NeuroRehabilitation - Volume 40, issue 4

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