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NeuroRehabilitation, an international, interdisciplinary, peer-reviewed journal, publishes manuscripts focused on scientifically based, practical information relevant to all aspects of neurologic rehabilitation. We publish unsolicited papers detailing original work/research that covers the full life span and range of neurological disabilities including stroke, spinal cord injury, traumatic brain injury, neuromuscular disease and other neurological disorders.
We also publish thematically organized issues that focus on specific clinical disorders, types of therapy and age groups. Proposals for thematic issues and suggestions for issue editors are welcomed.
Authors: Gorgoraptis, Nikos | Zaw-Linn, Joanna | Feeney, Claire | Tenorio-Jimenez, Carmen | Niemi, Mari | Malik, Aysha | Ham, Timothy | Goldstone, Anthony P. | Sharp, David J.
Article Type: Research Article
Abstract: BACKGROUND: Cognitive impairment is a common and disabling consequence of traumatic brain injury (TBI) but its impact on health-related quality of life is not well understood. OBJECTIVE: To investigate the relationship between cognitive impairment and health-related quality of life (HRQoL) after TBI. METHODS: Retrospective, cross-sectional study of a specialist TBI outpatient clinic patient sample. Outcome measures: Addenbrooke’s Cognitive Examination Tool - Revised (ACE-R), and SF-36 quality of life, Beck Depression Inventory II (BDI-II), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires. RESULTS: 240 adults were assessed: n = 172 (71.7%) moderate-severe, 41 …(23.8%) mild, 27 (11.3%) symptomatic TBI, 174 (72.5%) male, median age (range): 44 (22–91) years. TBI patients reported poorer scores on all domains of SF-36 compared to age-matched UK normative data. Cognitively impaired patients reported poorer HRQoL on the physical, social role and emotional role functioning, and mental health domains. Cognitive impairment predicted poorer HRQoL on the social and emotional role functioning domains, independently of depressive symptoms, sleep disturbance, daytime sleepiness and TBI severity. Mediation analysis revealed that the effect of depressive symptoms on the emotional role functioning domain of HRQoL was partially mediated by cognitive dysfunction. CONCLUSION: Cognitive impairment is associated with worse health-related quality of life after TBI and partially mediates the effect of depressive symptoms on emotional role functioning. Show more
Keywords: SF-36, cognition, depression, sleep disturbance, TBI
DOI: 10.3233/NRE-182618
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 321-331, 2019
Authors: Church, Haley R. | Seewald, P. Michelle | Clark, Jillian M.R. | Jak, Amy J. | Twamley, Elizabeth W.
Article Type: Research Article
Abstract: BACKGROUND: The effects of traumatic brain injury (TBI) on return to work have been the focus of many clinical studies in recent years. Veterans with a history of TBI may be at increased risk of unemployment. OBJECTIVE: We sought to understand predictors of work outcomes for Veterans with a history of TBI who received evidence-based supported employment. METHODS: Fifty unemployed Veterans with a history of mild-to-moderate TBI and current neuropsychological impairment participated in a 12-month supported employment intervention. Demographic data and baseline assessments of neuropsychological impairment, functional capacity, and psychiatric and post-concussive symptom severity were investigated …as predictors of work outcomes (job attainment, weeks worked, and wages earned). RESULTS: Bivariate analyses showed that lower disability ratings, more recent work history, more months worked in the past 5 years, lower PTSD symptom severity, worse verbal memory, and better cognitive flexibility were all associated with better work outcomes. In multivariate regression analyses, better cognitive flexibility and worse verbal memory performance predicted better work outcomes. CONCLUSIONS: Further research is needed to determine how treatment of cognitive impairments and psychiatric symptoms is related to return to work in Veterans with a history of TBI. Show more
Keywords: Brain injuries, cognition, unemployment, neuropsychological tests, mental disorders, return to work
DOI: 10.3233/NRE-182631
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 333-339, 2019
Authors: West, Anders | Simonsen, Sofie Amalie | Zielinski, Alexander | Cyril, Niklas | Schønsted, Marie | Jennum, Poul | Sander, Birgit | Iversen, Helle K.
Article Type: Research Article
Abstract: BACKGROUND: Patients admitted for rehabilitation often lack sufficient natural light to entrain their circadian rhythm. OBJECTIVE: Installed diurnal naturalistic light may positively influence the outcome of depressive mood, anxiety, and cognition in such patients. METHODS: A quasi-randomized controlled trial. Ninety stroke patients in need of rehabilitation were randomized between May 1, 2014, and June 1, 2015 to either a rehabilitation unit equipped entirely with always on naturalistic lighting (IU), or to a rehabilitation unit with standard indoor lighting (CU). Examinations were performed at inclusion and discharge. The following changes were investigated: depressive mood based on the …Hamilton Depression scale (HAM-D6 ) and Major Depression Inventory scale (MDI), anxiety based on the Hospital Anxiety and Depression Scale (HADS), cognition based on the Montreal Cognitive Assessment (MoCA) and well-being based on the Well-being Index (WHO-5). RESULTS: Depressive mood (MDI p = 0.0005, HAM-D6 p = 0.011) and anxiety (HADS anxiety p = 0.045) was reduced, and well-being (WHO-5 p = 0.046) was increased, in the IU at discharge compared to the CU. No difference was found in cognition (MoCA p = 0.969). CONCLUSIONS: This study is the first to demonstrate that exposure to naturalistic light during admission may significantly improve mental health in rehabilitation patients. Further studies are needed to confirm these findings. Show more
Keywords: Circadian rhythm, stroke, clinical trial, depression, anxiety, cognitive, light
DOI: 10.3233/NRE-182565
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 341-351, 2019
Authors: de Oliveira, Débora Carvalho | Ferreira, Paula Regina Cavalcanti | Silveira Fernandes, Aline Braga Galvão | Pacheco, Thaiana Barbosa Ferreira | Avelino, Matheus Madson Lima | Cavalcanti, Fabrícia Azevedo da Costa | Vieira, Edgar Ramos | Campos, Tania Fernandes
Article Type: Research Article
Abstract: BACKGROUND: Activity levels and disturbances of the sleep-wake pattern affect health and quality of life and need to be further explored in patients with stroke. OBJECTIVE: To evaluate activity levels and their association with sleep-wake patterns in patients with stroke. METHODS: Ten adults with (51±6 years) and 10 without stroke (52±7 years) participated in the study; they were matched on age, sex and educational level. Neurological status, motor function, sleep quality, and activity levels were measured. The groups were compared using Student t -tests and the association between the measures was assessed using Pearson’s correlation. …RESULTS: Compared to people without stroke, those with stroke had worse sleep quality (p = 0.044), twice lower 24h-activity levels (p < 0.0001), higher interdaily stability and intradaily variability, lower activity during the most active 10 h and during the least active 5 h. Sleep quality was associated with activity level (r = –0.72) and with within-day activity variability (r = 0.53). CONCLUSIONS: Activity level and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke. Show more
Keywords: Stroke, activity levels, sleep-wake cycle, neurorehabilitation
DOI: 10.3233/NRE-182665
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 353-360, 2019
Authors: Ozdil, Aytul | Iyigun, Gozde | Kalyoncu, Cem
Article Type: Research Article
Abstract: BACKGROUND: Balance problems are common after stroke. OBJECTIVE: The aims of this study was to compare the results of computerized and clinical sitting balance measurements in stroke patients and healthy individuals and to identify the agreement and relationship between the two measurement methods in stroke patients. METHODS: This study included 30 chronic stroke patients and 30 age-matched healthy individuals. A force platform chair was used for the computerized and the Function in Sitting Test (FIST) was used for the clinical sitting balance measurement. RESULTS: The sitting balance of the stroke patients, measured with computerized …and clinical measurements, were still affected in the chronic phase. The CoP deviation (eyes-open and eyes-closed) was higher whereas the FIST score was lower in the stroke group than the healthy group (p < 0.05). The computerized sitting balance measurements [eyes-open (r = –0.177, p = 0.349) and eyes-closed (r = –0.294, p = 0.114)] CoP deviation was not correlated with the FIST scores (p < 0.05). However, there was an excellent agreement (96.6%) between the methods. CONCLUSION: The results of this study implies that both the computerized and clinical sitting balance measurements can be used objectively for the assessment of sitting balance but the computerized methods might be preferable due to requiring shorter time with less intra-tester variability. Show more
Keywords: Stroke, force platform, sitting balance, function in sitting
DOI: 10.3233/NRE-182634
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 361-368, 2019
Authors: Souza, Daniele Costa Borges | de Sales Santos, Matheus | da Silva Ribeiro, Nildo Manoel | Maldonado, Igor Lima
Article Type: Review Article
Abstract: INTRODUCTION: Although the role of trunk exercises in the chronic phase of stroke is acknowledged, the addition of specific inpatient training in the subacute stage is a matter of debate and varies among centers. Recent new evidence suggests the question should be revisited. OBJECTIVE: To assess the impact of the addition of specific trunk training to inpatient rehabilitation protocols after a recent stroke. METHODS: A systematic review was performed assessing the impact of inpatient trunk training. The search was performed in LILACS, SciELO, PEDro, Cochrane, and NCBI PubMed databases for clinical trials published up to December …31st, 2017. The initial bibliographic research identified 3202 articles. After analyzing the titles, 19 abstracts were selected for detailed analysis. After application of the eligibility criteria, the final selection included nine studies. Outcome measurements from the same evaluation instruments were submitted to a meta-analysis to improve homogeneity (7 studies). RESULTS: All patients in the included studies were recruited less than three months after a stroke. Seven studies assessed trunk control using the Trunk Impairment Scale (TIS). There was a significant improvement in trunk control with a pooled increase in TIS score of 3.3 points from the baseline (CI95:2.54–4.06, p < 0.0001). Three studies assessed balance using the Brunel Balance Assessment (BBA) scale. There was also a significant improvement in balance with a pooled increase in BBA score of 2.7 points (CI95:1.5–4.03, p < 0.0001). The Berg Balance Scale was used for balance assessment in three studies. The meta-analysis of their results showed a pooled increase of 13.2 points (CI95:9.49–16.84, p < 0.0001). Weight transfer was evaluated in four studies using different methods. The addition of inpatient trunk exercises was associated with an improvement in the ability to transfer the trunk laterally in three studies. CONCLUSION: The introduction of trunk-based inpatient training protocols brings short-term benefits in trunk performance and balance in stroke patients. Show more
Keywords: Stroke, neurological rehabilitation, postural balance, exercise therapy
DOI: 10.3233/NRE-182585
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 369-377, 2019
Authors: Molina, Francisco | Lomas-Vega, Rafael | Obrero-Gaitán, Esteban | Rus, Alma | Almagro, Daniel Rodríguez | del-Pino-Casado, Rafael
Article Type: Research Article
Abstract: BACKGROUND: The interpretation of the verticality of the environment is crucial for a proper body balance. The subjective visual vertical test (SVV) is a widely used method to determine the visual perception of the verticality, whose alteration has been related with poor functional status. OBJECTIVE: To analyze the visual perception of the verticality in neurological patients in comparison with healthy controls. METHODS: We searched PubMed, Scopus, and Scielo from the start of the databases until October 2017 and manually searched the reference lists of studies comparing SVV values between neurological patients and controls. Standardized mean difference …(SMD) and subgroup analysis were used to analyze differences between neurological patients and healthy subjects and between stroke and non-stroke patients, respectively. RESULTS: A total of 1,916 subjects from 31 studies were included. Neurological patients misestimate the true vertical in comparison with controls (SMD = 1.05; 95% CI: 0.81, 1.28). The misperception of the verticality was higher in stroke patients (SMD = 1.35; 95% CI: 1.02, 1.68) than in patients with other neurological conditions (SMD = 0.48; 95% CI: 0.29, 0.68). CONCLUSIONS: Neurological patients showed a misperception of the verticality, estimated using the SVV. The neurological pathology that most alters the SVV is stroke. Show more
Keywords: Stroke, neurological disorders, gravity perception, subjective visual vertical, balance
DOI: 10.3233/NRE-182642
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 379-388, 2019
Authors: Shariat, Ardalan | Najafabadi, Mahboubeh Ghayour | Ansari, Noureddin Nakhostin | Cleland, Joshua A. | Singh, Maria A. Fiatarone | Memari, Amir-Hossein | Honarpishe, Roshanak | Hakakzadeh, Azadeh | Ghaffari, Maryam Selk | Naghdi, Soofia
Article Type: Review Article
Abstract: BACKGROUND: One of the leading causes of disability in the world with enormous economic burden is stroke. OBJECTIVE: To quantify the effectiveness of different protocols of cycling with/without functional electrical stimulation on functional mobility after stroke. METHODS: Multiple databases were searched till 2018. Data extraction was performed using a pre-determined data collection form. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: A total of 14 trials satisfied eligibility criteria and were included. Cycling had a positive effect on the 6-meter walking test performance (SMD, 0.41; …95% CI, 0.11 –0.71; I2 = 0% ) compared with no or placebo intervention (control). Compared with control, cycling had a positive effect on 10-meter walking speed (SMD, 0.30; 95% CI, 0.05 –0.55; I2 = 0% ), and on balance based on the Berg score (SMD, 0.32; 95% CI, 0.06 –0.57; I2 = 49% ). Cycling with functional electrical stimulation had a positive effect on balance (SMD, 1.48; 95% CI, 0.99 –1.97; I2 = 91% ) compared with cycling alone. CONCLUSIONS: It appears that cycling has a positive effect on walking speed, walking ability and balance. Functional electrical stimulation combined with cycling has positive effects on balance beyond cycling alone. Show more
Keywords: Meta-analysis, stroke, lower limb, cycling, disability, functional electrical stimulation
DOI: 10.3233/NRE-182671
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 389-412, 2019
Authors: Castagna, Alberto | Ferrara, Lucia | Asnaghi, Emanuela | Rega, Vincenzo | Fiorini, Gianfrancesco
Article Type: Research Article
Abstract: BACKGROUND: Dysphagia prevalence increases with age and a significant contribution is given by stroke survivors; its treatment is mainly based on rehabilitation, but outcome cannot be easily predicted. OBJECTIVE: The aim of this study is to detect possible predictors of the outcome of dysphagia in patients beginning rehabilitation after a major Central Nervous System injury. METHODS: Dysphagia severity was measured in 95 consecutive patients (71 with ischemic or hemorrhagic stroke) upon admission to our neurorehabilitation unit and at discharge, during the year 2017. The initial evaluation included also demographic data, functional and geriatric multidimensional assessment, laboratory …test results and comorbidities. Their possible predictive value on the degree of recovery of the swallowing process at discharge has been analyzed. RESULTS: Poor functional conditions and the presence of cognitive impairment on admission appear to be associated with a worse outcome of dysphagia at discharge. A significant correlation exists between scores at functional scales at the beginning of rehabilitation and dysphagia score at discharge. Patients with cognitive impairment at the beginning (n = 60) showed a significantly lower degree of recovery of dysphagia at discharge. CONCLUSION: Other factors, beside the degree of dysphagia itself, are important to predict its outcome. Their knowledge not only allows an initial prognostic assessment; it can also be useful to decide which aspects should receive greater attention when treating patients with dysphagia. Show more
Keywords: Dysphagia outcome, stroke, functional conditions, cognitive impairment
DOI: 10.3233/NRE-182635
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 413-418, 2019
Authors: Alwardat, Mohammad | Schirinzi, Tommaso | Di Lazzaro, Giulia | Franco, Donatella | Sinibaldi Salimei, Paola | Mercuri, Nicola Biagio | Pisani, Antonio
Article Type: Research Article
Abstract: BACKGROUND: Postural deformities, such as Pisa syndrome (PS), and camptocormia and antecollis (C&A) are common in patient with Parkinson’s disease (PwPD). These deformities can lead to back disability and pain with different mechanisms, including abnormal loading or stress on soft tissues as muscles, lumbar discs and ligaments. OBJECTIVES: To evaluate the effect of different postural deformities including PS and C&A on back function and pain in PwPD. METHODS: The function, disability and pain were assessed by Oswestry disability index (ODI) and brief pain inventory (BPI). All participants completed clinical assessments by the Unified Parkinson’s Disease Rating …Scale (UPDRS), Modified Hoenh & Yahr (mH&Y) staging and the Levodopa Equivalent Daily Dose (LEDD). RESULTS: PS and C&A groups significantly showed worse disability ODI and pain BPI, and higher LEDD and mH&Y stage compared with PD groups. However, no differences were found in PD duration and UPDRS in the same groups. Moreover, no differences were observed between PS and C&A groups in the mentioned scales. CONCLUSION: These results demonstrated that PS and C&A are associated with severe impairment of back functions and pain. Rehabilitation programs for PwPD and PS, and C&A should include spine alignment and postural training. Show more
Keywords: Parkinson’s disease, postural deformity, trunk alignment, back function, physiotherapy, rehabilitation, aging
DOI: 10.3233/NRE-182637
Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 419-424, 2019
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