: During swing, peak ankle dorsiflexion was greater with the orthosis and associated with a decrease …of pelvic obliquity angle. In stance, peak ankle plantarflexion and dorsiflexion were greater with the orthosis and associated with an increase of ankle angle at heel strike and toe-off. Electromyographic activities of both the tibialis anterior and the medial gastrocnemius were greater with the orthosis. Conclusions: This dynamic-ankle-foot orthosis improved gait in hemiplegic patients with spastic foot equinus. The spatiotemporal adaptations seem to be caused mainly by the increase of ankle dorsiflexion during stance and swing phases. The changes in electromyographic activity were related to an active dorsiflexion in stance and swing phases and an active plantarflexion in stance phase. Show more

Keywords: Foot deformity, dynamic ankle-foot-orthosis, muscular activity, kinematic

DOI: 10.3233/NRE-141128

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 369-379, 2014

Authors: You, Guoqing | Liang, Huiying | Yan, Tiebin

Article Type: Research Article

Abstract: Background: Functional electrical stimulation (FES) to patients early after stroke has been proved to improve walking ability. The effects on abilities in activities of daily living (ADL) are not clear. Objective: To investigate the effectiveness of FES in improving lower limb function and ability in ADL of early stroke patients. Methods: Thirty-seven stroke patients were randomly allocated to standard rehabilitation (SR) group (n = 18), and FES group with FES and SR (n = 19). SR included 60 minutes each for physiotherapy and occupational therapy. FES was delivered for 30 min to induce ankle dorsiflexion and …eversion. Treatments were 5 days per week for 3 weeks. Evaluations including the composite spasticity scale (CSS), lower-extremity subscale of Fugl-Myer Assessment (FMA), postural assessment scale for stroke patients (PASS), Berg Balance Scale (BBS), and modified Barthel Index (MBI) assessed before treatment, after 2 and 3 week treatment respectively. Results: After 2 week treatment, FES group showed a significant reduction of CSS and improvements of FMA, MBI and PASS. After 3 week treatment, FES group showed a further reduction of CSS and also improvement of FMA, MBI and BBS as well. Conclusions: FES on the paretic lower limbs early after stroke improved the mobility and ability in ADL. Show more

Keywords: Functional electrical stimulation, stroke, lower limb, motor, activities of daily living

DOI: 10.3233/NRE-141129

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 381-389, 2014

Authors: Lima, R.C.M. | Michaelsen, S.M. | Nascimento, L.R. | Polese, J.C. | Pereira, N.D. | Teixeira-Salmela, L.F.

Article Type: Research Article

Abstract: Background: People with stroke excessively move their trunk, when reaching and grasping objects. Objective: To determine if the addition of trunk restraint to modified constraint-induced movement therapy (mCIMT) was better than mCIMT alone in improving strength, function, and quality of life after stroke. Methods: A pilot randomized double-blinded clinical trial was conducted. Twenty-two participants with chronic stroke were randomly assigned to an experimental group that received mCIMT plus trunk restraint, or a control group (only mCIMT). Primary outcomes were the amount of use and quality of movement of the paretic upper limb (UL), determined by the …Motor Activity Log (MAL) scores. Secondary outcomes included the observed performance of the paretic UL during unimanual and bimanual tasks, kinematics of reaching, strength, and quality of life. Results: Both groups demonstrated significant improvements in the MAL scores and in the time to perform bimanual activities immediately after the interventions. However, no between-group differences were observed. Conclusions: The addition of trunk restraint to mCIMT resulted in no additional benefits, compared with mCIMT alone with stroke individuals with mild to moderate impairments. Unimanual and bimanual improvements were observed after mCIMT, regardless of trunk restraint, and the intervention did not adversely affect their reaching patterns. Show more

Keywords: Stroke, constraint-induced movement therapy, trunk restraint, rehabilitation, randomized clinical trial

DOI: 10.3233/NRE-141130

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 391-404, 2014

Authors: Paoloni, Marco | Tavernese, Emanuela | Fini, Massimo | Sale, Patrizio | Franceschini, Marco | Santilli, Valter | Mangone, Massimiliano

Article Type: Research Article

Abstract: Background: Segmental muscle vibration (SMV) improves motor performances in neurological conditions, including stroke. Objective: To determine if SMV modifies upper limb muscular activity in chronic stroke patients performing a reaching movement. Methods: We randomized 22 chronic stroke patients to an experimental group (EG; n = 12), receiving 10 sessions of exercise + 120 Hz SMV over the biceps brachii (BB) and the flexor carpi ulnaris (FCU) muscles, or to a control group (CG; n = 10) receiving exercise only. All subjects performed a reaching movement with the affected side before and 4 weeks after therapy ended. …We recorded surface EMG activity of the anterior deltoid (AD), posterior deltoid (PD), BB, triceps brachii (TB), FCU and extensor carpi radialis (ECR) muscles. We calculated muscular onset times, modulation ratio, co-contractions and degree of contraction. Results: After SMV, onset times of the PD (p = 0.03), BB (p = 0.02) and ECR (p = 0.04) in the EG were less anticipated than at baseline; the modulation ratio increased in AD (p = 0.003) and BB (p = 0.01); co-contractions decreased in the pairs BB/TB (p = 0.007), PD/BB (p = 0.004) and AD/BB (p = 0.01); and the degree of contraction decreased in BB (p = 0.01). Conclusions: The modulation of muscular function induced by SMV may aid to explain its action on smoothness and coordination of movements. Show more

Keywords: Stroke, rehabilitation, electromyography, reaching movement, vibration therapy

DOI: 10.3233/NRE-141131

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 405-414, 2014

Authors: Sawaki, Lumy | Butler, Andrew J. | Leng, Xiaoyan | Wassenaar, Peter A. | Mohammad, Yousef M. | Blanton, Sarah | Sathian, K. | Nichols-Larsen, Deborah S. | Wolf, Steven L. | Good, David C. | Wittenberg, George F.

Article Type: Research Article

Abstract: Objective: Constraint-induced movement therapy (CIMT) has been shown to improve upper extremity voluntary movement and change cortical movement representation after stroke. Direct comparison of the differential degree of cortical reorganization according to chronicity in stroke subjects receiving CIMT has not been performed and was the purpose of this study. We hypothesized that a higher degree of cortical reorganization would occur in the early (less than 9 months post-stroke) compared to the late group (more than 12 months post-stroke). Methods: 17 early and 9 late subjects were enrolled. Each subject was evaluated using transcranial magnetic stimulation (TMS) and the …Wolf Motor Function Test (WMFT) and received CIMT for 2 weeks. Results: The early group showed greater improvement in WMFT compared with the late group. TMS motor maps showed persistent enlargement in both groups but the late group trended toward more enlargement. The map shifted posteriorly in the late stroke group. The main limitation was the small number of TMS measures that could be acquired due to high motor thresholds, particularly in the late group. Conclusion: CIMT appears to lead to greater improvement in motor function in the early phase after stroke. Greater cortical reorganization in map size and position occurred in the late group in comparison. Significance: The contrast between larger functional gains in the early group vs larger map changes in the late group may indicate that mechanisms of recovery change over the several months following stroke or that map changes are a time-dependent epiphenomenon. Show more

Keywords: Plasticity, recovery, transcranial magnetic stimulation, upper extremity, motor

DOI: 10.3233/NRE-141132

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 415-426, 2014

Authors: Krukowska, Jolanta | Świątek, Ewa | Sienkiewicz, Monika | Czernicki, Jan

Article Type: Research Article

Abstract: Background: Impaired limb mobility is the most troublesome condition in patients after cerebral stroke. The application of the electrode-glove might reduce dysfunctions in patients treated due to stroke. Objective: The electrode-glove use in rehabilitation is investigated. The study was conducted on 54 patients aged 28 – 72 (the mean age 54.3 ± 10.3) with hemiparesis who had suffered from cerebral stroke. The patients from Group 1 were applied bipolar stimulation of forearm muscles (flexors and extensors of the wrist joint and hand) with the use of two flat electrodes of the same size. With regards to Group 2, …in the study used an electrode-glove. Methods: The excitation threshold was determined once a week with the use of the EMG. Secondary outcomes: The evaluation of the electromyographic bioelectric activity of flexor and extensor muscles in the forearm, of the functional mobility of the hand according to the Brunnström test and of the functional mobility of the hand according to the seven-graded task Frenchay scale. Results: The authors of the study observed a much greater improvement in the function of the hand in Group 2, where the mean value increased by 2.1 points. With regards to Group 1, the mean value increased by 1 point and the differences of the results in the studied groups after the therapy were statistically significant (p = 2.830). Conclusions: The electrical stimulation method controlled/triggered by muscle contractions is an effective method of normalization of muscle tension in the forearm and hand as well as restoration of the hand function in patients with cerebral stroke. Show more

Keywords: Cerebral stroke, electrostimulation, hand function

DOI: 10.3233/NRE-141133

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 427-434, 2014

Authors: Yeh, Shih-Ching | Lee, Si-Huei | Chan, Rai-Chi | Chen, Shuya | Rizzo, Albert

Article Type: Research Article

Abstract: Background: Among numerous studies on virtual reality (VR) technology for motor rehabilitation, the majorities have only used it as a motor training system and did not use the kinematic or kinetic information obtained as the basis for therapeutic effect assessment. Objective: Incorporating the kinematic and kinetic information acquired through a robot-assisted VR system on pinch-grip training, this study intends to propose novel motor ingredients represented as indices for the interpretation of motor behaviors and verify the efficacy of them for the assessment in chronic stroke. Methods: Clinical trials were conducted on eight stroke patients and clinical …assessments were made as the objective standard. Non-parametric test and correlation analysis were performed on results of motor indices and clinical assessments. Results: Non-parametric test indicated that 50% of the motor indices significantly improved while the others showed a trend of improvement, consisting with the findings in clinical assessments. Correlation analysis showed that the three clinical assessment items were correlated to items in the motor ingredients. Conclusions: The proposed motor ingredients gathered from the robot-assisted VR training system were able to contribute to the assessment of therapeutic effect in chronic stroke and were capable for the interpretation of behavior phases. Show more

Keywords: Stroke, rehabilitation, haptics, virtual reality, assessment

DOI: 10.3233/NRE-141134

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 435-449, 2014

Authors: Chitambira, Benjamin

Article Type: Research Article

Abstract: Background and objective: The aim was to compare follow up impairment, function and quality of life outcomes between dense parietal centred strokes treated by the optokinetic chart based OKCSIB protocol and those treated by conventional neuro-physiotherapy. Design and setting: Follow up retrospective case control series in the community. Method and materials: 643 persons with stroke were eligible for initial screening to see if they met inclusion criteria. Only 37 potential participants were eligible, with 18 of them still alive. From the 18 only 8 consented to participate in the follow up study. Results: Sixteen …mortalities that occurred post discharge were all from the conventional group. The OKCSIB group had statistically significant improved upper limb STREAM scores (p < 0.05). The OKCSIB group had statistically significant reduction in hand spasticity with none of the OKCSIB participants developing hand spasticity (p < 0.05). The OKCSIB group also had better lower limb STREAM scores although these were not statistically significant (p > 0.05). Barthel Index, and quality of Life improvements were non-significant (p > 0.05). Conclusion: The OKCSIB protocol led to better recovery of voluntary movements at 3 year follow up. However lack of randomisation and the small number of participants, necessitate further research to be carried out. Show more

Keywords: Dense acute parietal strokes, optokinetic chart stimulation, OKCSIB protocol, upper limb recovery, lower limb recovery, neuro-physiotherapy

DOI: 10.3233/NRE-141135

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 451-458, 2014