NeuroRehabilitation - Volume 49, issue 1

Authors: McHugh, Conor | Taylor, Clare | Mockler, David | Fleming, Neil

Article Type: Review Article

Abstract: BACKGROUND: Epidural spinal cord stimulation (ESCS) emerged as a technology for eliciting motor function in the 1990’s and was subsequently employed therapeutically in the population with spinal cord injury (SCI). Despite a considerable number of ESCS studies, a comprehensive systematic review of ESCS remains unpublished. OBJECTIVE: The current review of the existing literature evaluated the efficacy of ESCS for improving motor function in individuals with SCI. METHODS: A search for ESCS studies was performed using the following databases: Medline (Ovid), Web of Science and Embase. Furthermore, to maximize results, an inverse manual search of references cited …by identified articles was also performed. Studies published between January 1995 and June 2020 were included. The search was constructed around the following key terms: Spinal cord stimulation, SCI and motor response generation. RESULTS: A total of 3435 articles were initially screened, of which 18 met the inclusion criteria. The total sample comprised of 24 participants with SCI. All studies reported some measure of improvement in motor activity with ESCS, with 17 reporting altered EMG responses. Functional improvements were reported in stepping (n  = 11) or muscle force (n  = 4). Only 5 studies assessed ASIA scale pre- and post-intervention, documenting improved classification in 4 of 11 participants. Appraisal using the modified Downs and Black quality checklist determined that reviewed studies were of poor quality. Due to heterogeneity of outcome measures utilized in studies reviewed, a meta-analysis of data was not possible. CONCLUSION: While the basic science is encouraging, the therapeutic efficacy of ESCS remains inconclusive. Show more

Keywords: Spinal cord stimulation, spinal cord injury and motor response generation

DOI: 10.3233/NRE-210093

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 1-22, 2021

Authors: Grampurohit, Namrata | Bell, Alison | Duff, Susan V. | Mulcahey, MJ | Thielen, Christina Calhoun | Kaplan, Gary | Marino, Ralph J.

Article Type: Review Article

Abstract: BACKGROUND: Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE: To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS: The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders …three months post onset/injury. RESULTS: The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION: The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI. Show more

Keywords: Activity-based, high-intensity, rehabilitation, therapy, scoping review, upper extremity, neurological conditions, spinal cord injury

DOI: 10.3233/NRE-210042

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 23-38, 2021

Authors: Cheng, Yun | Wang, Yong-Zheng | Zhang, Yi | Wang, Ya | Xie, Fan | Zhang, Yu | Wu, Ye-Huan | Guo, Jing | Fei, Xiao

Article Type: Research Article

Abstract: BACKGROUND: Rowland Universal Dementia Assessment Scale (RUDAS) has demonstrated usefulness in cognitive assessment. Studies supporting the use of RUDAS as an evaluation tool in traumatic brain injury (TBI) patients remain limited. This study examined whether the Chinese version of RUDAS can be effectively applied to the cognitive assessment of TBI patients in China. OBJECTIVE: To compare the performance of Mini-Mental State Examination (MMSE) and the Chinese version of RUDAS in the cognitive assessment of Chinese patients with TBI so as to provide reference for clinical use. METHODS: 86 inpatients with TBI in a hospital were selected …from July 2019 to July 2020 and were enrolled as the TBI group, while another 40 healthy individuals matched with age, sex and education level were selected as the control group. All subjects were assessed by trained rehabilitation physicians with MMSE and RUDAS. RESULTS: (1) Compared with the control group, the scores of MMSE and RUDAS in the TBI group decreased significantly; (2) The results of MMSE and RUDAS in the TBI group were positively correlated (r  = 0.611, P  < 0.001); (3) Linear correlation suggested that age was negatively correlated with MMSE (r  = –0.344, P  = 0.001) and RUDAS (r  = –0.407, P  < 0.001), while education years were positively correlated with MMSE (r  = 0.367, P  = 0.001) and RUDAS (r  = 0.375, P  < 0.001). However, according to the multiple linear regression, the results of RUDAS were not affected by the years of education; (4) Receiver operating curve analysis showed that there was no significant difference in the areas under the curve between MMSE and RUDAS. The best cut-off values of MMSE and RUDAS were 27.5 and 24.5, respectively. CONCLUSIONS: MMSE and RUDAS have similar diagnostic efficacy in evaluating cognitive impairment of patients with TBI. Since the Chinese version of RUDAS is not affected by the education level, it is more suitable for TBI patients in China. Show more

Keywords: Traumatic brain injury, cognitive impairment, Mini-Mental State Examination (MMSE), Rowland Universal Dementia Assessment Scale (RUDAS), educational level

DOI: 10.3233/NRE-210044

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 39-46, 2021

Authors: Cohen, Noa | Manor, Yael | Green, Yitzhak | Tahel, Gail | Badichi, Inbal | Ben-Or, Galit | shtainshlaifer, Neta | Shiffer, Asaf | Gabso-Rajuan, Maayan | Kurtzman, Hadar | Shtraifler, Liat | Furst, Tova | Shtein, Shlomi | Shulman, Juli | Hyute, Anat | Levin, Issachar | Inbar, Noit | Ariela, Hilel | Peled, Roni | Gheriani, Nurit | Ezra, Adi | Messer, Stav | Geva, Noya | Giladi, Nir | Gurevich, Tanya

Article Type: Research Article

Abstract: BACKGROUND: Intensive, multi-disciplinary, rehabilitation programs for patients with Parkinson’s disease (PWPs) have shown to be effective. However, most programs are based on in-patient service, which is expensive. OBJECTIVE: To demonstrate the feasibility of a multidisciplinary, intensive, outpatient rehabilitation program (MIOR) for moderate to advanced Parkinson’s Disease (H&Y≥2). METHOD: The MIOR program takes place at a community rehabilitation center (‘Ezra Le’Marpe’), 3 times a week, 5 hours, 8 weeks, and includes 20 PWPs in each cycle. The multi-disciplinary team includes physical, occupational, speech and hydro therapists. Additional activities include, social work groups, boxing, dancing and bridge. …RESULTS: Data was collected retroactively for the first two years. Data analysis includes 158 patient files who completed the program (mean disease duration 10.1±6 and mean H&Y stage 2.8±0.67). Assessments were performed at the beginning and end of the intervention. Positive results were collected: improvement in number of falls (p  < 0.0001), Functional Independence Measure (p  < 0.0001), quality of life (p  < 0.01), balance (p  < 0.0001), upper limb function (p  < 0.0001) and paragraph reading vocal intensity (p  < 0.01). CONCLUSIONS: MIOR is a feasible program, showing positive results in moderate to advanced PWP’s, improving quality of life, daily function, and motor performance. The current outcomes demonstrate feasibility of MIOR in addition to medical treatment. Show more

Keywords: Parkinson’s disease, rehabilitation, multidisciplinary, quality of life

DOI: 10.3233/NRE-210031

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 47-55, 2021

Authors: Lee, Ya-Yun | Li, Min-Hao | Luh, Jer-Junn | Tai, Chun-Hwei

Article Type: Research Article

Abstract: BACKGROUND: Recent advances in technology have warranted the use of wearable sensors to monitor gait and posture. However, the psychometric properties of using wearable devices to measure gait-related outcomes have not been fully established in patients with Parkinson’s disease (PD). OBJECTIVE: This study aimed to investigate the test-retest reliability of body-worn sensors for gait evaluation in people with PD. Additionally, the influence of disease severity on the reliability was determined. METHODS: Twenty individuals with PD were recruited. During the first evaluation, the participants wore inertial sensors on their shoes and walked along a walkway thrice at …their comfortable walking speed. The participants were then required to return to the lab after 3–5 days to complete the second evaluation with the same study procedure. Test-retest reliability of gait-related outcomes were calculated. To determine whether the results would be affected by disease severity, reliability was re-calculated by subdividing the participants into early and mid-advanced stages of the disease. RESULTS: The results showed moderate to good reliability (ICC = 0.64–0.87) of the wearable sensors for gait assessment in the general population with PD. Subgroup analysis showed that the reliability was higher among patients at early stages (ICC = 0.71–0.97) compared to those at mid-advanced stages (ICC = 0.65–0.81) of PD. CONCLUSIONS: Wearable sensors could reliably measure gait parameters in people with PD, and the reliability was higher among individuals at early stages of the disease compared to those at mid-advanced stages. Absolute reliability values were calculated to act as references for future studies. Show more

Keywords: Parkinson’s disease, gait, reliability, minimal detectable change, wearable sensors

DOI: 10.3233/NRE-210101

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 57-64, 2021

Authors: Song, Kyeong Joo | Chun, Min Ho | Lee, Junekyung | Lee, Changmin

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the effects of the robot–assisted gait training on cortical activation and functional outcomes in stroke patients. METHODS: The patients were randomly assigned: training with Morning Walk® (Morning Walk group; n  = 30); conventional physiotherapy (control group; n  = 30). Rehabilitation was performed five times a week for 3 weeks. The primary outcome was the cortical activation in the Morning Walk group. The secondary outcomes included gait speed, 10-Meter Walk Test (10MWT), FAC, Motricity Index–Lower (MI–Lower), Modified Barthel Index (MBI), Rivermead Mobility Index (RMI), and Berg Balance Scale (BBS). RESULTS: Thirty-six subjects were analyzed, 18 in …the Morning Walk group and 18 in the control group. The cortical activation was lower in affected hemisphere than unaffected hemisphere at the beginning of robot rehabilitation. After training, the affected hemisphere achieved a higher increase in cortical activation than the unaffected hemisphere. Consequently, the cortical activation in affected hemisphere was significantly higher than that in unaffected hemisphere (P  = 0.036). FAC, MBI, BBS, and RMI scores significantly improved in both groups. The Morning Walk group had significantly greater improvements than the control group in 10MWT (P  = 0.017), gait speed (P  = 0.043), BBS (P  = 0.010), and MI–Lower (P  = 0.047) scores. CONCLUSION: Robot-assisted gait training not only improved functional outcomes but also increased cortical activation in stroke patients. Show more

Keywords: Stroke, stroke rehabilitation, robotics, gait, hospitalization, functional connectivity

DOI: 10.3233/NRE-210034

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 65-73, 2021

Authors: Vanoglio, Fabio | Olivares, Adriana | Bonometti, Gian Pietro | Damiani, Silvia | Gaiani, Marta | Comini, Laura | Luisa, Alberto

Article Type: Research Article

Abstract: BACKGROUND: Walking independently after a stroke can be difficult or impossible, and walking reeducation is vital. But the approach used is often arbitrary, relying on the devices available and subjective evaluations by the doctor/physiotherapist. Objective decision making tools could be useful. OBJECTIVES: To develop a decision making algorithm able to select for post-stroke patients, based on their motor skills, an appropriate mode of treadmill training (TT), including type of physiotherapist support/supervision required and safety conditions necessary. METHODS: We retrospectively analyzed data from 97 post-stroke inpatients admitted to a NeuroRehabilitation unit. Patients attended TT with body weight …support (BWSTT group) or without support (FreeTT group), depending on clinical judgment. Patients’ sociodemographic and clinical characteristics, including the Cumulative Illness Rating Scale (CIRS) plus measures of walking ability (Functional Ambulation Classification [FAC], total Functional Independence Measure [FIM] and Tinetti Performance-Oriented Mobility Assessment [Tinetti]) and fall risk profile (Morse and Stratify) were retrieved from institutional database. RESULTS: No significant differences emerged between the two groups regarding sociodemographic and clinical characteristics. Regarding walking ability, FAC, total FIM and its Motor component and the Tinetti scale differed significantly between groups (for all, p  < 0.001). FAC and Tinetti scores were used to elaborate a decision making algorithm classifying patients into 4 risk/safety (RS) classes. As expected, a strong association (Pearson chi-squared, p  < 0.0001) was found between RS classes and the initial BWSTT/FreeTT classification. CONCLUSION: This decision making algorithm provides an objective tool to direct post-stroke patients, on admission to the rehabilitation facility, to the most appropriate form of TT. Show more

Keywords: Algorithm, body weight support, rehabilitation, safety, treadmill

DOI: 10.3233/NRE-210065

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 75-85, 2021

Authors: Bigoni, Matteo | Cimolin, Veronica | Vismara, Luca | Tarantino, Andrea G. | Baudo, Silvia | Trotti, Claudio | Galli, Manuela | Mauro, Alessandro

Article Type: Research Article

Abstract: BACKGROUND: Hemiparetic patients lose the ability to move their trunk selectively, abdominals are affected and neither voluntary nor reflex activity is present. OBJECTIVE: To investigate if the inclusion of specific exercises for the trunk muscles in a rehabilitation program for chronic hemiparetic patients could lead to an additional improvement. METHODS: A multiple-participant single-subject design was replicated in patients with hemiplegia. The study was conducted in two cycles: for the first cycle (A), patients received conventional rehabilitation program, then for the second cycle (B), six months later, the same subjects received conventional rehabilitation therapy plus an additional …specific selective trunk muscles training. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), 10 meters distance walk test (10 MWT), Functional Independence Measure (FIM) and instrumental gait analysis were performed before and after both treatment cycles. RESULTS: Significant changes were observed in TIS and 10 MWT after the two treatment cycles. However, after treatment cycle B, BBS and FIM score showed an additional improvement. Whereas, after treatment cycle A gait analysis did not relevantly changed, but after cycle B a significant improvement was registered in velocity, cadence and percentage of stance in the gait cycle. CONCLUSIONS: In our patients, the training for selective activation of the trunk muscles had led to a consistent improvement of gait analysis parameters, and hemiparesis-related disability in stance and activities of daily living. Show more

Keywords: Trunk, rehabilitation, stroke, kinematics, muscle activity

DOI: 10.3233/NRE-210094

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 87-94, 2021

Authors: Ribeiro, Tatiana S. | Silva, Emília M.G. | Vasconcellos, Liliane S. | Souza, Aline A. | Lindquist, Ana Raquel R.

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate if the capacity to perform functional mobility activities change within the first year post-stroke using the Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS). METHODS: A cross-sectional study was conducted with thirty-eight stroke individuals. A motion analysis system was used during the Timed “Up and Go” (TUG) test to evaluate the following activities: sit-to-stand, gait, turn, and stand-to-sit. Kinematic variables related to each activity were obtained in addition to TUG-ABS scores. The ability to perform the activities was compared between subacute (up to 3 months post-stroke, n  = 21) and chronic participants (4 to 12 …months post-stroke, n  = 17) using Mann-Whitney U tests (α = 5%). RESULTS: Results were expressed as median difference (MD) and 95% confidence intervals (95% CI). TUG-ABS scores: Sit-to-stand (MD = 0, 95% CI = 0.0 to 1), gait (MD = 0, 95% CI = 0.0 to 1), stand-to-sit (MD = 0, 95% CI = 0.0 to 1), and total score (MD = 2.0, 95% CI = 0.0 to 6) were not different between groups. Subacute participants presented significant better scores during turn activity (MD = 2.0, 95% CI 0.0 to 2.0). All kinematic variables were not different between participants. CONCLUSIONS: Capacity to perform functional activities was not different within the first year post-stroke, suggesting that biomechanical strategies are developed within the first three months following stroke. Show more

Keywords: Walking, disability evaluation, neurological rehabilitation

DOI: 10.3233/NRE-210027

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 95-101, 2021

Authors: Chen, Qingmei | Shen, Wenjun | Sun, Haiwei | Shen, Dan | Cai, Xiuying | Ke, Jun | Zhang, Lichi | Fang, Qi

Article Type: Research Article

Abstract: BACKGROUND: Mirror therapy (MT) has proven to be beneficial for treating patients suffering from motor aphasia after stroke. However, the impacts of MT on neuroplasticity remain unexplored. OBJECTIVE: In this paper we conducted a randomized controlled trial to evaluate the treatment using the MT on motor aphasia following acute cerebral infarction. METHODS: We randomly assigned 30 patients into test and control groups, with test group patients treated with MT, whereas control group patients were treated with sham MT. At 24 hours prior to and after the intervention, we obtained functional magnetic resonance imaging (fMRI) data from …study subjects. At baseline, after treatment and 12-week follow-up, we additionally evaluated patients with the Modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the aphasia quotient (AQ) in the western aphasia test. RESULTS: After 2 weeks of treatment, the test group demonstrated significant improvements in AQ values, naming, repetition, spontaneous speech, and mRS scores compared to the control group (P  < 0.05). Furthermore, in the follow-up time point (12 weeks), we found that the test group exhibited significantly better NIHSS scores and AQ evaluation indicators than the control group (P  < 0.05). Specifically, the fMRI study shows that functional connectivity significantly improved in test group patients mainly among frontal, temporal, and parietal lobes of the left hemisphere with each other than controls group. Meanwhile, we found significantly enhanced functional connectivity with the hippocampus (P  < 0.01). CONCLUSIONS: Our results indicate that the MT can expedite the recovery of language function during the early phases of stroke recovery. These findings may elucidate the underlying mechanism of MT and the application of this therapy as an adjunct rehabilitation technique in language recovery. Show more

Keywords: Mirror therapy, acute cerebral infarction, motor aphasia, rehabilitation, neural mechanism, functional magnetic resonance imaging

DOI: 10.3233/NRE-210125

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 103-117, 2021