NeuroRehabilitation - Volume 38, issue 1

Authors: Kane, Heather | Teixeira-Poit, Stephanie | Halpern, Michael T. | Keating, Michael | Olmsted, Murrey

Article Type: Research Article

Abstract: BACKGROUND: Rehabilitation care is an important part of care for individuals with multiple sclerosis (MS). Little is known about factors influencing physiatrists’ desire to provide MS care. OBJECTIVE: This study examines factors associated with physiatrists’ attitudes towards providing MS care. METHODS: We collaborated with the American Academy of Physical Medicine and Rehabilitation to survey a sample of 300 U.S. physiatrists. Analyses examined the association of exposure to MS care resources during residency, physician demographic and practice characteristics with attitudes toward providing MS care. RESULTS: Physiatrists indicating negative factors limiting the number of MS patients …seen in clinical practice were more likely to practice in a setting other than a major city and less likely to have interacted with MS specialists during residency. Physiatrists indicating factors having a positive influence on providing MS patient care were more likely to practice within a major city, see one or more MS patients per week, and serve as the primary physiatrist directing care for one or more MS patients. CONCLUSIONS: Physiatrists indicated positive and negative attitudes towards MS care. Increasing exposure to MS patients, providing resources for MS care, and participating in continuing education on MS, may encourage physiatrists to provide MS patient care. Show more

Keywords: Multiple sclerosis, physical and rehabilitation medicine, physiatry, survey

DOI: 10.3233/NRE-151289

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 1-6, 2016

Authors: Kahraman, Turhan | Savci, Sema | Coskuner Poyraz, Esra | Ozakbas, Serkan | Idiman, Egemen

Article Type: Research Article

Abstract: BACKGROUND: The Expanded Disability Status Scale (EDSS) is a well-established clinical measure to assess disability in multiple sclerosis (MS). Gait dysfunction is primarily considered for scoring only above EDSS 3.5. However, the changes in functional systems in below EDSS 3.5 may result gait disturbances. OBJECTIVE: To determine the distinctive ability of the EDSS 2.0 in terms of walking impairment as well as fatigue, depression, and quality of life in persons with MS with mild disability. METHODS: All participants underwent the neurological examination for generating an EDSS score and completed the measures of walking performance, as well …as other measures of fatigue, depression, and quality of life. The participants were divided into two groups according to the EDSS scores (i.e. EDSS <2.0 and 2.0–3.5). RESULTS: Participants with EDSS 2.0–3.5 had significantly worse walking performance, as well as fatigue, depression, and quality of life levels than the participants with EDSS <2.0 (p  <  0.05). The EDSS significantly correlated with the measures of walking performance, as well as other measures of fatigue, depression, and quality of life. CONCLUSIONS: The EDSS 2.0 has a distinctive ability in terms of walking impairment as well as fatigue, depression, and quality of life. Show more

Keywords: Multiple sclerosis, EDSS, walking, disability, assessment, fatigue, depression, quality of life

DOI: 10.3233/NRE-151290

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 7-14, 2016

Authors: Raithatha, Ravi | Carrico, Cheryl | Powell, Elizabeth Salmon | Westgate, Philip M. | Chelette II, Kenneth C. | Lee, Kara | Dunsmore, Laura | Salles, Sara | Sawaki, Lumy

Article Type: Research Article

Abstract: BACKGROUND: Locomotor training with a robot-assisted gait orthosis (LT-RGO) and transcranial direct current stimulation (tDCS) are interventions that can significantly enhance motor performance after spinal cord injury (SCI). No studies have investigated whether combining these interventions enhances lower extremity motor function following SCI. OBJECTIVE: Determine whether active tDCS paired with LT-RGO improves lower extremity motor function more than a sham condition, in subjects with motor incomplete SCI. METHODS: Fifteen adults with SCI received 36 sessions of either active (n  = 9) or sham (n  = 6) tDCS (20 minutes) preceding LT-RGO (1 hour). Outcome measures included manual muscle …testing (MMT; primary outcome measure); 6-Minute Walk Test (6MinWT); 10-Meter Walk Test (10MWT); Timed Up and Go Test (TUG); Berg Balance Scale (BBS); and Spinal Cord Independence Measure-III (SCIM-III). RESULTS: MMT showed significant improvements after active tDCS, with the most pronounced improvement in the right lower extremity. 10MWT, 6MinWT, and BBS showed improvement for both groups. TUG and SCIM-III showed improvement only for the sham tDCS group. CONCLUSION: Pairing tDCS with LT-RGO can improve lower extremity motor function more than LT-RGO alone. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living. Show more

Keywords: Lower extremity, motor function, neuroplasticity, treadmill training, transcranial direct current stimulation

DOI: 10.3233/NRE-151291

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 15-25, 2016

Authors: Powell, Elizabeth Salmon | Carrico, Cheryl | Raithatha, Ravi | Salyers, Emily | Ward, Andrea | Sawaki, Lumy

Article Type: Research Article

Abstract: STUDY DESIGN: This double-blind, sham-controlled, crossover case study combined transvertebral direct current stimulation (tvDCS) and locomotor training on a robot-assisted gait orthosis (LT-RGO). OBJECTIVE: Determine whether cathodal tvDCS paired with LT-RGO leads to greater changes in function and neuroplasticity than sham tvDCS paired with LT-RGO. SETTING: University of Kentucky (UK) HealthCare Stroke and Spinal Cord Neurorehabilitation Research at HealthSouth Cardinal Hill Hospital. METHODS: A single subject with motor incomplete spinal cord injury (SCI) participated in 24 sessions of sham tvDCS paired with LT-RGO before crossover to 24 sessions of cathodal tvDCS paired with LT-RGO. …Functional outcomes were measured with 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), Spinal Cord Independence Measure-III (SCIM-III) mobility component, lower extremity manual muscle test (MMT), and Berg Balance Scale (BBS). Corticospinal changes were assessed using transcranial magnetic stimulation. RESULTS: Improvement in 10MWT speed, SCIM-III mobility component, and BBS occurred with both conditions. 6MWT worsened after sham tvDCS and improved after cathodal tvDCS. MMT scores for both lower extremities improved following sham tvDCS but decreased following cathodal tvDCS. Corticospinal excitability increased following cathodal tvDCS but not sham tvDCS. CONCLUSION: These results suggest that combining cathodal tvDCS and LT-RGO may improve functional outcomes, increase corticospinal excitability, and possibly decrease spasticity. Randomized controlled trials are needed to confirm these conclusions. SPONSORSHIP: This publication was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000117, and the HealthSouth Cardinal Hill Stroke and Spinal Cord Endowment (1215375670). Show more

Keywords: Neuromodulation, neuroplasticity, transcutaneous spinal direct current stimulation, motor function, lower extremity, treadmill training

DOI: 10.3233/NRE-151292

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 27-35, 2016

Authors: Chai, Qianwen | Yuan, Zhifang | Jin, Yi | Zhang, Qing

Article Type: Research Article

Abstract: BACKGROUND: Stroke has become the leading cause of acquired disability worldwide. Psychological maladjustment and related reactions for stroke disability has subsequently revealed a negative impact on stroke rehabilitation process. Acceptance of disability (AOD) is widely confirmed as a critical factor for psychosocial regulation and disability acceptance. OBJECTIVE: This study aims to investigate acceptance of disability and its influencing factors among stroke patients in China. METHODS: A total of 220 hospitalized stroke patients were investigated using questionnaire on demographics and disease characters, Adaptation Of Disability Scale-Revised, and other psychological instruments: Medical Coping Modes Questionnaire (MCMQ), Functional Activities …Questionnaire (FAQ), Self-Rating Depression Scale (SDS), and Perceived Social Support Scale (PSSS). RESULTS: The mean score of AOD is 74.15 (range 32∼128), which reflected a moderate level of disability acceptance among stroke patients in China. Statistical analysis showed that confrontation, the understanding of stroke, self-rating depression, ability of functional activities and family support were major factors affecting acceptance of disability among disabled stroke patients, which explained 49.6% of the total variance. CONCLUSIONS: In clinical practice, professionals should identify patients with low levels of disability acceptance and explore effective psychological intervention model on the theoretical foundation of different dimensions in AOD theory and related predictors. Show more

Keywords: Acceptance of disability, stroke, psychophysical rehabilitation

DOI: 10.3233/NRE-151293

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 37-44, 2016

Authors: Vincent-Onabajo, Grace | Blasu, Cephas

Article Type: Research Article

Abstract: BACKGROUND: Leisure provides pleasure and relaxation, and has health benefits even after a stressful and life-changing event such as a stroke. OBJECTIVE: This study examined leisure participation among a sample of community-residing stroke survivors in Nigeria. METHODS: Fifty-five stroke survivors undergoing rehabilitation were consecutively recruited from two government hospitals in Northern Nigeria. Data on pre- and post-stroke participation, and socio-demographic (age, sex, marital, employment, and educational status) and clinical (level of disability, post-stroke duration, stroke type and side of hemiplegia/hemiparesis) attributes of the stroke survivors were obtained. Leisure participation was assessed in four domains of recreational, …social, cognitive, and productive/creative activities. Associations between leisure participation and the socio-demographic and clinical variables were examined using bivariate analysis. RESULTS: Mean (SD) age of the stroke survivors was 53.55 (14.39) years. Prevalence of leisure participation was 89.1%. Participation in specific leisure domains however varied thus: social (83.6%), cognitive (60%), recreational (41.8%), productive/creative activities (30.9%). Significant associations were observed between participation in cognitive, productive/creative, and recreational leisure activities, and specific socio-demographic and clinical attributes. CONCLUSIONS: Leisure participation was high in a general sense but marginal in recreational and productive/creative activities. The observed socio-demographic and clinical associations with post-stroke leisure participation may assist in providing effective leisure rehabilitation strategies. Show more

Keywords: Leisure, Nigeria, participation, stroke

DOI: 10.3233/NRE-151294

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 45-52, 2016

Authors: Calabrò, Rocco Salvatore | Nibali, Valeria Conti | Naro, Antonino | Floridia, Daniela | Pizzimenti, Maria | Salmeri, Lucia | Salviera, Carlo | Bramanti, Placido

Article Type: Research Article

Abstract: BACKGROUND: Neurogenic dysphagia is a difficulty in swallowing induced by nervous system disease. It often causes serious complications, which are preventable if dysphagia is properly managed. There is growing debate concerning the usefulness of non-invasive neuromuscular electrical stimulation (NMES) in treating swallowing dysfunction. OBJECTIVE: Aim of this study was to assess the effectiveness of Vitalstim© device, and to investigate the neurophysiological mechanisms underlying functional recovery. METHODS: A 34-year-old man, affected by severe chronic dysphagia following traumatic brain injury, underwent two different intensive rehabilitation trainings, including either conventional rehabilitation alone or coupled to Vitalstim training. We …evaluated patient swallowing function in two separate sessions (i.e. before and after the two trainings) by means of ad hoc swallowing function scales and electrophysiological parameters (rapid paired associative stimulation). The overall Vitalstim program was articulated in 6 weekly sessions for 6 weeks. RESULTS: The patient did not report any side-effect either during or following both the intensive rehabilitation trainings. We observed an important improvement in swallowing function only after Vitalstim training. In fact, the patient was eventually able to safely eat even solid food. CONCLUSIONS: This is the first report objectively suggesting (by means of rPAS) a correlation between the brain neuroplastic changes induced by Vitalstim and the swallowing function improvement. It is hypothesizable that Vitalstim may have targeted cortical (and maybe subcortical) brain areas that are recruited during the highly coordinated function of swallowing, and it may have thus potentiated the well-known neuroplastic changes induced by repetitive and intensive swallowing exercises, probably thanks to metaplasticity phenomena. Show more

Keywords: Metaplasticity, neurogenic dysphagia, NMES, PAS, vitalstim

DOI: 10.3233/NRE-151295

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 53-57, 2016

Authors: Lu, William | Krellman, Jason W. | Dijkers, Marcel P.

Article Type: Research Article

Abstract: BACKGROUND: Individuals with traumatic brain injury (TBI) often develop sleep disorders post-injury. The most common one is insomnia, which can exacerbate other post-injury symptoms, including fatigue, impaired cognition, depression, anxiety, and pain. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a manualized treatment that effectively treats insomnia with secondary effects on cognition, mood, and pain in various populations. OBJECTIVE: This paper reviews the use of CBT-I for three participants with TBI of different severities. METHODS: Pre- and post-treatment assessments of insomnia, fatigue, depression, anxiety, and pain were conducted. Mood was further assessed at follow-up. Minimal clinically important …difference (MCID) scores derived from the research literature were used to establish clinically meaningful symptom improvement on self-report questionnaires. RESULTS: The reduction in insomnia severity scores for all three participants were not large enough to be considered a clinically significant improvement following CBT-I, although trends toward improvement were observed. However, all participants showed clinically significant reductions in anxiety at post-treatment; the effects persisted for 2 participants at follow-up. Reductions in depression symptoms were observed for 2 participants at post-treatment, and treatment effects persisted for 1 participant at follow-up. One participant endorsed clinically significant improvements in fatigue and pain severity. CONCLUSIONS: We conclude that CBT-I may provide secondary benefits for symptoms commonly experienced by individuals with TBI, especially mood disturbances. Show more

Keywords: Insomnia, traumatic brain injury, cognitive behavioral therapy, case study

DOI: 10.3233/NRE-151296

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 59-69, 2016

Authors: Marsh, Nigel V. | Ludbrook, Maria R. | Gaffaney, Lauren C.

Article Type: Research Article

Abstract: OBJECTIVE: To describe the long-term prevalence and severity of cognitive deficits following significant (i.e., ventilation required for >24 hours) traumatic brain injury. To assess a comprehensive range of cognitive functions using psychometric measures with established normative, reliability, and validity data. METHODS: A group of 71 adults was assessed at approximately five years (mean = 66 months) following injury. Assessment of cognitive functioning covered the domains of intelligence, attention, verbal and visual memory, visual-spatial construction, and executive functions. RESULTS: Impairment was evident across all domains but prevalence varied both within and between domains. Across aspects of intelligence clinical impairment …ranged from 8–25% , attention 39–62% , verbal memory 16–46% , visual memory 23–51% , visual-spatial construction 38% , and executive functions (verbal fluency) 13% . In addition, 3–23% of performances across the measures were in the borderline range, suggesting a high prevalence of subclinical deficit. CONCLUSIONS: Although the prevalence of impairment may vary across cognitive domains, long-term follow-up documented deficits in all six domains. These findings provide further evidence that while improvement of cognitive functioning following significant traumatic brain injury may be possible, recovery of function is unlikely. Show more

Keywords: Traumatic brain injury, cognitive functioning, neuropsychological assessment, long-term outcome

DOI: 10.3233/NRE-151297

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 71-78, 2016

Authors: Bertens, Dirk | Kessels, Roy P.C. | Boelen, Danielle H.E. | Fasotti, Luciano

Article Type: Research Article

Abstract: BACKGROUND: Previous findings had shown that the addition of errorless learning to traditional Goal Management Training (GMT) resulted in superior results when training everyday tasks in persons with executive deficits after brain injury. OBJECTIVE: To investigate the additional effects of an errorless GMT on cognitive function and quality of life after acquired brain injury. METHODS: This is a supplementary analysis of findings from an RCT in which 67 patients with executive impairments after acquired brain injury were randomly allocated to an experimental errorless GMT (n  = 33) or conventional GMT (n  = 34) to train two individually chosen …everyday tasks. Objective cognitive function using neuropsychological tests, subjective cognitive complaints and quality of life using questionnaires were assessed before and after training. RESULTS: No significant interaction effects between these three types of outcome measures and the two forms of GMT were found. Irrespective of treatment, performance on two executive tests (Modified Six Elements Test; p  = 0.006, Zoo Map test; p  = 0.001) improved and daily executive function problems as reported by the participants (EFI; p  = 0.001) and proxies (DEX; p  = 0.01) diminished. CONCLUSIONS: Besides the previously found superiority of errorless GMT when training everyday tasks, additional improvements in cognition and quality of life did not differ between the two treatments. Show more

Keywords: Cognitive rehabilitation, cognitive function, executive function, quality of life, activities of daily living

DOI: 10.3233/NRE-151298

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 79-84, 2016

Authors: Marin, Sheilla de Medeiros Correia | Bertolucci, Paulo Henrique Ferreira | Marin, Luis Fabiano | de Oliveira, Fabricio Ferreira | Wajman, Jose Roberto | Bahia, Valéria Santoro | Mansur, Letícia Lessa

Article Type: Research Article

Abstract: BACKGROUND: Few studies have described characteristics of swallowing in primary progressive aphasia (PPA) and its variants. OBJECTIVE: To describe and characterize swallowing and eating behaviors of patients with PPA, as well as their correlates with neuropsychiatric symptoms and patterns of communication. METHODS: We studied 16 patients with PPA and 16 their caregivers. PPA was subdivided in agrammatic variant (PPA-G), semantic variant (PPA-S) and logopenic variant (PPA-L). All patients and their caregivers were screened with the following scales: “Assessment of Feeding and Swallowing Difficulties in Dementia”, “Neuropsychiatric Inventory”, and “Functional Outcome Questionnaire for Aphasia”. RESULTS: …Patients with PPA-S had diverse swallowing problems such as drooling of saliva or food, multiple swallows, delayed swallow and choking, all of which correlated with anxiety, apathy and aberrant motor behavior. Patients with PPA-G and PPA-L had choking and delayed swallow, respectively. Disturbances in eating behaviors were more frequent in the group with PPA-L, and they correlated with difficulties in patterns of communication. CONCLUSIONS: All variants showed swallowing difficulties and they were more frequent in PPA-S. Further studies with larger samples of patients are needed to better characterize swallowing problems and their consequences in the different variants of PPA. Show more

Keywords: Aphasia, primary progressive, deglutition disorders/diagnosis, feeding behavior, communication, behavior, questionnaires

DOI: 10.3233/NRE-151299

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 85-92, 2016

Authors: Palmer, Christina | Kneebone, Ian I. | Strauss, Clara | Jones, Anna-Marie

Article Type: Research Article

Abstract: BACKGROUND: It is important to evaluate change in order to re-assure commissioners, staff and patients of the effectiveness of interventions, but also in order to identify areas for improvement. OBJECTIVE: To consider whether analysis of improvement at the level of the individual, taking into account measurement error, may offer a further valuable way to assess change and inform service development over considering change at the group level in a post-acute neuro-rehabilitation unit. METHOD: Pre and post intervention Scores on the FIM+FAM Full Scale and Cognitive and Motor subscales were considered for eighteen patients aged between 35 …and 81 with mixed diagnoses who attended a post-acute inpatient neuro-rehabilitation unit for treatment. RESULTS: Statistically significant improvements were achieved on the FIM+FAM Full Scale and Cognitive and Motor subscales in a whole group analysis. Reliable change analyses for each patient within each subscale however identified only half of the sample achieved reliable improvement within the Motor domain and just one person within the Cognitive domain (5.6%). CONCLUSIONS: Findings are consistent with the emphasis of the rehabilitation unit on physical/motor function, and unsurprising as many of those assessed had multiple sclerosis, an often deteriorative condition. Use of reliable change analysis allowed a more detailed understanding of intervention impact, potentially identifying what services reliably work for whom, thereby informing future planning. Show more

Keywords: Neurorehabilitation, reliable change analysis, neurodisability, neurological illness

DOI: 10.3233/NRE-151300

Citation: NeuroRehabilitation, vol. 38, no. 1, pp. 93-98, 2016