NeuroRehabilitation - Volume 49, issue 1

Authors: Wyatt, Lindsay E. | Champod, Anne Sophie | Haidar, Gabrielle M. | Eskes, Gail A.

Article Type: Research Article

Abstract: BACKGROUND: While prism adaptation (PA) has been recognized as a promising tool for treating spatial neglect, implementation as a standard treatment in clinical care has been lagging. Limited evidence for the generalization of after-effects to everyday activities has been a barrier towards implementation. OBJECTIVES: This study examined whether a home-friendly standardized PA protocol (Peg-the-Mole, PTM) induces after-effects that can transfer to wheelchair maneuvering. We also examined the impact of using constant (1 starting hand position) or variable (3 starting hand positions) training conditions on the transfer of after-effects to wheelchair maneuvering. METHODS: Sixty participants were randomly …assigned to one of four PTM conditions: 1) prisms/constant training; 2) prisms/variable training; 3) sham goggles/constant training; 4) sham goggles/variable training. RESULTS: The use of PTM with rightward shifting prisms induced after-effects on proprioceptive and visual pointing outcome tasks. Groups using PTM with prism goggles showed a leftward shift in their position within a wheelchair course and a reduction in the number of right-sided collisions. The training condition did not have an impact on the transfer of after-effects to wheelchair driving. CONCLUSION: PTM is a clinically appealing PA protocol that induces after-effects that can transfer to an everyday activity relevant to patients with neglect. Show more

Keywords: Prism adaptation, after-effects, activities of daily living, wheelchair maneuvering, spatial neglect

DOI: 10.3233/NRE-210028

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 119-128, 2021

Authors: Benedetti, Maria Grazia | De Santis, Letizia | Mariani, Giorgio | Donati, Danilo | Bardelli, Roberta | Perrone, Mariada | Brunelli, Stefano

Article Type: Research Article

Abstract: BACKGROUND: Chronic pain is common in patients who undergo lower limb amputation. The use of epidural or perineural catheters seems to reduce acute pain after surgery but their effects in a longer follow up are unknown. OBJECTIVE: To evaluate the long-term prevalence of phantom limb sensation (PLS), phantom limb pain (PLP), and residual limb pain (RLP) and their correlation with perioperative use of epidural or perineural catheters. METHODS: Postal survey. Patients with trans-femoral, trans-tibial or hemi-pelvectomy amputation were asked to partake in the study. The Prosthetic Evaluation Questionnaire was used for the presence of chronic post-surgical …pain. Use of catheters was retrieved from medical notes. RESULTS: 57 patients at a mean of 4.4 years follow up were included. PLS was reported in 68.4%, PLP in 63.2 % and RLP in 54.4% of amputees. No correlation was identified between pain syndromes and the presence of individual catheters and the duration of their permanence. The simultaneous use of 2 catheters was related to a lesser presence of PLP. CONCLUSIONS: Data on prevalence of PLP, PLS and RLP are consistent with the literature. Favourable effects in PLP reduction in the long term follow up was related to the simultaneous use of two catheters. Show more

Keywords: Amputation, chronic pain, epidural analgesia, perineural catheters

DOI: 10.3233/NRE-210077

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 129-138, 2021

Authors: Elnaggar, Ragab K. | Alqahtani, Bader A. | Alsubaie, Saud F. | Mohamed, Rania R. | Elbanna, Mohammed F.

Article Type: Research Article

Abstract: BACKGROUND: Children with unilateral cerebral palsy (UCP) experience an asymmetrical gait pattern and poor balance capabilities. Effective interventions, therefore, are needed to facilitate remediation of these functional issues. OBJECTIVE: This study was set out to investigate the emerging role of stretch-shortening cycle (SSC) exercises on gait-symmetry and balance in children with UCP. METHODS: In this randomized controlled trial, 42 children with UCP (age; 8 –12 years) were enrolled and received either standard physical rehabilitation (control group; n  = 21) or the SSC exercise program plus physical rehabilitation (SSC group; n  = 21). Spatial- and temporal-gait symmetry index (GSI) …and specific balance capabilities [reactive balance, directional control, movement synchronization, and sensory organization] were assessed before and after 16 sessions that were carried out twice/week over non-sequential days in an 8-week program. RESULTS: Using the pre-treatment scores as covariates, the post-treatment spatial- (P  = 0.006; η p 2 = 0.17) and temporal- GSI (P  < .001; η p 2 = 0.46) scores reduced significantly in the SSC group as compared to the control group, suggesting favorable improvement of gait symmetry. Also, all measures of balance (P  < 0.05; η p 2 ranged between 0.10 and 0.29) improved remarkably, post-treatment, in SSC group in comparison with the control group. CONCLUSION: The evidence from this study suggests that SSC exercises besides standard physical rehabilitation appear to be effective for improving gait symmetry and boosting balance capabilities in children with UCP. Show more

Keywords: Cerebral palsy, strength training, plyometric exercise, gait, postural balance

DOI: 10.3233/NRE-210063

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 139-149, 2021

Authors: Papa, Evan V. | Patterson, Rita M. | Bugnariu, Nicoleta

Article Type: Research Article

Abstract: BACKGROUND: Nearly half of persons with Parkinson disease (PD) report fatigue as a factor in their fall history. However, it is unknown whether these self-reported falls are caused by a sensation of fatigue or performance fatigue. OBJECTIVE: We sought to investigate the influences of performance fatigue and age on postural control in persons with PD. METHODS: Individuals with PD (n  = 14) underwent postural control assessments before (T0) and immediately after (T1) fatiguing exercise. Biomechanical data were gathered on participants completing a treadmill-induced, posterior-directed fall. Performance fatigue was produced using lower extremity resistance exercise on an isokinetic …ergometer. Repeated measures ANCOVAs were used with age as a covariate to determine the effects of performance fatigue on biomechanical variables. RESULTS: After adjustment for age, there was a statistically significant difference in peak center of pressure (COP) latency during the support phase of recovery. Pairwise comparisons demonstrated a decrease in peak ankle displacement from T0 to T1. Age was also found to be significantly related to reaction time and peak knee displacement while participants were fatigued. CONCLUSIONS: The decreased peak COP latency, along with decreased ankle angular displacement, suggest that persons with PD adopt a stiffening strategy in response to backward directed falls. Postural stiffening is not uncommon in persons with PD and could be a risk factor for falls. Older individuals with PD demonstrate slower mobility scores and decreased reaction times in the setting of fatigue, suggesting a combined effect of the aging and fatigue processes. Show more

Keywords: Parkinson’s disease, balance, falls, fatigue, performance fatigue

DOI: 10.3233/NRE-210040

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 151-159, 2021

Authors: Kim, Heakyung | Kolaski, Kat

Article Type: Other

Abstract: BACKGROUND: Botulinum toxin A (BoNT-A) is a well-accepted treatment for the medical management of spasticity in children with cerebral palsy (CP). OBJECTIVE: To assess the efficacy and safety of BoNT-A compared with other treatment options in managing lower limb spasticity in children with CP. METHODS: A summary of the Cochrane Review update by Blumetti et al. (2019) , with comments. RESULTS: This review included 31 randomized controlled trials (1508 participants). Compared with usual care/physiotherapy, the evidence is very uncertain about the effect of BoNT-A on gait, function, ankle joint range of motion (ROM), satisfaction, …and ankle spasticity in children with CP. Compared with placebo/sham, BoNT-A probably benefits these same outcomes, although the results for function are contradictory. BoNT-A may not be more effective than serial casting at improving gait, function, ankle ROM and spasticity at any time point. However, it may be more effective than an orthosis at medium-term follow-up for hip ROM and adductor spasticity, but not function. The rate of adverse events with BoNT-A is similar to placebo/sham and serial casting. CONCLUSIONS: Evidence for the effectiveness and safety of BoNT-A for the management of lower limb spasticity in children with CP is uncertain, with better quality evidence available from studies of placebo/sham than non-placebo controls. To produce high-quality evidence, future studies need to improve their methodological quality and increase sample sizes. Show more

Keywords: Botulinum toxin A, spasticity, efficacy, safety, evidence

DOI: 10.3233/NRE-218003

Citation: NeuroRehabilitation, vol. 49, no. 1, pp. 161-164, 2021