NeuroRehabilitation - Volume 45, issue 1

Authors: Moriyama, Cristina H. | Mustacchi, Zan | Pires, Sandra | Massetti, Thaís | da Silva, Talita | Herrero, Dafne | de Abreu, Luiz | Monteiro, Carlos | Leone, Claudio

Article Type: Research Article

Abstract: BACKGROUND: Research into the evolution of the functional performance of children and adolescents with DS enables parents and professionals involved in their follow-up to promote their development. OBJECTIVE: To evaluate the functional abilities of children and adolescents with Down syndrome and the assistance offered by their parents/caregivers. METHOD: A cross-sectional study, with 100 children and adolescents with DS whom parents or caregivers were interviewed to complete the Paediatric Evaluation of Disability Inventory (PEDI). Linear regression analyses were performed with the software MedCalc version 16.8.4 and GraphPad Prism version 6.07. RESULTS: Children and adolescents with …DS need more time to acquire skills of self-care, mobility and social function. Their parents were able to better identify the difficulties before the children reached 8-years of age. CONCLUSION: Parents can identify the difficulties of their children when they are younger and offer more assistance, but this does not happen when the children are of elementary school age. This suggests that they need professional support that is not restricted to the guidelines and the schools. Show more

Keywords: Down syndrome, functional skills, caregivers, disabilities, public health

DOI: 10.3233/NRE-192763

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 1-9, 2019

Authors: Yehene, Einat | Golan, Sapir | Brezner, Amichai | Gerner, Maya | Landa, Janna

Article Type: Research Article

Abstract: BACKGROUND: Pediatric acquired brain injury may result in a significant gap between the “pre” and “post-injury” child. OBJECTIVE: We aimed to quantitatively explore the mechanism underlying parents’ loss experience by examining the mediating role of behavioral outcomes (observed-problems and perceived-change) in the relationship between injury severity and grief. METHOD: The study employed a cross-sectional retrospective design and comprised 40 parents of children (aged 3–18 years) with moderate-severe brain injury. Data for each parent included an adapted version of the Two-Track Bereavement Questionnaire and Socio-demographic s; Data for each child included the child’s Information Processing Speed …Index ; the Child Behavioral Checklist and Parental Perception of Behavioral Changes scale. RESULTS: Slowed information processing speed was significantly associated with elevated ratings on both measures of behavioral outcomes and with intensified grief. Mediation analyses revealed that parental perceived behavioral change , significantly mediate the relationship between information processing speed and grief; the Child Behavioral Checklist total score also mediated the same relationship but only in 90% confidence interval. CONCLUSIONS: Findings reveal the adverse impact of behavioral outcomes on grief and suggest parents’ loss experience to be stemming primarily from their subjective perception over their “changed-child”, rather than the observed problems. Implications for clinical practice are discussed. Show more

Keywords: Pediatric, brain injury, rehabilitation, behavioral outcomes, parental grief

DOI: 10.3233/NRE-192751

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 11-18, 2019

Authors: Fadida, Yahaloma | Shapira-Vadler, Orit | Spasser, Raluca | Frenkel-Toledo, Silvi

Article Type: Research Article

Abstract: BACKGROUND: Reliable evaluation is of utmost importance to the therapist and the patient. There is no data about the test-retest reproducibility of 6-Minute Walk Test (6MWT) and Energy Expenditure Index (EEI) for children and adolescents with an Acquired Brain Injury (ABI) in the sub-acute phase. OBJECTIVE: To determine test-retest reproducibility and smallest real differences (SRDs) of the 6MWT and EEI in children and adolescents with an ABI during rehabilitation in the sub-acute phase. Our second aim was to assess the correlation between the objective measure, the EEI, and the subjective perception of physical exertion obtained by using the …pictorial children‘s effort rating scale (PCERT). METHODS: Twenty eight participants (12.5±4.3 years; 10 females) with an ABI in the sub-acute phase were asked to perform the 6MWT twice during their hospitalization. Heart rate was monitored during rest and throughout the 6MWT to calculate the EEI. Intra-class correlation coefficients (ICCs) and SRDs of the 6MWT and EEI were determined. RESULTS: Test-retest reproducibility was excellent for the 6MWT (ICC = 0.98, SRD = 65.73 m) and EEI tests (ICC = 0.99, SRD = 0.65 beats/m). Excluding one participant who walked extremely slowly resulted in ICC = 0.97, SRD = 67.01 m for the 6MWT, and ICC = 0.91, SRD = 0.25 beats/m for the EEI. No significant correlations were found between the EEI and PCERT. CONCLUSIONS: 6MWT and EEI are reliable measures in children and adolescents with an ABI during hospitalization in the sub-acute phase. Show more

Keywords: Children and adolescents with an acquired brain injury, reproducibility, 6-Minute Walk Test, Energy Expenditure Index

DOI: 10.3233/NRE-192716

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 19-24, 2019

Authors: Wallace, Sarah E. | Donoso Brown, Elena V. | Schreiber, James B. | Diehl, Sarah | Kinney, Joanne | Zangara, Lani

Article Type: Research Article

Abstract: BACKGROUND: Electronic cognitive assessment tools present potential benefits for clinical practice; however, they warrant examination before use with clinical populations such as people with traumatic brain injury (TBI). OBJECTIVE: The primary study purpose was to compare results from a tablet-based, electronic cognitive assessment to two paper cognitive assessments when administered to adults with TBI. We also explored the effect of iPad comfort on performance. METHODS: We employed a quasi-experimental, correlational study design. Forty adults between 18 to 615 months post TBI completed the Standardized Touchscreen Assessment of Cognition (STAC), the Montreal Cognitive Assessment (MoCA), and the …Cognitive Linguistic Quick Test (CLQT) in a systematically, counterbalanced order. We compared participants’ performance on these tools and examined the effect of iPad comfort. RESULTS: Three STAC subtests had a good relationship with CLQT subtests: orientation, generative naming category, and generative naming first letter. A good relationship was also identified between two STAC and two MoCA subtests: orientation and generative naming first letter. People who were very comfortable using the iPad performed statistically better on the STAC first letter fluency item than participants who were not comfortable. CONCLUSIONS: Moderate correlations suggest validity for some STAC items; however, modifications and further testing are needed. Show more

Keywords: Cognitive assessment, electronic assessment, mobile technology, traumatic brain injury

DOI: 10.3233/NRE-192725

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 25-36, 2019

Authors: Montaldi, Marina Rodrigues | Dantas, Roberto Oliveira

Article Type: Research Article

Abstract: BACKGROUND: Our hypothesis was that even patients without complaints and without evident clinical signs of dysphagia three months after ischemic stroke, may have swallowing alterations. OBJECTIVE: To evaluate, by videofluoroscopy, swallowing pattern of ischemic stroke patients without symptomatic dysphagia or restriction of food intake. METHOD: Videofluoroscopic examinations were performed in 33 ischemic stroke patients three to five months after the accident, and 19 healthy volunteers. Oral and pharyngeal phases of swallowing were evaluated after swallowing of 5 mL and 10 mL of liquid and paste boluses, and after swallowing of a solid bolus, in duplicate and in a …random sequence. RESULTS: Stroke patients had higher frequency of head movement, multiple swallows, premature spilage and vallecular residue than volunteers, after swallowing of 5 mL liquid bolus. There was no difference between patients and volunteers in oral and pharyngeal transit, except for a longer oral preparation for a 5 mL liquid bolus in patients. Changes in swallowing caused by increases in bolus volume and consistency were not different between patients and volunteers. CONCLUSION: No significant changes in swallowing dynamics were found in patients with no dysphagia symptoms and no restriction of food intake three months after isquemic stroke. Show more

Keywords: Stroke, cerebrovascular accident, dysphagia, swallowing, deglutition

DOI: 10.3233/NRE-192775

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 37-43, 2019

Authors: Dash, Adyasha | Dutta, Anirban | Lahiri, Uttama

Article Type: Research Article

Abstract: BACKGROUND: Reduction in grip-strength due to spasticity is a common cause of impairment after stroke. OBJECTIVE: To find an objective measure of post-stroke spasticity affecting grip-strength through quantification of interaction between antagonist and agonist muscles using complexity analysis of surface electromyogrm (sEMG) signals during isometric grip in healthy and post-stroke participants. METHODS: The interaction between sEMG signals from antagonist and agonist muscles is quantified through Multiscale-Multivariate-Sample-Entropy (MMSE). This is used to quantify dissimilarity between hands of 12 healthy and 8 post-stroke participants during isometric grip. The clinical relevance of MMSE is explored by examining its correlation …with spasticity score i.e. Modified-Ashworth-Scale (MAS). Further, potential of sEMG-based approach to quantify muscle-specific dissimilarity in sEMG activation across hands is investigated in terms of Cepstral-coefficients and power content of sEMG during grip tasks. RESULTS: Mean MMSE scores of sEMG signals were significantly different (p  < 0.05) between paretic and non-paretic hands of Post-stroke participants. High negative correlation was observed between spasticity and complexity scores of paretic hand for post-stroke participants. CONCLUSIONS: A negative correlation between MAS and MMSE shows higher spasticity can lead to reduced complexity in sEMG. Thus, MMSE based complexity analysis can be used as an indicator of spasticity, affecting grip function. Show more

Keywords: Stroke, complexity, electromyogram, grip strength

DOI: 10.3233/NRE-192734

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 45-56, 2019

Authors: Lee, Hyo Jeong | Moon, Hyun Im | Kim, Joo Sup | Yi, Tae Im

Article Type: Research Article

Abstract: BACKGROUND: Impairment of upper extremity function is a common sequelae of stroke. It has been reported that modified constraint-induced movement therapy (mCIMT) could prove to be effective. OBJECTIVE: To investigate the relationship between the intensity of rehabilitation such as treatment and constraining time, and the functional outcome for the paretic upper extremity in stroke patients through mCIMT. METHODS: We conducted an observational prospective study of 31 patients with hemiplegia and subacute or chronic stroke. The mCIMT was performed for two weeks. Rehabilitation time and constraining time were variable among patients. The rehabilitation time included an individualized …task-oriented program and conventional occupation treatment with an individualized therapist. The constraining time, with mit or splint, was also asked to self-record individually. The outcome was evaluated on the more affected side by the Wolf Motor Function Test, Fugl-Meyer Assessment, Motor Activity Log 14, and Functional Independence Measure for self-care tasks after the therapy. RESULTS: All participants after the modified constraint-induced movement therapy program for two weeks improved on the evaluated outcome measures (P  < 0.05). No significant correlation was found between the dose-dependent treatment or constraining time and outcomes. Comparisons improvement with subgroups based on the duration from onset, constraining component, dominant hand consistent with lesion side of stroke, and initial medical research council score for muscle strength, also showed no significant differences. CONCLUSIONS: This is the first study on the effects of intensity of mCIMT with respect to time-dosage. Although all patients in this study showed improved functional status, no significant correlation between dose-dependent rehabilitation or constraining time and outcomes was seen. Show more

Keywords: mCIMT, hemiplegia, rehabilitation time, constraining time, outcome

DOI: 10.3233/NRE-192721

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 57-66, 2019

Authors: Amatya, B. | Cofré Lizama, L.E. | Elmalik, A. | Bastani, A. | Galea, M.P. | Khan, F.

Article Type: Research Article

Abstract: BACKGROUND: There are limited evidence of instrumented measures of gait and balance to determine the functional effects of botulinum toxin injections (BoNT-A) in spasticity after stroke. OBJECTIVE: To evaluate the functional changes in gait and balance following upper limb and lower limb BoNT-A in persons with stroke. METHODS: A pre-post prospective study of 35 stroke patients with upper and/or lower limb spasticity after focal treatment with BoNT-A. Assessments were at baseline (T0), 6-weeks (T1) and 12-weeks (T2), using validated subjective and objective physical activity measures. RESULTS: After BoNT-A injections, significant improvements in most measures …of impairments, activity and participation domains were found at T1 (p  < 0.05, effect sizes (r) = 0.5–0.9). There was a significant increase in low intensity physical activity (at T1) and sedentary time reductions at both follow-up periods. Instrumented gait/balance measures showed a significant increase in cadence and turn velocity, but no changes in sway measures were found using posturography. Improvements in most outcome measures were maintained at 12-weeks. CONCLUSION: BONT-A improved scores in most clinical measures but only in some of the objective gait/balance and physical activity measures. Further robust studies should utilize a larger sample size to better determine the benefits of BoNT-A for stroke-related spasticity. Show more

Keywords: Spasticity, stroke, gait, balance, disability, participation, impairment

DOI: 10.3233/NRE-192722

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 67-78, 2019

Authors: Campos, Tania Fernandes | de Melo, Luciana Protásio | Dantas, Ana Amália Torres Souza Gandour | de Oliveira, Débora Carvalho | Oliveira, Raul Alexandre Nunes da Silva | Cordovil, Rita | Silveira Fernandes, Aline Braga Galvão

Article Type: Research Article

Abstract: BACKGROUND: Functional autonomy and social inclusion are of key importance for stroke patient‘s rehabilitation. OBJECTIVE: To evaluate activity and participation of chronic stroke patients by means of basic (BADL), instrumental (IADL) and social (SADL) activities of daily living. METHODS: Forty individuals, 24 patients and 16 healthy individuals fill in a functional activities habits questionnaire. RESULTS: Regarding BADL, 25% of the patients did not get out of bed and 70.8% did not use toilet by themselves. Considering IADL, 29.2% of the patients did not dial the telephone, 70.8% did not wash dishes and clothes, 58.3% …did not cook, 100% did not sew, 87.5% did not carry out repairs, 41.7% did not go to the bank, 54.2% did not shop and 45.8% did not write (all p  < 0.05). Regarding SADL, 87.5% of the patients were not working professionally, 41.7% did not visit friends or relatives, 75% did not travel and go to the beach and 95.8% did not dance (all p  < 0.05). CONCLUSIONS: Chronic stroke patients have limitations in activity and restrictions to participation, even after few years of stroke onset, particularly regarding applying knowledge, use of communication devices, domestic life, major life areas and community, social and civic life. Show more

Keywords: Cerebrovascular disorder, activities of daily living, international classification of functioning, disability and health, disability evaluation, social participation

DOI: 10.3233/NRE-192754

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 79-85, 2019

Authors: Nordin, Nor Azlin Mohd | Aziz, Noor Azah | Sulong, Saperi | Aljunid, Syed Mohamed

Article Type: Research Article

Abstract: BACKGROUND: The benefits of engaging informal carers or family in the delivery of therapy intervention for people with stroke have not been well researched. OBJECTIVES: To assess the effectiveness of a home-based carer-assisted in comparison to hospital-based therapist-delivered therapy for community-dwelling stroke survivors. METHODS: An assessor blinded randomised controlled trial was conducted on 91 stroke survivors (mean age 58.9±10.6 years, median time post-onset 13.0 months, 76.5% males) who had completed individual rehabilitation. The control group received hospital-based group therapy delivered by physiotherapists as out-patients and the test group was assigned to a home-based carer-assisted therapy. Targeted …primary outcomes were physical functions (mobility, balance, lower limb strength and gait speed). A secondary outcome index was health-related quality of life. An intention-to-treat analysis was used to evaluate outcomes at week 12 of intervention. RESULTS: Both therapy groups improved significantly in all the functional measures; mobility (p  < 0.01), balance (p  < 0.01), lower limb strength (p  < 0.01), gait speed (p  < 0.05), and in the quality of life score (p  < 0.05) at trial completion. No statistical differences were found between the two groups in any outcome indices (all p  > 0.05). CONCLUSIONS: The home-based carer-assisted therapy is as effective as the hospital-based therapist-delivered training in improving post-stroke functions and quality of life. Show more

Keywords: Stroke, home-based therapy, carer, functional outcome, quality of life

DOI: 10.3233/NRE-192758

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 87-97, 2019

Authors: Keytsman, Charly | Hansen, Dominique | Wens, Inez | Eijnde, Bert O.

Article Type: Research Article

Abstract: BACKGROUND: Persons with Multiple Sclerosis have elevated resting serum lactate concentrations compared to healthy controls (HC). OBJECTIVE: To evaluate lactate concentrations during acute exercise and/or following training in MS compared to HC. METHODS: In this retrospective study, blood lactate concentrations (mmol/l) originating from two previous studies were analyzed. Lactate concentrations originated from acute submaximal (MSsubmax ; HC, n  = 11; MS, n  = 32) or maximal (MSmax ; HC, n  = 20; MS, n  = 24) exercise tests and following a 24-week mild to moderate intensity (MSsubmax , n  = 12) or 12-week high intensity interval (MSmax , n  = 13) exercise …intervention. RESULTS: Under submaximal conditions in MS and compared to HC, lactaterest (MS: 2.7±0.6 vs HC: 2.3±0.7 was significantly (p  < 0.05) elevated. After 24 weeks of mild-to-moderate-intensity exercise training and compared to PRE-values, lactatebout2 (2.5±0.7 vs 3.4±1.1) significantly (p  < 0.05) decreased during submaximal testing in MSsubmax . Under maximal conditions, lactatestart (2.3±1.0 vs 1.7±0.9) was significantly (p  > 0.05) elevated in MS. Twelve weeks of high intensity interval training did not improve this (p  > 0.05). CONCLUSIONS: Under the conditions of this retrospective analysis we conclude that lactate concentrations during acute submaximal and maximal exercise in persons with MS are similar compared to healthy controls. Moderate intensity exercise therapy appeared to improve lactate accumulation but high intensity exercise therapy did not. Show more

Keywords: Multiple sclerosis, rehabilitation, lactate, endurance training, interval training

DOI: 10.3233/NRE-192740

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 99-106, 2019

Authors: Al-Sharman, Alham | Khalil, Hanan | El-Salem, Khalid | Aldughmi, Mayis | Aburub, Aseel

Article Type: Research Article

Abstract: BACKGROUND: Sleep disturbances are highly prevalent in people with multiple sclerosis(MS), and are associated with pain, fatigue, depression, and reduced quality of life (QoL). Importantly, sleep has been considered a critical brain state for motor learning and memory consolidation. Therefore, interventions that target sleep managementin people with MS are needed. OBJECTIVES: To explore the effects of a six weeks moderate-intensity aerobic exercise intervention on sleep characteristics and sleep-related biomarkers specifically serotonin, melatoninand cortisol in people with MS using a pilot randomized controlled trial. METHODS: Participants were randomly allocated to either a moderate-intensity aerobic exercise program (MAE, …n  = 20) or a home exercise program (HEP, n  = 20). Participants were assessed at baseline and follow-up. Subjective and objective measures were used to assess sleep quality. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to subjectively assess sleep. While Actigraphy was used to objectivelyassess sleep. Blood samples were collected for measurement of cortisol, melatonin and serotonin from MS participants in both groups at 8:00 am±1 hour. RESULTS: Seventeen participants in the MAE and 13 in the HEP group completed the study. Compared to the HEP group, people with MS who participated in a moderate-intensity aerobic exercise experienced significant improvements (P  < 0.05) on the PSQI, ISI, and several objective sleep parameters measured using actigraphy. Only the serotonin levels increased significantly over the six-week period in the MAE group compared to the HEP group. The change score in serotonin (from baseline to follow up assessment) was significantly correlatedwith the change score in PSQI (r  = –0.97, p  < 001) and the change score in ISI (r  = –0. 56, p  = 0.015) only in the MAE group but not the HEP group. CONCLUSIONS: Exercise may be a non-pharmacological, inexpensive, safe method to improve sleep quality in people with MS. The improvement in the serotonin level due to aerobic exercisemight explain one of the physiologic mechanisms driving these improvements. Show more

Keywords: Multiple sclerosis, sleep, motor training, rehabilitation

DOI: 10.3233/NRE-192748

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 107-115, 2019

Authors: Donia, Scott A. | Allison, David J. | Gammage, Kimberley L. | Ditor, David S.

Article Type: Research Article

Abstract: BACKGROUND: Spinal cord injury (SCI) and multiple sclerosis (MS) are associated with increased risks of depression. Acute exercise may improve mood in these populations via its affect on inflammation. OBJECTIVE: To determine if acute exercise can positively affect mood in individuals with SCI and MS, and whether exercise-induced changes in inflammation contribute to such improvements. METHODS: Thirteen participants completed 30 minutes of moderate-intensity exercise. Mood data (POMS questionnaire) and blood samples were taken before and after exercise, and blood was analyzed for inflammatory mediators and kynurenine pathway metabolites. RESULTS: There was a significant reduction …in total mood disturbance (TMD) pre to post-exercise, and pre to one-hour post-exercise. There was a significant decrease in TNF-α from pre to post-exercise, with further reductions one-hour post-exercise. There were no correlations between changes in TMD and changes in inflammation. However, changes in certain cytokines showed significant or trending correlations with changes in subsets of the POMS. Likewise, there was a trend for a correlation between exercise-induced changes in KYN/TRP and depression (p  = 0.096). CONCLUSIONS: Acute exercise can positively affect mood after SCI and MS, and this change may be partially accounted for by exercise-induced changes in inflammation. This relationship may be, in part, kynurenine pathway-dependent. Show more

Keywords: Exercise, mood, inflammation, spinal cord injury, multiple sclerosis, kynurenine pathway

DOI: 10.3233/NRE-192773

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 117-124, 2019

Authors: Olivares, Adriana | Comini, Laura | Orfano, Jacopo | Froldi, Marcello | Vezzadini, Giuliana

Article Type: Research Article

Abstract: BACKGROUND: Physical exercise combined with occupational therapy (OT) can lead to a global improvement in personal well-being. OBJECTIVE: To assess in PD patients: 1) if a rehabilitation program involving OT, Nordic walking (NW) and therapeutic touch (TT) yields motor/non-motor benefits; 2) if the time collocation of OT within the program influences results. METHODS: This is a pilot study on 17 PD patients undergoing a 10-week rehabilitation program consisting of OT, NW and TT. Patients were randomized to receive OT in the first [Group 1, n  = 8] vs. last five weeks [Group 2, n  = 9] of the …program. Scales (MMSE, FAB, BDI, UPDRS II and III, PDQ39 and AES-S) and 6MWT, Gait speed and length were assessed at three time-points. RESULTS: Thirteen out of 17 patients were analyzed. 6MWT, Gait speed and length improved in time without between-group differences (p  < 0.05) as did UPDRII, UPDRSIII, FAB and PDQ39 (p  < 0.05). Baseline UPDRS II and III significantly determined Δ 6MWT (adjusted R2  = 0.6738) and Δ GAIT speed (R2  = 0.6746) at multiple regression, while Δ GAIT length showed the best regression (adjusted R2  = 0.8247) with impact of age, gender and baseline PDQ39 (ADL and cognition dimensions). CONCLUSIONS: Multidisciplinary rehabilitation including OT can improve motor and non-motor conditions in PD patients. The OT time-collocation at beginning or end of the rehabilitation program does not significantly affect results. Show more

Keywords: Parkinson’s disease, occupational therapy, Nordic walking, multidisciplinary rehabilitation, outcome

DOI: 10.3233/NRE-192772

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 125-134, 2019

Authors: Engkasan, Julia Patrick

Article Type: Other

Abstract: The aim of this commentary is to discuss in a rehabilitation perspective the recently published Cochrane Review “Vitamin D for the management of multiple sclerosis” by Jagannath et al. (2018) 1 under the direct supervision of Cochrane Multiple Sclerosis and rare diseases of the CNS Group. This Cochrane Corner is produced in agreement with NeuroRehabilitation by Cochrane Rehabilitation.

DOI: 10.3233/NRE-189008

Citation: NeuroRehabilitation, vol. 45, no. 1, pp. 135-136, 2019