NeuroRehabilitation - Volume 35, issue 4

Authors: Lannin, Natasha A. | Laver, Kate | Henry, Kareena | Turnbull, Michelle | Elder, Megan | Campisi, Josephine | Schmidt, Julia | Schneider, Emma

Article Type: Review Article

Abstract: Background: Adults who survive traumatic brain injury (TBI) often receive case (care) management to overcome the difficulties commonly faced negotiating a number of different health and social care services and systems. Little is known about the effectiveness of a case management intervention. Objective: To examine the effects of case management for patients with severe head injury on outcome, family function, and provision of rehabilitation services. Methods: Systematic review methodology. Electronic databases (Medline, CINAHL, Psycbite and OTSeeker) were searched up to 7/1/2013. A total of 655 articles were screened of which six met the criteria for inclusion …in the review. Study quality was evaluated using the PEDro scale or AMSTAR checklist dependent on study design. Results: One systematic review, three controlled trials and two case series reports were appraised. There was significant clinical heterogeneity between studies and studies scored poorly on the appraisal checklists. Due to methodological limitations, there was no clear evidence of effectiveness or ineffectiveness of case management after brain injury. Conclusion: Principal findings are that there is a paucity of applicable research on case management, and a need to evaluate the impact of case management on life participation outcomes. Show more

Keywords: Case management, managed care programs, review, brain injuries, rehabilitation

DOI: 10.3233/NRE-141161

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 635-641, 2014

Authors: Willerslev-Olsen, Maria | Lorentzen, Jakob | Nielsen, Jens Bo

Article Type: Research Article

Abstract: Background: Foot drop and toe walking are frequent concerns in children with cerebral palsy (CP). Increased stiffness of the ankle joint muscles may contribute to these problems. Objective: Does four weeks of daily home based treadmill training with incline reduce ankle joint stiffness and facilitate heel strike in children with CP? Methods: Seventeen children with CP (4–14 years) were recruited. Muscle stiffness and gait ability were measured twice before and twice after training with an interval of one month. Passive and reflex-mediated stiffness were measured by a dynamometer which applied stretches below and above reflex threshold. …Gait kinematics were recorded by 3-D video-analysis during treadmill walking. Foot pressure was measured by force-sensitive foot soles during treadmill and over-ground walking. Results: Children with increased passive stiffness showed a significant reduction in stiffness following training (P = 0.01). Toe lift in the swing phase (P = 0.014) and heel impact (P = 0.003) increased significantly following the training during both treadmill and over-ground walking. Conclusions: Daily intensive gait training may influence the elastic properties of ankle joint muscles and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP. Show more

Keywords: Cerebral palsy, gait training, passive muscle stiffness

DOI: 10.3233/NRE-141180

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 643-655, 2014

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

Article Type: Research Article

Abstract: Background: Information on altered foot pressures during ambulation would clarify how far limb deformities modify walking patterns in cerebral palsy (CP), and whether such data can inform prognosis and guide rehabilitation. Objective: To compare patterns of plantar pressures during walking between children with CP and their able-bodied (AB) peers. Methods: Twenty-five children/adolescents (10 with hemiplegia, 5 with diplegia, and 10 AB, respective ages 13.0 ± 1.9, 13.0 ± 0.6 and 14.0 ± 0.7 years) walked a 12 m line at a self-selected speed. Spatio-temporal parameters and peak in-shoe plantar pressures were recorded for both feet, using …the Parotec analysis system. Results: Walking speeds (m·−1 ) differed significantly between groups (0.65 ± 0.13, hemiplegia, 0.93 ± 0.22 diplegia and 1.26 ± 0.05 AB), with shorter stride lengths in CP. Contact time, double support time and step duration were also shorter in hemiplegia. Plantar pressures differed substantially and consistently between AB and CP, with increased medial heel pressures in hemiplegia, and reduced hallux and lateral heel pressures but increased lateral, medial mid-foot and first metatarsal pressures in diplegia. Conclusions: Substantial alterations in spatio-temporal parameters (greater in hemiplegia than in diplegia) and plantar pressure distribution reflect attempts to compensate for poor stability of posture in CP. Further study of these adaptive changes holds clinical promise in providing data relevant to the design of orthotics, determinations of prognosis and the planning of neurorehabilitation. Show more

Keywords: Children, cerebral palsy, rehabilitation, gait cycle, plantar pressures

DOI: 10.3233/NRE-141163

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 657-663, 2014

Authors: Plata Bello, Julio | Modroño, Cristián | González-Mora, José Luis

Article Type: Research Article

Abstract: Background: A great deal of research has focused on demonstrating the existence of mirror neurons in humans and the factors that modulate their activity after their discovery in macaques approximately two decades ago. Objectives: With this in mind, the parieto-frontal mirror neuron system (MNS) has been described as a brain network that is activated when either an action is executed or as it is observed. The clinical importance of these findings have been related with neurological and psychiatric disorders, but no one has focused until now on the possibilities that this network could provide to achieve better results …in neurosurgical patients. Methods and results: One of the applications of the MNS with clinical significance is the observation based rehabilitation programs. These programs have demonstrated their usefulness in certain pathologic entities but as yet there are no reports regarding neurosurgical patients in the literature. The activation of brain areas during observation of motor actions which are also activated when those actions are executed define the physiopathological principle of this kind of therapy that has been shown to get better results than standard rehabilitation programs and that should also be tested on neurosurgical patients. If observation based rehabilitation is considered, the MNS should be as intact as possible. Indeed, the surgeon can try to respect mirror areas during surgery by mapping them pre-surgically. Furthermore, damage to the MNS is associated with some degree of cognitive impairment, so better functional results can be achieved by respecting these mirror areas. Conclusion: Therefore, the aim of the present work is to describe how the MNS can contribute to neurosurgery and to put forward the hypothesis that by considering and using MNS properties better functional outcomes can be achieved. Show more

Keywords: Mirror neurons, observation based rehabilitation, neurosurgery

DOI: 10.3233/NRE-141167

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 665-671, 2014

Authors: Chong, Hyun Ju | Han, Soo Jeong | Kim, Yong Jae | Park, Hye Young | Kim, Soo Ji

Article Type: Research Article

Abstract: Background: While a number of studies have tested the therapeutic effectiveness of playing musical instruments, such as the electronic keyboard using Musical Instrument Digital Interface (MIDI), it is still unclear whether outcomes of electronic keyboard playing are related to hand function tests. Objective: The purpose of this study was to investigate the correlation between MIDI-keyboard playing and hand function tests, including grip strength, Box and Block test (BBT), and Jensen-Taylor Hand Function Test (JTHF). Methods: A total of 66 stroke patients were recruited from medical centers and were classified into acute (n = 21), subacute (n …= 28), and chronic (n = 17) recovery stages. The participants' mean age was 60.5 years. The MIDI-keyboard playing protocol based on sequential key pressing was implemented. All hand function tests were performed by certified occupational therapists. Results: MIDI scores from participants at all three recovery stages were significantly correlated with BBT and grip strength. Overall, MIDI-keyboard playing scores demonstrated moderate to high correlations with hand function tests except for participants at the chronic stage and the JTHF, which showed no correlation. Conclusions: These findings suggest that MIDI-keyboard playing has great potential as an assessment tool of hand function, especially hand dexterity in acute and subacute stroke patients. Further studies are needed to refine the specific keyboard playing tasks that increase responsiveness to traditional hand function tests. Show more

Keywords: Hand function, stroke rehabilitation, MIDI-keyboard playing

DOI: 10.3233/NRE-141166

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 673-680, 2014

Authors: Cha, Yuri | Kim, Young | Hwang, Sujin | Chung, Yijung

Article Type: Research Article

Abstract: Background: Motor relearning protocols should involve task-oriented movement, focused attention, and repetition of desired movements. Objectives: To investigate the effect of intensive gait training with rhythmic auditory stimulation on postural control and gait performance in individuals with chronic hemiparetic stroke. Methods: Twenty patients with chronic hemiparetic stroke participated in this study. Subjects in the Rhythmic auditory stimulation training group (10 subjects) underwent intensive gait training with rhythmic auditory stimulation for a period of 6 weeks (30 min/day, five days/week), while those in the control group (10 subjects) underwent intensive gait training for the same duration. Two …clinical measures, Berg balance scale and stroke specific quality of life scale, and a 2-demensional gait analysis system, were used as outcome measure. To provide rhythmic auditory stimulation during gait training, the MIDI Cuebase musical instrument digital interface program and a KM Player version 3.3 was utilized for this study. Results: Intensive gait training with rhythmic auditory stimulation resulted in significant improvement in scores on the Berg balance scale, gait velocity, cadence, stride length and double support period in affected side, and stroke specific quality of life scale compared with the control group after training. Conclusions: Findings of this study suggest that intensive gait training with rhythmic auditory stimulation improves balance and gait performance as well as quality of life, in individuals with chronic hemiparetic stroke. Show more

Keywords: Gait, rhythmic auditory stimulation, stroke

DOI: 10.3233/NRE-141182

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 681-688, 2014

Authors: Manson, Gerome A. | Alekhina, Maria | Srubiski, Shirley L. | Williams, Camille K. | Bhattacharjee, Arindam | Tremblay, Luc

Article Type: Research Article

Abstract: Background: Robotic guidance has been shown to facilitate motor skill acquisition, through altered sensorimotor control, in neurologically impaired and healthy populations. Objective: To determine if robot-guided practice and online visual feedback availability primarily influences movement planning or online control mechanisms. Methods: In this two-experiment study, participants first performed a pre-test involving reaches with or without vision, to obtain baseline measures. In both experiments, participants then underwent an acquisition phase where they either actively followed robot-guided trajectories or trained unassisted. Only in the second experiment, robot-guided or unassisted acquisition was performed either with or without online vision. …Following acquisition, all participants completed a post-test that was the same as the pre-test. Planning and online control mechanisms were assessed through endpoint error and kinematic analyses. Results: The robot-guided and unassisted groups generally exhibited comparable changes in endpoint accuracy and precision. Kinematic analyses revealed that only participants who practiced with the robot exhibited significantly reduced the proportion of movement time spent during the limb deceleration phase (i.e., time after peak velocity). This was true regardless of online visual feedback availability during training. Conclusion: The influence of robot-assisted motor skill acquisition is best explained by improved motor planning processes. Show more

Keywords: Motor control, robot, upper-limb, assistance, rehabilitation

DOI: 10.3233/NRE-141168

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 689-700, 2014

Authors: Hussain, Shahid

Article Type: Research Article

Abstract: Background: Robot assisted gait training is a rapidly evolving rehabilitation practice. Various robotic orthoses have been developed during the past two decades for the gait training of patients suffering from neurologic injuries. These robotic orthoses can provide systematic gait training and reduce the work load of physical therapists. Biomechanical gait parameters can also be recorded and analysed more precisely as compared to manual physical therapy. Objectives: A review of robotic orthoses developed for providing gait training of neurologically impaired patients is provided in this paper. Methods: Recent developments in the mechanism design and actuation methods of …these robotic gait training orthoses are presented. Control strategies developed for these robotic gait training orthoses in the recent years are also discussed in detail. These control strategies have the capability to provide customised gait training according to the disability level and stage of rehabilitation of neurologically impaired subjects. Results: A detailed discussion regarding the mechanism design, actuation and control strategies with potential developments and improvements is provided at the end of the paper. Conclusions: A number of robotic orthoses and novel control strategies have been developed to provide gait training according to the disability level of patients and have shown encouraging results. There is a need to develop improved robotic mechanisms, actuation methods and control strategies that can provide naturalistic gait patterns, safe human-robot interaction and customized gait training, respectively. Extensive clinical trials need to be carried out to ascertain the efficacy of these robotic rehabilitation orthoses. Show more

Keywords: Control strategies, gait rehabilitation, neurologic injuries, robot desing, robotic orthosis

DOI: 10.3233/NRE-141174

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 701-709, 2014

Authors: De Luca, Rosaria | Calabrò, Rocco Salvatore | Reitano, Simone | Digangi, Giuseppina | Bertè, Francesco | Sergi, Giuseppa | Bramanti, Placido

Article Type: Case Report

Abstract: Objective: Aim of this study was to evaluate the effects of an emerging rehabilitative tool (“Power-AFA” - software) in the recovery of a patient with chronic non-fluent aphasia. Material and methods: A 56-year-old woman, affected by post-stroke severe expressive aphasia, underwent two different intensive rehabilitation trainings, including either standard language rehabilitation alone or a proper PC based speech training in addition to conventional treatment. We evaluated her cognitive and psychological profile in two separate sessions, before and after the two different trainings, by using a proper psychometric battery, to assess cognitive status, language abilities, and to estimate the …presence of mood alterations and coping strategies. The overall PC-program was articulated in 6 sessions/weekly for 3 months. Results: Only at the end of the PC-training, we observed an important improvement in peculiar cognitive domains (attention and memory functions), in denomination, in verbal understanding ability, in written, in communication skills as well as an optimization of the mood and coping styles. Conclusions: Computer-based cognitive and language rehabilitation, using proper and dedicated software, may be a valuable tool in improving either communication or cognitive skills in patient affected by aphasia, even in the chronic state. Show more

Keywords: PC-training, chronic aphasia, stroke

DOI: 10.3233/NRE-141175

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 711-717, 2014

Authors: Jani, Mansi Pankaj | Gore, Geeta Bharat

Article Type: Research Article

Abstract: Background: Communication and swallowing problems are common as a result of neurological conditions like stroke, traumatic brain injury, neoplasms of the nervous systems, viral encephalitis, diseases affecting neuromuscular junction and neuro degenerative conditions. The most frequently encountered problems are dysarthria, aphasia, dysphagia and apraxia of speech. Objectives: Although these disorders are mentioned in literature, very few studies describing the occurrence in different neurological conditions are available in Indian context. Hence, a need was felt to carry out such a study. Methodology: A heterogenous group of forty patients with neurological conditions were assessed for presence of speech, …language and swallowing problems. A percent analysis was carried out to determine the occurrence of aphasia, dysarthria and dysphagia in general, in specific diseases and also to describe type of aphasia and dysarthria according to the characteristics presented. Results: It was seen that the most frequently occurring disorder was dysarthria (60%), followed by dysphagia (55%) and aphasia (18%). It was also noted that dysarthria and dysphagia co-existed in around 45% patients with neurological diseases. Conclusions: It can be concluded that speech, language and swallowing problems are frequent in individuals with neurological conditions. Speech language pathologist plays an important role as a member of the rehabilitation team in a neurological setup with respect to identifying these problems and initiating intervention at the earliest. Hence, it is necessary for speech language pathologist to be well versed with the features each disorder may present with in terms of communication and swallowing. Show more

Keywords: Neurological disorders, dysarthria, dysphagia, aphasia, speech language pathologist

DOI: 10.3233/NRE-141165

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 719-727, 2014

Authors: Allart, Etienne | Paquereau, Julie | Rogeau, Caroline | Daveluy, Walter | Kozlowski, Odile | Rousseaux, Marc

Article Type: Research Article

Abstract: Background: Stroke often leads to upright standing and walking impairments. Clinical assessments do not sufficiently address ecological aspects and the patient's subjective evaluation of function. Objective: To perform a pilot assessment of the psychometric properties of the Lower Limb-Function Assessment Scale (LL-FAS). Methods: The LL-FAS includes 30 items assessing the patient's perception (in a questionnaire) and the examiner's perception (in a practical test) of upright standing and walking impairments and their impact on activities of daily living. We analyzed the LL-FAS's reliability, construct validity, internal consistency, predictive validity and feasibility. Results: Thirty-five stroke patients …were included. The scale's mean ± SD completion time was 25 ± 6 min. Intra-observer reliability was good to excellent (intraclass correlation coefficients (ICC >0.82). Interobserver reliability was moderate (0.67 < ICC < 0.9). The questionnaire and test items showed excellent construct validity for neuromotor disabilities (p < 0.05), postural ability (Postural Assessment Scale for Stroke; p < 10−5 ), severity of gait disorders (Gait Assessment and Intervention Tool; p < 10−3 ), walking ability (New Functional Ambulation Categories, 10 m walk test, Rivermead Mobility Index; p < 10−3 ) and functional level (Barthel Index; p < 10−3 ). Internal consistency (Cronbach-α >0.9) and predictive validity were excellent. Conclusions: The LL-FAS showed fair psychometric properties in this pilot study and may be of value for evaluating post-stroke lower limb impairment. Show more

Keywords: Stroke, posture, walking, gait, assessment, scale

DOI: 10.3233/NRE-141171

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 729-739, 2014

Authors: Middleton, Addie | Fritz, Stacy L. | Liuzzo, Derek M. | Newman-Norlund, Roger | Herter, Troy M.

Article Type: Research Article

Abstract: Background: Transcranial direct current stimulation (tDCS) may provide a safe, non-invasive technique for modulating neural excitability during neurorehabilitation. Objective: 1) Assess feasibility and potential effectiveness of tDCS as an adjunct to standard upper extremity (UE) physical therapy (PT) for motor impairments resulting from neurological insult. 2) Determine sustainability of improvements over a six month period. Methods: Five participants with chronic neurologic insult (stroke or traumatic brain injury > 6 months prior) completed 24 sessions (40 minutes, three times/week) of UE-PT combined with bihemispheric tDCS delivered at 1.5 mA over the motor cortex during the first 15 …minutes of each PT session. Outcomes were assessed using clinical (UE Fugl-Meyer, Purdue Pegboard, Box and Block, Stroke Impact Scale) and robotic (unimanual and bimanual motor control) measures. Change in scores and associated effects sizes from Pre-test to Post-test and a six month Follow-up were calculated for each participant and group as a whole. Results: Scores on UE Fugl-Meyer, Box and Block, Purdue Pegboard, Stroke Impact Scale, and robotic measures improved from Pre- to Post-test. Improvements on UE Fugl-Meyer, Box and Block, and robotic measures were largely sustained at six months. Conclusions: Combining bihemispheric tDCS with UE-PT in individuals with neurological insult warrants further investigation. Show more

Keywords: tDCS, stroke, TBI, upper extremity, rehabilitation

DOI: 10.3233/NRE-141178

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 741-754, 2014

Authors: Linnemann, Mia | Tibæk, Maiken | Kammersgaard, Lars Peter

Article Type: Research Article

Abstract: Background: Post traumatic hydrocephalus (PTH) is a frequent complication during rehabilitation following severe TBI. However, the diagnosis of PTH is not straightforward and despite shunting recovery may be delayed. Objective: To study the influence of PTH on recovery and outcome during rehabilitation. Methods: We studied 417 patients with severe TBI admitted consecutively to a single hospital-based neurorehabilitation department serving Eastern Denmark between 2000 and 2010. Demographics (age and gender) and clinical characteristics (length of acute treatment, post traumatic amnesia (PTA), level of consciousness, injury severity (ISS), and admission FIM™), and PTH were related to recovery (discharge …FIM™), outcome (GOS), and length of rehabilitation stay. Results: Patients with PTH were older, brain injury more severe, and acute treatment was longer. At discharge they had more disability, longer rehabilitation stays, and unfavorable outcome. However, after adjusted multiple regression analyses PTH was not associated with disability at discharge or outcome. Instead, PTH was associated with longer stay for rehabilitation. Conclutions: Shunting for PTH does not affect recovery and outcome per se, but prolongs lengths of stay by almost 3 weeks. Therefore, patients treated for PTH are as likely to benefit from rehabilitation as patients without, but require longer rehabilitation stays. Show more

Keywords: Brain injury, traumatic, hydrocephalus, rehabilitation, outcome, prediction

DOI: 10.3233/NRE-141160

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 755-761, 2014

Authors: Corral, Luisa | Conde, Laura | Guillamó, Elisabet | Blasi, Juan | Juncadella, Montserrat | Javierre, Casimiro | Viscor, Ginés | Ventura, Josep L.

Article Type: Research Article

Abstract: Background: Circulating progenitor cells (CPC) treatments may have great potential for the recovery of neurons and brain function. Objective: To increase and maintain CPC with a program of exercise, muscle electro-stimulation (ME) and/or intermittent-hypobaric-hypoxia (IHH), and also to study the possible improvement in physical or psychological functioning of participants with Traumatic Brain Injury (TBI). Methods: Twenty-one participants. Four groups: exercise and ME group (EEG), cycling group (CyG), IHH and ME group (HEG) and control group (CG). Psychological and physical stress tests were carried out. CPC were measured in blood several times during the protocol. …Results: Psychological tests did not change. In the physical stress tests the VO2 uptake increased in the EEG and the CyG, and the maximal tolerated workload increased in the HEG. CPC levels increased in the last three weeks in EEG, but not in CyG, CG and HEG. Conclusions: CPC levels increased in the last three weeks of the EEG program, but not in the other groups and we did not detect performed psychological test changes in any group. The detected aerobic capacity or workload improvement must be beneficial for the patients who have suffered TBI, but exercise type and the mechanisms involved are not clear. Show more

Keywords: Traumatic brain injury, circulating progenitor cells, exercise, physiology

DOI: 10.3233/NRE-141172

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 763-769, 2014

Authors: Choi, Seong-Youl | Lee, Jae-Shin | Song, A-Young

Article Type: Research Article

Abstract: Objectives: This study performed meta-analysis on the literatures that surveyed cognitive test to forecast unsafe driving by older drivers and identified objective and consistent cognitive test for predicting unsafe driving of older drivers. Selection criteria: The study of RCT (Randomized Control Trial) that conducted cognitive test by classifying older drivers into safe-drivers and unsafe-drivers was done and a total of nine studies suitable for the selection criteria were chosen. Search strategy: To meet subject selection, online search was performed by keyword such as “Older”, “Driving”, “Safe”, “Cognition”, etc. Qualitative analysis of the study was conducted using …Jadad evaluation. Quantitative analysis also conducted statistical heterogeneity, effect size, sensitivity and publication bias every cognitive assessment tool. Result: The Jadad evaluation grade of the studies was assessed on papers of a high quality – all study received over 3 points. The result of the effect sizes was that TMT-B, TMT-A, UFOV-subtest 2 and MMSE were statistically significant (P < .05). As a result, TMT-B was “Big effect size”, TMT-A and UFOV-subtest 2 were “Medium effect sizes” and MMSE was “Small effect size.” Conclusion: TMT-A, TMT-B and UFOV-subtest 2 were found to be useful as cognitive test tools to forecast unsafe driving of older drivers. Show more

Keywords: Cognitive test, meta-analysis, older drivers, unsafe driving

DOI: 10.3233/NRE-141170

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 771-778, 2014

Authors: Nardo, Alice | Anasetti, Federica | Servello, Domenico | Porta, Mauro

Article Type: Research Article

Abstract: Background: Despite Deep Brain Stimulation (DBS) improves cardinal symptoms of Parkinson's Disease (PD), its effect on walking impairment is less evident. Robotic-assisted rehabilitation systems could serve as “add-on” physical therapy for PD patients. This systems are able to anticipate and correct the trajectory of patients' motion to improve their motor function recovery. Objective: Aim of the present study was the quantitative assessment of the effects of a Robotic-Assisted Rehabilitation Protocol (RARP) on gait patterns by means of three-dimensional gait analysis on PD patients treated with DBS. Methods: 9 patients with PD treated with DBS were submitted …to 5 weeks robotic-assisted rehabilitation sessions. Three-dimensional gait analysis was performed before the starting session, and one day after the last session using an optoelectronic system with passive markers. Results: The RARP showed significant improvements on spatio-temporal gait parameters and on the Unified Parkinson's Disease Rating Scale motor score. Conclusions: The RARP with Lokomat may have positive effects on spatio-temporal gait parameters of PD patients and it could be an adjunct therapy for patients treated with DBS. On the other hand kinematic and kinetic gait parameters did not show significant improvements, remaining almost comparable before and after the RARP. Show more

Keywords: Parkinson's disease, gait analysis, robotic-assisted rehabilitation, deep brain stimulation, locomotor system

DOI: 10.3233/NRE-141173

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 779-788, 2014

Authors: Cugusi, Lucia | Solla, Paolo | Zedda, Francesca | Loi, Martina | Serpe, Roberto | Cannas, Antonino | Marrosu, Francesco | Mercuro, Giuseppe

Article Type: Research Article

Abstract: Background: Several studies have clearly shown that strategies of health promotion, such as fitness and general exercise programs, may improve quality of life (QoL), motor and non-motor functions in Parkinson's disease (PD) patients. However, little is known about the effects of specific Adapted Physical Activity (APA) programs on PD patients. Objective: To determine the effects of an APA program on motor and non-motor symptoms, functional performances and QoL in PD patients. Methods: Nine consecutive PD patients (5 men, 4 women, 64.4 ± 6.8 years) able to ambulate independently (Hoehn and Yahr: from stage 1 to 3) …and not demented, were enrolled. Patients performed an APA program, 3 sessions/week, for 9 weeks. Exercises focused on balance, walking, strength and functional activities. Functional effects were assessed by Six Minute Walking Test (6MWT), Five Time Sit to Stand Test (FTSST), Berg Balance Scale (BBS), Sit and Reach Test (SRT), and Timed Up and Go test (TUG). Motor impairment and disability were assessed using the Unified Parkinson's Disease Rating Scale – part III (UPDRS-III) and the Hoehn and Yahr Scale, respectively. Non-motor symptoms were evaluated by PD Fatigue Scale (PFS), Beck Depression Inventory II (BDI-II) and PD Quality of life scale, 8 items (PDQ-8). Results: A significant decrease in resting HR (67.55 ± 10.85 vs 70.22 ± 12.34 bpm, p < 0.05) and a significant increase in walked distance (p < 0.0005) were observed. A significant impairment of the muscles strength was noted (FTSST, p < 0.05). BBS showed a significant increase in balance abilities (p < 0.0005) and safety with mobility (TUG, p < 0.005) was enhanced. Finally, a significant improvement in motor and non-motor symptoms was detected: UPDRS-III (p < 0.00005), PFS (p < 0.005), BDI-II (p < 0.05) and PDQ-8 (p < 0.05). Conclusions: A tailored exercise program in PD patients could be effective as an adjunct to conventional therapy on improving daily activities, motor and non-motor symptoms, with better QoL. Show more

Keywords: APA, Parkinson's disease, QoL

DOI: 10.3233/NRE-141162

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 789-794, 2014

Authors: Malloy, Jessica R. | Valentin, Juliana C. | Hands, Gabrielle L. | Stevens, Christina A. | Langmore, Susan E. | Noordzij, J. Pieter | Stepp, Cara E.

Article Type: Research Article

Abstract: Objective: To compare performance of individuals with Parkinson's disease (PD) and age-matched controls on a visuomotor tracking task controlled via surface electromyography (sEMG). Methods: Twenty-seven adults with PD and twenty-four older controls produced dry swallows and completed a visuomotor tracking task utilizing both static and dynamic targets. sEMG was recorded at the anterior neck and submental surface during both tasks. Results: There was no significant difference in visuomotor tracking ability between cohorts. Post hoc analyses indicated that there was no significant difference between participant groups in the strength or duration of swallows as measured by sEMG …but that participants with PD showed a trend for decreased swallow durations at the anterior neck (padj = 0.067) whereas controls showed a trend for increased durations at the anterior neck (padj = 0.112), compared to the submental surface. However, there were no significant correlations between swallowing behavior and visuomotor tracking ability. Conclusion: There were no significant differences in visuomotor tracking performance between individuals with PD and controls. Furthermore, there was no relationship between tracking ability and swallowing behavior. We conclude that sEMG-mediated biofeedback may have limited promise as a tool for treating PD-related dysphagia. Show more

Keywords: Swallowing, dysphagia, Parkinson's disease, surface electromyography, biofeedback

DOI: 10.3233/NRE-141169

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 795-803, 2014

Authors: Op ’t Eijnde, Bert | Keytsman, Charly | Wens, Inez | Hansen, Dominique

Article Type: Research Article

Abstract: Background: Whole-body cooling improves exercise tolerance in patients with multiple sclerosis (pwMS). To be able to exercise at greater intensities and/or for longer durations with whole-body cooling, it should be examined whether this compromises skeletal muscle oxidative capacity (assessed by exercise-onset VO2 kinetics). Objective: To study the impact of whole-body cooling on exercise-onset VO2 kinetics in pwMS. Methods: From 12 pwMS (EDSS 3.5 ± 1.5) and 12 healthy age, BMI, and gender-matched subjects exercise-onset VO2 kinetics (mean response time [MRT]) and body temperature were determined under normothermic and hypothermic (pre-exercise 60-min whole-body cooling) …conditions during submaximal exercise testing (two 6-min constant-load exercise bouts). Moreover, heart rate, blood lactate content, expiratory volume and ratings of perceived exertion (RPE) were assessed during exercise. Results: Exercise heart rate (−7 ± 6 beats/min) and end-exercise body temperature (−0.9 ± 0.5°C) was significantly lower in hypothermic vs. normothermic conditions in both populations (p < 0.05). In pwMS exercise RPE was lower in hypothermic vs. normothermic condition (p = 0.056). No significantly different MRT was found between normothermic vs. hypothermic conditions in both populations. Conclusions: Lowering body temperature prior to endurance exercise does not affect muscle oxidative capacity in pwMS, but lowers RPE, thus making it possible to prescribe exercises of greater intensity and/or longer duration. Show more

Keywords: Multiple sclerosis, endurance exercise, oxygen uptake kinetics, oxidative capacity, whole-body cooling

DOI: 10.3233/NRE-141159

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 805-811, 2014

Authors: Rudroff, T. | Kindred, J.H. | Koo, P.J. | Karki, R. | Hebert, J.R.

Article Type: Research Article

Abstract: Background: In patients with Multiple Sclerosis (MS), comparative leg muscle strength asymmetries are common and typically accompanied by walking difficulties. Underlying mechanisms for these asymmetries are not completely known, but altered muscle energetics may play a role. Objective: To investigate glucose uptake asymmetries in leg muscles of patients with mild MS during walking. Methods: Eight MS and 8 healthy control (CON) participants performed a 15-min treadmill walking test at self-selected speed. They were injected with a glucose tracer (18 F-FDG) two minutes into the test and immediately upon completion, underwent Positron Emission Tomography/Computed Tomography (PET/CT) imaging. …Results: MS group walked at a lower speed than the healthy control group (P < 0.01), however it was found that: 1) ([18 F]-FDG) uptake in knee and hip flexors was higher compared to the CON group (P = 0.02); 2) the MS group exhibited asymmetrical strength of the knee flexors (P = 0.03); 3) [18 F]-FDG uptake was significantly lower in the weaker knee flexors of patients with MS (P < 0.01). Conclusions: [18 F]-FDG uptake and strength asymmetries in the legs of patients with MS indicate greater metabolic costs during activity, which may play a major role in premature muscle fatigability and subsequent impaired walking capacity. Show more

Keywords: Positron emission tomography, glucose uptake, strength asymmetries, multiple sclerosis

DOI: 10.3233/NRE-141179

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 813-823, 2014

Authors: Wang, Zhun | Kou, Dangpei | Li, Zhaoduan | He, Yongjin | Yu, Wenli | Du, Hongyin

Article Type: Research Article

Abstract: Background: Due to the lack of efficient neuroprotective therapies, the ischemia-reperfusion (I/R) injury is a major medical problem urgently needed to be further studied. Objective: To investigate the neuro-protective effects of propofol-dexmedetomidine (dex) combination on I/R-induced cerebral injury and potential mechanisms. Methods: Sprague-Dawley rats were randomized to sham-operated, I/R, I/R plus propofol, I/R plus dex, and I/R plus propofol-dex combination group. I/R insult was induced by 2 h middle cerebral artery occlusion (MCAO) followed by 24 h reperfusion; Drugs were administered 20 min before the onset of ischemia and continued for another 2 h. Functional outcomes, …the expression of Superoxide dismutase (SOD), Methane Dicarboxylic Aldehyde (MDA), Tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β), caspase-3 and protein kinase B (AKT) were tested. Results: Propofol-dex combination significantly mitigates I/R-induced neurological deficits in model rats compared to dex or propofol infusion alone. The decreased activity of SOD was significantly reversed following co-administration of propofol and dex, along with the down-regulated MDA content. Perioperative treatment with propofol and dex significantly suppressed I/R-up regulated TNF-α and IL-1β expressions, ameliorated AKT1 expression and caspase-3 activity. Conclusion: Propofol-dex combination exerted a stronger neuro-protection against I/R injury when compared with propofol or dex alone. Show more

Keywords: Propofol-dexmedetomidine combination, cerebral ischemia reperfusion injury, antioxidant, anti-inflammatory, anti-apoptosis, neuroprotection

DOI: 10.3233/NRE-141177

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 825-834, 2014

Authors: Xie, Caizhong | Shan, Chunlei | Liu, Beibei | Ding, Zhiqing | Ding, Qinneng | Wang, Tong

Article Type: Research Article

Abstract: Background: For a therapeutic intervention after spinal cord injury (SCI), it is important to take accurate and objective assessment tools. Objective: To explore the practicability of somatosensory evoked potentials (SEPs) and Modified Barthel Index (MBI) scale and describe the rehabilitation value of SEPs in different degrees of SCI. Methods: Thirty-six SCI patients were enrolled in this study. All the patients received comprehensive rehabilitation treatment, such as physical therapy, occupational therapy, functional electrical stimulation, and psychotherapy. The nerve function of the spinal cord was assessed by SEPs, the activities of daily living (ADL) was evaluated by MBI …scale, and SEP recordings and MBI scores were obtained before and after treatment. Results: There were statistically significant differences in SEPs latency among different grades of SCI before treatment. The SEPs latency after treatment was better than that before treatment in every grade (p < 0.05). Comparable differences among different grades were also detected by MBI scores before treatment (p < 0.05), and the MBI scores increased significantly after treatment (p < 0.05), higher in each group than another from grade A to B, C, and D. There was a linear correlation between SEPs latency and MBI scores before and after treatment. Conclusion: SEPs combined with MBI scale could objectively reflect the SCI degree and accurately monitor therapeutic intervention in SCI. SEPs have a greater value in monitoring SCI than MBI and their rehabilitation value varies in different grades of SCI. Show more

Keywords: Spinal cord injury, somatosensory evoked potentials, Modified Barthel Index, activities of daily living, rehabilitation treatment, outcome

DOI: 10.3233/NRE-141158

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 835-840, 2014

Authors: Morlett-Paredes, Alejandra | Perrin, Paul B. | Olivera, Silvia Leonor | Rogers, Heather L. | Perdomo, Jose Libardo | Arango, Jose Anselmo | Arango-Lasprilla, Juan Carlos

Article Type: Research Article

Abstract: Background/objective: The purpose of this study was to examine the influence of appraisal, belonging, and tangible social support on the mental health (depression, satisfaction with life, anxiety, and burden) of Colombian spinal cord injury (SCI) caregivers. Methods: Forty SCI caregivers from Neiva, Colombia completed questionnaires assessing their perceived social support and mental health. Results: Four multiple regressions found that the three social support variables explained 42.8% of the variance in caregiver depression, 22.3% of the variance in satisfaction with life, 24.1% of the variance in anxiety, and 16.5% of the variance in burden, although the effect …on burden was marginally significant. Within these regressions, higher belonging social support was uniquely associated with lower depression, and higher tangible social support was uniquely associated with higher caregiver satisfaction with life. Conclusions: Social support may have a particularly important influence on SCI caregiver mental health in Colombia, due in part to the high levels of collectivism and strong family values shown to exist in Latin America, and may therefore be an important target for SCI caregiver interventions in this region. Show more

Keywords: SCI caregivers, social support, mental health

DOI: 10.3233/NRE-141164

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 841-849, 2014

Authors: Sobry, Vinciane | Badin, Philippe | Cernaianu, Sorina | Agnani, Olivier | Toussaint, Michel

Article Type: Research Article

Abstract: Background: Neuroplastic compensations are reported to improve static balance in visually impaired people (VIP). Objective: To compare the static balance of VIP with control sighted subjects in different conditions of proprioceptive disturbance. Methods: Thanks to a stabilometric platform, static balance was determined by measuring (1) the speed of displacement of the center of pressure of the subjects and (2) its total surface. Recordings on surfaces with (foam) or without (hard) proprioceptive disturbance were taken with both open and closed eyes. Results: We compared 38 VIP to 36 control subjects. On hard surface, the speed …of displacement was always higher in VIP than in control. On the foam surface, the speed was higher in VIP with open eyes while no difference was seen with closed eyes. The total surface of displacement was larger in VIP on the foam surface with open eyes while there was no difference either with closed eyes or on hard surface between VIP and control. Conclusions: Static balance with open eyes is more precarious in VIP than in control. Nevertheless, VIP subjects do as well as control sighted subjects with closed eyes as shown by similar total surface of displacement irrespective with the type of surface. Show more

Keywords: Balance (static), visual handicap, Vietnamese, stabilometric platform

DOI: 10.3233/NRE-141181

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 851-861, 2014

Authors: Bach, Laura J.

Article Type: Case Report

Abstract: Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an auto immune-disorder. It is a life threatening condition that typically presents with viral illness, headaches, severe psychiatric symptoms, seizures, behavioural changes, decreasing levels of unconsciousness and progressive unresponsiveness, cognitive impairment, abnormal movements (e.g., dyskinesia), ataxia and hypoventilation. Objective: This paper describes the long term outcome and rehabilitation management of patients with NMDAR encephalitis and highlights the diverse outcome of this condition and the unique and individual long term management needs associated with this disorder. Methods: This is a case report study of three different patients with NMDAR encephalitis. All …three cases are young women, two of whom presented with ovarian teratoma. Patient KH is the most impaired and was resident in a slow stream rehabilitation care home and presented with challenging behaviour. Patients RM and OA both lived in the community and presented with similar anxieties but diverse levels of cognition and motivation. A review of the literature is provided summarizing the disorder, interventions, management and challenges of this varied and complex condition. Standard neuropsychological tests and questionnaires to assess community integration (BICRO-39), quality of life (QOLIBRI-OS) and mood (HADS) were administered. Results: Positive outcomes were achieved for all three patients using a variety of interventions which included behavioural management, family psycho-education and an integrated holistic multi-disciplinary team community approach. Memory and executive deficits were persistent in the long term and severity of impairments showed wide variability between patients. Emotional distress and behavioural difficulties were prominent and persistent and had a pronounced impact on rehabilitation. Continence issues were also a major factor impacting on the rehabilitation. Conclusions: Long term integrated and multi-disciplinary input by a variety of therapies and health disciplines is required in order to improve the long term outcome and quality of life for NMDAR patients and their families, and ultimately leads to improved positive outcomes. Each of these cases had markedly differing cognitive profiles suggesting that in the context of long term rehabilitation outcome, cognition may have less valence than emotional and behavioural factors. Guidelines and standardised procedures for ethical issues and counselling for iatrogenic infertility should be developed and integrated into long term programmes of rehabilitation care. Show more

Keywords: NMDAR, rehabilitation outcome, community integration, BICRO, QOLIBRI, quality of life, fertility, cognition

DOI: 10.3233/NRE-141176

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 863-875, 2014

Article Type: Other

DOI: 10.3233/NRE-2014-35426

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 877-884, 2014

Article Type: Other

DOI: 10.3233/NRE-2014-35427

Citation: NeuroRehabilitation, vol. 35, no. 4, pp. 885-888, 2014