NeuroRehabilitation - Volume 49, issue 3

Authors: Ohara, Kensuke | Kuriyama, Chiaki | Hada, Takuya | Suzuki, Shin | Nakayama, Yasuhide | Abo, Masahiro

Article Type: Research Article

Abstract: BACKGROUND: A lot of research on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in patients with aphasia in the chronic stage deals with low-frequency stimulation, and reports on high-frequency stimulation (HF-rTMS) are scarce. OBJECTIVE: The purpose of this study was to evaluate retrospectively the effectiveness of high-frequency rTMS in combination with intensive speech-language-hearing therapy (ST) following the identification of the stimulation site using functional magnetic resonance imaging (fMRI) before, after the procedure and at 3 months in patients with aphasia in the chronic stage. METHODS: 20 patients with aphasia in the chronic stage who met …the eligibility criteria for rTMS therapy and who underwent HF-rTMS for the first time were included in the present study. All patients received fMRI before hospitalization, and the stimulation site was decided accordingly. RESULTS: There was a significant improvement in all patients, rTMS to the left hemisphere, fluent and non-fluent groups by the evaluation of pre- and post- treatment by hospitalization. All groups had a significant improvement in total Standard Language Test of Aphasia score at 3 months when compared with the time of hospitalization. CONCLUSIONS: The current study indicates that HF-rTMS in combination with intensive ST is an effective therapeutic approach for patients with aphasia in the chronic stage. Show more

Keywords: rTMS, aphasia, fMRI, speech-language-hearing therapy, high-frequency, stroke

DOI: 10.3233/NRE-210139

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 459-467, 2021

Authors: Dimitrova, Rozalina | McCusker, Emily | Gormley, Mark | Fehlings, Darcy | Alter, Katharine E. | Greaves, Susan | Liu, Chengcheng | Brin, Mitchell F.

Article Type: Research Article

Abstract: BACKGROUND: This is the first large study of onabotulinumtoxinA as treatment for pediatric upper limb spasticity. OBJECTIVE: Evaluate efficacy and safety of a single treatment with onabotulinumtoxinA plus occupational therapy (OT). METHODS: In this registrational phase III, multinational study (NCT01603602), participants were randomized 1:1:1 to onabotulinumtoxinA 3 U/kg/OT, 6 U/kg/OT, or placebo/OT. Primary endpoint was average change from baseline at weeks 4 and 6 in Modified Ashworth Scale-Bohannon (MAS) score. Secondary endpoints included Modified Tardieu Scale (MTS), Clinical Global Impression of Change (CGI) and functional Goal Attainment Scale (GAS). RESULTS: 235 participants were randomized. At weeks …4 and 6, onabotulinumtoxinA groups had greater mean reductions in MAS (both –1.9; p  < 0.001) versus placebo (–1.2). OnabotulinumtoxinA doses improved dynamic tone per MTS. Mean CGI at weeks 4 and 6 was unchanged in the overall population, but improved in a post hoc analysis of patients with a single affected upper limb (UL) muscle group (elbow or wrist). GAS score for passive goals was significantly higher for 6 U/kg versus placebo at week 12. Most AEs were mild/moderate in severity; overall incidence was similar between groups. CONCLUSIONS: OnabotulinumtoxinA (3 and 6 U/kg) was safe and effective in reducing upper limb spasticity in pediatric participants. Show more

Keywords: Children, onabotulinumtoxinA, randomized clinical trial, spasticity, upper limb

DOI: 10.3233/NRE-210071

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 469-479, 2021

Authors: Liguori, Sara | Moretti, Antimo | Palomba, Angela | Paoletta, Marco | Gimigliano, Francesca | De Micco, Rosa | Siciliano, Mattia | Tessitore, Alessandro | Iolascon, Giovanni

Article Type: Research Article

Abstract: BACKGROUND: In patients with Parkinson disease (PD), severe postural and gait impairments are rarely observed in early stage of disease and non-motor symptoms (NMS) are often overlooked. OBJECTIVE: This observational study aimed to characterize the impact of non-motor impairments on walking kinematics in early stages PD patients, and to assess the differences of gait parameters and NMS between PD patients with and without mild cognitive impairment (MCI). METHODS: Twenty-six patients with Modified Hoehn and Yahr Scale score≤2 were evaluated for NMS using Kings Parkinson’s Pain Scale, Parkinson Fatigue Severity scale, Parkinson Anxiety Scale, Beck Depression Inventory …and Epworth Sleepiness Scale, kinematic parameters through an inertial sensor and cognitive performance by a comprehensive neuropsychological battery. RESULTS: Fatigue had a moderate negative correlation with step cadence, and a moderate to strong positive correlation with gait duration, Timed Up and Go (TUG) and TUG Dual Task (p  < 0.01). Pain showed positive moderate correlation with gait duration (p  < 0.01). Twelve patients resulted affected by MCI and reported significantly worse scores in gait duration, pain and fatigue (p  < 0.05). According to cognitive z scores, PD-MCI group showed a moderate negative correlation between visuospatial abilities and fatigue (p  < 0.05). CONCLUSIONS: NMS significantly affect walking kinematics whereas a limited role of cognitive status on motor performance occur in the early PD stages. Show more

Keywords: Parkinson disease, gait disorder, neurologic, fatigue, pain, cognitive dysfunction

DOI: 10.3233/NRE-210146

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 481-489, 2021

Authors: Meiner, Zeev | Marmor, Anat | Jalagel, Murad | Levine, Hagai | Shiri, Shimon | Schwartz, Isabella

Article Type: Research Article

Abstract: BACKGROUND: More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome. OBJECTIVE: To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years. METHODS: A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities …of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires. RESULTS: Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions. CONCLUSIONS: Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging. Show more

Keywords: Poliomyelitis, functional outcomes, ADL, wheelchair use

DOI: 10.3233/NRE-210216

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 491-499, 2021

Authors: Hirakawa, Yuichi | Koyama, Soichiro | Takeda, Kazuya | Iwai, Masanobu | Motoya, Ikuo | Sakurai, Hiroaki | Kanada, Yoshikiyo | Kawamura, Nobutoshi | Kawamura, Mami | Tanabe, Shigeo

Article Type: Case Report

Abstract: BACKGROUND: There are no reports regarding the long-term retention of effects of Lee Silverman Voice Treatment® BIG (LSVT® BIG) on improvements in quality of life (QOL) among patients with Parkinson’s disease (PD). OBJECTIVE: This study aimed to evaluate the short-term effect of LSVT® BIG on QOL improvement and its retention in a patient with PD. Motor symptoms, walking ability, and walking speed were evaluated as factors associated with QOL. METHODS: A 63-year-old woman who was diagnosed with PD received a 4-week LSVT® BIG program under the supervision of certified LSVT® BIG physical …therapists. The participant’s disease severity was classified as Hoehn and Yahr stage 2. The Parkinson’s Disease Questionnaire-39 (PDQ-39), Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part 3, timed up-and-go test (TUG), and 10 m walk test (10 MWT) were evaluated before, after, and 1-year after the intervention. RESULTS: The results indicated short-term improvements in the PDQ-39, MDS-UPDRS part 3, TUG, and 10 MWT which were retained for up to 1 year. CONCLUSIONS: This case report suggests the possibility of 1-year retention of improvements in QOL, motor symptoms, walking ability, and walking speed resulting from LSVT® BIG intervention in a patient with mild PD. Show more

Keywords: Parkinson’s disease, Lee Silverman Voice Treatment® BIG, long-term retention, case report

DOI: 10.3233/NRE-210129

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 501-509, 2021

Authors: Gimigliano, Francesca

Article Type: Other

Abstract: BACKGROUND: Mental practice, which is proposed for the rehabilitation of people post-stroke, is a training method based on the repetition of the internal representation of a movement or a task with the aim of improving the performance. OBJECTIVE: The aim of this commentary is to discuss Cochrane evidence on the efficacy of mental practice in improving upper extremity functioning in people with hemiparesis after stroke. METHODS: To summarize and discuss from a rehabilitation perspective the published Cochrane Review “Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke” by Barclay et al. …RESULTS: This Cochrane Review included 25 studies involving 676 people with hemiparesis after stroke. The authors analysed the following two comparisons: mental practice versus conventional therapy and mental practice in addition to other treatment versus other treatment (±placebo). CONCLUSIONS: Mental practice in addition to other treatment, compared with other treatment, probably improves upper extremity activity and function in people with hemiparesis after stroke. Show more

Keywords: Mental practice, hemiparesis, stroke, rehabilitation, activity, functioning

DOI: 10.3233/NRE-218005

Citation: NeuroRehabilitation, vol. 49, no. 3, pp. 511-513, 2021