NeuroRehabilitation - Volume 44, issue 2

Authors: Kavlak, Erdoğan | Tekin, Fatih

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Cerebral palsied children may have difficulties in acting as senders and/or receivers in the communication process. The aim of this study is examining that which maternal and child-related factors affect the communication skills of cerebral palsied children. METHODS: 188 cerebral palsy diagnosed children ages between 2–18 years were assessed by Communication Function Classification System for communication skills. Maternal factors such as occupation, and educational status, and child-related factors such as gender, time of birth, clinical type of cerebral palsy, origin period of cerebral palsy; also daily living activities and gross motor functions of children were …included in the assessment for examining how they affect the communication skills of cerebral palsied children. RESULTS: Lower maternal age, higher gross motor function level, ataxic type and hemiparetic involvement (p  < 0,05); educational status, maternal unemployment, female gender, and premature birth (p  > 0,05) affected positively on the communication skills. There were no effects of delivery method (p  > 0,05). CONCLUSIONS: Communication skills of cerebral palsied children are affected by maternal age, educational status, occupation, and child’s gender, birth term, origin period of cerebral palsy, clinical type of cerebral palsy, extremity involvement, motor development level and gross motor function. But the method of delivery has no effect on the communication functions of cerebral palsied children. Show more

Keywords: Cerebral palsy, communication, maternal factors, gross motor functions, clinical type, CFCS

DOI: 10.3233/NRE-182580

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 161-173, 2019

Authors: Yana, Metehan | Tutuola, Fadodun | Westwater-Wood, Sarah | Kavlak, Erdoğan

Article Type: Review Article

Abstract: BACKGROUND: To assess treatment effect of lower limb botulinum toxin type A (BTX-A) in combination with physiotherapy approaches on gross motor functions in children with cerebral palsy compared with only physiotherapy treatment. OBJECTIVE: The purpose of this review was to analyze the efficacy botulinum toxin a lower limb injections in addition to physiotherapy approaches in children with cerebral palsy. METHODS: A literature search was conducted in the following databases: Cochrane, PEDro, PubMed, MEDLINE, AMED and EMBASE. The searches were limited to the period from July 2009 to July 2015. The intervention had to contain BTX-A into …the lower limb plus physiotherapy approaches and be compared with only physiotherapy. The methodological quality and clinical relevance were independently assessed by the authors. RESULTS: The database search resulted in a total of 1521 studies, of which 4 (Level II of evidence) trials were included in this review. The population represented by were age between from 11 month to 15 years. Overall there were 153 children all diagnosed with CP (87 Male, 66 Female). CONCLUSIONS: The use of BTX-A injections in addition to physiotherapy approaches seems to have positive effect on spasticity and ROM. However, the question of whether the treatment of BTX-A plus physiotherapy has a greater improvement on functional capacity, such as gross motor function or gait parameter than only physiotherapy treatments, was inconclusive. Further investigation by rigorous studies is required. Show more

Keywords: Physiotherapy, cerebral palsy, botulinum toxin type A, GMFCS, GMFM

DOI: 10.3233/NRE-182581

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 175-189, 2019

Authors: Hwang, Jongseok | Lee, Jung Ah | You, Joshua (Sung) Hyun

Article Type: Research Article

Abstract: BACKGROUND: The World Health Organization (WHO) has developed the International Classification of Functioning, Disability and Health (ICF) model in order to provide a theoretical foundation of physical therapy diagnosis and intervention. However, the multidirectional relationships between the body structure/function domain variables (spasticity and movement kinematics) and the activity domain variables (e.g. reaching, grasping, folding, and lifting abilities) using the Wolf Motor Function Test (WMFT) remain unknown. OBJECTIVE: The purpose of the present study was to examine the directional relationships between the body function and structure domain variables and the activity domain variables using the WMFT. METHODS: …Nineteen children with cerebral palsy (CP) were recruited from a major rehabilitation center. Standardized clinical tests included Tardieu scale and WMFT, which were used to measure the body function and structure domain (spasticity) and activity domain (reaching, grasping, folding, and lifting abilities). An eight infrared motion capture system (VICON, Oxford, UK) was used to collect kinematics data during reaching, which represent the body function and structure domain variables. Correlational analysis was performed at P  < 0.05. RESULTS: Our results revealed a fair to strong relationship between the body function and structure domain variables (11 out of 18 kinematic data) and activity domain variables (WMFT). However, no significant correlation was observed between the Tardieu score and the kinematics data or between the Tardieu score and the WMFT variables. CONCLUSIONS: The present findings suggest that the body structure/function domain variables (Kinematic data) are closely associated with activity domain variables (WMFT). However, the body function and structure domain variables within Tardieu spasticity and kinematic data variables were not associated each other, nor between Tardieu spasticity and activity domain variables (WMFT), indicating that Tardieu spasticity test does not seem to account for or reflect active kinematic movement or WFMT variables. This finding provides an important clinical insight when developing a comprehensive assessment and intervention for children with CP. Show more

Keywords: ICF, cerebral palsy, correlation, Tardieu Scale, Wolf Motor Function Test, Kinematic data

DOI: 10.3233/NRE-182610

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 191-197, 2019

Authors: Yoshida, Akihito | Kurimoto, Shigeru | Iwatsuki, Katsuyuki | Saeki, Masaomi | Nishizuka, Takanobu | Nakano, Tomonori | Yoneda, Hidemasa | Onishi, Tetsurou | Yamamoto, Michiro | Tatebe, Masahiro | Hirata, Hitoshi

Article Type: Research Article

Abstract: BACKGROUND: The upper extremity disability in patients with carpal tunnel syndrome (CTS) is related to dysfunction due to the median nerve damage. However, there is no report on which dysfunctions affect the upper extremity disability. PURPOSE: This study aimed to investigate which clinical factors influence upper extremity disability in women with CTS. METHODS: We analyzed 60 hands of women with bilateral idiopathic CTS. Upper extremity disability was assessed using Hand10, a validated and self-administered tool. Pain intensity was measured using the Japanese version of the Short-Form McGill Pain Questionnaire (SF-MPQ-J). We performed nerve conduction studies, assessed …physical and psychological parameters, and collected demographic data. Physical parameters comprised grip strength, pinch strength, tactile threshold, static 2-point discrimination sensation, and severity of numbness. Psychological parameters include depression, pain anxiety, and distress. RESULTS: The bivariate analysis revealed that Hand10 was significantly correlated with age, symptom duration, SF-MPQ-J, grip strength, pain anxiety, and distress. Multiple regression analysis demonstrated that SF-MPQ-J and grip strength were related to Hand10 score. CONCLUSIONS: Pain intensity and grip strength were dysfunctions affecting the upper extremity disability in women with bilateral idiopathic CTS. Rehabilitation approaches for CTS should be considered based on the adaptive activities of the neural networks. Show more

Keywords: Idiopathic carpal tunnel syndrome, bilateral carpal tunnel syndrome, women, upper extremity disability, pain intensity, central sensitization

DOI: 10.3233/NRE-182589

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 199-205, 2019

Authors: Gerber, Lynn H. | Bush, Haley | Cai, Cindy | Garfinkel, Steven | Chan, Leighton | Cotner, Bridget | Wagner, Amy

Article Type: Review Article

Abstract: INTRODUCTION: Understanding the impact of disease on function and improving functional outcomes is an important goal of rehabilitation. This scoping review analyzes 25 years of published traumatic brain injury (TBI) clinical rehabilitation research (CRR) to determine the frequency with which function is a research goal. METHODS: The review protocol was prepared by experienced clinical researchers in the field. We used these search terms: “moderate traumatic brain injury” and “severe traumatic brain injury” and “functional outcomes”; and “rehabilitation” and “educational outcomes” or “cognition” or “community roles” or “community integration” “behavior” or “neuropsychology” or “quality of life”, or “vocational outcomes” …or “work” or “return to work”. Publications from January 1, 1990-December 31, 2016 were included. RESULTS: 1,815 articles met initial criteria, of which 202 were intervention studies, 84 were randomized controlled trials and 353 prospective non-intervention studies. The combination of intervention and prospective non-intervention studies (n  = 555) were analyzed for the kind of measurement tools used. Impairment measures (60%) and symptom measures (43%) either singly or in combination were most frequently used. Measures of function were employed in fewer than 30%. For single outcomes, 95 publications used impairment measures, 60 used symptoms and only18 used function. There were 117 studies that used neurocognitive measures. Participation/societal integration evaluation tools were used for community integration(n  = 77) employment (n  = 50) and independent living status (n = 37). DISCUSSION: This scoping review identifies a need for additional types of clinical research in the field of TBI CRR. Much of the research is aimed at mitigating impairment and controlling symptoms rather than promoting function. Future efforts by the CRR community studying TBI should address this need. Show more

Keywords: Traumatic brain injury, clinical rehabilitation, literature review

DOI: 10.3233/NRE-182599

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 207-215, 2019

Authors: Liao, Yi-Hung | Chen, Chiao-Nan | Hu, Chia-Yueh | Tsai, Shiow-Chwen | Kuo, Yu-Chi

Article Type: Research Article

Abstract: PURPOSE: This study investigates the effects of an 8-weeks rehabilitation exercise plus soymilk ingestion immediately after exercise on functional outcomes in chronic stroke patients. METHODS: Twenty-two stroke patients (age: 57–84 yrs; time since stroke onset: 2–19 yrs) participated and completed the study. A randomized, placebo-controlled and double-blind design was used. Participants were randomly allocated to either soymilk (SMS; n  = 11) or placebo (PLA; n  = 11) group and received identical 8-weeks rehabilitation intervention (3 sessions/week; 120 min/session) with corresponding treatment beverages. The physical and functional outcomes were evaluated before, during, and after the intervention. RESULTS: The 8-weeks rehabilitation …program enhanced functional outcomes of participants. The immediate soymilk ingestion after exercise additionally improved hand grip strength (p  = 0.021 ), 8-feet walking speed (p  = 0.019 ), walking performance per unit lean mass (p  = 0.024 ), and 6-minute walk performance (6MWT, p  = 0.016 ) compared with PLA after the intervention. However, the improvements in the total score for short physical performance battery (SPPB) and lean mass did not differ between groups. CONCLUSION: Compared with rehabilitation alone, the 8-week rehabilitation program combined with immediate soymilk ingestion further improved walking speed, exercise endurance, grip strength, and muscle functionality in chronic stroke patients. Show more

Keywords: Endurance training, resistance training, protein supplementation, functional ability, muscle strength, walking speed

DOI: 10.3233/NRE-182574

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 217-229, 2019

Authors: Kim, Yeo Hyung | Han, Tai Ryoon | Nam, Hyung Seok | Seo, Han Gil | Oh, Byung-Mo

Article Type: Research Article

Abstract: BACKGROUND: Despite the importance of understanding penetration-aspiration (PA) in patients with stroke, the pathophysiology of PA remains unclear. OBJECTIVES: This study aimed to investigate the temporal characteristics of PA in post-stroke patients in terms of the timing of the PA event and hyolaryngeal incoordination. METHODS: Fifty-eight swallows (38 stroke patients), showing PA when swallowing a thin liquid, were included. The timing of PA was classified kinematically as before or during the swallow. The movement sequence of vertical laryngeal elevation, horizontal hyoid excursion, and epiglottic rotation were compared with healthy controls. Spatiotemporal measurements, videofluoroscopic dysphagia scale parameters …were compared between subgroups. RESULTS: Thirteen swallows (22.4%) were classified as PA before the swallow and 45 were classified as PA during the swallow (77.6%). Among the PA during the swallow, 26 (57.8%) swallows exhibited abnormal sequences of hyolaryngeal movements and 19 (42.2%) swallows showed normal sequences of hyolaryngeal movements compared with healthy controls. The onset time of horizontal hyoid excursion (P  = 0.028), the time to maximal horizontal hyoid excursion (P  = 0.010), and maximal epiglottic rotation (P  = 0.030) were significantly more delayed in the PA during the swallow group than in the PA before the swallow group. In the swallows with abnormal sequential movements, the onset of horizontal hyoid excursion occurred significantly later than the onset of epiglottic rotation (P  < 0.001). Pyriform sinus residue was observed significantly more often in the swallows with abnormal sequences (P  = 0.030) than in the swallows with normal sequences. CONCLUSIONS: The timing of PA can be classified as before and during the swallow with significantly different temporal characteristics. The horizontal movement of hyoid is the most important factor associated with the pathophysiology of PA in stroke patients. Show more

Keywords: Stroke, deglutition, deglutition disorders, hyoid bone, motion analysis

DOI: 10.3233/NRE-182569

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 231-238, 2019

Authors: Park, Myoung-Ok | Lee, Sang-Heon

Article Type: Research Article

Abstract: BACKGROUND: Dual-task training using one walking and one cognitive task is effective in improving post-stroke motor functions. OBJECTIVE: We aimed to investigate the effectiveness of dual-task training using various cognitive tasks for the assessment of attention, executive function, and motor function in stroke patients. METHODS: This was a single-center, randomized trial involving 30 stroke patients who were divided into a dual-task (test) group (n  = 15) using different cognitive tests, and a conventional occupational therapy (control) group (n  = 15). In both groups, interventions were conducted 18 times, at 30 minutes per session, 3 sessions per week, for …6 weeks. Primary outcome measures were the Trail Making Test A&B, the Digit Span Test (DST) Forward and Backward, and the Stroop (ST) Color and Word test. Secondary outcome measures were the Fugl-Meyer Assessment, the Modified Functional Reach Test, and the Berg Balance Scale. Each test was applied pre-and post- intervention. RESULTS: Post-intervention, the dual-task group showed a significantly stronger effect than the occupational therapy group in the DST-Forward (p  = 0.04), DST-Backward (p  = 0.001), ST-Color (p  = 0.023), and Berg Balance Scale (p  = 0.009) assessments. CONCLUSIONS: Dual-task training using various cognitive tasks had a greater positive effect than conventional occupational therapy on auditory attention, memory span, executive function, and balance. Show more

Keywords: Dual-task, cognition, attention, executive function, motor

DOI: 10.3233/NRE-182563

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 239-249, 2019

Authors: Obayashi, Shigeru

Article Type: Research Article

Abstract: BACKGROUND There is a tendency to pay little attention to cognitive dysfunction after a subcortical stroke, resulting in this condition being overlooked. Damage to the brainstem may affect cognition, probably originating from the fronto-cerebellar circuit, but details remain obscure. OBJECTIVE To investigate the effect of damage to pons on frontal function via the fronto-cerebellar circuit. METHODS We measured frontal dynamic responses in patients with acute pontine ischemia during phonemic verbal fluency task using near-infrared spectroscopy (NIRS). Furthermore, to determine whether the fronto-cerebellar circuit is affected by pontine ischemia, 99 m Tc-ECD single photon emission computed tomography (SPECT) …was performed. RESULTS Twenty-five patients with pontine isolated infarction met the criteria. Especially, 80 percent of the pontine lesioned patients affected cognition. The patients exhibited hyper-frontal activity according to the neuropsychological tests. Follow-up NIRS showed increased frontal activity as being linked to improved cognition. This may indicate the involvement of frontal activity in cognitive recovery. The SPECT showed consistently hyper-frontal perfusion as well as hypo-cerebellar perfusion. CONCLUSIONS This suggested that hyper-frontal activity might contribute to compensation for cognitive dysfunction after pontine ischemia and that recovery from the cognitive deficits is attributable to frontal activity. Show more

Keywords: Cerebral blood flow, cerebro-cerebellar diaschisis, compensation, supplementary motor area, SPECT, NIRS

DOI: 10.3233/NRE-182566

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 251-261, 2019

Authors: Dehem, Stéphanie | Montedoro, Vincenza | Edwards, Martin Gareth | Detrembleur, Christine | Stoquart, Gaëtan | Renders, Anne | Heins, Sophie | Bruno, Dehez | Lejeune, Thierry

Article Type: Research Article

Abstract: BACKGROUND ROBi GAME project aims to implement serious games on robots to rehabilitate upper limb (UL) in stroke patients. The serious game characteristics (target position, level of assistance/resistance, level of force) are adapted based on the patient’s assessment before and continuously during the game (measuring UL working area, kinematics and muscle strength). OBJECTIVE To develop an UL robotic motor assessment protocol to configure the serious game. METHODS 32 healthy subjects and 20 stroke patients participated in the study. Subjects were clinically assessed (UL length and isometric force) and using a robot. The robot assessment consisted of …the patient’s UL working area (WA), the UL isometric and isokinetic force in three directions and the UL kinematics during a pointing task toward targets placed at different distances. RESULTS The WA and the UL isometric force were moderately to highly correlated with clinical measures (respectively ρ = 0.52; p  = 0.003, ρ = 0.68–0.73; p  < 0.001). Ratios between the UL isokinetic force generated on three directions were established. The velocity and straightness indexes of all subjects increased when subjects had to reach to targets placed more distantly (r = 0.82–0.90; ρ = 0.86–0.90 respectively; p  < 0.001). CONCLUSIONS This protocol can be integrated into a serious game in order to continuously configure the game characteristics to patient’s performance. Show more

Keywords: Stroke, upper limb, robotics, motor assessment, serious game

DOI: 10.3233/NRE-182525

Citation: NeuroRehabilitation, vol. 44, no. 2, pp. 263-274, 2019