NeuroRehabilitation - Volume 49, issue 4

Authors: da Silva Machado, Camila Beatriz | da Silva, Letícia Maria | Gonçalves, Alessandra Feitosa | Andrade, Palloma Rodrigues de | Mendes, Cristina Katya Torres Teixeira | de Assis, Thais Josy Castro Freire | Godeiro Júnior, Clécio de Oliveira | Andrade, Suellen Marinho

Article Type: Review Article

Abstract: BACKGROUND: Parkinson’s disease (PD) is a progressive neurodegenerative disorder, characterized by cardinal motor symptoms in addition to cognitive impairment. New insights concerning multisite non-invasive brain stimulation effects have been gained, which can now be used to develop innovative treatment approaches. OBJECTIVE: Map the researchs involving multisite non-invasive brain stimulation in PD, synthesize the available evidence and discuss future directions. METHODS: The databases PubMed, PsycINFO, CINAHL, LILACS and The Cochrane Library were searched from inception until April 2020, without restrictions on the date of publication or the language in which it was published. The reviewers worked in …pairs and sequentially evaluated the titles, abstracts and then the full text of all publications identified as potentially relevant. RESULTS: Twelve articles met the inclusion criteria. The target brain regions included mainly the combination of a motor and a frontal area, such as stimulation of the primary motor córtex associated with the dorsolateral prefrontal cortex. Most of the trials showed that this modality was only more effective for the motor component, or for the cognitive and/or non-motor, separately. CONCLUSIONS: Despite the results being encouraging for the use of the multisite aproach, the indication for PD management should be carried out with caution and deserves scientific deepening. Show more

Keywords: Parkinson’s disease, non-invasive brain stimulation, transcranial magnetic stimulation, transcranial direct current stimulation

DOI: 10.3233/NRE-210190

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 515-531, 2021

Authors: Kim, Mikyoung | Park, Chanhee | Jeon, Hyeseon | Choi, Woochol Joseph | You, Sung (Joshua) Hyun

Article Type: Research Article

Abstract: BACKGROUND: While the transdisciplinary-based rehabilitation provided ample evidence on improving impairment (body structure and functions) levels, the therapeutic effects on the international classification of functioning, disability, and health (ICF) domains are unknown in cerebral palsy (CP). OBJECTIVE: To compare the effects of the community-based family-child-centered care (CFC) and conventional pediatric rehabilitation (CPR) on the physical, cognitive, sensory, and social integration domains in children and adolescents with CP. METHODS: Twenty-six participants with CP (mean age = 9.37±5.24, 14 females) were assigned into either CPR or CFC groups. Clinical outcomes included gross motor function measure (GMFM-66), Pediatric Balance Scale (PBS), …fine motor area of Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), Functional Independence Measure (FIM) cognition area, Short Sensory Profile (sSP), COPM, Pediatrics Quality of Life (PedsQL) questionnaire, Short Falls Efficacy Scale (sFES), and Dynamic Postural Instability (DPI). An analysis of variance (ANOVA) and an analysis of covariance (ANCOVA) was conducted at P  < 0.05. RESULTS: ANOVA revealed the superior effects of CFC in GMFM-66, PBS, BOT-2, FIM, and PedsQL compared to CPR (P  < 0.05). ANCOVA showed the superior effects of CFC in Z-axis of DPI than CPR (P  < 0.05). CONCLUSIONS: Our results provide novel, promising clinical evidence that CFC was more effective than CPR at improving impairment, activity, as well as participation levels in participants with CP. Show more

Keywords: Cerebral palsy, ICF model, impairment, activity, participants, behavior therapy, community (re)integration, motor impairment, physical therapy

DOI: 10.3233/NRE-210219

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 533-546, 2021

Authors: Shaik, Abdul Rahim | Ahmad, Fuzail | Miraj, Mohammad | Alqahtani, Mazen | Alzhrani, Msaad | Alanazi, Ahmad | Kashoo, Faizan

Article Type: Research Article

Abstract: BACKGROUND: The risk of falling for individuals with stroke is about twice that of healthy older adults. Lack of appropriate initiative to address the fear-related maladaptive behaviour can manifest itself in the form of loss of physical functions resulting in disability and handicap. OBJECTIVE: To examine the effectiveness of the structured balance awareness program (SBAP) in improving the perceived balance confidence, and thereby modifying the fear-related maladaptive behaviour in post-stroke survivors. METHODS: A randomized experimental control design was used on a sample of 97 post-stroke survivors aged between 55 to 75 years. The patients received either …the SBAP or health awareness program (HAP) for eight weeks and were compared on Activities-specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS) and Falls Efficacy Scale International (FESI). RESULTS: A paired t -test demonstrated statistically significant improvement among all the variables in the SBAP group. An independent t -test exhibited a statistically significant improvement on ABC (t = 2.57, p  = 0.012* ), BBS (t = 3.32, p  = 0.001* ) and FESI (t = 3.38, p  = 0.001* ) in the SBAP group. CONCLUSION: The study showed that the SBAP was effective in minimizing the fear-related maladaptive behaviour in post-stroke survivors. Show more

Keywords: Stroke, balance awareness program, activities-specific balance confidence scale, berg balance scale, falls efficacy scale international

DOI: 10.3233/NRE-210144

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 547-552, 2021

Authors: Jeong, Seon Ah | Park, Chanhee | Oh, Seung Jun | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: The World Health Organization has developed the International Classification of Functions, Disabilities, and Health (ICF) model providing a theoretical basis for physical therapy diagnosis and interventions related to health conditions. However, the multiple relationship between body structure/function and activity domain variables is unknown on the cognition, spasticity, trunk and lower extremity recovery of the sensorimotor function and activity. OBJECTIVE: Our study aimed to determine the relationship between body structure/functions and body activity domain variables in adults with stroke. METHODS: A total of 218 hemiplegic survivors (102 females, mean age 64.98±13.53) were recruited from the Chungdam …Hospital Center for our retrospective study. We used Mini-Mental State Examination (MMSE), Fugl-Meyer Assessment for lower extremity (FMA-LE), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Trunk Impairment Scale (TIS) as clinical outcome measures. The Pearson correlation coefficient was used to determine the multiple relationships among the variables at P  < 0.05. RESULTS: The correlations between body structure/function domain (MMSE, FMA-LE, MAS) and activity domain variables (BBS, MBI, and TIS) were significant, rending from pre -intervention r  = –0.216 to 0.766 and post-intervention r  = –0.213 to 0.776, P  < 0.05, except for MMSE and MAS. CONCLUSIONS: Establishing a significant difference between body structure/functions and activity domain variables in our research implies important multiple relationships between cognitive function, lower extremity function, lower extremity spasticity, and balance, and performance of ADL and trunk control coordination after stroke. Show more

Keywords: ICF, stroke, correlation, outcome measures, impairment

DOI: 10.3233/NRE-210195

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 553-563, 2021

Authors: Kim, Jong Moon | Tay, Matthew Rong Jie | Rajeswaran, Deshan Kumar | Tham, Shuen-Loong | Lui, Wen Li | Kong, Keng He

Article Type: Research Article

Abstract: BACKGROUND: Early muscle changes are believed to occur in patients with stroke. However, there are insufficient data on the changes in muscle mass and architecture of these patients. OBJECTIVES: This study investigates differences in ultrasound-derived muscle architecture parameters of the hemiplegic upper and lower limbs in patients with subacute stroke. METHODS: This is a prospective observational study, which recruited 40 adult patients who had experienced a first ever unilateral stroke (ischemic or hemorrhagic), with a duration of < 1 month post stroke. The brachialis, vastus lateralis and medial gastrocnemius on both the hemiplegic and normal side were evaluated …via ultrasound. We recorded clinical variables including Motricity Index, Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM)-walk. RESULTS: We found reduced mean muscle thickness (p  < 0.001) and increased echo intensity (p  < 0.001) in the brachialis muscle, increased echo intensity (p  = 0.002) in the vastus lateralis muscle, and reduced muscle thickness (p  < 0.001) with increased echo intensity (p  < 0.001) in the medial gastrocnemius muscle compared to the normal side. There were no significant correlations between ultrasound findings and Motricity Index. CONCLUSIONS: We report changes in ultrasound-derived muscle architecture in the hemiplegic limbs of patients with subacute stroke, with consistent findings of decreased muscle mass and increased echo intensity. Show more

Keywords: Ultrasonography, skeletal muscle, hemiplegia, neurologic disorders

DOI: 10.3233/NRE-210257

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 565-572, 2021

Authors: Boissoneault, Catherine | Rose, Dorian K. | Grimes, Tyler | Waters, Michael F. | Khanna, Anna | Datta, Somnath | Daly, Janis J.

Article Type: Research Article

Abstract: BACKGROUND: Gait deficits and functional disability are persistent problems for many stroke survivors, even after standard neurorehabilitation. There is little quantified information regarding the trajectories of response to a long-dose, 12-month intervention. OBJECTIVE: We quantified treatment response to an intensive neurorehabilitation mobility and fitness program. METHODS: The 12-month neurorehabilitation program targeted impairments in balance, limb coordination, gait coordination, and functional mobility, for five chronic stroke survivors. We obtained measures of those variables every two months. RESULTS: We found statistically and clinically significant group improvement in measures of impairment and function. There was high variation …across individuals in terms of the timing and the gains exhibited. CONCLUSIONS: Long-duration neurorehabilitation (12 months) for mobility/fitness produced clinically and/or statistically significant gains in impairment and function. There was unique pattern of change for each individual. Gains exhibited late in the treatment support a 12-month intervention. Some measures for some subjects did not reach a plateau at 12 months, justifying further investigation of a longer program (>12 months) of rehabilitation and/or maintenance care for stroke survivors. Show more

Keywords: Stroke, gait, balance, coordination, gait speed, functional mobility, quality of life

DOI: 10.3233/NRE-210147

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 573-584, 2021

Authors: Almutairi, Sattam | Swank, Chad | Wang-Price, Sharon | Gao, Fan | Medley, Ann

Article Type: Research Article

Abstract: BACKGROUND: Robotic exoskeleton (RE) enables individuals with lower extremity weakness or paralysis to stand and walk in a stereotypical pattern. OBJECTIVE: Examine whether people with chronic incomplete spinal cord injury (SCI) demonstrate a more typical gait pattern when walking overground in a RE than when walking without. METHODS: Motion analysis system synchronized with a surface electromyographic (EMG) was used to obtain temporospatial gait parameters, lower extremity kinematics, and muscle activity in ambulatory individuals with SCI and healthy adults. RESULTS: Temporospatial parameters and kinematics for participants with SCI (n  = 12; age 41.4±12.5 years) with and …without RE were significantly different than a typical gait (healthy adults: n  = 15; age 26.2±8.3 years). EMG amplitudes during the stance phase of a typical gait were similar to those with SCI with and without RE, except the right rectus femoris (p  = 0.005) and left gluteus medius (p  = 0.014) when participants with SCI walked with RE. EMG amplitudes of participants with SCI during the swing phase were significantly greater compared to those of a typical gait, except for left medial hamstring with (p  = 0.025) and without (p  = 0.196) RE. CONCLUSIONS: First-time walking in a RE does not appear to produce a typical gait pattern in people with incomplete SCI. Show more

Keywords: Bionics, rehabilitation, walking, spinal cord disorder, kinematics, muscle activity

DOI: 10.3233/NRE-210187

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 585-596, 2021

Authors: Khalil, Hanan | Aburub, Aseel | Kanaan, Saddam F. | AlSharman, Alham | Khazaaleh, Shada | Al Qawasmeh, Majdi | El-Salem, Khalid

Article Type: Research Article

Abstract: BACKGROUND: Assessing physical activity (PA) in people with multiple sclerosis (PwMS) is essential to follow-up the recommended PA level. The International Physical Activity Questionnaire (IPAQ) and the Incidental and Planned Exercise Questionnaire (IPEQ) have been widely used, but their validity has not been investigated previously in PwMS. OBJECTIVE: This study aimed to assess the convergent and criterion validity of the IPAQ and the IPEQ in PwMS. METHODS: 50 PwMS were asked to wear an Actigraph for seven days and to fill the IPAQ and IPEQ. Sedentary, moderate (MPA), vigorous (VPA) and moderate to vigorous PA (MVPA) …levels were recorded. RESULTS: Significant correlations were found between sitting time as reported by IPAQ and sedentary time as recorded by Actigraph (r  = 0.41, p  = 0.003), VPA by IPAQ and VPA as recorded by Actigraph (r  = 0.46, p  = 0.001), and MVPA by IPAQ and MVPA by Actigraph (r  = 0.36, p  = 0.011). IPEQ showed poor both criterion and convergent validity when compared to the Actigraph. Both IPAQ and IPEQ overestimate the intensities of PA for all the derived parameters. CONCLUSIONS: Findings of this study are important as they suggest that IPAQ in particular had convergent validity when compared to Actigraph data, but still had the problem of overestimating PA levels. Show more

Keywords: Physical activity, IPAQ; IPEQ, Actigraph, multiple sclerosis, Incidental and Planned Exercise Questionnaire, International Physical Activity Questionnaire

DOI: 10.3233/NRE-210188

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 597-606, 2021

Authors: Allen, Diane D. | Gadayan, Jessica | Hughes, Rebecca | Magdalin, Christine | Jang, Catherine | Schultz, Amy | Scott, Kathryn | Vivero, Leah | Lazaro, Rolando L. | Widener, Gail L.

Article Type: Research Article

Abstract: BACKGROUND: Multiple sclerosis (MS) and Parkinson’s disease (PD) may affect balance differently. However, no studies have compared loss of balance (LOB) patterns following multi-directional perturbations. OBJECTIVE: 1) determine reliability of LOB ratings following standardized manual perturbations; 2) compare LOB ratings in MS, PD, and healthy control (HC) groups following perturbations at upper/lower torso, in anterior/posterior, right/left, and rotational directions. METHODS: 1) reviewers rated videotaped LOB following perturbations applied by 4 clinicians in 6–10 HCs. 2) three groups (64 MS, 42 PD and 32 HC) received perturbations. LOB ratings following perturbations were analyzed using two-factor mixed ANOVAs …for magnitude and prevalence. RESULTS: 1) LOB ratings showed moderate to good ICC and good to excellent agreement. 2) MS group showed greater magnitude and prevalence of LOB than PD or HC groups (p  < .001). All groups showed greater LOB from right/left versus anterior/posterior perturbations (p  < .01). PD showed greater LOB from perturbations at upper versus lower torso; MS and HC showed greater LOB from posterior versus anterior perturbations. CONCLUSIONS: Our reliable rating scale showed differences in patterns of LOB following manual perturbations in MS, PD, and HC. Clinically accessible and reliable assessment of LOB could facilitate targeted perturbation-based interventions and reduce falls in vulnerable populations. Show more

Keywords: Parkinson’s disease, multiple sclerosis, balance, perturbations, assessment, reliability

DOI: 10.3233/NRE-210200

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 607-618, 2021

Authors: Shearin, Staci | Braitsch, Michael | Querry, Ross

Article Type: Research Article

Abstract: BACKGROUND: Parkinson disease (PD) is a progressive neurological disease resulting in motor impairments, postural instability, and gait alterations which may result in self-care limitations and loss of mobility reducing quality of life. OBJECTIVE: This study’s purpose was to determine the impact of a community-based boxing program on gait parameters, dual task and backwards walking in individuals with PD. METHODS: This study included 26 community dwelling individuals with PD who participated in 12-week boxing classes (1 hour, 2 times a week). The focus was on upper/lower extremity exercises using punching bags, agility drills, and strengthening activities. Pre/post …testing was performed for dual task and gait parameters and was analyzed using t -tests. RESULTS: Analysis of the scores indicated participants performed significantly better at post-test compared to pre-test on self-selected walking velocity (P  = 0.041), cadence (P  = 0.021); backwards walking velocity (P  = 0.003), step length (P  = 0.022); dual task walking velocity (P  = 0.044), step length (P  = 0.023), and gait variability index (P  = 0.008). No significant differences for fast walking. CONCLUSIONS: Multi-modal boxing produced improvements in gait velocity, dual task velocity, step length, and gait variability, as well as backwards walking velocity and step length. These improvements may impact independence with functional mobility and may improve safety but require further studies. Show more

Keywords: Parkinson’s disease, gait, boxing, community program, physical therapy, rehabilitation

DOI: 10.3233/NRE-210218

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 619-627, 2021