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

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

Authors: Luchesi, K.F. | Kitamua, S. | Mourão, L.F.

Article Type: Research Article

Abstract: Background: Dysphagia-related complications, such as aspiration pneumonia and malnutrition, are major causes of death among patients with Amyotrophic Lateral Sclerosis (ALS). Objective: To analyze clinical features associated with worsened swallowing and non-oral feeding in ALS. Methods: This is a long-term study of 33 ALS patients, who were observed between 2006 and 2011 in three month intervals. These subjects underwent Fiberoptic Endoscopic Evaluation of Swallowing and Functional Oral Intake Scale classification. Survival analysis was performed using Cox Regression. Results: The worsening of swallowing functionality was more rapid in late-onset ALS patients (risk of 4% per …year) and individuals with bulbar onset ALS (risk of 188% per year). Non-oral feeding was associated with both the later onset of ALS symptoms (risk of 7.5% per year) and shorter disease duration (risk of 13% per year). Conclusion: Worsened swallowing was more rapid in individuals who were older at symptoms onset and who had bulbar onset ALS. Non-oral feeding was associated with both age at symptoms onset and shorter disease duration. Show more

Keywords: Dysphagia, deglutition, survival analysis, Amyotrophic Lateral Sclerosis, disease progression

DOI: 10.3233/NRE-141149

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 535-542, 2014

Authors: Raji, Parvin | Ansari, Noureddin Nakhostin | Naghdi, Soofia | Forogh, Bijan | Hasson, Scott

Article Type: Research Article

Abstract: Background: The Semmes-Weinstein Monofilament Test (SWMT) is a clinical widely used test to quantify the sensibility in patients with Carpal Tunnel Syndrome (CTS). No study has investigated the relationship between the SWMT and sensory nerve conduction studies (SNCS) in patients with CTS. Objective: To assess the relationship between the SWMT and SNCS findings in patients with CTS. Methods: This cross-sectional clinical measurement study included 35 patients with CTS (55 hands) with a mean age of 45 ± 12 years. The outcome measures were the SWMT and SNCS measures of distal latency (DLs), amplitude (AMPs), and nerve …conduction velocity (NCV). The median innervated fingers were tested using SWMT and electrodiagnostic tests. The primary outcome was the correlations between the SWMTs and NCS measures. Results: All of the patients/hands had abnormal NCS findings. When looking at the three digits of interest (thumb, index and middle), the thumb SWMTs had the highest number of abnormal findings (58.2%), with the middle digit having the lowest (45.5%). All NCS findings were statistically different between abnormal and normal thumb SWMTs and abnormal and normal total summed SWMTs. There were significant moderate correlations between thumb SWMT scores and all NCS outcomes. Conclusions: Although only approximately 50% of the CTS diagnosed through NCS are corroborated through SWMT; the significant associations between SWMT and NCS measures suggest that SWMT is a valid test for assessing sensations in patients with CTS. Show more

Keywords: Carpal Tunnel Syndrome, Semmes-Weinstein Monofilament Test, nerve conduction study

DOI: 10.3233/NRE-141150

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 543-552, 2014

Authors: Hynes, S.M. | Fish, J. | Manly, T.

Article Type: Research Article

Abstract: Background: Multitasking measures, in which a series of tasks must be completed within a naturalistic setting not fully under the experimenter's control, have been shown to be more sensitive than traditional measures in detecting organisational problems in people with difficulties in executive functioning. There are a number of drawbacks to such tasks however. They can take considerable time to administer and are demanding in terms of examiners noting and recording all relevant aspects of performance. This potentially leaves them more open to subtle bias. One method that could offset these limitations is to video record performance. Objectives: The …practicality and outcome of using video ratings to accurately score performance off-line is investigated here. Methods: Nineteen participants completed a Multiple Errands Task (MET) while wearing a body-worn camera. Their performance was scored “live” and by an independent rater who had only access to video footage of the task. Results: Significant relationships were seen on all variables of the MET between the live and video ratings. The inter-rater reliability of the measure appears strong. Conclusion: We provide initial support for the use of a video rater when assessing performance on an MET. Show more

Keywords: Rehabilitation, memory; neurorehabilitation, assessment, therapy, executive function

DOI: 10.3233/NRE-141151

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 553-562, 2014

Authors: Glegg, Stephanie M.N. | Holsti, Liisa | Stanton, Sue | Hanna, Steven | Velikonja, Diana | Ansley, Barbara | Sartor, Denise | Brum, Christine

Article Type: Research Article

Abstract: Background: Virtual reality (VR) is a relatively new treatment tool with emerging evidence supporting its use in neurorehabilitation, although no information exists about how therapists use VR clinically. Objective: This study's purpose was to document current practice in GestureTek VR use for inpatient acquired brain injury (ABI) rehabilitation as a benchmark for clinicians integrating the approach into practice, and to inform future research to improve its clinical applicability. Methods: As part of a larger study examining barriers and facilitators to VR use, participating therapists at two rehabilitation centres documented descriptive data about client demographics and VR …treatment programme characteristics for 29 ABI clients on their caseloads over eight months. Results: Differences between the clinical population and published research samples were apparent. Treatment characteristics and several outcomes of interest paralleled those in the literature; however, novel outcome areas were identified as research gaps. By study's end, more than half of clients' VR programmes had been discontinued, for reasons consistent with documented barriers to VR use. Conclusions: These findings can help bridge the knowledge-to-action gap by informing the design of research that has high clinical relevance, and by providing a point of reference for clinicians incorporating VR into their practices. Show more

Keywords: Brain injury, rehabilitation, virtual reality, GestureTek, clinical applicability

DOI: 10.3233/NRE-141152

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 563-577, 2014

Authors: Hiyamizu, Makoto | Maeoka, Hiroshi | Matsuo, Atsushi | Morioka, Shu

Article Type: Research Article

Abstract: Background: Studies suggest that the observation of others' actions leads to enhanced motor skill learning. Objective: We examined whether others' or self-action observation is effective for standing balance learning. In addition, we examined cortical activation during action observation using functional near-infrared spectroscopy. Methods: Thirty-nine healthy young subjects were assigned randomly to the Control, Other-Observation (O-O), and Self-Observation (S-O) groups. The subjects learned to stand on a tilting platform while maintaining a horizontal position. The Control group alternated each trial with a rest period. The O-O and S-O groups were provided with information related to their performance …during the rest period: the O-O group observed another person, while the S-O group observed their previous performance. Cortical activation was assessed by changes of hemoglobin oxygenation (oxyHb). Results: A 2-way analysis of variance with repeated measures on balance performance revealed a significant difference in post-training (p < 0.05) and retention (p < 0.01) only in the S-O group. And an increase of oxyHb levels at post-training in the S-O group was observed in the supplementary motor area. Conclusion: Self-action observation improved standing balance and brain activity during training and at 24 h after training. Show more

Keywords: Action observation, balance, motor learning, fNIRS

DOI: 10.3233/NRE-141153

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 579-585, 2014

Authors: Shin, Yoon Kyum | Lee, Dong Ryul | Kim, Do Hyun | Lee, Jae Jin | You, Sung (Joshua) Hyun | Yi, Chung Hwi | Jeon, Hye Seon

Article Type: Research Article

Abstract: Background: Gait impairments from a neuromuscular imbalance are crucial issues in cerebral palsy. The purpose of our study was to compare the effects of the assistive tubing gait (ATG) and assistive-resistive tubing gait (ARTG) on improving the vasti and hamstring muscle imbalance during the initial contact to mid-stance phases in individuals with spastic diplegic cerebral palsy (CP). Methods: Fourteen age-matched individuals including seven normal individuals (11.7 years) and seven individuals with CP (12.9 years) were recruited. All participants underwent electromyography (EMG) measurement of the unilateral vasti and hamstring muscle activity during the three gait training conditions of no-tubing …gait (NTG), ATG, and ARTG. A statistical one-way repeated-measure analysis of variance (ANOVA) was used to determine differences in the vasti and hamstring activity, the vasti/hamstring ratio, and the knee joint angle across the three gait training conditions for each group. Results: The initial vasti and hamstring muscle imbalance in CP was significantly improved by applying the ARTG compared with the ATG. The vasti/hamstring ratio during the ARTG was compatible with the ratio value obtained from the NTG of normal individuals. The knee joint angle in CP was not improved in this short-term intervention. Conclusions: The ARTG proportionately increased the vasti activation and reciprocally inhibited the hamstring activity, subsequently improving the neuromuscular imbalance associated with the flexed-knee gait in individuals with spastic diplegic CP. Show more

Keywords: Neuromuscular imbalance, reciprocal inhibition, spastic diplegic CP, tubing gait

DOI: 10.3233/NRE-141154

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 587-596, 2014

Authors: Nsenga Leunkeu, Angeline | Lelard, Thierry | Shephard, Roy J. | Doutrellot, Pierre-Louis | Ahmaidi, Said

Article Type: Research Article

Abstract: Background: Gait cycle and pressure distribution patterns can now be recorded quite simply and reproducibly with inexpensive in-sole pressure recorders. However, it is not known whether such readings are sufficiently stable to provide useful information in monitoring children with spastic hemiplegic cerebral palsy (HCP). Objective: The aim of this study was to asses the reproducibility of gait cycle and plantar pressure in HCP. Methods: Fourteen children with HCP (Gross Motor Function Classification System level I or II) undertook two walking trials (4 × 12 meters at self-selected speeds) with a one-week inter-test interval. Spatio-temporal gait cycle …parameters and peak plantar pressures were measured at each visit, using Parotec in-shoe pressure sensors. Results: In the unaffected limb, satisfactory reproducibility was found for measurements of velocity, step frequency, time of double support, and step duration, but not for step amplitude or contact time. However, in the affected limb, only velocity and step duration showed moderate reproducibility. Likewise, all of 8 pressure measurements were reproducible for the unaffected limb, but pressures for the affected limb were only consistent at 4 sites (metatarsals 4-5, lateral heel, lateral mid-foot and hallux). Conclusions: Since plantar pressures are unstable only in the affected limb, the cause of variation is likely immediate spasm during movement of this limb rather than a more permanent change of posture. Some spatio-temporal parameters and plantar pressure readings have sufficient stability in both unaffected and affected limbs to allow their use when evaluating gait and planning therapy for children with HCP. Show more

Keywords: Bland-Altman tests, children, hemiplegic cerebral palsy, rehabilitation, gait cycle, peak plantar pressures

DOI: 10.3233/NRE-141155

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 597-606, 2014

Authors: Kim, Yushin | Kim, Jungjin | Shim, Jae Kun | Suh, Dong-Won | Yoon, BumChul

Article Type: Research Article

Abstract: Background: Sensitivity of the myofascial trigger point (MTrP) can be inhibited by electrical stimulation of remote site. However, it remains unclear whether remote pain control of the MTrP occurs in the same spinal segment or in the supraspinal system. Objectives: The aims of this study were to identify whether the remote pain control occurs in the spinal segment corresponding to the MTrP or in the supraspinal system. Methods: Test subjects (n = 10) received transcutaneous electrical nerve stimulation for 5 minutes, whereas control subjects (n = 10) received no intervention. The threshold for tactile sensory modulation …at the lateral elbow was assessed using Von Frey filaments. The pressure sensitivities of MTrPs in both the infraspinatus and upper trapezius muscles were quantified by algometry. Measurements were performed at baseline and 1 and 15 minutes after the intervention. Results: Increases of the tactile threshold at the remote site decreased the sensitivity of the MTrP innervated by same spinal segment. However, no changes were observed at MTrP sites innervated by contralateral fibers or those from different spinal segment. Conclusion: MTrP sensitivity is more strongly affected by interventions at remote ipsilateral sites in the same spinal segment than by stimulation of extra-segmental sites. Show more

Keywords: Remote pain control, myofascial trigger points, transcutaneous electrical nerve stimulation, hypoalgesia, tactile sensory modulation

DOI: 10.3233/NRE-141156

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 607-614, 2014

Authors: Wallace, Sarah E. | Purdy, Mary | Skidmore, Elizabeth

Article Type: Case Report

Abstract: Background: Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. Objective: The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication …breakdowns. Methods: Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. Results: Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. Conclusions: Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting. Show more

Keywords: Aphasia, acute rehabilitation, multimodal treatment, stroke

DOI: 10.3233/NRE-141136

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 615-625, 2014

Authors: Morris, Lottie L. | Dysch, Leon | Salkovskis, Paul M. | Giffin, Nicola

Article Type: Case Report

Abstract: Background: Stiff Person Syndrome (SPS) is a rare neurological condition, characterised by rigidity in the trunk and limbs. Comorbid anxiety is common and known to exacerbate stiffness. Objective: This case study examines the extent to which psychological treatment of comorbid anxiety alleviated stiffness in a patient whose condition was exacerbated by social anxiety. Methods: A patient was treated using cognitive behavioural therapy, focussing on reducing anxiety and therefore stiffness by addressing rumination, self-focussed attention, and distressing cognitions relating to walking in public. The patient's walking, stiffness, and anxiety were assessed during and post-therapy using questionnaires. …Results: Walking, stiffness, and anxiety improved during treatment. At five months' follow up, while the improvement in anxiety was maintained, walking and stiffness had deteriorated. The patient and his Neurologist felt that this deterioration was biological, rather than psychological in nature. Conclusions: This is the first published case where SPS has been ameliorated (albeit temporarily) using psychological therapy, and has important implications for future research and treatment. Show more

Keywords: Stiff Person Syndrome, stiff man syndrome, cbt, psychotherapy

DOI: 10.3233/NRE-141147

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 627-631, 2014

Article Type: Correction

Abstract: Related article: http://iospress.metapress.com/content/b308uw7n55642201/

DOI: 10.3233/NRE-141157

Citation: NeuroRehabilitation, vol. 35, no. 3, pp. 633-633, 2014