NeuroRehabilitation - Volume 46, issue 1

Authors: Dein, Simon

Article Type: Editorial

DOI: 10.3233/NRE-200001

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 1-2, 2020

Authors: Simpson, Grahame Kenneth | Anderson, Malcolm Ikin | Jones, Kate Fiona | Genders, Michelle | Gopinath, Bamini

Article Type: Research Article

Abstract: BACKGROUND: A deficits approach to understanding psychological adjustment in family caregivers of individuals with a neurological disability is extensive, but further research in the field of positive psychology (spirituality, resilience, hope) may provide a potential avenue for broadening knowledge of the family caregiver experience after traumatic brain injury (TBI) or spinal cord injury (SCI). OBJECTIVE: To test a proposed model of spirituality among family caregivers of individuals with TBI or SCI, using structural equation modelling (SEM). METHODS: A cross-sectional design was employed to survey ninety-nine family participants (TBI = 76, SCI = 23) from six rehabilitation units from NSW and …Queensland. Assessments comprised Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale-Expanded, Connor –Davidson Resilience Scale, Herth Hope Index, and three measures of psychological adjustment including Caregiver Burden Scale, Positive and Negative Affect Scale, and Depression Anxiety Stress Scale. RESULTS: SEM showed the proposed model was a good fit. The main findings indicated spirituality had a direct negative link with burden. Spirituality had a direct positive association with hope which, in succession, had a positive link with resilience. Spirituality influenced positive affect indirectly, being mediated by resilience. Positive affect, in turn, had a negative association with depression in caregivers. CONCLUSIONS: This study contributes to better targeting strength-based family interventions. Show more

Keywords: Traumatic brain injury, spinal cord injury, spirituality, resilience, hope, family caregiver, burden, depression, psychological adjustment

DOI: 10.3233/NRE-192945

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 3-15, 2020

Authors: Jones, Kate Fiona | Pryor, Julie | Care-Unger, Candice | Simpson, Grahame Kenneth

Article Type: Research Article

Abstract: BACKGROUND: Spirituality has been positively associated with key adjustment indicators for individuals affected by traumatic brain injury or spinal cord injury. OBJECTIVE: To explore the perceptions of health professionals working in rehabilitation in relation to spirituality and spiritual care practice. METHODS: An observational study. An adapted version of the Royal College of Nursing Spirituality Survey was emailed to specialty networks of rehabilitation health professionals across Australia. RESULTS: The majority of the 125 participants were female (92.8%), from a nursing (67.2%) background, and selected ‘Christian’ as their religious affiliation (68.8%). A range of spiritual needs …for rehabilitation clients were identified, including a source of hope and strength. Although 84% agreed that spirituality was a fundamental aspect of healthcare, 85% agreed that staff did not receive enough education or training. Thematic analysis identified three key ways participants felt their workplaces could better address spirituality: increasing staff knowledge and skills in providing spiritual care, incorporating spirituality into rehabilitation processes, and providing patients with access to spiritual resources. CONCLUSIONS: Spirituality is considered to play an important role after traumatic injury, but most staff do not feel well equipped to provide spiritual care. Training in spiritual care for rehabilitation professionals is warranted. Show more

Keywords: Spirituality, spinal cord injury, traumatic brain injury, rehabilitation, health professionals

DOI: 10.3233/NRE-192857

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 17-30, 2020

Authors: Redfern, Clare | Mason, Sarah L. | Barker, Roger A. | Coles, Alasdair

Article Type: Research Article

Abstract: OBJECTIVE: To assess the claim that Parkinson’s disease (PD) specifically reduces religiosity religious faith and spirituality. METHODS: A longitudinal case-control study over 12 months of spirituality in 42 patients with idiopathic PD and 39 disease controls matched for age, gender, educational attainment and disability. There was no selection on grounds of religious affiliation. Participants were assessed on the Beck Depression Inventory, Medical Outcomes Score (MOS), cognitive tests including Paired Associate Learning [PAL], One Touch Stocking [OTS]) and Stroop test. Tests of spirituality were the Brief Multidimensional Measure of Religiousness and Spirituality questionnaire (BMMRS), a Mystical Experiences Questionnaire (MEQ), …and the Rivermead Life Goals Score, supplemented by qualitative interview methods. RESULTS: Over one year, as expected, mobility and cognition declined in the PD group. However, there was no significant change in scores of religiosity and spirituality scores in this group. Likewise, there were no subjective reports of a decrease of interest in religious faith or spirituality, although anecdotal accounts of decreasing mobility, loss of driving ability, increasing emotional lability and tiredness meant reduced participation in some religious and spiritual practices. However, over one year there was a significant fall in controls’ religiosity score due mainly to a fall in ‘religious practices’ with no clear underlying reason. CONCLUSIONS: Compared to non-neurological patients with similar disability, Parkinson’s disease is not associated with a decline in religious faith or spirituality. Declining mobility and cognition in Parkinson’s disease does not lead to diminished religiosity. Show more

Keywords: Parkinson’s disease, spirituality

DOI: 10.3233/NRE-192947

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 31-39, 2020

Authors: Gibbs, Letetia Anne Louise | Anderson, Malcolm Ikin | Simpson, Grahame Kenneth | Jones, Kate Fiona

Article Type: Review Article

Abstract: BACKGROUND: Stroke is the leading cause of disability in Australia and the third-leading cause of disability worldwide and a significant burden on caregivers. OBJECTIVE: To map the extent, range and nature of the literature investigating spirituality and resilience among family caregivers of survivors of stroke. METHOD: A scoping review. RESULTS: Six studies were identified, conducted in the United States, United Kingdom, China and Turkey. These included two quantitative, one experimental and three qualitative designs. No studies linked spirituality to resilience. For the qualitative studies, spirituality was the primary focus of one, and the secondary …focus of two others. Qualitative data reflected the lived experience of caregivers drawing upon spirituality to help cope with the burden of caregiving. For the two quantitative studies, spirituality was measured as a secondary focus and showed no significant links between spirituality or adjustment in caregivers. The one experimental study comprised a psycho-educational intervention focused on building resilience, finding a significant increase in social support not reflected in a matched control group. Clinical implications suggested the need for strength-based interventions, including spiritual needs and religious beliefs of the family caregiver. CONCLUSIONS: Spirituality and resilience following stroke are essential factors in caregiver adjustment following stroke. Further research with a focus on causality and the link between spirituality, resilience and adjustment in this population is needed. Show more

Keywords: Stroke, family, caregiver, spirituality, resilience, scoping review

DOI: 10.3233/NRE-192946

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 41-52, 2020

Authors: Souto, Deisiane Oliveira | Cruz, Thalita Karla Flores | Coutinho, Kênia | Julio-Costa, Annelise | Fontes, Patrícia Lemos Buenos | Haase, Vitor Geraldi

Article Type: Research Article

Abstract: INTRODUCTION: Evidence indicates that motor deficits in hemiplegic cerebral palsy (HCP) impair both motor execution and planning. However, current rehabilitation efforts focus mainly on relieving impairments in motor execution. Motor imagery (MI) is a promising method for stimulating neural networks underlying the planning and control of movements. OBJECTIVE: Evaluate the effectiveness of MI combined with physical practice in improving the function of the upper limbs in children with HCP. METHOD: Twenty-four participants, aged 7–14 years were divided into two groups: intervention group (IG) and control group (CG). The IG was subjected to MI training and physical …practice twice a week for eight consecutive weeks, while the CG received conventional therapy. Participants were assessed with the Assisting Hand Assessment (AHA) at pre-intervention, post-intervention, and follow up. RESULTS: The results showed improved motor functions in both groups. Analysis using the general linear model (analysis of covariance) and Bonferroni post hoc tests showed significant improvements from pre-intervention to post-intervention in the AHA for the IG. The CG showed non-significant improvement in AHA scores. CONCLUSIONS: These findings suggest that the MI training, combined with the physical practice program used in this study, was effective in improving upper limb function in children with HCP. Show more

Keywords: Motor imagery, rehabilitation, upper limb, children, hemiplegic cerebral palsy

DOI: 10.3233/NRE-192931

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 53-63, 2020

Authors: Bodien, Yelena G. | Martens, Geraldine | Ostrow, Joseph | Sheau, Kristen | Giacino, Joseph T.

Article Type: Research Article

Abstract: BACKGROUND: Although emergence from the minimally conscious state (eMCS) is associated with symptoms including disorientation, memory and attention impairment, restlessness, and significant functional disability, the neurobehavioral profile of eMCS has not been empirically characterized. OBJECTIVE: Determine degree of cognitive impairment, presence of clinical symptoms and functional disability at time eMCS in patients with traumatic and non-traumatic brain injury (TBI, nTBI). METHODS: Retrospective observational study of 169 adults (median [interquartile range] age: 51 [29, 62] years; male: 116; TBI: 103) who emerged from MCS based on the Coma Recovery Scale-Revised while in an inpatient Disorders of Consciousness …program. Outcome measures include the Confusion Assessment Protocol (CAP) and Disability Rating Scale (DRS). RESULTS: CAP administration was attempted in 54 subjects. Twenty-eight subjects had valid scores on all CAP items, with a median [interquartile range] of 4 [3–5] symptoms of confusion. Scores in 93% of this subsample were consistent with an acute confusional state. The most common symptoms were cognitive impairment (98% of subjects), disorientation (93%), and agitation (69%). The median DRS score upon emergence from MCS was 14.5 [13, 16], indicating severe disability (n  = 140). CONCLUSIONS: eMCS is associated with an acute confusional state and severe disability. This finding may inform the lower boundary of confusion as well as approach to treatment and caregiver education. Show more

Keywords: Brain injury, traumatic brain injury, consciousness, confusion

DOI: 10.3233/NRE-192860

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 65-74, 2020

Authors: Xiong, Jian | Zhang, Zhichao | Ma, Yan | Li, Zuhong | Zhou, Fang | Qiao, Na | Liu, Qi | Liao, Weijing

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the effect of combined scalp acupuncture and cognitive training on cognitive and motor functioning in patients with stroke during the recovery stage. METHODS: Seventy patients with post-stroke cognitive impairment were randomly divided into an experimental group and a control group. Patients in the experimental group additionally received scalp acupuncture and cognitive training, while the control group received sham scalp acupuncture and cognitive training. The cognitive and motor functioning of all patients were assessed using MMSE, LOTCA, and FMA, before and 12 weeks after treatment. In addition, the plasma BDNF and NGF levels were measured from …peripheral blood samples using ELISA kits. RESULTS: After 12 weeks, the MMSE, LOTCA and FMA scores were significantly higher in the experimental group than in the control group. In the experimental group, there was an improvement in the total MMSE score, orientation, spatial executive function, the total LOTCA score, and the score of command of language orientation post-treatment. Significant improvements of BDNF and NGF were found in the experimental group after treatment, while only significant improvements of NGF was found in the control group after treatment. Both BDNF and NGF in the experiment group were higher than those in the control group at the last day of treatment. CONCLUSIONS: Combined scalp acupuncture and cognitive training can efficiently enhance cognitive and motor functions in patients with stroke during the recovery stage, which may be a more effective rehabilitation treatment after stroke than routine therapy and rehabilitation training alone. Show more

Keywords: Stroke, cognitive impairment, scalp acupuncture, cognitive training, the Loewenstein Occupational Therapy Cognition Assessment (LOTCA)

DOI: 10.3233/NRE-192942

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 75-82, 2020

Authors: Iwański, Szczepan | Leśniak, Marcin | Polanowska, Katarzyna | Bembenek, Jan | Czepiel, Wojciech | Seniów, Joanna

Article Type: Research Article

Abstract: BACKGROUND: Visuospatial neglect (VSN) may be caused by an inter-hemispheric imbalance of neural activity after brain injury. Repetitive transcranial magnetic stimulation (rTMS) allows rebalancing restoration to a certain degree, relieving neglect symptoms. OBJECTIVE: This study investigates the therapeutic effect of 1 Hz rTMS applied over the left angular gyrus combined with visual scanning training in patients with left VSN in the subacute stroke phase. METHODS: Twenty-eight patients with VSN were randomly assigned to either experimental (fifteen sessions of rTMS consisted of 1800 magnetic pulses delivered to the left angular gyrus with a neuronavigation control), or control group …(fifteen sessions of sham stimulation), followed by visual scanning training. VSN severity was assessed both before and after treatment with a 3-month follow up employing the Behavioural Inattention Test and functional measures. RESULTS: No statistically significant differences were detected in outcome measures between the rTMS and sham groups after completion of 3-week therapy and at 3-month follow up. The magnitude of stimulation effects was not associated either with lesion volume, its location, or baseline motor threshold. CONCLUSIONS: Our study did not confirm efficacy of 1 Hz rTMS over the angular gyrus as an adjuvant method to visual scanning training in patients with VSN in the subacute stroke. Show more

Keywords: Neglect, cerebrovascular disease/accident and stroke, rehabilitation, transcranial magnetic stimulation, visual scanning training

DOI: 10.3233/NRE-192951

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 83-93, 2020

Authors: Zhang, Qing | Fu, Chenying | Liang, Zejun | Peng, Lihong | Xiong, Feng | Chen, Li | He, Chengqi | Wei, Quan

Article Type: Review Article

Abstract: BACKGROUND: The effectiveness of trunk restraint on post-stroke arm motor function and daily function remain controversial. OBJECTIVE: To evaluate the effect of adding trunk restraint to task-oriented rehabilitation of arm motor function and functional ability after stroke. METHODS: Nine databases were systematically searched for randomized controlled trials studying the effects of trunk restraint in post-stroke task-oriented training. Researchers assessed methodological qualities using the Physiotherapy Evidence Database scale, and extracted data related to study participants, intervention, and outcomes. The overall effectiveness was calculated using a meta-analytic method. RESULTS: In total, ten articles met the inclusion …criteria and nine trails (n  = 255 subjects) were included in quantitative analyses. Meta-analysis revealed that trunk restraint exhibited a significant improvement on the Motor Activity Log-amount of use, 0.39 (95% CI: 0.25– 0.54), the Motor Activity Log-quality of movement, 0.45 (95% CI: 0.27– 0.63), the Fugl-Meyer Assessment (upper extremity), 1.09 (95% CI: 0.67– 1.51), Action Research Arm test, 4.51 (95% CI: 2.49– 6.54) and performance of Activities of daily living, 1.70 (95% CI: 0.19– 3.21) in trunk restraint group in patients at subacute stage, compared to the non-trunk restraint group, but no significant difference was found in patients with chronic stroke. CONCLUSIONS: Adding trunk restraint to task-oriented training may improve function in patients with subacute stroke. Show more

Keywords: Stroke, trunk restraint, task-oriented training, upper extremity, functional performance

DOI: 10.3233/NRE-192964

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 95-108, 2020

Authors: Pettemeridou, Eva | Kennedy, Mary R.T. | Constantinidou, Fofi

Article Type: Research Article

Abstract: BACKGROUND: Moderate-to-severe traumatic brain injury (TBI) leads to significant neuropsychological impairment, further affecting quality of life (QOL). OBJECTIVE: Investigate the effects of chronic moderate-to-severe TBI on Executive Functions (EF), Self-awareness (SA), QOL, and the associations between them. METHODS: 33 males with moderate-to-severe TBI (ages 18–51; time since injury 1–19 years) were compared to 24 non-injured males, matched on age and education. EF measures included the Rey Complex Figure Test (copy), the Trail Making Test A & B, the Symbol Digits Modalities Test, and the Control Oral Word Association Test. SA was assessed using the Dysexecutive Questionnaire …Revised, and the Self-Regulation Skills Interview. QOL and health-realted QOL were assessed using the WHOQOL-BREF and the QOL after Brain Injury, respectively. RESULTS: TBI participants scored lower on EF, and SA, reported less satisfaction regarding physical health and greater satisfaction with environmental support, than controls. TBI survivors scoring lower on EF, exhibited lower SA. Lower SA correlated with greater satisfaction regarding cognitive skills, self-perception, and overall HRQOL. Lower EF performance correlated with greater satisfaction in social relationships. CONCLUSIONS: The long-term effects of TBI on EF, SA and QOL seem to support the role of EF and SA on QOL, and therefore, the need for personalized interventions in improving recovery outcome. Show more

Keywords: Cognitive dysfunction, neuropsychological assessment, patient outcome assessment, recovery of function, health-related quality of life, closed head injury

DOI: 10.3233/NRE-192963

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 109-118, 2020

Authors: Alghwiri, Alia A. | Khalil, Hanan | Al-Sharman, Alham | El-Salem, Khalid

Article Type: Research Article

Abstract: BACKGROUND: Balance and gait impairments are common disorders in people with multiple sclerosis (MS). The Activities-specific Balance Confidence scale (ABC) is one of the important measures of balance confidence that can be used in people with MS. The Arabic version of the ABC was developed and validated in other than MS population. OBJECTIVE: To examine the psychometric properties of the Arabic Activities-specific Balance Confidence scale (A-ABC) among patients with MS. METHODS: A multicenter, reliability design was used to administer the A-ABC to a convenience sample of people with MS. The test-retest reliability of the A-ABC item …and total scores were examined using the intraclass correlation coefficient (ICC) and 95% confidence interval (CI). Additionally, the validity of the A-ABC with Arabic Berg Balance Scale (A-BBS), Arabic Dynamic Gait Index (A-DGI), and Barthel Index (BI) was assessed using Spearman Correlation Coefficient (r ). Moreover, the minimal detectable change for the A-ABC was established in people with MS. RESULTS: Eighty nine patients with MS (mean [SD] age = 38 [10]; female = 58) were enrolled. The internal consistency of the A-ABC was 0.96 while the minimal detectable change was 11.28. The A-ABC (mean [SD] = 61 [29]) had significant correlations with A-BBS (r  = 0.76, P  < 0.05), A-DGI (r  = 0.65, P  < 0.05), BI (r  = 0.63, P  < 0.05), and age (r  = –0.37, P  < 0.05). Fifty-two patients (58%) completed the A-ABC twice with one week interval. Excellent test-retest reliability of the A-ABC item (ICC≥0.90) and total scores [ICC = 0.98; 95% CI (0.96–0.99)] was found. CONCLUSIONS: The Arabic Activities-specific Balance Confidence scale showed very good psychometric properties and can be utilized with Arabic-speaking patients with multiple sclerosis. Show more

Keywords: Multiple sclerosis, activities-specific balance confidence scale, reliability, validity

DOI: 10.3233/NRE-192900

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 119-125, 2020

Authors: Kim, Jong Keun | Park, Hyo Sik | Bae, Jin Seok | Jeong, Yong Sung | Jung, Kang Jae | Lim, Jong Youb

Article Type: Research Article

Abstract: BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is one of the effective treatments for neuropathic pain. Little is known about the effects of multi-session theta burst stimulation, one of the new paradigms of rTMS. OBJECTIVE: The aim of this study was to investigate the effects of multi-session intermittent theta burst stimulation (iTBS) on central neuropathic pain, using evaluation tools specific to neuropathic pain. METHODS: Patients with central neuropathic pain diagnosed using Neuropathic Pain Special Interest Group guidelines were recruited. Thirty patients were randomly assigned to either a real or sham iTBS group. Each patient underwent 5 sessions …of iTBS; before and after completion of the 5 sessions, participants were evaluated using the self-completed Leeds assessment of neuropathic symptoms and signs (S-LANSS), the numeric rating scale (NRS), the neuropathic pain symptom inventory (NPSI), and the neuropathic pain scale (NPS). RESULTS: S-LANSS, NRS, NPSI, and 3 of 4 NPS combination scores decreased significantly in the real iTBS group but not in the sham iTBS group. No adverse effects were reported during or after iTBS sessions. CONCLUSIONS: Multi-session iTBS was associated with a significant decrease in neuropathic pain, indicating its effectiveness as a treatment for patients with central neuropathic pain. Show more

Keywords: Theta burst stimulation, repetitive transcranial magnetic stimulation, central neuropathic pain

DOI: 10.3233/NRE-192958

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 127-134, 2020

Authors: Levack, William

Article Type: Other

Abstract: BACKGROUND: Communication impairments are a common challenge for children with non-progressive motor disorders and their parents. OBJECTIVE: To assess the effects of parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders. METHODS: To summarize a rehabilitation-relevant Cochrane Review conducted by Pennington et al. RESULTS: Two studies were identified, involving 38 children and their mothers. These studies provided very low quality evidence that parent-mediated communication might improve parental responsiveness to their children’s communication efforts, but no evidence it influence the children’s communication or participation. Small samples sizes, low study …numbers, and lack of reporting on some outcomes limited the conclusion that could be drawn from this review. CONCLUSIONS: High quality adequately powered trials of parent-mediate communication interventions for children with communication impairments arising from non-progressive motor disorders should be encouraged. Show more

Keywords: Preschool child, motor disorders, communication impairment, parents

DOI: 10.3233/NRE-209001

Citation: NeuroRehabilitation, vol. 46, no. 1, pp. 135-137, 2020