NeuroRehabilitation - Volume 44, issue 3

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

Authors: Combs-Miller, Stephanie A. | Moore, Elizabeth S.

Article Type: Research Article

Abstract: BACKGROUND: Exercise may modify disease progression in persons with Parkinson disease (PD). OBJECTIVE: The purpose of this longitudinal cohort study was to determine factors that predict motor, activity, and participation-based outcomes over two years in exercisers with PD. METHODS: A convenience sample with idiopathic PD was included in the analysis [n  = 74; mean age 66.7(8.4) years; male 54%; median months post diagnosis 69.0(76.0), median Hoehn and Yahr score 1.0(2.0)]. Exercise behaviors (minutes of exercise/week, peak rate of perceived exertion (RPE) and mode of exercise) and outcomes of impairment [grip strength], activity [10-meter walk test, functional reach …test, activity specific balance confidence scale] and participation [Parkinson Disease Questionnaire-39] were assessed at baseline, 6, 12, 18 and 24 months. RESULTS: Using generalized estimating equations at least one exercise behavior was a significant predictor across most of the models (p ≤0.026), with higher RPE predicting better outcomes in all activity and participation domains. Younger age, male gender and lower disease severity also significantly predicted better outcomes over time (p ≤0.041). CONCLUSIONS: Exercise behaviors contributed to activity and participation-based outcomes over two years in exercisers with PD. Participation in high-intensity exercise programs may enhance maintenance of health and function over time in individuals with PD. Show more

Keywords: Parkinson disease, exercise, intensity, boxing, participation

DOI: 10.3233/NRE-182641

Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 425-432, 2019

Authors: Fernández-Lago, Helena | Bello, Olalla | Salgado, Antía Vidal | Fernandez-del-Olmo, Miguel

Article Type: Research Article

Abstract: BACKGROUND: The use of the treadmill as a gait rehabilitation tool has provided novel options for treatment of gait impairments in Parkinson’s Disease (PD). However, the neural mechanisms underlying these therapeutic effects in PD remain unknown and whether any therapeutic effects from treadmill training can be reproduced on overground walking. OBJECTIVE: To examine the immediate short-term effects of a single session of treadmill and overground walking on gait, spinal and corticospinal parameters in PD. METHODS PD participants (N = 15) were evaluated in two separate sessions under two walking conditions: walking over a treadmill and walking overground. Overground …walking performance, the Soleus H-reflex, Reciprocal Ia-Inhibition, Intracortical Facilitation (ICF) and Short Intracortical Inhibition (SICI), were evaluated before and after each condition. RESULTS: Gait speed and stride length improved in post-treadmill compared with pre-treadmill. No significant changes in these gait parameters were found for the pre vs. post-overground condition. ICF values and Hmax/Mmax ratio decreased after, compared with before, the two walking conditions. CONCLUSIONS: Treadmill walking, but not overground walking, lead to an improvement in the stride length and gait speed in the PD patients without evidence of different modulation on spinal and corticospinal parameters. Show more

Keywords: Parkinson’s disease, rehabilitation, gait, transcranial magnetic stimulation, H-reflex

DOI: 10.3233/NRE-182638

Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 433-443, 2019

Authors: Mascialino, Guido | Gromisch, Elizabeth S. | Zemon, Vance | Foley, Frederick W.

Article Type: Research Article

Abstract: BACKGROUND: While there is evidence of differences in the disease characteristics of multiple sclerosis (MS) across ethnic and racial groups, there has been limited research on cognitive functioning. OBJECTIVE: To explore potential differences among Caucasian (CA), African-American (AA), and Hispanic (HA) adults from a clinical sample on the Minimal Assessment of Cognitive Function in MS (MACFIMS). METHODS: A total of 245 age- and disease duration-matched individuals (194 CA, 23 AA, and 28 HA) were included in the analyses. Their rates of impairment, using the criterion of two standard deviations (SD) below the normative mean, on the …MACFIMS were compared using chi-square analyses with post-hoc pairwise comparisons (Bonferroni adjusted). RESULTS: Compared to CA, AA had higher rates of impairment on measures of complex attention (p  < 0.001) and executive functions (p  < 0.001). CONCLUSIONS: These findings raise questions of whether the observed differences reflect the more aggressive disease course noted among AA or are due to discrepancies in performance on neuropsychological assessment that is associated with race/ethnicity in the general population. Future directions and implications are discussed. Show more

Keywords: Multiple sclerosis, MACFIMS, cognitive dysfunction, ethnicity

DOI: 10.3233/NRE-182654

Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 445-449, 2019

Authors: Ladera, Valentina | Perea, M. Victoria | García, Ricardo | Prieto, Gerardo | Delgado, Ana R.

Article Type: Research Article

Abstract: OBJECTIVE: The objective of this study was to provide normative data for the 5 Objects Test in a large Spanish community sample, as well as some validity evidence. METHODS: The sample was composed of 427 participants (of which 220 females, age 15 to 95 years old; educational level range: 2–17 years). Normative data are provided, as well as correlations with test scores from Benton Visual Retention test, Rey-Osterrieth Complex Figure and Mini Mental State Examination. RESULTS: No association was found between delayed recall score and level of education, age or gender. Immediate recall score was correlated …with age. Both immediate and delayed recall significantly correlated with the criteria, evidencing concurrent validity. CONCLUSIONS: It is recommended that the 5 Objects Test be used for assessing persons in primary care, including those from different linguistic backgrounds or with limited language use. Delayed recall scores are especially recommended given the lack of association with demographic variables. Show more

Keywords: 5 Objects test, delayed recall, immediate recall, normative study, visuospatial memory

DOI: 10.3233/NRE-182579

Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 451-456, 2019

Authors: Knapp, Peter

Article Type: Other

Abstract:  The aim of this commentary is to discuss in a rehabilitation perspective the published Cochrane Review “Interventions for treating anxiety after stroke” by Knapp, Campbell Burton, Holmes, Murray, Gillespie, Lightbody, Watkins, Chun, & Lewis1 , under the direct supervision of the Cochrane Stroke Group. This Cochrane Corner is produced in agreement with NeuroRehabilitation by Cochrane Rehabilitation.

DOI: 10.3233/NRE-189006

Citation: NeuroRehabilitation, vol. 44, no. 3, pp. 457-458, 2019