NeuroRehabilitation - Volume 46, issue 4

Authors: Doussoulin, Arlette | Bacco, José L. | Rivas, Claudia | Saiz, José L.

Article Type: Research Article

Abstract: BACKGROUND: Spastic hypertonia of the upper limb after stroke or traumatic brain injuries (TBI) is a prevalent clinical sign causing abnormal postures and movement patterns due to hyperexcitability of the upper motor neurons and rheological alterations in the affected muscles. These alterations limit the use of the upper limb, restricting its functional activities and affecting the individual’s quality of life and social participation. OBJECTIVE: To determine the association between spastic patterns of the upper limb, wrist, fingers and thumb, and independence in everyday activities after a stroke or TBI. METHODS: The design is a cross-sectional descriptive …and correlational study. The sample consisted of 206 individuals who complied with the eligibility criteria and signed an informed consent. Clinical evaluation was carried out, including determination of the postural pattern of the upper extremity according to Hefter’s taxonomy and postural pattern classification of the wrist, fingers and thumb. Functional independence was evaluated using the Functional Independence Measure (FIM) and the Barthel Index (BI). RESULTS: Univariate between-subject ANOVAs were used to examine associations of the four pattern classifications with the two independence measures, FIM and BI. Results indicate that Pattern I of Hefter’s upper limb taxonomy is associated with lesser functional independence according to FIM and BI mean scores. CONCLUSIONS: The postural pattern of the upper limb after TBI or stroke is related to the patient’s functional independence. Specifically, Pattern I tends to co-occur with low independence. Show more

Keywords: Muscle spasticity, rehabilitation, stroke, traumatic brain injury, prevalence, upper limb

DOI: 10.3233/NRE-203042

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 551-559, 2020

Authors: Duray, Mehmet | Baskan, Emre

Article Type: Research Article

Abstract: BACKGROUND: Hemiplegic shoulder pain (HSP) after stroke has negative effects on functional use of hemiplegic arm. OBJECTIVE: This study aimed to investigate the effects of HSP on upper extremity motor function and proprioception. METHODS: Hundred and twenty-two patients with hemiplegia were included in this study. The patients’ shoulder pain was evaluated by Visual Analog Scale. According to pain scores, patients were divided into two groups as group with HSP (Group 1, n  = 76) and group without HSP (Group 2, n  = 46). Upper extremity motor function level and proprioception were assessed by using Fugl Meyer Motor Function …Scale and the Laser-pointer Assisted Angle Reproduction Test for the 45°, 60° and 90° of shoulder flexion. RESULTS: Upper extremity motor function and shoulder’s proprioceptive sense at each angles of group 1 were found significantly worse than group 2’s (p ≤0.005). Correlation analysis revealed a significant positive correlation between HSP severity, and upper extremity motor dysfunction and proprioceptive impairment (p  < 0.005). CONCLUSIONS: Presence of HSP is one of the main determinators of upper extremity motor function level and proprioceptive ability at different angles. Management of HSP can make a significant contribution to sensorimotor integration by leading to recovery in the motor function and proprioceptive acuity. Show more

Keywords: Stroke, hemiplegia, shoulder pain, upper extremity, Visual Analog Scale, proprioception

DOI: 10.3233/NRE-203049

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 561-567, 2020

Authors: Obayashi, Shigeru | Takahashi, Rina

Article Type: Research Article

Abstract: BACKGROUND: It is very difficult for patients with severe upper extremity (UE) paresis after stroke to achieve full recovery because of the lack of a definitive approach for improving severe UE paresis immediately after onset. OBJECTIVE: to investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on severe UE paresis during early acute phase of stroke. METHODS: Nineteen participants with severe UE disability met the criteria. 10 subjects received 15–20 minutes of rPMS prior to standard care per session, while 9 age- and severity-matched subjects received two times 20 minutes of standard care. Outcome measures included …UE motor section of the Fugl-Meyer Motor Assessment Scale (FMA-UE), Wolf motor function test (WMFT), and box and block test (BBT). RESULTS: The rPMS group received treatment (average sessions: 7.8) after a median 9.2 days from stroke (16.5 sessions after 5 days for control). To adjust the different treatment durations, we defined “progress rate” as the gains of UE function scores divided by treatment duration. The progress rate was significantly different in FMA-UE and WMFT, but not in BBT. CONCLUSIONS: The present study suggested beneficial effects of rPMS on severe UE paresis during early acute phase of stroke. Show more

Keywords: Cortical reorganization, peripheral magnetic stimulation, motor recovery, stroke, upper extremity

DOI: 10.3233/NRE-203085

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 569-575, 2020

Authors: Park, Chanhee | Oh-Park, Mooyeon | Dohle, Carolin | Bialek, Amy | Friel, Kathleen | Edwards, Dylan | Krebs, Hermano Igo | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: While Walkbot-assisted locomotor training (WLT) provided ample evidence on balance and gait improvements, the therapeutic effects on cardiopulmonary and psychological elements as well as fall confidence are unknown in stroke survivors. OBJECTIVE: The present study aimed to compare the effects of Walkbot locomotor training (WLT) with conventional locomotor training (CLT) on balance and gait, cardiopulmonary and psychological functions and fall confidence in acute hemiparetic stroke. METHODS: Fourteen patients with acute hemiparetic stroke were randomized into either the WLT (60 min physical therapy + 30 min Walkbot-assisted gait training) or CLT (60 min physical therapy + 30 min …gait training) groups, 7 days/week over 2 weeks. Clinical outcomes included the Berg Balance Scale (BBS), Functional Ambulation Category (FAC), heart rate (HR), Borg Rating of Perceived Exertion (BRPE), Beck Depression Inventory-II (BDI-II), and the activities-specific balance confidence (ABC) scale. The analysis of covariance (ANCOVA) was conducted at P  < 0.05. RESULTS: ANCOVA showed that WLT showed superior effects, compared to CLT, on FAC, HR, BRPE, BDI-II, and ABC scale (P  < 0.05), but not on BBS (P  = 0.061). CONCLUSIONS: Our results provide novel, promising clinical evidence that WLT improved balance and gait function as well as cardiopulmonary and psychological functions, and fall confidence in acute stroke survivors who were unable to ambulate independently. Show more

Keywords: Neurorehabilitation, stroke, hemiplegia, robot-assisted gait training, Walkbot, cardiopulmonary function, psychological function

DOI: 10.3233/NRE-203086

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 577-587, 2020

Authors: Sangarapillai, Kishoree | Norman, Benjamin M. | Almeida, Quincy J.

Article Type: Research Article

Abstract: BACKGROUND: The cardinal motor symptoms of Parkinson’s disease (PD) include postural instability, bradykinesia, tremor and rigidity. The overall Unified Parkinson’s Disease Rating Scale (UPDRS-III) indicates, the gold-standard treatment for PD (dopaminergic-therapy) is very effective in improving these symptoms. However, recent research indicated that 2 of the 4 cardinal symptoms of PD (balance and tremor) remain unimproved by dopaminergic-therapy. This prompts the investigation of other alternative and adjunct treatments such as exercise rehabilitation. Unfortunately, like drug studies, exercise studies often focus on overall symptom improvement yet fail to monitor changes to specific symptoms. This may be problematic for individuals with different …symptomatic phenotypes. If tremor/balance were the main concern, then adjunct therapies may be critically important when these symptoms may be dopa-resistant. Thus, it is important for all therapies to examine individual symptomatic-improvement. Interestingly, recent studies show PDSAFEx™ (a sensory integration therapy) to have a significantly improve motor symptoms in comparison to traditional exercise (14). Yet, the effects of PDSAFEx™ on individual PD symptoms is unknown. OBJECTIVE: To explore the effects of PDSAFEx™ on PD symptoms in adjunct to medications. METHODS: UPDRS-III scores of 229 cases were retrospectively examined and analysed in SPSS using Wilcoxon pairs singed-rank test to evaluate specific symptom-improvements. RESULTS: PDSAFEx™ was confirmed to improve overall motor symptoms (p  = 0.0001), but more importantly a significant improvement to tremor (p  < 0.00001) and balance (p  < 0.00001) were also identified. CONCLUSIONS: These findings suggest that PDSAFEx™ is an important adjunct to medications, since it is able to address all four cardinal symptoms of PD. Show more

Keywords: Parkinson’s disease, medication, levodopa, sensory attention focused exercise, exercise, motor symptoms

DOI: 10.3233/NRE-203025

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 589-593, 2020

Authors: Yasuda, Kazuhiro | Kato, Ryoichi | Sabu, Rikushi | Kawaguchi, Shuntaro | Iwata, Hiroyasu

Article Type: Brief Report

Abstract: BACKGROUND: Unilateral spatial neglect (USN) is defined as impaired attention to sensory stimuli on one side. The symptoms can exist for near and far spaces combined or independently. Thus, it is important to evaluate both possibilities in a clinical environment. OBJECTIVE: To develop a tractable immersive virtual reality (iVR) system that can evaluate both near and far space neglect along with a proof of concept study to determine whether near and far spatial neglect could be described in an actual patient with USN. METHODS: An object-detecting task was developed in a three-dimensional virtual reality space. The …examiner recorded the positional data of objects that were recognized by the patient with USN using coordinate data. RESULTS: The system could be used to detect near and far space neglects in a patient with USN. No side effects such as vertigo were seen during measurement. This patient showed that the angle for recognition was significantly larger for near space than far space, and exhibited a tendency for the angle of recognition to increase with lower height. CONCLUSIONS: Our proof of concept study indicated the possibility of applying an evaluation system that separates far and near space neglect using iVR. Show more

Keywords: Stroke, higher brain dysfunction, attention, unilateral spatial neglect, immersive virtual reality, three-dimensional space, evaluation

DOI: 10.3233/NRE-203014

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 595-601, 2020

Authors: Indorewalla, Khushnoo K. | McArdle, Melanie | Tomlinson, Erika | Piryatinsky, Irene

Article Type: Case Report

Abstract: BACKGROUND: Moyamoya disease (MMD) is a rare cardiovascular condition characterized by stenosis and gradual occlusion of the internal carotid arteries near the Circle of Willis. Current research on the disease has primarily been restricted to its medical implications, without adequate appreciation for its neurocognitive and/or neuropsychiatric implications. OBJECTIVES: The current study presents the neurocognitive profile of a 31-year-old woman diagnosed with MMD, further complicated by cerebral vascular accidents (CVAs) and history of bilateral craniotomy aimed at providing maximal revascularization. METHODS: Although speech and motor disturbances experienced by Ms. Doe around the time of her craniotomy and …CVA were resolved at the time of current evaluation, she reported experiencing continued difficulties in processing speed, concentration, memory, word-retrieval, and planning. The patient underwent comprehensive neuropsychological evaluation assessing multiple cognitive domains. RESULTS: Neurocognitive evaluation revealed the presence of a lateralized profile as well as impairments in simple auditory attention, processing speed, working memory, verbal learning, verbal fluency, and speeded fine-motor dexterity. CONCLUSIONS: MMD significantly impacts cognition and daily functioning in affected individuals. This is often further exacerbated by additional CVAs requiring surgical intervention. While there is a clear growth of research on MMD, limited information is available on the neurocognitive and neuropsychiatric outcomes of the disease process. Neuropsychological data from the current case study is closely examined to provide a unique example of the lateralized neuropsychological profile and deficit pattern in a historically high functioning individual diagnosed with MMD following a stroke. Show more

Keywords: Moyamoya disease (MMD), cerebral vascular accident (CVA), stroke, bilateral craniotomy, neuropsychological profile, cognitive functioning

DOI: 10.3233/NRE-192903

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 603-611, 2020

Authors: Ceravolo, Maria Gabriella

Article Type: Other

Abstract: BACKGROUND: Even if there is sparse evidence of efficacy of stem cell administration for amyotrophic lateral sclerosis (ALS) in preclinical studies, the clinical use of cell-based therapy is yet to be defined. OBJECTIVE: To assess the efficacy, feasibility and safety of cell-based therapy in people with ALS/MND, compared with placebo or no treatment. METHODS: A Cochrane Review on the topic was summarized with comments. RESULTS: Two randomized controlled trials met the selection criteria, but only one provided data useful for the analysis. It compared autologous bone marrow-mesenchymal stem cells, combined with riluzole, to riluzole …only, in 64 people with ALS. The ALS Functional Rating Scale-Revised score slightly improved 6 months after the intervention, though the change was not clinically meaningful. Respiratory function, overall survival and the risk of total adverse events or serious adverse events were not different in the two groups. CONCLUSIONS: The available evidence does not support the use of bone marrow-mesenchymal stem cells to treat people with ALS/MND. Show more

Keywords: Mesenchymal stem cells, amyotrophic lateral sclerosis, functional recovery, respiratory function, ALSFRS-R

DOI: 10.3233/NRE-209004

Citation: NeuroRehabilitation, vol. 46, no. 4, pp. 613-615, 2020