NeuroRehabilitation - Volume 36, issue 1

Authors: Brogårdh, Christina | Lexell, Jan

Article Type: Editorial

DOI: 10.3233/NRE-141183

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 1-3, 2015

Authors: Lexell, Jan | Brogårdh, Christina

Article Type: Research Article

Abstract: Introduction: Rehabilitation is often described as a process that starts when the diagnosis is made and continues as long as the person needs interventions. This process comprises four steps: assessment, goal setting, interventions and outcome measurement. In each step, the WHO International Classification of Functioning, Disability and Health (ICF) can be used and the results can be summarized in a rehabilitation plan. Objectives: In this brief review, we describe the use of the ICF in the neurorehabilitation process in the form of an ICF based rehabilitation plan and how the rehabilitation plan can facilitate interdisciplinary team work in …each of the four steps that comprise the rehabilitation process. Conclusion: An ICF based rehabilitation plan that comprises a common language, understood by team members, patients and their family, is a valuable tool in the rehabilitation of persons with injuries and diseases to the nervous system. The use of the ICF has thereby enabled the development of a common framework for our neurorehabilitation methodology, regardless of diagnosis or disability. Show more

Keywords: Disability evaluation, International Classification of Functioning, Disability and Health; nervous system diseases, outcome and process assessment (health), patient outcome assessment, physical and rehabilitation medicine

DOI: 10.3233/NRE-141184

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 5-9, 2015

Authors: Tempest, Stephanie | Jefferson, Richard

Article Type: Research Article

Abstract: Introduction: Although deemed a globally accepted framework, there remains scare evidence on the process and outcome of implementing the International Classification of Functioning, Disability and Health (ICF) within neurorehabilitation. Objectives: This review briefly explores the existing, broader literature and then reports on two action research projects, undertaken in England, specifically within stroke and neurorehabilitation. Working with participants, including clinicians from in-patient and community settings, there are now 35 different ways identified for the use of the ICF. Conclusion: The outcome of the first project highlights that using the ICF enhances communication within and beyond the acute …stroke service, fosters holistic thinking and clarifies team roles. To adopt it into clinical practice, the ICF must be adapted to meet local service needs. The use of action research has facilitated the knowledge translation process which has enabled the ICF to become a clinical reality in neurorehabilitation, with clinicians identifying a range of potential uses. Show more

Keywords: International Classification of Functioning, Disability and Health, implementation, neurorehabilitation

DOI: 10.3233/NRE-141185

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 11-15, 2015

Authors: Raggi, A. | Leonardi, M. | Covelli, V. | Sattin, D. | Scaratti, C. | Schiavolin, S. | Willems, M. | Meucci, P.

Article Type: Research Article

Abstract: Introduction: Neurological conditions are associated with high levels of disability. Objectives: The aim of this study was to describe, using the International Classification of Functioning, Disability and Health (ICF), the most relevant aspects of disability in patients with neurological conditions. We collated data from previous studies on myasthenia gravis, migraine, Parkinson's disease, multiple sclerosis, traumatic brain injury, stroke, epilepsy, vegetative state and minimally conscious state, and identified as relevant those ICF categories reported by at least 50% of patients in each condition. Conclusions: Records from 1310 patients were available. A total of 97 ICF categories were …reported, and 21 were commonly addressed in more than five conditions. Approximately half of the categories in body functions were related to mental and movement-related functions and more than 25% of the activities-related categories involved activities that require the support from a caregiver. Environmental factors were mostly reported as facilitators. Our data indicate a residual mind-body dichotomy, the relevance of disability not only for the patients but also for their caregivers, and the difficulties in addressing barriers in the environment. Show more

Keywords: Disability, ICF classification, mental functions, mobility, barriers

DOI: 10.3233/NRE-141186

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 17-22, 2015

Authors: Raggi, A. | Covelli, V. | Leonardi, M. | Meucci, P. | Scaratti, C. | Schiavolin, S. | Willems, M. | Sattin, D.

Article Type: Research Article

Abstract: Introduction: The aim of this study was to explore the most relevant determinants of severe disability in a heterogeneous sample of patients with neurological conditions. Objectives: We used data from previous studies on patients with myasthenia gravis (MG), migraine, Parkinson's disease (PD), multiple sclerosis, traumatic brain injury (TBI), stroke and epilepsy (349 patients, aged 18–74 years; mean 48.0, SD 11.7). We calculated count-based extension indexes to address severe disability, and hierarchical logistic regression to assess the association between severe disability, sociodemographic and health status information. Conclusions: Results show that sociodemographic variables played a minor role, while …health state information was a stronger determinant of severe disability. Compared to the reference value of TBI patients, those with MG, PD and epilepsy had higher odds to have severe difficulties undertaking daily activities despite the presence of environmental factors. Our results contrast with those of previous studies, mostly derived from general populations, showing the different impact of clinical and sociodemographic variables. Show more

Keywords: Disability, ICF classification, mental functions, mobility, barriers

DOI: 10.3233/NRE-141187

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 23-29, 2015

Authors: Martinuzzi, Andrea | De Polo, Gianni | Bortolot, Sonia | Pradal, Monica

Article Type: Research Article

Abstract: Introduction: One of the major intended uses of the International Classification of Functioning, Disability and Health (ICF) is the clinical world of rehabilitation. The intrinsic qualities of ICF, especially in its children and youth version (ICF-CY) seem to perfectly match the needs for the complex process of pediatric neurorehabilitation. Objectives: We here report on the effect that the implementation of ICF-CY had on team members and families when it was used as a guiding structure in framing the rehabilitation project in a pediatric outpatient clinic dealing with adolescents with cerebral palsy and complex needs. The two-year experience was …positive and an ad-hoc questionnaire delivered to team members and families returned very positive remarks. Conclusion: The main messages coming from this experience is on the feasibility of the introduction of ICF-CY language and the bio-psycho-social model in the described setting and on the positive response by the stakeholders. Show more

Keywords: Disability, cerebral palsy, ICF-CY, pediatric neurorehabilitation, rehabilitation teams

DOI: 10.3233/NRE-141188

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 31-36, 2015

Authors: Laxe, Sara | Cieza, Alarcos | Castaño-Monsalve, Beatriz

Article Type: Research Article

Abstract: Introduction: Traumatic brain injury is a sudden and unexpected condition that gives rise to different impairments in body functions and structures leading to dramatic life changes, not only to the patient but also to his or her family and ultimately in the wider society. As a health strategy, rehabilitation aims to reduce disability and increasing the quality of life of those people that suffer from TBI but also to reduce the social burden associated with it. Functioning is the starting point of rehabilitation and the use of measurement instruments and classifications are commonly used tools for its definition. Within the …endorsement of the ICF by WHO, there is now a classification and a conceptual framework for the description of functioning providing an opportunity of a full understanding of the experience of TBI. Objective: This paper aims to identify the utility of ICF in TBI as well as bringing new challenges for further clinical practice and research. Conclusions: ICF has shown itself to be useful in the content comparison of measurement instruments. It has also been used to describe the functional profile of individuals with TBI in both acute and chronic phases making it possible to draw comparisons across other health conditions. Furthermore, the development of the TBI ICF Core Sets provided an item bank to describe not only functional status but also to set goals and plan interventions. Overall, we now have a potentially useful tool in rehabilitation of TBI that allows us to understand the full burden of traumatic brain injury. Show more

Keywords: Traumatic brain injury, ICF, TBI ICF Core Sets, functioning, disability

DOI: 10.3233/NRE-141189

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 37-43, 2015

Authors: Arvidsson, Patrik | Granlund, Mats | Thyberg, Mikael

Article Type: Review Article

Abstract: Introduction: Interdisciplinary differences regarding understanding the International Classification of Functioning, Disability and Health (ICF) concepts activity/participation may hinder its unifying purpose. In the ICF model, functioning (and disability) is described as a tripartite concept: 1) Body structures/functions, 2) Activities, and 3) Participation. Activities refer to an individual perspective on disability that does not tally with the basic structure of social models. Objective: To review how activity and participation are actually used in studies of intellectual disability (ID). Conclusion: Based on 16 papers, four different usages of activity/participation were found. 1) Theoretical reference to tripartite ICF concept …with attempts to use it. 2) Theoretical reference to tripartite ICF concept without actual use of activities. 3) “Atheoretical” approach with implicit focus on participation. 4) Theoretical reference to bipartite concept with corresponding use of terms. The highlighted studies have in common a focus on participation. However, the usage of the term “activity” differs both within and between studies. Such terminology will probably confuse interdisciplinary communication rather than facilitating it. Also, the use of an explicit underlying theory differs, from references to a tripartite to references to a bipartite concept of disability. This paper is focused on ID, but the discussed principles regarding the ICF and interdisciplinary disability theory are applicable to other diagnostic groups within rehabilitation practices. Show more

Keywords: Activity, ICF, intellectual disability, interdisciplinary rehabilitation, participation

DOI: 10.3233/NRE-141190

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 45-49, 2015

Authors: Demirtas-Tatlidede, Asli | Alonso-Alonso, Miguel | Shetty, Ravi P. | Ronen, Itamar | Pascual-Leone, Alvaro | Fregni, Felipe

Article Type: Research Article

Abstract: Background: Contralesional hemispheric repetitive transcranial magnetic stimulation (rTMS) may improve motor function in mild to moderate stroke and effects are considered to be mediated through transcallosal motor fibers. Objective: This study aimed to investigate the safety of contralesional rTMS in a selected group of severe chronic stroke patients. Methods: Ten sessions of 1 Hz rTMS were applied to contralesional primary motor cortex (M1) using neuronavigated stimulation and changes in motor impairment were evaluated before, during and after rTMS applications and at 4-weeks follow-up. Neurophysiological response to stimulation was assessed through cortical excitability evaluations. The relationship between …functional and neurophysiological response to rTMS and microstructural integrity of transcallosal motor fibers were searched using diffusion tensor imaging (DTI) based fractional anisotropy (FA). Results: rTMS was well-tolerated with high compliance and no dropouts; no seizures or motor worsening occurred. Transcallosal FA values revealed a positive linear relationship with the mild motor improvement detected after rTMS while higher FA values were observed in subjects with better motor outcome. Cortical excitability showed a significant change in contralesional short-interval intracortical inhibition indicating altered plasticity following rTMS. Conclusions: Our results suggest that noninvasive neuromodulation of the contralesional hemisphere may present a possibility to assist adaptive neuroplastic changes in severe chronic stroke. Implementation of DTI-derived measures of transcallosal microstructural integrity may allow for individually-tailored interventions to guide processes of interhemispheric neuroplasticity. Further research is warranted to establish the clinical value of these findings in neurorehabilitation settings for subjects with chronic severe stroke. Show more

Keywords: Severe stroke, cerebrovascular disease, repetitive transcranial magnetic stimulation (rTMS), diffusion tensor imaging (DTI), neurorehabilitation, cortical excitability

DOI: 10.3233/NRE-141191

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 51-59, 2015

Authors: Ansari, Noureddin Nakhostin | Naghdi, Soofia | Fakhari, Zahra | Radinmehr, Hojjat | Hasson, Scott

Article Type: Case Report

Abstract: Background: Spasticity is a common symptom that can be detrimental to the quality of life and daily function of patients with stroke. Objective: To introduce the use of dry needling (DN) as a novel method for the treatment of affected upper limb spasticity in a patient with chronic ischemic stroke who was admitted at the Stroke Physiotherapy Clinic. Methods: The pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) on the affected side were needled. The patient received deep DN for 1 session, and the duration of needling for each muscle was 1 …minute. The main outcomes were the Modified Modified Ashworth Scale (MMAS) muscle spasticity score, and the Hmax /Mmax ratio which were measured before (T0), immediately after (T1), and 15 minutes after the end of needling (T2). Results: The case was a 53-year-old man with a 13-year history of right hemiparesis poststroke. After DN, the spasticity scores improved and maintained as indicated in the MMAS grades (PT 3 to 2, finger flexors 1 to 0) and the Hmax /Mmax ratio (0.39, 0. 29, and 0.32 at T0, T1, and T2, respectively). The patient was able to voluntarily extend the wrist and fingers slightly after DN. The upper limb Brunnstrom recovery stage (3 to 4) and hand function (2 to 3) improved and maintained. The passive supination increased at T1 (75°) and T2 (50°) compared to T0 (38°). Conclusions: This prospective case report presents dry needling as a novel method in neurorehabilitation for the treatment of poststroke spasticity. Further research is recommended. Show more

Keywords: Stroke, spasticity, dry needling, H-reflex

DOI: 10.3233/NRE-141192

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 61-65, 2015

Authors: Daliri, Seyedeh Somayeh | Forogh, Bijan | Emami Razavi, Seyedeh Zahra | Ahadi, Tannaz | Madjlesi, Faezeh | Ansari, Noureddin Nakhostin

Article Type: Research Article

Abstract: Background: Spasticity is a common, serious symptom after stroke. Extracorporeal shock wave therapy (ESWT) has been suggested for the treatment of muscle spasticity. Objective: To investigate the effects of ESWT on post stroke wrist flexor spasticity. Methods: Fifteen patients with poststroke wrist flexor spasticity (12 male and 3 female with a mean age of 54 years) were enrolled. Patients received 1 sham ESWT followed by 1 active ESWT 1 week later. The outcome measures were the Modified Modified Ashworth Scale (MMAS), the Hmax /Mmax ratio, and the Brunnstrom motor recovery stage. Results: The …sham ESWT had not effects on the outcome measures. After active ESW, the MMAS scores of spasticity and the Hmax /Mmax ratio improved. The improvements were maintained 5 weeks after active ESWT. No significant improvements were observed for the motor recovery after sham or active ESWT. Conclusions: In adult patients after stroke, a single session of active ESWT resulted in significant improvement in the wrist flexor spasticity and alpha motor neuron excitability. Show more

Keywords: Stroke, spasticity, rehabilitation, extracorporeal shock wave therapy, spinal excitability, H-reflex

DOI: 10.3233/NRE-141193

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 67-72, 2015

Authors: Bonnyaud, Céline | Pradon, Didier | Zory, Raphael | Bensmail, Djamel | Vuillerme, Nicolas | Roche, Nicolas

Article Type: Research Article

Abstract: Background: The Timed Up and Go (TUG) is a test of functional mobility which is routinely used in the assessment of hemiparetic patients. This easy and rapid to perform test includes motor tasks which occur frequently in daily life (stand up, walk, turn, sit down). Correlations between TUG performance and kinematic and kinetic gait parameters have never been studied. Objective: The aim of this study was to determine whether kinematic and kinetic gait parameters would be more related to TUG performance than spatio-temporal parameters in stroke patients. Methods: Sixty hemiparetic patients able to walk alone performed …the TUG test and underwent 3D gait analysis and a clinical evaluation. A stepwise regression analysis was used to select the gait variables that best explained the variability in TUG performance. Results: The percentage of the gait cycle spent in single support phase on the paretic limb was the factor which was the most predictive and correlated with TUG performance, explaining 67% of the variance. No kinematic or kinetic gait parameters explained TUG performance. The results also suggested that TUG performance is mainly related to paretic lower limb motor function. Conclusions: TUG performance in hemiparetic patients mainly depends on the motor ability of the paretic lower limb, particularly the single support phase on the paretic side. Kinematic and kinetic gait parameters do not predict the TUG performance in stroke patients. Show more

Keywords: Timed Up and Go test, hemiparesis, gait analysis, predictive factors, gait parameters

DOI: 10.3233/NRE-141194

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 73-80, 2015

Authors: Swinnen, Eva | Baeyens, Jean-Pierre | Hens, Gerrit | Knaepen, Kristel | Beckwée, David | Michielsen, Marc | Clijsen, Ron | Kerckhofs, Eric

Article Type: Research Article

Abstract: Background: Efficacy studies concerning robot assisted gait rehabilitation showed limited clinical benefits. A changed kinematic pattern might be responsible for this. Little is known about the kinematics of the trunk and pelvis during robot assisted treadmill walking (RATW). Objective: The aim of this study was to assess the trunk and pelvis kinematics of healthy subjects during RATW, with different amounts of body weight support (BWS) compared to regular treadmill walking (TW). Method: Eighteen healthy participants walked on a treadmill, while kinematics were registered by an electromagnetic tracking device. Hereafter, the kinematics of pelvis and trunk were …registered during RATW (guidance force 30%) with 0%, 30% and 50% BWS. Results: Compared to TW, RATW showed a decrease in the following trunk movements: axial rotation, anteroposterior flexion, lateral and anteroposterior translation. Besides, a decrease in lateral tilting and all translation of the pelvis was found when comparing RATW with TW. Furthermore, the anteroposterior tilting of the pelvis increased during RATW. Conclusion: In general, there was a decrease in trunk and pelvis movement amplitude during RATW compared with regular TW. Though, it is not known if these changes are responsible for the limited efficacy of robot assisted gait rehabilitation. Further research is indicated. Show more

Keywords: Kinematics, trunk, robotics, gait, rehabilitation

DOI: 10.3233/NRE-141195

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 81-91, 2015

Authors: Bertolucci, F. | Di Martino, S. | Orsucci, D. | Ienco, E. Caldarazzo | Siciliano, G. | Rossi, B. | Mancuso, M. | Chisari, C.

Article Type: Research Article

Abstract: Background: Gait impairment, balance problems and falls have a negative impact on independence in ADL and quality of life of patients affected by Hereditary Spastic Paraplegia (HSP). Since no pharmacological options are available, treatments rely mostly on rehabilitation therapy, although almost no data on this topic exist. Given the demonstrated effectiveness of robotics in improving gait and balance in various neurological diseases, aim of this study is to test the effectiveness of a robotic-aided program of gait training on balance, walking ability and quality of life in adult subjects affected by uncomplicated HSP. Methods: Thirteen patients affected by …uncomplicated HSP were subjected to a six-week robotic-aided gait training protocol. Participants underwent a battery of 3 walking test, 1 balance test and 2 quality of life questionnaires. Results: At the end of the treatment a significant improvement of balance, walking ability and quality of life was observed in almost all the tests. The improvements were maintained over a two-month follow-up period. Conclusions: Our study indicates that a robotic gait training is long term effective in improving balance and walking ability with a positive impact on quality of life in patients affected by uncomplicated form of HSP. As currently there is no specific treatment to prevent or reverse HSP progression, our contribution would be significant for the development of exercise recommendations in this rare disease. Show more

Keywords: Hereditary spastic paraplegia, gait rehabilitation, balance, robotics

DOI: 10.3233/NRE-141196

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 93-99, 2015

Authors: Hägg, Mary K.D. | Tibbling, Lita I.E.

Article Type: Research Article

Abstract: Background: Most patients with post-stroke dysphagia are also affected by facial dysfunction in all four facial quadrants. Intraoral stimulation can successfully treat post-stroke dysphagia, but its effect on post-stroke facial dysfunction remains unknown. Objective: This study aimed to investigate whether intraoral stimulation after stroke has simultaneous effects on facial dysfunction in the contralateral lower facial quadrant and in the other three facial quadrants, on lip force, and on dysphagia. Methods: Thirty-one stroke patients were treated with intraoral stimulation and assessed with a facial activity test, lip force test, and swallowing capacity test at three time-points: before …treatment, at the end of treatment, and at late follow-up (over one year after the end of treatment). Results: Facial activity, lip force, and swallowing capacity scores were all improved between baseline and the end of treatment (P < 0.001 for each), with these improvements remaining at late follow-up. Baseline and treatment data did not significantly differ between patients treated short and late after stroke. Conclusions: Treatment with intraoral stimulation significantly improved post-stroke dysfunction in all four facial quadrants, swallowing capacity, and lip force even in cases of long-standing post-stroke dysfunction. Furthermore, such improvement remained for over one year after the end of treatment. Show more

Keywords: Facial dysfunction, dysphagia, lip force, stroke, oral screen, palatal plate

DOI: 10.3233/NRE-141197

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 101-106, 2015

Authors: Yoon, Tae Hee | Han, Soo Jeong | Yoon, Tae Sik | Kim, Joo Sup | Yi, Tae Im

Article Type: Research Article

Abstract: Objective: To investigate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) and speech and language therapy (SLT) on the improvement of performance on the Korean-version of the Western Aphasia Battery (K-WAB) in post-stroke non-fluent aphasic patients. Methods: Twenty post-stroke, non-fluent aphasic patients were enrolled and assigned to one of two groups: a case group (n = 10) or a control group (n = 10). Participants were recruited from the inpatient clinic of the Physical and Rehabilitation Medicine Department of Bundang Jesaeng General Hospital from March 2011 to January 2012. The case group received rTMS and SLT and …the control group received SLT; both groups received these therapies for four weeks. Language functioning was evaluated using K-WAB before and after treatment. Results: There were no significant differences between the groups' baseline characteristics and initial values (p > 0.05). After four weeks of therapy, there were significant improvements in repetition and naming in the case group (p < 0.05). However, there was no significant improvement in the control group (p > 0.05). Conclusions: rTMS combined with SLT can be an effective therapeutic method for treating aphasia in post-stroke non-fluent aphasic patients, although additional controlled and more systemic studies should be conducted. Show more

Keywords: Stroke, aphasia, repetitive transcranial magnetic stimulation

DOI: 10.3233/NRE-141198

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 107-114, 2015

Authors: Richardson, Jessica | Datta, Abhishek | Dmochowski, Jacek | Parra, Lucas C. | Fridriksson, Julius

Article Type: Research Article

Abstract: Background: Transcranial direct current stimulation (tDCS) enhances treatment outcomes post-stroke. Feasibility and tolerability of high-definition (HD) tDCS (a technique that increases current focality and intensity) for consecutive weekdays as an adjuvant to behavioral treatment in a clinical population has not been demonstrated. Objective: To determine HD-tDCS feasibility outcomes: 1) ability to implement study as designed, 2) acceptability of repeated HD-tDCS administration to patients, and 3) preliminary efficacy. Methods: Eight patients with chronic post-stroke aphasia participated in a randomized crossover trial with two arms: conventional sponge-based (CS) tDCS and HD-tDCS. Computerized anomia treatment was administered for five …consecutive days during each treatment arm. Results: Individualized modeling/targeting procedures and an 8-channel HD-tDCS device were developed. CS-tDCS and HD-tDCS were comparable in terms of implementation, acceptability, and outcomes. Naming accuracy and response time improved for both stimulation conditions. Change in accuracy of trained items was numerically higher (but not statistically significant) for HD-tDCS compared to CS-tDCS for most patients. Conclusions: Regarding feasibility, HD-tDCS treatment studies can be implemented when designed similarly to documented CS-tDCS studies. HD-tDCS is likely to be acceptable to patients and clinicians. Preliminary efficacy data suggest that HD-tDCS effects, using only 4 electrodes, are at least comparable to CS-tDCS. Show more

Keywords: Aphasia, feasibility, high-definition tDCS, stroke, tDCS, treatment outcomes

DOI: 10.3233/NRE-141199

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 115-126, 2015

Authors: da Costa Franceschini, Andressa | Mourão, Lucia Figueiredo

Article Type: Research Article

Abstract: Background: Dysarthria and dysphagia are the most common clinical problems encountered in Amyotrophic Lateral Sclerosis and may reduce the quality of life. Objective: Evaluate the association of dysarthria and dysphagia and to evaluate the impact of dysphagia on swallowing quality of life in patients with ALS with spinal onset. Methods: Seventeen patients underwent to speech and swallowing evaluation and filled out self-report assessment of the Swallowing Quality of Life (SWAL-QOL). The dysarthria severity was graded using the Speech Subscale of ALS Severity Scale. The dysphagia severity was graded using a scale proposed by Dziweas et al., …and the Functional Oral Intake Scale. Results: Over 70% of the ALS patients with spinal onset had dysarthria and dysphagia. The correlation of dysarthria and dysphagia scales was statistically significant (p < 0.001). The correlation between dysarthria and dysphagia severity and SWAL-QOL outcomes was significant for the same domains: “symptom frequency”, “communication” and “fear of eating”. The SWAL-QOL domains presented a mild to moderate impact on quality of life. Disease duration did not impact on SWAL-QOL. Conclusions: Dysarthria and dysphagia were common symptoms in patients with spinal onset of ALS and the swallowing quality of life decrease was directly related to with severity of dysarthria and dysphagia. Show more

Keywords: Amyotrophic Lateral Sclerosis, dysarthria, dysphagia, quality of life

DOI: 10.3233/NRE-141200

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 127-134, 2015

Authors: Lindqvist, Eva | Larsson, Tore J. | Borell, Lena

Article Type: Research Article

Abstract: Background: Studies have shown that Assistive Technology (AT) for cognitive support can support users in everyday activities. However, whether the AT actually supports the user to achieve their individual goals must further be examined. Objective: The study objective was to examine the experienced usability of features in AT for cognitive support for users with cognitive impairment. Methods: A content analysis was applied on data from interviews and field notes collected during two six-month interventions in which persons with cognitive impairment tested AT for cognitive support. Results: Features, included in the AT support that enhanced …the user's sense of control, were identified as promotional for the achievement of user goals, and some features, such as reminders, were more sensitive to the specific user's perceptions and motives. Also, features related to how the AT was maintained and communicated with other technology were very influential. Conclusions: The results show that easily maintained AT that fits in to the context of use increases the user's sense of control of the AT and thereby promotes the goal achievement and usability of the AT. Further, the usability of the AT is very influenced by contextual factors such as the ordinary mobile network, the Internet, and the operators. Show more

Keywords: Stroke, dementia, home environment, ADL, cognition, technology

DOI: 10.3233/NRE-141201

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 135-149, 2015

Authors: Spagnolo, Pierpaolo | Aricò, Maria | Bergamelli, Cristina | Mazzucco, Stefano | Boldrini, Paolo | Di Giorgi, Enrico | Gallucci, Maurizio

Article Type: Research Article

Abstract: Objectives: Cognitive Stimulation (CS) trainings are non-pharmacological treatments widely used in dementia care. 3R Mental Stimulation is a particular type of CS, which consists of sequential association of ROT, Reminiscence and Remotivation during the same session. This pilot study sought to investigate whether CS, based on 3R program, could benefit cognitive functions, autonomy and behavioral disorders. Method: 3R-CS treatment was applied to 36 patients, which are part of the “TREDEM” study sample, and their caregivers. All patients received a multidimensional assessment consisting of a socio-demographic, clinical and neuropsychological data collection. Results: After CS treatment a significant …improvement was detected in cognition and autonomy in basic activities of daily living. Caregiver distress was decreased. Behavioral disturbances were reduced even when considering a potential confounding factor such as treatment with anticholinesterase or NMDA receptor antagonist drugs. Conclusion: The findings demonstrated that 3R-CS can benefit cognitive functions and level of autonomy in the basic activities of daily living and also it can reduce behavioral disorders and caregiver's distress. Show more

Keywords: Cognitive Stimulation Training, 3R Mental Stimulation, TREDEM study, dementia, caregiver distress

DOI: 10.3233/NRE-141202

Citation: NeuroRehabilitation, vol. 36, no. 1, pp. 151-156, 2015