NeuroRehabilitation - Volume 40, issue 4

Authors: Folkerts, Mireille A. | Hijmans, Juha M. | Elsinghorst, Anne L. | Mulderij, Yvon | Murgia, Alessio | Dekker, Rienk

Article Type: Research Article

Abstract: BACKGROUND: Strength training can increase function in individuals with stroke. However it is unclear which type of strength training is most effective and feasible. OBJECTIVE: To assess the effect and feasibility of an intervention combining eccentric and task-oriented strength training in individuals with chronic stroke. METHODS: Eleven participants were randomly assigned to a group first receiving four weeks of eccentric strength training and then four weeks of task-oriented strength training (EST-TOST) or vice versa (TOST-EST). Strength and upper limb function were administered with a hand-held dynamometer (HHD) and the Action Research Arm Test (ARAT) respectively. …Feasibility was evaluated with the Intrinsic Motivation Inventory (IMI), the adherence and drop-out rate. RESULTS: Significant increases were found in ARAT score (mean difference 7.3; p  < 0.05) and in shoulder and elbow strength (mean difference respectively 23.96 N; p  < 0.001 and 27.41 N; p  < 0.003). Participants rated both EST and TOST with 81% on the IMI, the adherence rate was high and there was one drop-out. CONCLUSION: The results of this study show that a combination of eccentric and task-oriented strength training is an effective and feasible training method to increase function and strength in individuals with chronic stroke. Show more

Keywords: Stroke, strength training, eccentric, task-oriented, effectiveness, feasibility

DOI: 10.3233/NRE-171433

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 459-471, 2017

Authors: Kang, Tae-Woo | Cynn, Heon-Seock

Article Type: Research Article

Abstract: BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF) provides models for functions and disabilities. The ICF is presented as a frame that enables organizing physical therapists’ clinical practice for application. OBJECTIVE: The purpose of the present study was to describe processes through which stroke patients are assessed and treated based on the ICF model. METHODS: The patient was a 65-year-old female diagnosed with right cerebral artery infarction with left hemiparesis. Progressive interventions were applied, such as those aiming at sitting and standing for the first two weeks, gait intervention for the third and …fourth weeks, and those aiming at sitting from a standing position for the fifth and sixth weeks. RESULTS: The ICF model provides rehabilitation experts with a frame that enables them to accurately identify and understand their patients’ problems. The ICF model helps the experts understand not only their patients’ body structure, function, activity, and participation, but also their problems related to personal and environmental factors. CONCLUSIONS: The experts could efficiently make decisions and provide optimum treatment at clinics using the ICF model. Show more

Keywords: Stroke, ICF model, progressive intervention, case study

DOI: 10.3233/NRE-171434

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 473-481, 2017

Authors: Mazzoleni, Stefano | Focacci, Antonella | Franceschini, Marco | Waldner, Andreas | Spagnuolo, Chiara | Battini, Elena | Bonaiuti, Donatella

Article Type: Research Article

Abstract: BACKGROUND: Until now studies report inconclusive results as regards the effectiveness of exclusive use of robot-assisted training and clinical indications in stroke patients. OBJECTIVE: To evaluate if the only robot-assisted end-effector-based gait training can be feasible in chronic stroke subjects in terms of gait recovery. METHODS: Five rehabilitation centers participated and one hundred chronic post-stroke patients were recruited. Patients underwent a robot-assisted end-effector-based gait training as only rehabilitation treatment. 6 Minute Walk Test, 10 Meter Walk Test, Timed Up and Go test, Modified Ashworth Scale, Motricity Index, Functional Ambulation Classification (FAC) and Walking Handicap …Scale were used as outcome clinical measure. Patients were divided into two groups: those assessed as FAC <3 (Group 1) and as FAC ≥ 3 (Group 2). RESULTS: Statistically significant changes were observed in each clinical outcome measure. Significant changes were observed in Group 1 and in Group 2. Significant percentages of patients achieved Minimally Clinically Important Difference in 6 Minute Walk Test in Group 2 and Timed Up and Go test in Group 1. CONCLUSIONS: Chronic stroke patients exposed to only robot-assisted end-effector-based gait training showed significant improvements in global motor performances, gait endurance, balance and coordination, lower limbs strength and even spasticity. Show more

Keywords: Rehabilitation, robotics, gait, stroke

DOI: 10.3233/NRE-161435

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 483-492, 2017

Authors: Chrisman, Sara P.D. | Whitlock, Kathryn B. | Somers, Elissa | Burton, Monique S. | Herring, Stanley A. | Rowhani-Rahbar, Ali | Rivara, Frederick P.

Article Type: Research Article

Abstract: BACKGROUND: Prior studies suggest potential benefit using monitored aerobic exercise to treat youth with persistent concussion symptoms, but these studies have been small. OBJECTIVES: To explore the safety and potential benefits of a rehabilitative exercise intervention, the Sub-symptom Threshold Exercise Program (SSTEP), for treating youth with persistent concussion symptoms >1 month. METHODS: We conducted a retrospective cohort study of 83 youth who participated in SSTEP, completing trajectory analysis of concussion symptoms using the symptom subscale of the Sport Concussion Assessment Tool, version 2 (SCAT-2). RESULTS : The average age of patients was 14.9+/–2.3 years …and 54% were female. Most concussions (76%) were due to sports, the majority from football and girls’ soccer, and 55% had a previous concussion. Comorbidity was not uncommon: 14% had history of ADHD and 16% history of depression and/or anxiety. Most patients improved following the intervention, and none reported worsening. Symptoms decreased exponentially following initiation of SSTEP, and trajectory did not differ by duration of symptoms at presentation (<6 weeks, 6–12 weeks, >12 weeks). CONCLUSIONS: Monitored exercise programs appear to be safe and potentially beneficial for youth with persistent concussive symptoms. Large-scale controlled studies are needed to examine efficacy, ideal timing and duration. Show more

Keywords: Brain concussion, sport, child, adolescent, traumatic brain injury, exercise, treatment, prolonged concussion syndrome

DOI: 10.3233/NRE-161436

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 493-499, 2017

Authors: Petrone, Ashley B. | Gionis, Valerie | Giersch, Richard | Barr, Taura L.

Article Type: Research Article

Abstract: BACKGROUND: In 2010, there were approximately 2.2 million emergency room visits associated with traumatic brain injury (TBI), with 80 percent diagnosed as mild TBI or concussion. In addition, there are a large number of TBIs, especially mild TBIs, which go either unreported by patients or initially undiagnosed by clinicians. Our team has previously identified a panel of immune-related genes that can diagnose ischemic stroke at triage, and due to shared pathophysiological mechanisms of TBI and stroke, we hypothesized that this panel of genes may also be utilized for the diagnosis of TBI. OBJECTIVES: The primary aims of …this pilot study were to: (1) characterize changes in a panel of immune-related genes in TBI; (2) identify immune-related biomarkers that may be used to diagnose TBI and (3) describe the peripheral immune response following TBI. METHODS: Blood was drawn from TBI patients no later than 24 h of injury onset and matched control subjects. Real-time PCR was used to measure gene expression, and a white blood cell differential was performed to obtain neutrophil and lymphocyte percentages. RESULTS: Relative mRNA expression of ARG1, LY96, MMP9, s100a12 was significantly increased and CCR7 was significantly decreased in peripheral blood of TBI patients within 24 hours of injury compared to control subjects. We also observed a different pattern of leukocyte dynamics following TBI between mild and severe TBI. CONCLUSIONS: We have described a panel of immune-related genes that can accurately predict/diagnose TBI with higher sensitivity and specificity of other biomarkers to date. Show more

Keywords: Traumatic brain injury, inflammation, neutrophil-lymphocyte ratio

DOI: 10.3233/NRE-171437

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 501-508, 2017

Authors: Lopez-Rolon, Alex | Vogler, Jana | Howell, Kaitlen | Shock, Jonathan | Czermak, Stefan | Heck, Suzette | Straube, Andreas | Bender, Andreas

Article Type: Research Article

Abstract: OBJECTIVES: To assess long-term clinical outcome, functional independence and health-related quality of life (HRQOL) in acquired brain injury (ABI) patients with a disorder of consciousness at admission to inpatient rehabilitation. METHODS: We selected patients from a cohort of ABI patients from a single centre. In addition to mortality, we measured level of consciousness with the Coma Remission Scale, functional independence with the Barthel Index, as well as generic and condition-specific HRQOL with the EQ5D and the “Quality of Life after Brain Injury” (QOLIBRI) respectively. RESULTS: Half of the obtained sample had died by follow-up. Survivors …were younger at onset, in a minimally conscious state (MCS) at admission and had spent longer time in rehabilitation. Patients in a MCS were more likely to survive, and be in a state better than MCS over the follow-up time than patients with an unresponsive wakefulness syndrome (UWS). A small proportion of patients with UWS at admission emerged from MCS at follow-up. Emergence from MCS was associated with traumatic brain injury (TBI) and higher functional independence. CONCLUSION: Clinical outcome is mostly concordant with previous findings. Survivors’ rehabilitation duration suggest revision of current standards. HRQOL results indicate a correlation with functional independence and that condition-specific HRQOL should not be neglected. Show more

Keywords: Acquired brain injury, disorders of consciousness, long-term outcome, health-related quality of life

DOI: 10.3233/NRE-171438

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 509-517, 2017

Authors: Doig, Emmah | Fleming, Jenny | Lin, Bonnie

Article Type: Research Article

Abstract: BACKGROUND: Online awareness and error behaviour has largely been studied using computer-based tests or prescribed functional tasks in participants with traumatic brain injury (TBI). OBJECTIVES: This study aimed to compare online awareness and error behaviour of two participants with TBI with two matched controls during tasks of meaning and importance to the participants with TBI, using an occupation-based online awareness assessment. METHODS: Participants were two males with TBI (aged 22 and 23) and two controls (aged 23 and 27). The participants with TBI identified personally meaningful occupations and performed each task on two consecutive occasions. …Performances were video-recorded and assessed by two occupational therapists to measure the frequency of errors, the percent of errors that were self-corrected, and the types of error behaviours observed. RESULTS: The participants with TBI demonstrated more frequent errors and poorer self-correction of errors compared to controls. Control participants made greater improvements in error frequency and self-correction with practice, and demonstrated a narrower range of error behaviours. CONCLUSIONS: This study builds upon previous research, by utilising an individualised, occupation-based approach to assess error behaviour and online awareness. Show more

Keywords: Brain injury, error detection, online awareness, self-awareness, naturalistic assessment, meaningful occupation

DOI: 10.3233/NRE-171439

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 519-529, 2017

Authors: Ditchman, Nicole | Sung, Connie | Easton, Amanda B. | Johnson, Kristina S. | Batchos, Elisabeth

Article Type: Research Article

Abstract: BACKGROUND: Although the negative impact of symptom severity on subjective well-being outcomes has been established among individuals with brain injury, the mediating and protective role that positive human traits might have on this relationship has not been adequately explored. OBJECTIVE: The purpose of this study was to examine the impact of social self-efficacy and disability acceptance on the relationship between symptom severity and life satisfaction among individuals with brain injury. METHODS: Hierarchical regression analysis and correlation techniques were used to test a hypothesized dual-mediation model of life satisfaction in a sample of 105 adults with …acquired brain injury. RESULTS: Results indicated that social self-efficacy and disability acceptance fully mediated the relationship between symptom severity and life satisfaction, lending support for a dual-mediation model with disability acceptance being the strongest contributor. CONCLUSIONS: These findings suggest there may be considerable value for rehabilitation providers to develop strengths-based service strategies and/or specialized intervention programs that focus on capitalizing these positive human traits to promote life satisfaction and well-being for clients with brain injury. Implications for clinical practice and future research direction are also discussed. Show more

Keywords: Brain injury, self-efficacy, positive psychology, disability acceptance, life satisfaction, quality of life

DOI: 10.3233/NRE-171440

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 531-543, 2017

Authors: Meixner, Cara | O’Donoghue, Cynthia R. | Hart, Vesna

Article Type: Research Article

Abstract: BACKGROUND: The psychological impact of TBI is vast, leading to adverse effects on survivors and their caregivers. Unhealthy family functioning may be mitigated by therapeutic strategies, particularly interdisciplinary family systems approaches like the well-documented Brain Injury Family Intervention (BIFI). Little is known about the experience of providers who offer such interventions. OBJECTIVE: This mixed methods study aims to demonstrate that a structured three-day training on the BIFI protocol improves providers’ knowledge and confidence in working with survivors and families, and that this outcome is sustainable. METHODS: Participants were 34 providers who participated in an intensive …training and completed a web-based survey at four points of time. Quantitative data were analyzed via Wilcoxon signed-rank tests and binomial test of proportions. Qualitative data were analyzed according to rigorous coding procedures. RESULTS: Providers’ knowledge of brain injury and their ability to conceptualize treatment models for survivors and their families increased significantly and mostly remain consistent over time. Qualitative data point to additional gains, such as understanding of family systems. CONCLUSIONS: Past studies quantify the BIFI as an evidence-based intervention. This study supports the effectiveness of training and serves as first to demonstrate the benefit for providers short- and long-term. Show more

Keywords: Brain injury, family systems, BIFI, mixed methods

DOI: 10.3233/NRE-171441

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 545-552, 2017

Authors: Perrin, Paul B. | Paredes, Alejandra Morlett | Olivera, Silvia Leonor | Lozano, Juan Esteban | Leal, Wendy Tatiana | Ahmad, Usman F. | Arango-Lasprilla, Juan Carlos

Article Type: Research Article

Abstract: BACKGROUND: Research has begun to document the bivariate connections between pain in individuals with spinal cord injury (SCI) and various aspects of health related quality of life (HRQOL), such as fatigue, social functioning, mental health, and physical functioning. OBJECTIVE: The purpose of this study was to construct and test a theoretical path model illuminating the stage-wise and sequential (cascading) HRQOL pathways through which pain increases physical disability in individuals with SCI in a sample from Colombia, South America. It was hypothesized that increased pain would lead to decreased energy, which would lead to decreased mental health and …social functioning, which both would lead to emotional role limitations, which finally would lead to physical role limitations. METHODS: A cross-sectional study assessed individuals with SCI (n  = 40) in Neiva, Colombia. Participants completed a measure indexing various aspects of HRQOL. RESULTS: The path model overall showed excellent fit indices, and each individual path within the model was statistically significant. Pain exerted significant indirect effects through all possible mediators in the model, ultimately suggesting that energy, mental health, social functioning, and role limitations-emotional were likely pathways through which pain exerted its effects on physical disability in individuals with SCI. CONCLUSIONS: These findings uncover several potential nodes for clinical intervention which if targeted in the context of rehabilitation or outpatient services, could result in salubrious direct and indirect effects reverberating down the theoretical causal chain and ultimately reducing physical disability in individuals with SCI. Show more

Keywords: Spinal cord injury, pain, disability, health-related quality of life

DOI: 10.3233/NRE-171442

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 553-560, 2017

Authors: Neto, Lavoisier Leite | Constantini, Ana Carolina | Chun, Regina Yu Shon

Article Type: Review Article

Abstract: BACKGROUND: Individuals with Amyotrophic Lateral Sclerosis (ALS) exhibit speech disorders since the early stages that decrease the communication rate and interfere in social participation. OBJECTIVE: To conduct a literature review on communication vulnerable and Augmentative and Alternative Communication (AAC) in Amyotrophic Lateral Sclerosis. METHOD: Descriptors of the Health Sciences Descriptors (DeCS) were used: Amyotrophic Lateral Sclerosis, Health Vulnerability, Communication Barriers, Nonverbal Communication, and Communication Aids for Disabled. Articles in Portuguese and English from 2010 to 2015, fully available in the Virtual Health Library, PubMed, and Scopus were used. Duplicate articles and those not related to …communication/language were excluded. RESULTS: Of the 94 articles found, 37 met the criteria. All of them were published in the USA and Europe, none was Brazilian; 27% of 2012 to 2014; 40.5% descriptive studies and 24.3% case studies; 45.9% addressed ALS and 24.3%, other serious motor alterations, including ALS. A large proportion (89.2%) addressed AAC, 70.3% Brain-Computer Interface (BCI). CONCLUSION: The results show that the researches recurrently addressed communication vulnerable, although not necessarily in these terms. The device which was most employed was the BCI, mainly in advanced stages of the disease. Show more

Keywords: Amyotrophic Lateral Sclerosis, health vulnerability, nonverbal communication, communication barriers, communication aids for disabled

DOI: 10.3233/NRE-171443

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 561-568, 2017

Authors: Cano-de-la-Cuerda, Roberto | Vela-Desojo, Lydia | Miangolarra-Page, Juan Carlos | Macías-Macías, Yolanda

Article Type: Research Article

Abstract: BACKGROUND: Rigidity is a cardinal symptom of Parkinson’s disease (PD) and is often clinically assessed by passively flexing and extending a patient’s limb. Objective measurements had been employed to examine rigidity in PD subjects, including wrist, elbow or knee. OBJECTIVE: This study aimed to investigate the relationship between an objective measurement of trunk rigidity and risk of falls in patients with mild to moderate PD. METHODS: An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 patients with mild to moderate PD at a University Department in a cross-sectional study. Risk …of falls was measured by the Get Up & Go test (GU&G). Disease severity (Hoehn and Yahr staging score and the Unified Parkinson’s Disease Rating Scale III), disease duration and functional status (Schwab & England activities of daily living scale) were also evaluated. RESULTS: Significant correlations between trunk extensors rigidity at 45°/s and 60°/s and risk of falls were obtained. A correlation between trunk extensors tone at 30°/s and the GU&G test almost reached significant almost reached statistical significance (r  = 0.306; p  = 0,066). Significant correlations between trunk flexors-extensors tone and clinical status, disease duration and functional status at 30°/s, 45°/s and 60°/s were also obtained. CONCLUSION: The results from this study suggest that the axial rigidity is related to the risk of falls in patients with mild to moderate PD. Further studies are needed with quantitative devices for axial rigidity assessment to determine the relationship between trunk rigidity in PD patients with higher disease severity and risk of falls. Show more

Keywords: Parkinson’s disease, rigidity, axial impairments, objective measurement, trunk, risk of falls, falls

DOI: 10.3233/NRE-171444

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 569-577, 2017

Authors: Kalron, Alon

Article Type: Research Article

Abstract: BACKGROUND: We previously demonstrated that gait variability increases throughout the disease process in people with multiple sclerosis (PwMS). While gait variability tends to remain steady in the lower levels of disability, a significant increase occurs once patients reach the moderate neurological level. OBJECTIVE: To examine the relationship between variability of major spatio-temporal parameters of gait and falls, in PwMS with an expanded disability status scale score of 4.0 and 4.5. METHODS: The study included 91 PwMS, 50 women. Gait variability was studied using an electronic mat. Clinical gait measures included the Two-minute walk test, Timed …Up and Go test and the Timed 25-foot walk. RESULTS: Fifty patients were classified as fallers, 41, non-fallers. The MS fallers presented a higher variability score in the step length (37.3% increase) and single support (28.2% increase) compared to participants in the non-fallers. Additionally, gait variability scores were significantly correlated with clinical walking tests. The strongest correlation scores were for variability of the step length. Pearson’s rho scores for the Timed Up and Go test, 2-min walk and Timed 25-foot walk were 0.541, – 0.448 and 0.425, respectively. CONCLUSIONS: This study confirms that gait variability is a potential treatment target for PwMS moderately disabled, in order to decrease risk of falls. Show more

Keywords: Multiple sclerosis, gait, step length, EDSS, gait variability, neurological

DOI: 10.3233/NRE-171445

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 579-585, 2017

Authors: Brands, Ingrid | Custers, Maud | van Heugten, Caroline

Article Type: Research Article

Abstract: BACKGROUND: Being highly self-efficacious is a key factor in successful chronic disease self-management. It is unknown whether neuropsychological rehabilitation improves self-efficacy in managing the consequences of brain injury. OBJECTIVE: To investigate whether levels of general and brain injury specific self-efficacy and quality of life (QoL) increased after neuropsychological rehabilitation and whether cognitive performance was associated with self-efficacy. METHODS: We conducted a retrospective clinical cohort study of 62 patients with acquired brain injury and cognitive complaints with measurements before start and after completion of treatment. QoL was measured with the visual analogue scale (EQ VAS) of …the EuroQol (EQ-5D); self-efficacy with the TBI Self-efficacy Questionnaire (SEsx) and the General Self-efficacy Scale (GSES). Cognitive performance was measured as a compound score of tests for memory, attention and information processing speed. RESULTS: Self-efficacy for managing brain injury-specific symptoms and QoL increased significantly after neuropsychological rehabilitation. Both general and brain injury-specific self-efficacy were positively associated with QoL after completion of the programme. Cognitive performance was not associated with self-efficacy for managing brain injury-specific symptoms nor with general self-efficacy. CONCLUSIONS: Self-efficacy and QoL improve after treatment. Further research is needed to identify the specific ingredients responsible for improvement of self-efficacy in patients with cognitive complaints. Show more

Keywords: Self-efficacy, neuropsychological rehabilitation, cognition, quality of life

DOI: 10.3233/NRE-171446

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 587-594, 2017

Authors: Dunn, Justin | Yeo, Elizabeth | Moghaddampour, Parisah | Chau, Brian | Humbert, Sarah

Article Type: Review Article

Abstract: BACKGROUND: Phantom limb pain (PLP), the perception of discomfort in a limb no longer present, commonly occurs following amputation. A variety of interventions have been employed for PLP, including mirror therapy. Virtual Reality (VR) and augmented reality (AR) mirror therapy treatments have also been utilized and have the potential to provide an even greater immersive experience for the amputee. However, there is not currently a consensus on the efficacy of VR and AR therapy. OBJECTIVE: The aim of this review is to evaluate and summarize the current research on the effect of immersive VR and AR in …the treatment of PLP. METHODS: A comprehensive literature search was conducted utilizing PubMed and Google Scholar in order to collect all available studies concerning the use of VR and/or AR in the treatment of PLP using the search terms “virtual reality,” “augmented reality,” and “phantom limb pain.” Eight studies in total were evaluated, with six of those reporting quantitative data and the other two reporting qualitative findings. RESULTS: All studies located were of low-level evidence. Each noted improved pain with VR and AR treatment for phantom limb pain, through quantitative or qualitative reporting. Additionally, adverse effects were limited only to simulator sickness occurring in one trial for one patient. CONCLUSIONS: Despite the positive findings, all of the studies were confined purely to case studies and case report series. No studies of higher evidence have been conducted, thus considerably limiting the strength of the findings. As such, the current use of VR and AR for PLP management, while attractive due to the increasing levels of immersion, customizable environments, and decreasing cost, is yet to be fully proven and continues to need further research with higher quality studies to fully explore its benefits. Show more

Keywords: Virtual reality, augmented reality, phantom limb pain

DOI: 10.3233/NRE-171447

Citation: NeuroRehabilitation, vol. 40, no. 4, pp. 595-601, 2017