NeuroRehabilitation - Volume 43, issue 2

Authors: Zasler, Nathan | Kreutzer, Jeffrey | Arienti, Chiara | Oral, Aydan

Article Type: Editorial

DOI: 10.3233/NRE-180003

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 111-112, 2018

Authors: Riquelme, Inmaculada | do Rosário, Raphael S. | Vehmaskoski, Kari | Natunen, Pekka | Montoya, Pedro

Article Type: Research Article

Abstract: BACKGROUND: Children with cerebral palsy (CP) perform less physical activity than their typically developing peers (TDP). Pain, important comorbidity in children with CP, restrains levels of physical activity. OBJECTIVE: This study aims at exploring the influence of chronic pain in physical activity of children with CP and TDP. METHODS: 24-hour heart rate was registered in four groups of children: children with CP and TDP, with and without chronic pain. Heart rate based indexes of physical activity (MET percentages, energy expenditure) were computed. A self-reported diary of activities rated activities pain and fatigue intensity. RESULTS: …Children with CP and chronic pain reported more painful activities and higher pain than their TDP with chronic pain. Moreover, children with CP and chronic pain presented higher time and periods of light activity and less sedentary activity than their TDP with chronic pain. No differences were found between CP and TDP without chronic pain. CONCLUSION: Children with CP regulate physical activity differently than TD children in the presence of chronic pain. The maintenance of light levels of physical activity in children with CP may suggest efficient pain coping strategies and perseverance in participation. These findings encourage the implementation of programs to improve fitness in this population. Show more

Keywords: Cerebral palsy, children, chronic pain, MET, physical activity

DOI: 10.3233/NRE-172409

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 113-123, 2018

Authors: Powell, Elizabeth Salmon | Carrico, Cheryl | Salyers, Emily | Westgate, Philip M. | Sawaki, Lumy

Article Type: Research Article

Abstract: OBJECTIVES: This study investigated the feasibility of modulating bilateral corticospinal excitability with different polarities of transcutaneous spinal direct current stimulation (tsDCS) in chronic, incomplete spinal cord injury (SCI). METHODS: Six subjects with chronic incomplete SCI (>12 months post injury) participated in this crossover study. Intervention consisted of 3 sessions, separated by at least 1 week, in which each subject received the conditions cathodal, anodal, and sham tsDCS. Stimulation was delivered at 2.5 mA for 20 minutes with the active electrode positioned over the spinous processes of T10-T11 and the reference electrode over left deltoid. To measure the effects …of tsDCS on corticospinal excitability, motor evoked potentials (MEPs) from transcranial magnetic stimulation were measured bilaterally from soleus before and after tsDCS. RESULTS: Five subjects completed all 3 sessions. One subject withdrew after 2 sessions due to complications unrelated to the study. MEPs were measurable in 5 subjects. No significant differences in change of MEP amplitudes were found between the 3 conditions. However, there were trends that indicated laterality of response, particularly with cathodal tsDCS increasing corticospinal excitability contralateral to the reference electrode and decreasing corticospinal excitability ipsilateral to the reference electrode. CONCLUSION: Corticospinal excitability may be modulated with laterality by tsDCS in individuals with chronic, incomplete SCI. Further research is needed to 1) determine whether different placement of the reference electrode can lead to uniform modulation bilaterally, and 2) reveal whether these alterations in corticospinal excitability can lead to improved movement function in individuals with chronic, incomplete SCI. Show more

Keywords: Neuromodulation, neuroplasticity, lower extremity, humans, transcranial magnetic stimulation

DOI: 10.3233/NRE-172369

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 125-134, 2018

Authors: Gómez-Soriano, Julio | Serrano-Muñoz, Diego | Bravo-Esteban, Elisabeth | Avendaño-Coy, Juan | Ávila-Martin, Gerardo | Galán-Arriero, Iriana | Taylor, Julian

Article Type: Research Article

Abstract: BACKGROUND: Tibialis Anterior (TA) cutaneous reflex (CR) activity evoked following cutaneous stimulation of the plantar (Pl) surface (Pl-TA CR) has demonstrated hyperreflexia and damage of inhibitory mechanisms in subjects with spinal cord injury (SCI) and spasticity. OBJECTIVES: To modulate Pl-TA CR and Soleus H-reflex activity with transcutaneous electrical nerve stimulation (TENS) and vibratory stimulation of the plantar pad during rest and controlled isometric plantarflexion. METHODS: Non-injured subjects (n = 11) and individuals with incomplete SCI with (n = 14) and without spasticity (n = 14) were recruited. The effect of TENS and vibratory …stimuli on Pl-TA CR and soleus H-reflex activity were assessed during rest and controlled ramp-and-hold plantarflexion. RESULTS: Vibration failed to inhibit H-reflex activity during rest or plantarflexoin following SCI compared to healthy subjects. In contrast, vibration-induced inhibition of Pl-TA CR was specifically detected in SCI spastic subjects during both rest and the hold phase of plantarflexion. TENS inhibited Pl-TA CR activity in the SCI spasticity group only during hold plantarflexion. CONCLUSIONS: Plantar vibratory stimuli inhibited the pl-TA CR, but not the H reflex, during rest and controlled movement in SCI spastic subjects. Assessment of Pl-TA CR modulation should contribute to the development of modality-specific sensory stimuli programmes for the neurorehabilitation of SCI spasticity. Show more

Keywords: Reflex, abnormal, H-reflex, vibration, transcutaneous electrical nerve stimulation, spinal cord injuries, muscle spasticity

DOI: 10.3233/NRE-172404

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 135-146, 2018

Authors: Fiems, Connie L. | Dugan, Eric L. | Moore, Elizabeth S. | Combs-Miller, Stephanie A.

Article Type: Research Article

Abstract: BACKGROUND: The emergence of mobile technology allows the examination of balance through direct measures of postural sway in a cost-effective, convenient and portable fashion. However, there is insufficient evidence for use in populations with neurologic conditions. OBJECTIVES: 1) To determine the test-retest reliability of the Sway Balance™ mobile application in measuring postural sway in individuals with Parkinson disease, 2) To examine the concurrent validity of Sway Balance™ with inertial measurement units and 3) To determine if Sway Balance™ scores can predict disease severity. METHODS: Thirty subjects with early stage idiopathic Parkinson disease completed three trials of …two Sway Balance™ protocols while postural sway was simultaneously measured by two inertial measurement units and Sway Balance™, then repeated testing one week later. RESULTS: Sway Balance demonstrated high test-retest reliability for both protocols (ICC = 0.72 and 0.92) and good to excellent inverse correlation with the inertial measurement units across both protocols (ρ = –0.61– –0.92; p < 0.001). Sway Balance™ did not accurately predict disease severity. CONCLUSION: Sway Balance™ demonstrates strong test-retest reliability and concurrent validity with measures from inertial measurement units. Questions remain regarding the ability of Sway Balance™ to accurately characterize balance of individuals who demonstrate difficulty maintaining the test condition. Show more

Keywords: Postural sway, Parkinson disease, mobile technology, balance, falls

DOI: 10.3233/NRE-182424

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 147-154, 2018

Authors: Thastum, Mille Moeller | Rask, Charlotte Ulrikka | Naess-Schmidt, Erhard Trillingsgaard | Jensen, Jens Soendergaard | Frederiksen, Oana-Veronica | Tuborgh, Astrid | Svendsen, Susanne Wulff | Nielsen, Joergen Feldbaek | Schröder, Andreas

Article Type: Research Article

Abstract: BACKGROUND: About 5–15 % of patients with concussion experience persistent post-concussion symptoms (PCS) longer than 3 months post-injury. OBJECTIVE: To explore the feasibility of a new intervention for young patients with persistent PCS and long-term changes after intervention. METHODS: Thirty-two consecutive patients (15–30 years) with persistent PCS 2–4 months post-injury were recruited from a cohort study or referred to a non-randomized feasibility study of an individually tailored, 8-week, multidisciplinary intervention. Assessment was performed at baseline, end of intervention (EOI), and at 3- and 12-month follow-up (FU). Main measures were The Experience of Service Questionnaire (ESQ), Rivermead …Post-Concussion Symptoms Questionnaire (RPQ) and The Quality of Life after Brain Injury - Overall Scale (QOLIBRI-OS). RESULTS: Twenty-three (72%) patients completed the intervention. The ESQ demonstrated high patient satisfaction. There was a decrease of PCS and an increase in quality of life from baseline to EOI: RPQ score –8.9 points, 95% CI 4.5 to 13.3, p < 0.001; QOLIBRI-OS score +10.5 points, 95% CI 2.5 to 18.5, p = 0.010. Improvement was maintained at 3- and 12-month FU. CONCLUSION: The new early intervention is feasible and may prevent chronification of PCS. An RCT is currently performed to evaluate the effect of the intervention. Show more

Keywords: Brain concussion, behavior therapy, early intervention, feasibility study, mild traumatic brain injury, post-concussion syndrome, rivermead post-concussion symptoms questionnaire

DOI: 10.3233/NRE-172391

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 155-167, 2018

Authors: Yue, John K. | Rick, Jonathan W. | Morrissey, Molly Rose | Taylor, Sabrina R. | Deng, Hansen | Suen, Catherine G. | Vassar, Mary J. | Cnossen, Maryse C. | Lingsma, Hester F. | Yuh, Esther L. | Mukherjee, Pratik | Gardner, Raquel C. | Valadka, Alex B. | Okonkwo, David O. | Cage, Tene A. | Manley, Geoffrey T. | TRACK-TBI Investigators

Article Type: Research Article

Abstract: BACKGROUND: Preinjury employment status may contribute to disparity, injury risk, and recovery patterns following mild traumatic brain injury (MTBI). OBJECTIVE: To characterize associations between preinjury unemployment, prior comorbidities, and outcomes following MTBI. METHODS: MTBI patients from TRACK-TBI Pilot with complete six-month outcomes were extracted. Preinjury unemployment, comorbidities, injury factors, and intracranial pathology were considered. Multivariable regression was performed for employment and outcomes, correcting for demographic and injury factors. Mean-differences (B ) and 95% CIs are reported. Statistical significance was assessed at p < 0.05. RESULTS: 162 MTBI patients were aged 39.8±15.4-years and 24.6% …-unemployed. Unemployed patients demonstrated increased psychiatric comorbidities (45.0% -vs.– 23.8%; p = 0.010), drug use (52.5% -vs.– 21.3%; p < 0.001), smoking (62.5% -vs.– 27.0%; p < 0.001), prior TBI (78.4% -vs.– 55.0%; p = 0.012), and lower education (15.0% -vs.– 45.1% college degree; p = 0.003). On multivariable analysis, unemployment associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended: B = – 0.50, 95% CI [– 0.88, – 0.11]), increased psychiatric disturbance (Brief Symptom Inventory-18: B = 6.22 [2.33, 10.10]), postconcussional symptoms (Rivermead Questionnaire: B = 4.91 [0.38, 9.44]), and post-traumatic stress disorder (PTSD Checklist-Civilian: B = 5.99 [0.76, 11.22]). No differences were observed for cognitive measures or satisfaction with life. CONCLUSIONS: Unemployed patients are at risk for preinjury psychosocial comorbidities, poorer six-month functional recovery and increased psychiatric/postconcussional/PTSD symptoms. Resource allocation and return precautions should be implemented to mitigate and/or prevent the decline of at-risk patients. Show more

Keywords: Common data elements, comorbidities, mild traumatic brain injury, outcome measures, risk factors, unemployment

DOI: 10.3233/NRE-172375

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 169-182, 2018

Authors: Yoshida, Kazuki | Ogawa, Keita | Mototani, Takuroh | Inagaki, Yuji | Sawamura, Daisuke | Ikoma, Katsunori | Sakai, Shinya

Article Type: Research Article

Abstract: BACKGROUND: Flow is an optimal psychological state when people engage in a training task, and it is a theory explaining the absorbed state. OBJECTIVE: To investigate the additional effect of flow on attention deficits for chronic patients after traumatic brain injury. METHODS: Twenty patients were randomly assigned to the flow group (n = 10) or the control group. Patients performed a video game task, one inducing flow (flow group) and the other not (control group) for 4 weeks, and they were assessed with the flow state scale for occupational tasks (FSSOT) regularly and neuropsychological tests …at baseline, after intervention, and at 4 weeks after intervention (follow-up). RESULTS: Although both groups significantly improved their attentional function after intervention, patients in the flow group tended to show more improvement of attention. The effect size of the neuropsychological test of attention was positive, and its value was small to medium. There was a significant positive correlation between improvement of attention and the FSSOT score. CONCLUSIONS: Attention training with induction of the flow was associated with greater improvement of attention. The results of this study may provide provisional evidence of the effectiveness of rehabilitation considering the patient’s psychological state. Show more

Keywords: Flow state, attention, brain injury, randomized controlled trial, rehabilitation, psychological effects

DOI: 10.3233/NRE-172396

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 183-193, 2018

Authors: Burch, Danielle | Bernert, Silke | Fraser, Justin F.

Article Type: Research Article

Abstract: OBJECT: Recent efforts in neurocritical care have emphasized optimal timing and employment of rehabilitation services. However, there is sparse literature on the effect of team approaches to the intensive care patient. The aim of this study was to evaluate the effect of increased coordination between a physical therapist and an attending cerebrovascular neurosurgeon through daily multidisciplinary rounds. METHODS: A retrospective review was performed of 235 patients who were admitted to the neuroscience service under a single cerebrovascular neurosurgeon over a 16-month period (April 2014 through July 2015) in a level-I trauma hospital. The study consisted of an eight-month …pre-intervention period (n = 117) where the physical therapist did not attend physician rounds and an eight-month post-intervention period (n = 118). RESULTS: In the post-intervention group the physical therapy (PT) assessment occurred on average 1.57 days sooner (p < 0.001). Hospital Length of Stay (LOS) decreased by an average of 3.46 days (p = 0.04) and ICU LOS decreased on average by 1.83 days (p = 0.05) in the post-intervention group. Ventilator days decreased on average by 0.55 days, which was not statistically significant (p = 0.26). CONCLUSIONS: In conclusion, daily coordination with multidisciplinary rounds between the physician and the physical therapist was associated with decreased time to initial PT assessment, decreased hospital LOS, and decreased ICU LOS in the neuroscience population. Show more

Keywords: Neurocritical care, physical therapy, rounding, communication, length of stay

DOI: 10.3233/NRE-182444

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 195-199, 2018

Authors: Crotty, Maria | van den Berg, Maayken | Hayes, Allison | Chen, Celia | Lange, Kylie | George, Stacey

Article Type: Research Article

Abstract: BACKGROUND: Homonymous hemianopia post-stroke reduces independence. OBJECTIVE: To compare the effectiveness of a standardised program versus current individualized therapy in patients with homonymous hemianopia. METHODS: Single-blind randomized controlled trial, 24 patients (54% male), mean age (65±4.3), mean time since stroke (51±52.3 days), recruited from rehabilitation and vision services in Adelaide, Australia. Participants were randomized to a combined standardized scanning and mobility program of 7 weeks, 3 times per week or to individualized therapy recommended by clinicians. Primary outcome was an assessment of scanning ability whilst walking. Secondary outcomes included measures of visual scanning, reading, and vision …related quality of life (QOL). RESULTS: No significant differences were found between intervention groups for the primary outcome measure of scanning ability whilst walking at 7 weeks and at 3 months (P > 0.05). However, at 3 months significant differences were found for the QOL National Eye Institute Visual functioning Questionnaire (NEI VFQ25) total score (P = 0.03) and dependency sub-score (P = 0.03) measures. CONCLUSIONS: A standardized intervention of static scanning and mobility training improved QOL. Allocation of resources to visual rehabilitation services point towards the implementation of more mobility practice over a longer period of time. Show more

Keywords: Hemianopia, Hemianopsia, randomized controlled trial, quality of life, rehabilitation, stroke, technology, walking

DOI: 10.3233/NRE-172377

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 201-209, 2018

Authors: Moon, Hyun Im | Yoon, Seo Yeon | Jeong, Yoon Jeong | Cho, Tae Hwan

Article Type: Research Article

Abstract: BACKGROUND: Impaired gait function after stroke contributes strongly to overall patient disability. Recently, sleep disturbance was reported to negatively affect functional recovery after stroke. OBJECTIVE: The aim of this study was to identify the impact of sleep disturbance on balance and gait function in stroke patients. METHODS: We retrospectively reviewed 140 patients with first-ever stroke. The patients were divided into two groups according to the presence of sleep disturbances, and differences in characteristics, such as demographic information, lesion factors, initial balance, and gait function. Lesion volume was measured on magnetic resonance images. Linear regression analyses were …performed to examine predictors of balance and gait function after a 1-month rehabilitation program. RESULTS: Of the 140 patients, 35 had sleep disturbance (25%). The patients with sleep disturbance were older than those without. Patients who had sleep disturbance had worse balance and gait function. BBS and FAC were also predicted by the initial BBS and sleep disturbance. The 10-m velocity was strongly associated with initial BBS, onset duration, and the presence of sleep disturbance. CONCLUSIONS: Our study showed that sleep disturbances negatively affected functional outcomes, especially balance and gait function. Therefore, sleep problems should be controlled to improve outcomes in stroke patients. Show more

Keywords: Stroke, gait, balance, sleep, disturbance, insomnia

DOI: 10.3233/NRE-172351

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 211-218, 2018

Authors: Rand, Debbie

Article Type: Research Article

Abstract: BACKGROUND: Proprioception deficits are common post-stroke and may lead to impaired standing balance and restricted mobility. OBJECTIVES: To compare 1) mobility, balance, balance confidence (BC), independence in basic and instrumental activities of daily living (BADL and IADL) of individuals with and without mild proprioception deficits at the chronic stage post-stroke. In addition, 2) correlations between mobility, balance and BC to BADL and IADL will be assessed. METHODS: Sixty-four participants [mean(SD) age - 59.9(9.3), 61% men, 26.1(18.3) months post-stroke] underwent the Thumb Localization Test (TLT) to assess proprioception; 45 participants had intact proprioception and 19 participants had …mild proprioception deficits. The Timed Up and Go Test (TUG) and the Functional Reach Test (FRT) assessed mobility and balance (respectively). Activities-specific Balance Confidence (ABC) scale rated BC. BADL and IADL was also assessed. RESULTS: Significant differences in mobility, balance and BC, BADL, IADL were found between participants with and without mild proprioception deficits. Correlations between mobility, balance, and BC to BADL and IADL, were significant (p < 0.05) for all 64 participants, but not within groups. CONCLUSIONS: Mild proprioception deficits seem to be a confounding factor for explaining daily living at the chronic stage post-stroke. Proprioception screening is recommended for clinical practice and future research. Show more

Keywords: Balance confidence, stroke, cardiovascular accident, proprioception, mobility

DOI: 10.3233/NRE-172398

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 219-226, 2018

Authors: Park, Jaeho | Chung, Yijung

Article Type: Research Article

Abstract: BACKGROUND: Robot-assisted gait training provide a big therapeutic advantage in functional mobility for postural control. OBJECTIVES: The purpose of this study was investigate the effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in stroke patients. METHODS: All subjects were randomly divided into three groups where twelve subjects were in the Virtual reality robot-assisted gait training group (VRGT), twelve subjects in the auditory stimulation robot-assisted gait training group (ARGT), and sixteen subjects in the control group. Subjects received virtual reality and auditory stimulation while undergoing robot-assisted gait training for …45 minutes, three times a week for 6 weeks, and all subjects had undergone general physical therapy for 30 minutes, five times a week for 6 weeks. All subjects were assessed with the Medical Research Council (MRC), Berg balance scale (BBS), timed up and go test (TUG), 10-meter walk test (10MWT), Fugl-Myer Assessment (FMA) and Modified Barthel Index (MBI) pre- and post-intervention. RESULTS: Results showed that BBS, TUG, and 10MWT scores significantly improved post-intervention (p < 0.05), and the control group also had significantly improved in all areas post-treatment (p < 0.05). In addition, it has been confirmed that VRGT had significantly improved in MRC and FMA scores compared with the auditory stimulation. Also, it has significantly improved in MRC, BBS, TUG, 10MWT and FMA compared with control group (p < 0.05). CONCLUSIONS: The results of this study showed improve balance and gait abilities after VRGT compared with general physical therapy and were found to be effective in enhancing the functional activity of persons with stroke. Show more

Keywords: Stroke, rehabilitation, gait, balance, muscular strength

DOI: 10.3233/NRE-172415

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 227-235, 2018

Authors: Eyvaz, Nuran | Dundar, Umit | Yesil, Hilal

Article Type: Research Article

Abstract: BACKGROUND: After the stroke, a number of changes occur in the neuromuscular system functions. OBJECTIVE: To determine whether the water based exercise (WBE) program applied in combination with the land-based exercises (LBE) compared to LBE alone contributes to the stroke patients’ motor functions, walking, balance functions and quality of life (QoL). METHODS: In total, 60 patients participated in this study. Patients were randomly divided into two groups. WBE therapy (3/week) + LBE (2/week) combination was applied to the patients in the study group (n = 30) for six weeks. LBE was applied to the control …group (n = 30) 5/week for six weeks. Patients were evaluated before and after the treatment. Functional independence measurement, Berg balance scale, timed up and go test, and short form (SF) -36 assessment questionnaire were performed. RESULTS: Posttreatment results showed significant improvements in all of the parameters (except SF - 36 pain parameter) in both groups. The improvement in the vitality parameter of SF-36 was higher in the study group (p < 0.05), and improvement in the BBS was significantly higher in the LBE group than the WBE group (p < 0.05). CONCLUSION: Applying WBE together with the LBE (except SF-36 vitality sub-parameter) in patients with hemiplegia did not make any additional contribution to the application of LBE alone. Show more

Keywords: Stroke, aquatic rehabilitation, balance, quality of life

DOI: 10.3233/NRE-182422

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 237-246, 2018

Authors: Tramontano, Marco | Bergamini, Elena | Iosa, Marco | Belluscio, Valeria | Vannozzi, Giuseppe | Morone, Giovanni

Article Type: Research Article

Abstract: BACKGROUND: Vestibular rehabilitation (VR) consists in a customized exercise program patient-centred that includes a combination of different exercise components with the aim to promote gaze stability, improve balance and gait, and facilitate somatosensory integration. OBJECTIVE: The aim of this study was to investigate the effect of customized vestibular rehabilitation training on gait stability of patients with subacute stroke. METHODS: Twenty-five inpatients (12 M, age: 64.1±12.1 years) with diagnosis of subacute stroke were enrolled and randomized in two groups. All patients were evaluated before and after 4 weeks of training sessions. An instrumented 10-Meter Walk Test together …with traditional clinical scales were used to assess VR effects. To investigate if any fall event occurred after patients’ dismissal, they were followed-up at three and twelve months after dismissal. RESULTS: Higher values of walking speed and stride length were observed in the VR group. Conversely, no significant difference was found in terms of trunk stability. The results of between-group comparison highlight significant differences between the two groups for different clinical scale scores. CONCLUSION: VR could be included into a rehabilitation program for patients with stroke for improving their gait and dynamic balance acting on their vestibular system as facilitator of recovery. Show more

Keywords: Vestibular rehabilitation, stroke, instrumented assessment, dynamic balance and gait

DOI: 10.3233/NRE-182427

Citation: NeuroRehabilitation, vol. 43, no. 2, pp. 247-254, 2018