NeuroRehabilitation - Volume 40, issue 1

Authors: Park, Junhyuck | Gong, Jihwan | Yim, Jongeun

Article Type: Research Article

Abstract: BACKGROUND: Boxing training including traditional stretching, muscular strength training, and duration training would be considered to be effective for improved functional stretching, dynamic balance, walking speed, and quality of life. OBJECTIVE: We aimed to investigate upper limb function, balance, gait, and quality of life in stroke patients before and after a sitting boxing program. METHODS: Twenty-six participants were randomly allocated to a boxing group (n  = 13) and control group (n  = 13) after the upper limb function, balance, gait, and quality of Life were recorded. The boxing group underwent a sitting boxing program (3 times/week) as …well as conventional physical therapy (3 times/week) for 6 weeks. The control group only underwent conventional physical therapy (3 times/week) for 6 weeks. RESULTS: The Manual Functional Test (MFT), non-affected hand grip, Berg Balance Scale (BBS), velocity moment with eye opened, 10-m Walk Test (10 MWT), and Stroke-Specific Quality of Life questionnaire (SS-QOL) were significantly improved in the boxing group (p  < 0.05) and showed significantly greater improvements in the boxing group compared to the control group (p  < 0.05) after 6 weeks. CONCLUSIONS: The sitting boxing program group had positive effects on upper extremity function, balance, gait, and quality of life in stroke patients. Show more

Keywords: Boxing program, stroke, upper extremity function, balance, gait, quality of life

DOI: 10.3233/NRE-161392

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 77-86, 2017

Authors: Yoshikawa, Kenichi | Mizukami, Masafumi | Kawamoto, Hiroaki | Sano, Ayumu | Koseki, Kazunori | Sano, Kumiko | Asakawa, Yasutsugu | Kohno, Yutaka | Nakai, Kei | Gosho, Masahiko | Tsurushima, Hideo

Article Type: Research Article

Abstract: BACKGROUND: The robotic Hybrid Assistive Limb (HAL) provides motion according to the wearer’s voluntary activity. HAL training effects on walking speed and capacity have not been clarified in subacute stroke. OBJECTIVES: To determine improvement in walking ability by HAL and the most effective improvement measure for use in future large-scale trials. METHODS: Sixteen first-ever hemiplegic stroke patients completed at least 20 sessions over 5 weeks. Per session, the experimental group received no more than 20 min of gait training with HAL (HT) and 40 min of conventional physiotherapy, whereas the control group received at least 60 min of …conventional physiotherapy. Primary outcome was maximum walking speed (MWS). RESULTS: The change in MWS from baseline at week 5 was 11.6±10.6 m/min (HAL group) and 2.2±4.1 m/min (control group) (adjusted mean difference = 9.24 m/min, 95% confidence interval 0.48–18.01, P  = 0.040). In HAL subjects there were significant increases in Self-selected walking speed (SWS; a secondary outcome) and in step length (a secondary outcome) at MWS and SWS compared with controls. CONCLUSIONS: HT improved walking speed in hemiplegic sub-acute stroke patients. In future, randomized controlled trials are needed to confirm the utility of HT. Show more

Keywords: Hybrid Assistive Limb, robot-assisted gait training, stroke

DOI: 10.3233/NRE-161393

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 87-97, 2017

Authors: Lee, Seung-Mi | Cynn, Heon-seock | Yi, Chung-Hwi | Yoon, Tae-Lim | Lee, Ji-Hyun

Article Type: Research Article

Abstract: BACKGROUND: Stroke patients develop compensatory movements due to limitations of ankle dorsiflexion and knee flexion. To solve the limitations, there are many adjustable walking assistive devices such as robotic devices, ankle-foot orthoses, and functional electric stimulation in rehabilitation session. However, these assistive devices have some disadvantages, including expense and discomforts. Therefore, the development of a new assistive device for stroke patients is needed to assist ankle dorsiflexion and knee flexion. OBJECTIVE: This study investigated the effects of a wearable tubing assistive walking device (WTAWD) on gait parameters (gait speed, cadence, and step length and stride length on …affected and less affected sides) in patients with stroke. METHODS: Gait parameters were measured using the GAITRite system. One-way repeated measures analysis of variance was used to determine gait differences under three conditions (WTAWD, barefoot, and conventional elastic band orthosis). RESULTS: Gait speed, cadence, and step length and stride length on both affected and less affected sides were significantly greater with WTAWD, compared to barefoot and conventional elastic band orthosis conditions. CONCLUSION: WTAWD could be effective for patients with stroke. Show more

Keywords: Elastic band orthosis, gait, stroke

DOI: 10.3233/NRE-161394

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 99-107, 2017

Authors: In, Taesung | Jin, Youngmi | Jung, Kyoungsim | Cho, Hwi-young

Article Type: Research Article

Abstract: OBJECTIVES: The purpose of this study was to evaluate the effects of treadmill training with Thera-Band on motor function, gait and balance abilities in patients with stroke. METHODS: 30 participants with hemiparetic stroke were recruited and randomly divided into two groups: the experimental group (n  = 15) and the control group (n  = 15). Participants in both groups received conventional physical therapy for 30 minutes before the intervention. Additionally, subject in the experimental group performed treadmill training with Thera-Band for 30 minutes, five times a week for four weeks, while the control group conducted treadmill training only for the same …amount of time. To measure motor function, Fugl-Meyer assessment (FMA) was used. Timed-up and Go (TUG), 10-meter walk test (10MWT) and Performance-oriented mobility assessment (POMA) were used to analysis balance and gait abilities. RESULTS: In FMA, TUG, 10MWT and Gait POMA, there were significant improvements in both groups after intervention. And more significant changes were shown in the experimental group than the control group (p  < 0.05). However, there was no significant difference within group and between the groups in the Balance POMA. CONCLUSIONS: Our findings indicate that treadmill training with Thera-Band is beneficial and effective to improve motor function of the lower extremities, gait and balance ability in stroke patients. Show more

Keywords: Balance, gait, stroke, Thera-Band

DOI: 10.3233/NRE-161395

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 109-114, 2017

Authors: Sawan, Salah | Abd-Allah, Foad | Hegazy, Montasser M. | Farrag, Mohammad A. | El-Den, Nancy Hosney Sharf

Article Type: Research Article

Abstract: BACKGROUND: Large number of patients with first-ever stroke developed spasticity. Spasticity can reduce the range of motion, hinder voluntary movements, provoke pain, and result in impairment of functional activities of daily living. OBJECTIVE: Demonstrate the effect of shock wave therapy on ankle plantar flexors spasticity in stroke patients. METHODS: We included forty ischemic stroke patients divided into 2 groups; group I were subjected to the selected physical therapy program and shock wave therapy whereas group II received the selected physical therapy program as well as placebo shock wave for six weeks. Both groups were subjected …to pre- and post-treatment assessment by H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking. RESULTS: Baseline characteristics showed no significant difference between the two groups regarding the grades of spasticity. Whereas After treatment, there were a highly significant difference between both groups regarding the grades of spasticity according to the 3 parameters, H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking test (P values; <0.001, 0.006, and 0.009 respectively). CONCLUSIONS: Shock wave therapy is effective in controlling spasticity, increase dorsiflexion active range of motion of ankle and improving ten- meters walking test in stroke patients. Show more

Keywords: Stroke, spasticity, H/M ratio, extra corporeal shock wave therapy

DOI: 10.3233/NRE-161396

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 115-118, 2017

Authors: Alfieri, Fábio Marcon | Massaro, Ayrton Roberto | Filippo, Thais Raquel | Portes, Leslie Andrews | Battistella, Linamara Rizzo

Article Type: Research Article

Abstract: BACKGROUND: A stroke can cause alterations in thermal sensitivity. OBJECTIVE: to verify the conditions of body temperature in hemiplegic patients after stroke as compared to healthy individuals, as well as establish relations between thermal sensitivity and gender, age, Body Mass Index (BMI), plegic side, time after stroke, reports of thermal alterations and the motricity of patients with stroke sequelae. METHODS: This cross-sectional study included 100 patients (55.6±13 years) with ischemic or hemorrhagic stroke sequelae with unilateral hemiparesis and thirty healthy subjects (55±12.9 years). Individuals with nervous peripheral lesions, diabetes, peripheral vascular diseases or tumors were …not included in this study. The volunteers underwent axillary temperature evaluations with the use of a cutaneous thermometer and evaluations of cutaneous temperature of hands and feet as measured by infrared thermography captured by an infrared sensor (ThermaCAMTM SC 500-FLIR Systems). The mean temperature (°C) was analyzed with the SigmaStat 3.5 statistical package. RESULTS: The results have shown that healthy individuals have similar temperatures on either side of the body. The hemiplegic subjects presented a lower temperature on the plegic side and compared to the healthy subjects, both feet of the hemiparetic individuals were colder. The results have also shown that age, body mass index, and the time after stroke have no influence on the alterations in temperature. Regarding the paretic side, individuals with hemiplegia on the right side (right foot) had a lower temperature than those affected on the left side. Motricity was not related to any difference in temperature between the limbs and the reports of temperature differences had no relation with the actual differences found in the study. CONCLUSIONS: Healthy individuals have temperature symmetry between between sides of the body, while individuals with stroke sequelae present lower temperature in the paretic side, especially on their feet. Show more

Keywords: Stroke, thermal sensitivity, thermography, functional evaluation

DOI: 10.3233/NRE-161397

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 119-128, 2017

Authors: Perez-Rizo, Enrique | Trincado-Alonso, Fernando | Pérez-Nombela, Soraya | del Ama-Espinosa, Antonio | Jiménez-Díaz, Fernando | Lozano-Berrio, Vicente | Gil-Agudo, Angel

Article Type: Research Article

Abstract: BACKGROUND: Specific biomechanical models have been developed to study gait using crutches. Clinical application of these models is needed in adult spinal cord injury (SCI) population walking with different patterns of gait with crutches to prevent overuse shoulder injuries. OBJECTIVE: To apply a biomechanical model in a clinical environment to analyze shoulder in adult SCI patients walking with two different patterns of gait with crutches: two point reciprocal gait (RG) and swing-through gait (SG). METHODS: Load cells were fixed to the distal ends and forearm cuffs of a pair of crutches. An active markers system …was used for kinematics. Five cycles for each gait pattern were analyzed applying a biomechanical model of the upper limbs. Fifteen subjects with SCI were analyzed. RESULTS: The flexo-extension range of motion was significantly greater when using SG (p  < 0.01). Similarly, the superior, posterior and medial forces were significantly stronger for SG in all 3 directions. Flexion, adduction and internal rotation torques were also greater in SG (p  < 0.01). CONCLUSIONS: A biomechanical model was successfully applied to study shoulder biomechanics in adult patients with SCI walking with crutches in two different gait patterns. Greater loads exerted on the shoulder walking with SG were confirmed compared to RG. Show more

Keywords: Rehabilitation, spinal cord injury, biomechanics, shoulder, gait, crutches

DOI: 10.3233/NRE-161398

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 129-140, 2017

Authors: de Natale, Edoardo Rosario | Paulus, Kai Stephan | Aiello, Elena | Sanna, Battistina | Manca, Andrea | Sotgiu, Giovanni | Leali, Paolo Tranquilli | Deriu, Franca

Article Type: Research Article

Abstract: OBJECTIVE: To explore the effects of Dance Therapy (DT) and Traditional Rehabilitation (TR) on both motor and cognitive domains in Parkinson’s Disease patients (PD) with postural instability. METHODS: Sixteen PD patients with recent history of falls were divided in two groups (Dance Therapy, DT and Traditional Rehabilitation, TR); nine patients received 1-hour DT classes twice per week, completing 20 lessons within 10 weeks; seven patients received a similar cycle of 20 group sessions of 60 minutes TR. Motor (Berg Balance Scale – BBS, Gait Dynamic Index – GDI, Timed Up and Go Test – TUG, 4 Square-Step …Test – 4SST, 6-Minute Walking Test – 6MWT) and cognitive measures (Frontal Assessment Battery – FAB, Trail Making Test A & B – TMT A&B, Stroop Test) were tested at baseline, after the treatment completion and after 8-week follow-up. RESULTS: In the DT group, but not in the TR group, motor and cognitive outcomes significantly improved after treatment and retained after follow-up. Significant changes were found for 6MWT (p  = 0.028), TUG (p  = 0.007), TMT-A (p  = 0.014) and TMT-B (p  = 0.036). CONCLUSIONS: DT is an unconventional physical therapy for PD patients which effectively impacts on motor (endurance and risk of falls) and non-motor functions (executive functions). Show more

Keywords: Rehabilitation, dance therapy, Parkinson’s disease, executive functions

DOI: 10.3233/NRE-161399

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 141-144, 2017

Authors: DiFrancisco-Donoghue, Joanne | Apoznanski, Theresa | de Vries, Kristen | Jung, Min-Kyung | Mancini, Jayme | Yao, Sheldon

Article Type: Research Article

Abstract: BACKGROUND: Osteopathic Manipulative Medicine (OMM) is a therapy of manual forces that is directed to improve function and homeostasis. It has been shown to improve balance in individuals with dizziness, and improve gait in Parkinson’s disease (PD). This study was designed to determine if our pre-defined OMM protocol would improve motor function and balance in individuals with PD. METHODS: A randomized controlled trial to test OMM on balance and motor function in PD measured by the Mini-BESTest, Sensory Organization Test (SOT), and MDS-UPDRS. 11 Subjects (age 75±16) were randomly assigned to either bi-weekly OMM treatments first for 6 weeks …or weekly counseling sessions from a medical provider for 6 weeks as a placebo-control. 9 subjects completed this study. RESULTS: There were no significant changes in SOT or Mini BESTest in either group (p  < 0.05). There was significant improvement in the OMM group for MDS-UPDRS. CONCLUSIONS: Our pilot data showed OMM treatment bi-weekly for 6 weeks improved motor function. There were no significant changes in balance, however there were clinically relevant improvements after 6 weeks of OMM. Using a predefined protocol, OMM may be a complementary approach to improving balance and motor function in individuals with PD. Show more

Keywords: Osteopathic medicine, Parkinson’s disease, balance, motor function, manual manipulation

DOI: 10.3233/NRE-161400

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 145-151, 2017

Authors: Sebastião, Emerson | Learmonth, Yvonne C. | Motl, Robert W.

Article Type: Research Article

Abstract: BACKGROUND: Falls are of great concern among persons with multiple sclerosis (MS). OBJECTIVE: To examine differences in metrics of mobility, postural control, and cognition in persons with MS with distinct fall risk status; and to investigate predictors of fall risk group membership using discriminant analysis. METHODS: Forty-seven persons with MS completed the Activities-Balance Confidence (ABC) Scale and underwent a battery of assessments of mobility, balance, and cognition. Participants further wore an accelerometer for 7 days as an assessment of steps/day. Participants were allocated into fall risk groups based on ABC scale scores (increased fall risk …(IFR); and normal fall risk (NFR)). We examined univariate differences between groups using ANOVA, and discriminant function analysis (DFA) identified the significant multivariate predictors of FR status. RESULTS: After controlling for disability level, the IFR group had significantly (p  < 0.05) worse scores on measures of mobility (i.e., MSWS-12, 6 MW, and steps/day) compared to the NFR group. DFA identified MSWS-12 and 6 MW scores as significant (p  < 0.05) predictors of fall risk group membership. Those two variables collectively explained 55% of variance in fall risk grouping. CONCLUSIONS: The findings suggest that mobility should be the focus of rehabilitation programs in persons with MS, especially for those at IFR. Show more

Keywords: Disability, falls risk, neurological disorder, predictors, walking ability

DOI: 10.3233/NRE-161401

Citation: NeuroRehabilitation, vol. 40, no. 1, pp. 153-161, 2017