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

Authors: Luan, Shuo | Wu, Shao-Ling | Xiao, Ling-Jun | Yang, Hai-Yun | Liao, Mei-Xin | Wang, Shao-Ling | Fan, Sheng-Nuo | Ma, Chao

Article Type: Research Article

Abstract: BACKGROUND: Cricopharyngeal muscle dysfunction (CPD) management has been challenging in clinical practice. OBJECTIVE: To compare the efficacy and safety of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in treating CPD. METHODS: Forty patients with CPD were randomly divided into two groups, namely the botulinum toxin injection group (BTX group) and balloon dilatation group (BD group). Patients in the BTX group received a single ultrasound-guided injection of 50 units of botulinum toxin type A, while the BD group received dilatation therapy five times per week, consecutively for two weeks. Relative opening percentage of the upper esophageal …sphincter (UES), the penetration-aspiration scale (PAS), and the Dysphagia Outcome Severity Scale (DOSS) were evaluated by a videofluoroscopic swallowing study (VFSS) at baseline, 1-month, and 3-months posttreatment. The Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA) were also used to evaluate participants’ swallowing function at baseline and the 1-week, 2-week, 1-month, and 3-month follow-ups. RESULTS: A generalized estimating equation (GEE) model revealed the significant main effect for time in UES, PAS, DOSS, FOIS, and SSA compared to baseline (P <0.05), while no group-by-time interactions (except for the PAS assessment) or main effect for treatment was detected among the above multiple variances. No systematic complications or severe adverse effects were noted. CONCLUSION: Both ultrasound-guided botulinum toxin type A injections and balloon dilatation therapy have been proven as safe and effective treatments for CPD patients. Future clinical trials with longer follow-up periods and more participants are warranted. Show more

Keywords: Neurogenic cricopharyngeal muscle dysfunction, ultrasound-guided botulinum toxin injection, balloon catheter dilatation therapy, dysphagia

DOI: 10.3233/NRE-210113

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 629-639, 2021

Authors: Gu, Pengpeng | Tu, Wenzhan | Deng, Fen | Ye, Limei | Li, Sisi | Bai, Guanghui | Jin, Xiaofeng | Li, Shasha | Jiang, Songhe

Article Type: Research Article

Abstract: BACKGROUND: Graded motor imagery (GMI) therapy is a neural rehabilitative physiotherapy that has been shown to alleviate the severity of complex regional pain syndrome, phantom limb pain and disability. OBJECTIVE: To identify neural networks associated with the use of graded mirror therapy (MT) while imagining hand movements. METHODS: We made a block-design functional magnetic resonance imaging study of MT included three experiments: (1) immobile unimanual MT (IU-MT), in which the right hand flexed and made a fist, which then remained immobile; (2) mobilization unimanual MT (MU-MT), in which the right hand performed a flexion-extension movement; and …(3) mobilization bimanual MT (MB-MT), in which both hands performed a flexion-extension movement. When subjects started their hand movements, they gazed at the mirror and imagined the same movement behind the mirror. RESULTS: We discovered that the sensorimotor area of the left brain, superior temporal gyrus/middle temporal gyrus (STG/MTG) of the right brain and visual areas were activated by IU-MT. In MU-MT, only the STG/MTG was activated. Furthermore, MB-UT mostly activated the sensorimotor area and STG of the right brain. However, there were no brain areas activated by MU-MT compared with IU-MT or MB-MT; but, MB-MT activated more motor areas than IU-MT. Importantly, we determined that the level of mirror imagery was negatively correlated with signals in the mirror neuron system (MNS) and positively related with the signals in the sensorimotor areas. CONCLUSIONS: We suggest that graded MT might be a sequential therapeutic program that can enhance the sensorimotor cortex. The MNS might have an initiating role in graded MT. Thus, there is the possibility that graded MT is a helpful treatment strategy for the rehabilitation of dysfunctional patients. Show more

Keywords: Graded motor imagery, cerebral activation, visual illusion, functional magnetic resonance imaging (fMRI), rehabilitation

DOI: 10.3233/NRE-210185

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 641-654, 2021

Authors: Philipson, Erik B. | Gause, Emma | Conrick, Kelsey M. | Erickson, Scott | Muma, Amy | Liu, Zhinan | Ayyagari, Rajiv C. | Vavilala, Monica S.

Article Type: Research Article

Abstract: BACKGROUND: Many students return to school after concussion with symptoms but without formal support. OBJECTIVE: To examine concussion symptoms and temporary academic accommodations during school use of a four-week student-centered return to learn (RTL) care plan. METHODS: Five public high schools used the RTL care plan and contributed student-level data after student report of concussion. Data on concussion symptoms, temporary academic accommodations corresponding to reported symptoms, and accommodations provided during RTL care plan use were examined. RESULTS: Of 115 students, 55%used the RTL care plan for three (34%) or four (21%) weeks. Compared to …students whose symptoms resolve within the first two weeks, students who used the RTL care plan for three or four weeks reported more unique symptoms (P  = 0.038), higher total severity score (P  = 0.005), and higher average severity per symptom (P  = 0.007) at week one. Overall, 1,127 weekly accommodations were provided. While least reported, emotional symptoms received corresponding accommodations most often (127/155 reports: 82%of occurrences). CONCLUSIONS: Use of an RTL care plan can facilitate the RTL of students with a concussion and may aid in the identification of students who are in need of longer-term support. Show more

Keywords: Concussion, return to learn, traumatic brain injury

DOI: 10.3233/NRE-210182

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 655-662, 2021

Authors: Bateman, Emma A. | VanderEnde, Jordan | Sequeira, Keith | MacKenzie, Heather M.

Article Type: Case Report

Abstract: BACKGROUND: Hemicraniectomy to manage raised intracranial pressure following traumatic brain injury (TBI) has improved survival but may increase the incidence of Sinking Skin Flap Syndrome (SSFS). SSFS is a clinical syndrome in which patients with craniectomy develop objective neurologic abnormalities due to the pressure of the atmosphere on the unprotected brain, often presenting with postural headaches and neurologic deficits that localize to the craniectomy site. Previously thought to be a rare complication of craniectomy after TBI, evidence suggests SSFS is under-recognized. OBJECTIVE: To describe the clinical and radiographic features leading to diagnosis and the impact of temporizing and …definitive management of SSFS on outcomes in inpatients with moderate/severe TBI. METHODS: Two patients’ symptoms, qualitative behaviour observation, physical and cognitive outcome measures, and neuroimaging pre- and post-temporizing measures and cranioplasty are presented. RESULTS: Both patients demonstrated partial improvements with temporizing measures and substantial improvements in functional, cognitive, physical, and rehabilitation outcomes from the cranioplasty and resolution of SSFS. CONCLUSIONS: Rehabilitation care providers are critical to the timely diagnosis and management of SSFS, including the use of temporizing measures and advocacy for definitive treatment with cranioplasty. These cases highlight the diverse clinical presentations and importance of SSFS diagnosis to improve patient outcomes. Show more

Keywords: Decompressive craniectomy, case series, elevated intracranial pressure, traumatic brain injury, complications, neurorehabilitation, herniation, neurologic dysfunction

DOI: 10.3233/NRE-210160

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 663-672, 2021

Authors: Buckley, Trevor R.

Article Type: Case Report

Abstract: BACKGROUND: There is much research examining trajectories of cognitive recovery in those who sustain mild traumatic brain injury (mTBI). OBJECTIVE: Although the majority of research indicates a full recovery within months of a single, uncomplicated mTBI there remain few who report cognitive symptoms long after injury. Ample evidence indicates incentives to underperform on cognitive testing can negatively affect cognitive recovery, but there is little to no research on how incentives to perform well may affect recovery. This gap in research should be considered to obtain a full picture of cognitive recovery following mTBI. METHOD: Aeromedical Evaluations …present a unique opportunity to study cognitive and functional recovery after mTBI. Three case studies are presented from the Aviation Community of recovery from mTBI. Each case presented is one who was monetarily incentivized to perform well on testing. RESULTS: All three cases passed established guidelines for performance validity testing. Each case recovered to estimated baseline performance, though one case needed additional time. There was some evidence of lowered processing speed on two of the three cases. CONCLUSIONS: Consistent with current literature on mTBI, recovery from injury is considered the rule as opposed to the exception. Though there are many studies examining how incentives to underperform hinder recovery, there is little research on how incentives to perform well may affect cognitive performance after mTBI. Such may be considered a gap in research and should be a focus of future work. Show more

Keywords: Mild traumatic brain injury (mTBI), aeromedical psychology, mTBI recovery, pilot evaluation

DOI: 10.3233/NRE-210201

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 673-684, 2021

Authors: Ferrario, Irene | Negrini, Stefano

Article Type: Other

Abstract: BACKGROUND: Depression is very common in patients after a stroke and it can impact recovery. OBJECTIVE: The Cochrane Review aimed to determine whether psychological therapy, pharmacological interventions, non-invasive brain stimulation, or their combination can prevent depression after stroke. METHODS: The population addressed were patients who suffered from a stroke and had no previous diagnosis of depressive disorders. Studies comparing pharmacological intervention to placebo, psychological therapy to usual care, and non-invasive brain stimulation to sham stimulation or usual care were included. RESULTS: Outcome information was available for nine pharmacological and two psychological trials, showing favorable …treatment effects. CONCLUSIONS: The available evidence suggests that pharmacological interventions and psychological therapy may prevent depression and improve mood after stroke. Although, the current evidence is of very low quality resulting in serious uncertainties about the estimates of effect observed. Show more

Keywords: Depression, stroke, psychological therapy, antidepressant, non-invasive brain stimulation

DOI: 10.3233/NRE-218006

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 685-687, 2021