NeuroRehabilitation - Volume 48, issue 4

Authors: Plechatá, Adéla | Nekovářová, Tereza | Fajnerová, Iveta

Article Type: Review Article

Abstract: BACKGROUND: A growing interest in non-pharmacological approaches aimed at cognitive rehabilitation and cognitive enhancement pointed towards the application of new technologies. The complex virtual reality (VR) presented using immersive devices has been considered a promising approach. OBJECTIVE: The article provides a systematic review of studies aimed at the efficacy of VR-based rehabilitation. First, we shortly summarize literature relevant to the role of immersion in memory assessment and rehabilitation. METHODS: We searched Web of Science, ScienceDirect, and PubMed with the search terms “memory rehabilitation”, “virtual reality”, “memory deficit”. Only original studies investigating the efficacy of complex three-dimensional …VR in rehabilitation and reporting specific memory output measures were included. RESULTS: We identified 412 citations, of which 21 met our inclusion criteria. We calculated appropriate effect sizes for 10 studies including control groups and providing descriptive data. The effect sizes range from large to small, or no effect of memory rehabilitation was present, depending on the control condition applied. Summarized studies with missing control groups point out to potential positive effects of VR but do not allow any generalization. CONCLUSIONS: Even though there are some theoretical advantages of immersive VE over non-immersive technology, there is not enough evidence yet to draw any conclusions. Show more

Keywords: Virtual reality, immersion, memory, rehabilitation

DOI: 10.3233/NRE-201534

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 389-412, 2021

Authors: Cheng, Darren Kai-Young | Dagenais, Matthieu | Alsbury-Nealy, Kyla | Legasto, Jean Michelle | Scodras, Stephanie | Aravind, Gayatri | Takhar, Pam | Nekolaichuk, Erica | Salbach, Nancy Margaret

Article Type: Review Article

Abstract: BACKGROUND: Improving walking capacity is a key objective of post-stroke rehabilitation. Evidence describing the quality and protocols of standardized tools for assessing walking capacity can facilitate their implementation. OBJECTIVE: To synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people post-stroke. METHODS: Electronic database searches were completed in 2017. Records were screened and appraised for quality. RESULTS: Data were extracted from 43 eligible articles. Among the 12 walk tests identified, the 10-metre walk test (10mWT) at a comfortable pace was most commonly evaluated. Sixty-three unique protocols at comfortable and …fast paces were identified. Walking pace and walkway surface, but not walkway length, influenced walking speed. Intraclass correlation coefficients for test-retest reliability ranged from 0.80–0.99 across walk tests. Measurement error values ranged from 0.04–0.40 and 0.06 to 0.20 for the 10mWT at comfortable and fast and paces, respectively. Across walk tests, performance was most frequently correlated with measures of strength, balance, and physical activity (r  = 0.26-0.8, p  < 0.05). CONCLUSIONS: The 10mWT has the most evidence of reliability and validity. Findings indicate that studies that include people with severe walking deficits, in acute and subacute phases of recovery, with improved quality of reporting, are needed. Show more

Keywords: Gait, rehabilitation, stroke, assessment, measurement properties

DOI: 10.3233/NRE-210026

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 413-439, 2021

Authors: He, Yi | Zhao, Chen | Liu, Yong

Article Type: Review Article

Abstract: BACKGROUND: Patients with neurological disorders can present the weakness of respiratory muscle and impaired cough function. Previous studies have shown that respiratory muscle strength training (RMT) is an effective method of improving the strength of respiratory muscle. The effects of RMT on cough function remain controversial. OBJECTIVE: We aimed to analyze randomized controlled trials (RCTs) that investigated the effects of RMT on cough function of patients with neurological disorders. METHODS: Pubmed, Medline, Embase, and the Cochrane Library were searched electronically for RCTs. Two reviewers independently performed data extraction and quality assessment. Data were analyzed by using …RevMan 5.3 software of The Cochrane Collaboration. RESULTS: Five studies with 185 participants were included. The mean PEDro score was 6.2 (range 5 to 7), showing moderate methodological quality. Random-effects meta-analyses showed that respiratory muscle training improved peak expiratory cough flow of voluntary cough by 2.16 (95% CI 1.16 to 3.17) and involuntary cough by 2.84 (95% CI 1.29 to 4.39), with statistical significance (P  < 0.0001, P  = 0.0003). The experimental group had an improvement of 0.19 cmH2O (95% CI –0.12 to 0.5) on the maximal inspiratory pressure, 0.09 cmH2O (95% CI –0.23 to 0.42) on the maximal expiratory pressure, but with no statistical significance (P  = 0.23, P  = 0.58) between groups. CONCLUSION: Respiratory muscle training was considered as an effective method for improving cough function. However, this review was insufficient to conclude whether respiratory muscle training was effective in improving inspiratory and expiratory muscle strength, this was opposite with previous meta-analysis. These effects might due to the small samples and different diseases. Show more

Keywords: Neurological disorders, respiratory muscle training, cough function, pulmonary rehabilitation

DOI: 10.3233/NRE-210017

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 441-449, 2021

Authors: Gerber, Lynn H. | Deshpande, Rati | Moosvi, Ali | Zafonte, Ross | Bushnik, Tamara | Garfinkel, Steven | Cai, Cindy

Article Type: Review Article

Abstract: BACKGROUND: Practice guidelines (CPGs) provide informed treatment recommendations from systematic reviews and assessment of the benefits and harms that are intended to optimize patient care. Review of CPGs addressing rehabilitation for people with moderate/severe traumatic brain injury (TBI), has not been fully investigated. OBJECTIVE: Identify published, vetted, clinical practice guidelines that address rehabilitation for people with moderate/severe TBI. METHODS: Six data bases were accessed using key word search terms: “Traumatic Brain Injury” and “Clinical Practice Guidelines” and “Rehabilitation”. Further inclusions included “adult” and “moderate or severe”. Exclusions included: “mild” and “concussive injury”. Three reviewers read abstracts …and manuscripts for final inclusion. The AGREE II template was applied for additional appraisal. RESULTS: There were 767 articles retrieved using the search terms, 520 were eliminated because of content irrelevance; and 157 did not specify rehabilitation treatment or did not follow a process for CPGs. A total of 17 CPGs met all criteria and only 4 of these met all AGREE II criteria. CONCLUSION: There are few CPGs addressing rehabilitation for people with moderate/severe TBI. More interventional trials are needed to determine treatment effectiveness. Timely and methodologically sound vetting of studies are needed to ensure CPG reliability and facilitate access to quality, effective treatment for people with moderate/severe TBI. Show more

Keywords: Clinical practice guidelines, traumatic brain injury, rehabilitation

DOI: 10.3233/NRE-210024

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 451-467, 2021

Authors: Albu, Sergiu | Zozaya, Nicolás Rivas | Murillo, Narda | García-Molina, Alberto | Chacón, Cristian Andrés Figueroa | Kumru, Hatice

Article Type: Research Article

Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) patients present long-lasting physical and neuropsychological impairment, which may require rehabilitation. OBJECTIVES: The current cross-sectional study characterizes post COVID-19 sequelae and persistent symptoms in patients in an outpatient rehabilitation program. METHODS: Thirty patients [16 post-ICU and 14 non-ICU; median age = 54(43.8–62) years; 19 men] presenting sequelae and/or persistent symptoms (>3 months after acute COVID-19) were selected of 41 patients referred for neurorehabilitation. Patients underwent physical, neuropsychological and respiratory evaluation and assessment of impact of fatigue and quality of life. RESULTS: The main reasons for referral to rehabilitation were: fatigue (86.6%), …dyspnea (66.7%), subjective cognitive impairment (46.7%) and neurological sequelae (33.3%). Post-ICU patient presented sequelae of critical illness myopathy and polyneuropathy, stroke and encephalopathy and lower forced vital capacity compared to non-ICU patients. Cognitive impairment was found in 63.3% of patients, with a similar profile in both sub-groups. Increased physical fatigue, anxiety and depression and low quality of life were prevalent irrespective of acute COVID-19 severity. CONCLUSIONS: The variability of post COVID-19 physical and neuropsychological impairment requires a complex screening process both in ICU and non-ICU patients. The high impact of persistent symptoms on daily life activities and quality of life, regardless of acute infection severity, indicate need for rehabilitation. Show more

Keywords: COVID-19, sequelae, persistent symptoms, neurological impairment, cognitive impairment

DOI: 10.3233/NRE-210025

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 469-480, 2021

Authors: Mohon, Ricky T. | Sawyer, Kim | Pickett, Kaci | Bothwell, Samantha | Brinton, John T. | Sobremonte-King, Michelle | DelRosso, Lourdes M.

Article Type: Research Article

Abstract: BACKGROUND: Patients with cerebral palsy and other static encephalopathies (CP) are known to be at increased risk of sleep-related breathing disorders (SRBD). Few studies have reviewed whether intrathecal baclofen (ITB) can contribute to SRBD. OBJECTIVE: To assess the prevalence of SRBD in patients with CP receiving ITB by using nocturnal polysomnography (NPSG). METHODS: We performed a retrospective chart review of patients receiving ITB who had NPSG at Children’s Hospital Colorado (CHCO) and Seattle Children’s Hospital (SCH) from 1995 to 2019. The Gross Motor Function Classification System (GMFCS) measured the severity of motor disability. Screening sleep questionnaires …collected subjective data and NPSG provided objective data of SRBD. RESULTS: All patients except one were GMFCS 4 or 5 with median age at ITB pump placement of 9.7 years. The screening questionnaire for SRBD detected one or more nighttime symptoms in > 82% of all patient groups. Pre-ITB criteria for a SRBD was met in 83% of patients at CHCO and 91% at SCH. Post-ITB prevalence remained similarly high. CONCLUSIONS: NPSG identified a high prevalence of SRBD in these cohorts from CHCO and SCH. Our study showed neither improvement nor worsening of SRBD in patients receiving ITB. Show more

Keywords: Cerebral palsy, static encephalopathies, gross motor function classification system, GMFCS, nocturnal polysomnography, NPSG, Baclofen, intrathecal Baclofen, ITB, obstructive sleep apnea, OSA, central sleep apnea, CSA, periodic breathing, PB, sleep-related hypoxemia and hypoventilation

DOI: 10.3233/NRE-210012

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 481-491, 2021

Authors: Karunakaran, Kiran K. | Gute, Sharon | Ames, Gregory R. | Chervin, Kathleen | Dandola, Christina M. | Nolan, Karen J.

Article Type: Research Article

Abstract: BACKGROUND: Stroke is a leading cause of disability resulting in long-term functional ambulation deficits. Conventional therapy can improve ambulation, but may not be able to provide consistent, high dose repetition of movement, resulting in variable recovery with residual gait deviations. OBJECTIVE: The objective of this preliminary prospective investigation is to evaluate the ability of a robotic exoskeleton (RE) to provide high dose gait training, and measure the resulting therapeutic effect on functional ambulation in adults with acute stroke. METHODS: Participants (n  = 14) received standard of care (SOC) and RE overground gait training during their scheduled physical …therapy (PT) sessions at the same inpatient rehabilitation facility. The outcome measures included distance walked during their PT training sessions (RE and SOC), and functional ambulation measures (10-meter walk test (10MWT), 6-minute walk test (6 MWT), and timed up and go (TUG)). RESULTS: The average total distance walked during RE and the average distance per RE session was significantly higher than SOC sessions. Total walking distance during PT (RE+SOC) showed a strong positive correlation to the total number of steps during RE sessions and number of RE sessions. All functional ambulation measures showed significant improvement at follow-up compared to baseline. The improvement in functional ambulation measures showed a positive correlation with the increase in number of RE gait training sessions. CONCLUSION: The RE can be utilized for inpatient rehabilitation in conjunction with SOC gait training sessions and may result in improved functional ambulation in adults with acute stroke. This preliminary research provides information on the ability of the robotic exoskeleton to provide high dose therapy and its therapeutic effect on functional ambulation in adults with acute stroke during inpatient rehabilitation. Show more

Keywords: Wearable robotics, stroke, gait, functional measures, rehabilitation robotics, rehabilitation

DOI: 10.3233/NRE-210010

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 493-503, 2021

Authors: Gururaj, Sanjana | Natarajan, Manikandan | Balasubramanian, Chitralakshmi K. | Solomon, John M.

Article Type: Research Article

Abstract: BACKGROUND: Independent mobility is the most important determinant of quality of life after stroke and it is vital that training aimed at restoration of gait is based on contemporary evidence. Despite several practice guidelines for gait rehabilitation after stroke existing globally, their feasibility of application in low-resource settings is often questionable. OBJECTIVE: To investigate the current practices in gait training among Indian physiotherapists involved in the rehabilitation of stroke survivors. METHODS: A questionnaire on the various aspects of gait training was developed and the content was validated by experts. The survey was made available online and …distributed among Indian physiotherapists working in the field of stroke rehabilitation, using snowball sampling. Frequency distribution was used to summarize responses to each component of the questionnaire. RESULTS: Responses were obtained from 250 practicing physiotherapists. The majority of the respondents (55%) reported that they initiate gait training within seven days after stroke. Gait training sessions ranged from 15–30 minutes (55%), once every day (44%), and the majority (89%) reported use of subjective outcome measures to evaluate gait. Although most respondents agreed on the use of assistive aids, 24% indicated that their use may deter gait, rather than improve it. Nearly 86% of the respondents reported that they do not follow standard guidelines pertaining to gait rehabilitation for stroke survivors. CONCLUSION: The findings of the study point toward a lack of evidence-based practice among Indian physiotherapists while training gait after stroke. This implied the urgent need for development and implementation of country specific guidelines for stroke rehabilitation. Show more

Keywords: Healthcare surveys, low-middle income countries, guidelines, mobility, rehabilitation

DOI: 10.3233/NRE-210013

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 505-512, 2021

Authors: Lattouf, Nisrine Abdelnour | Tomb, Roland | Assi, Ayman | Maynard, Luc | Mesure, Serge

Article Type: Research Article

Abstract: BACKGROUND: In hemiparetic patients, the skeletal muscle is mainly affected with a combination of abnormalities (denervation, remodeling, spasticity, and eventually muscular atrophy). OBJECTIVE: This study examined the role of eccentric exercise in strengthening muscles of the lower extremity and ultimately improving autonomy in patients with post-stroke hemiparesis during gait. METHODS: Thirty-seven patients hemiparetic adults were recruited, randomized into a control group (n  = 19) and an intervention group receiving eccentric muscle strengthening (n  = 18). The protocol consisted of three sets of five repetitions of eccentric contraction of the paretic limb after determining the maximum repetition (1 MRI). …Evaluation of the 1RM, 10 meters and 6WMT was performed before and after the exercise for each group. Manova test was used to compare the differences between the control and intervention groups. RESULTS: The paretic limb showed significant increase in one-repetition maximum (1RM) between before and after rehabilitation (p ≤0.00003). The two groups of Patients increased their walking speed (p ≤0.0005), but we observed a significant difference between groups only for the 6MWT and not on the 10 meters Test. CONCLUSIONS: Eccentric training can be useful in strengthening the muscles of the lower limbs, and promoting gait performance. Eccentric training could complement other methods of managing patients with post-stroke hemiparesis. Show more

Keywords: Post-stroke hemiparesis, eccentric training, muscle rehabilitation, gait

DOI: 10.3233/NRE-201601

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 513-522, 2021

Authors: Rudomin, Guy | Keren, Ofer | Katz Leurer, Michal

Article Type: Research Article

Abstract: BACKGROUND: Nearly half of individuals post-stroke are dependent in their daily activities. The ability to ascend and descend stairs is an important component of independence in the community. OBJECTIVE: To predict the future ability of post-stroke individuals at the beginning of the sub-acute rehabilitation phase to achieve ascending and descending staircase independence. METHODS: 36 participants were recruited for the study. Outcome measures: independence in ascending and descending stairs up to the end of the sub-acute rehabilitation phase. Predictive measures included the knee extensors Muscles Strength (MS), the seated Modified Functional Reach (MFR) test, and Heart Rate …Variability (HRV) measures. Logistic and Cox regression were used. RESULTS: Twenty-four participants (66.7%) completed the sub-acute rehabilitation phase being independent in ascending and descending stairs. MFR was the best predictor (R2  = 0.18), and with MS the best predictors for the time (days) to achieve this goal during the sub-acute rehabilitation. HRV measure was found to be the main predictor of the staircase ascent model (R2  = 0.32), and MFR the best predictor for the descent model (R2  = 0.24). CONCLUSIONS: Balance performance is the main predictor of independence in ascending and descending stairs. Improving this component during the sub-acute rehabilitation phase might be reflected in achieving staircase independence. Show more

Keywords: Stroke, stairs ascending and descending, heart rate variability, muscles strength, balance performance

DOI: 10.3233/NRE-201641

Citation: NeuroRehabilitation, vol. 48, no. 4, pp. 523-532, 2021