NeuroRehabilitation - Volume 35, issue 3

Authors: Na, Eun Hye | Han, Soo Jeong | Yoon, Tae Sik

Article Type: Research Article

Abstract: Background: The patients with brain lesion have a high risk of pulmonary complication due to restrictive pulmonary impairment. Objective: To investigate the effectiveness of active pulmonary rehabilitation on pulmonary functional improvement in these patients. Methods: Twenty-two patients of hemiplegia or quadriplegia with brain lesion were recruited who had restrictive pulmonary impairment. The patients were randomly assigned to an experimental group that receive active pulmonary rehabilitation training and a control group without it. The active pulmonary rehabilitation training is composed of air-stacking exercise by ambu-bagging and functional electrical stimulation (FES) on phrenic nerve and abdominal muscle. We …examined respiration function test of all patients composed of peak cough flow (PCF), pulmonary function test (PFT), diaphragmatic motion evaluation and oxygen saturation (SaO2) at the beginning and 4 weeks after treatment. Results: There was no significant difference in pulmonary function between experimental group and control group at the beginning. After 4 weeks treatment, FVC and FEV1 of PFT, PCF, diaphragmatic motion, SaO2 have significantly improved (p < 0.05) in experimental group, but no significant changes were detected in control group. Conclusions: It is suggested that active pulmonary rehabilitation with air-stacking exercise and FES would be useful to improve pulmonary function in patients with brain lesion. Show more

Keywords: Pulmonary rehabilitation, pulmonary function test, FES, air-stacking exercise

DOI: 10.3233/NRE-141137

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 459-466, 2014

Authors: Dillbeck Regier, Angela | Berryman, Amy | Hays, Kaitlin | Smith, Cindy | Staniszewski, Kristi | Gerber, Don

Article Type: Research Article

Abstract: Objective: To determine whether manual wheelchair configuration impacts how well a person who has acquired brain injury (ABI) related hemiparesis performs functional tasks from his or her wheelchair. Design: Multi-treatment cross-over design. Setting: Inpatient rehabilitation hospital. Participants: Nineteen patients with ABI resulting in hemiparesis undergoing inpatient rehabilitation (average of 75 days post-injury (± 29.2 days); age range, 21–64; 9 with mechanical brain injury, 10 with cerebral vascular accident). Interventions: Participants in the study were placed in two different wheelchair configurations (position one and position two) and were randomized as to which position …they were placed in first. All outcome measures were taken twice on each individual within each wheelchair configuration during two consecutive days. Main outcome measures: Timed Forward Wheeling (TFW), Modified Functional Reach test (MFR), Visual Analogue Scale for Comfort (VAS), transfer score from the Functional Independence Measure (FIM), measurement of popliteal fossa to front of cushion. Results: The position two seating group's TFW was significantly faster than the position one seating group at both time points. There were no significant differences in the MFR scores, VAS comfort scale scores, and FIM transfer score between the two groups. Conclusion: A wheelchair configuration with no seat slope, solid backrest mounted at 95 degree (± 3 degrees) seat to back angle, and use of a solid seat insert with a flat foam cushion (position two) results in greater efficiency in foot propulsion for individuals with ABI than a wheelchair configuration with one inch of seat slope, solid backrest mounted at 105 degree (± 3 degrees) seat to back angle, and no solid seat insert with a gel/foam contoured cushion (position 1). Show more

Keywords: Wheelchairs, acquired brain injuries, activities of daily living

DOI: 10.3233/NRE-141138

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 467-473, 2014

Authors: Kuipers, Pim | Doig, Emmah | Kendall, Melissa | Turner, Ben | Mitchell, Marion | Fleming, Jennifer

Article Type: Research Article

Abstract: Background: Family member engagement is increasingly recognised as an influential factor in the rehabilitation continuum following Acquired Brain Injury, including the inpatient setting and longer-term community integration phases. Objective: To explore the experiences of patients and family members about their involvement in brain injury rehabilitation. Methods: This study comprised individual and group interviews with 14 ex-patients and family members. Interviews explored effects of inpatient rehabilitation on family relationships. Interview audio recordings were analysed using an interpretive approach by two independent researchers. Results: Findings clearly confirmed the significance of engaging family members in inpatient rehabilitation, …and specifically reinforced the importance of informational, emotional, practical and peer support. However, the key finding of the study was the importance of hope, and the need for rehabilitation professionals to foster hope. Despite not having included any questions on this topic, all interviewees noted the importance of hope, some saw it as fundamental to positive outcomes, and many were unconvinced of rehabilitation professionals' concern to avoid false hope. Various dimensions of hope are explored. Conclusions: The study notes that hope has been identified as highly important in many areas beyond brain injury rehabilitation. Based on this small preliminary study, the issue of hope is seen as a key focus for future research. Show more

Keywords: Brain injury, rehabilitation, family relationships, hope

DOI: 10.3233/NRE-141139

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 475-480, 2014

Authors: Munivenkatappa, Ashok | Rajeswaran, Jamuna | Indira Devi, Bhagavatula | Bennet, Niranjana | Upadhyay, Neeraj

Article Type: Research Article

Abstract: Background: Electroencephalogram Neurofeedback therapy (EEG-NFT) has several potential beneficial effects in terms of improving cognition and electrophysiological regulation among patients with brain injury. However, in vivo structural and functional changes remain less explored. Objective: The aim of the present study is to explore EEG-NFT induced in vivo changes in traumatic brain injury (TBI) patients. Method: Two patients with mean age of 15 years with moderate head injury who had more than seven post concussion symptoms and poor cognitive performances (<5 percentile) were subjected to 20 sessions of EEG-NFT. The neuropsychological test scores, post concussion symptoms and …MRI scan of the brain were recorded pre-post to EEG-NFT. Results: During EEG-NFT the cognitive scores and concussion symptoms improved significantly (p < 0.05). The EEG-NFT has shown significant increase in cortical grey matter (GM) volumes (p < 0.0001) and fractional anisotropy (FA) of cortical white matter (WM) tracts (p < 0.0001, voxel max 60 and above). There was a significant decrease in global, local efficiency, cost and clustering coefficient of functional connectivity (Wilcoxon Sign Rank Test p < 0.05). Interestingly there was a significant increase in thalamo-cortical connection (increase FA value) after EEG-NFT. Conclusion: The EEG-NFT therapy has shown significant changes in structural and functional connectivity among young moderately injured TBI patients. Show more

Keywords: EEG-NFT, TBI, MRI scan, neuropsychological scores, in vivo changes

DOI: 10.3233/NRE-141140

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 481-484, 2014

Authors: Lequerica, Anthony | Chiaravalloti, Nancy | Cantor, Joshua | Dijkers, Marcel | Wright, Jerry | Kolakowsky-Hayner, Stephanie A. | Bushnick, Tamara | Hammond, Flora | Bell, Kathleen

Article Type: Research Article

Abstract: Background: Sleep disturbances are common following traumatic brain injury (TBI). The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of sleep quality that has been used in numerous populations. Although this measure has been used in TBI research, there are few studies examining the psychometric properties in this population. Objective: The current study examined the factor structure of the PSQI in a sample of persons with TBI and tested the one, two, and three factor models derived from previous studies in other populations. Methods: A telephone interview was conducted with 243 individuals who had …sustained a TBI. All participants were approximately one year post-injury. Factor analyses were conducted (exploratory and confirmatory) to examine the factor structure of the PSQI. Results: Results confirm the fit of models previously tested in the literature but also reveal an alternative conceptualization of sleep containing both qualitative and quantitative factors. Conclusions: While the 3-factor model best fits the data in this TBI sample, the use of a 2-factor model is acceptable and may be more clinically relevant due to the grouping of time-related variables that could provide important information with regard to circadian rhythm disorders. Show more

Keywords: Brain injury, sleep, measurement

DOI: 10.3233/NRE-141141

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 485-492, 2014

Authors: Cano-de-la-Cuerda, Roberto | Vela-Desojo, Lydia | Miangolarra-Page, Juan Carlos | Macías-Macías, Yolanda

Article Type: Research Article

Abstract: Background: Rigidity is a cardinal symptom of Parkinson's disease (PD). There are few studies that have assessed rigidity with objective tools in PD patients. Objective: This study aimed to develop an objective measurement to quantify trunk rigidity in PD patients with a technology device and to investigate the relationship between this objective assessment and to examine its relationship with disease severity (Hoehn and Yahr staging score and the Unified Parkinson's Disease Rating Scale III) disease duration, functional status (Schwab & England activities of daily living scale) and health related quality of life (European Quality of Life-5 Dimensions and …Parkinson's Disease Questionnaire-39 items) in patients with mild to moderate PD. Methods: An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 PD patients. Passive trunk flexion and extension at 3 angular velocities, 30°/s, 45°/s and 60°/s were applied and resistive torques were recorded as trunk flexor and extensors rigidity. Results: Significant correlations between trunk flexors-extensors tone and clinical status, disease duration and functional status at 30°/s, 45°/s and 60°/s were obtained. No correlations were found among trunk muscle tone assessed with the isokinetic dynamometer and the EuroQoL-5D. Trunk rigidity was correlated with the HRQoL assessed with the mobility, cognition and stigma PDQ-39 domains and the total PDQ-39 scores. Conclusion: Our results suggest that the 30°/s, 45°/s and 60°/s angular velocities of this objective technology method were a valid assessment for trunk rigidity and were correlated with disease severity, disease duration, functional status and HRQoL in PD patients. Show more

Keywords: Parkinson's disease, rigidity, objective measurement, trunk, quality of life

DOI: 10.3233/NRE-141142

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 493-501, 2014

Authors: McLoughlin, J.V. | Barr, C.J. | Crotty, M. | Sturnieks, D.L. | Lord, S.R.

Article Type: Research Article

Abstract: Background: Fatigue, lower limb weakness and poor balance can significantly limit safe mobility in people with Multiple Sclerosis (MS). Further research is required to elucidate relationships among these factors. Objective: To investigate the effect of walking-induced fatigue on lower limb strength and postural sway in people with moderately disabling MS. Methods: Thirty-four people (26 female) with moderate MS (mean Expanded Disability Status Scale of 3.7 ± 0.7) underwent assessments of acute fatigue, postural sway and lower limb strength before and after six-minute conditions of seated rest and walking. A matched sample of 10 healthy controls also …undertook identical assessments before and after a six-minute walk. Results: Significant time by condition effects for all assessment measures indicated the six-minute walk induced fatigue with associated increases in postural sway and reductions in lower limb strength in people with MS. Increases in sway with eyes closed correlated with increases in acute fatigue and self-reported impact of fatigue on physical and psychological functioning. No changes were observed in healthy controls. Conclusion: People with MS show signs of fatigue after 6 minutes of walking, including strength and balance deficits. These findings have implications for both mobility and fall risk in this group. Show more

Keywords: Multiple Sclerosis, fatigue, muscle strength, postural balance, mobility limitation, accidental falls

DOI: 10.3233/NRE-141143

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 503-508, 2014

Authors: Chisari, C. | Venturi, M. | Bertolucci, F. | Fanciullacci, C. | Rossi, B.

Article Type: Research Article

Abstract: Background: Exercise is well tolerated and induces relevant improvements in physical and mental functioning of persons with Multiple Sclerosis (MS). Unfortunately, due to the wide variety of symptoms and the broad range of exercise interventions, it is not possible to make unified exercise recommendation as to what type of exercise is safe and effective for persons with MS. Objective: The aim was to test the impact of an intensive task-oriented training on motor function and quality of life in 17 MS patients with an Expanded Disability Status Scale (EDSS) between 4 and 5.5. Methods: Patients underwent …a two-week intensive, task-oriented rehabilitation program. Outcome measures were: Berg Balance Scale, Gait Dynamic Index, 6 Minute Walking Test, Physiological Cost Index, Fatigue Severity Scale, 10 metres Walking Test, Timed Up and Go test, Short form 36, Multiple Sclerosis Impact Scale, Patient Health Questionnaire. Results: All outcome measures showed a significant improvement after the treatment except for the 6 Minute Walking test and the Short form 36 that showed a trend of improvement although not statistically significant. Conclusions: An intensive task-oriented rehabilitation protocol is effective in improving motor function and has a positive impact on quality of life in MS patients with moderate disability. Show more

Keywords: Multiple Sclerosis, task-oriented rehabilitation, quality of life, energy expenditure

DOI: 10.3233/NRE-141144

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 509-518, 2014

Authors: Pusswald, Gisela | Mildner, Christa | Zebenholzer, Karin | Auff, Eduard | Lehrner, Johann

Article Type: Research Article

Abstract: Background: Forty to sixty percent of MS patients suffer from cognitive impairments. Cognitive deficits are a great burden for patients affected. In particular they may lead to a reduced quality of life, loss of work and problems with the social environment. Objective: The aim of this study was to evaluate a specific neuropsychological rehabilitation program for MS patients according to the ICF to be able to meet more properly individual requirements on the therapy level of function as well as of activities and participation. Methods: Forty patients with MS were randomised in an intervention (IG) – …and a control group (CG). The outcome measure of the IG, who started an intensive computer based home training of attention and attended psychological counselling was compared to the untrained CG. Results: In specific domains of attention (simple and cued alertness and divided attention) significant group differences between CG and IG could be found. The IG reported an improvement of mental fatigue and retardation. Conclusion: These findings support the idea that a neuropsychological rehabilitation program, which based on the model of ICF, could improve cognitive impairment and could also have a positive influence of activities and participation. Show more

Keywords: Multiple sclerosis, ICF, neuropsychological rehabilitation

DOI: 10.3233/NRE-141145

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 519-527, 2014

Authors: Gaber, Tarek A.-Z.K. | Oo, Wah Wah | Ringrose, Hollie

Article Type: Research Article

Abstract: Introduction: Fatigue is a major cause of disability and handicap in Multiple Sclerosis (MS) patients. The management of this common problem is often difficult. Chronic Fatigue Syndrome (CFS/ME) is another common cause of fatigue which is prevalent in the same population of middle aged females commonly affected by MS. Aim: This report aims at examining the potential coexistence of MS and CFS/ME in the same patients. Method: This is a retrospective study examining a cohort of MS patients referred for rehabilitation. The subjects were screened for CFS/ME symptoms. Results: Sixty-four MS patients (43 females) …were screened for CFS/ME. Nine patients (14%) with a mean age 52 (SD 9.7) who were all females fulfilled the Fukuda criteria for diagnosis of CFS/ME. Their symptoms, including muscular and joint pain, malaise and recurrent headaches, were not explained by the pattern of their MS. Discussion: MS and CFS/ME are two common conditions with increased prevalence in middle aged females. As the diagnosis of CFS/ME is clinical with no positive clinical signs or investigations; it can be made with difficulty in the presence of another clear explanation for the disabling fatigue. Our results suggest that the two conditions may co-exist. Considering CFS/ME as a potential co-morbidity may lead to more focused and appropriate management. Show more

Keywords: Multiple Sclerosis, Chronic Fatigue Syndrome, myalgic encephalitis, fatigue

DOI: 10.3233/NRE-141146

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 529-534, 2014