NeuroRehabilitation - Volume 50, issue 4

Authors: Hadoush, Hikmat | Alawneh, Anoud | Kassab, Manal | Al-Wardat, Mohammad | Al-Jarrah, Muhammed

Article Type: Review Article

Abstract: BACKGROUND: Multiple sclerosis (MS) is a progressive inflammatory and autoimmune neurological disease caused by inflammation and demyelination of the central nervous system. Pain is a typical symptom of central nervous system demyelination, affecting 63% of adults with MS. Recently, the role of non-pharmacological pain management in patients is growing because the non-pharmacological interventions are considered safe, affordable, easy, and accessible. However, to date, no systematic reviews or meta-analyses have comprehensively examined the therapeutic effects of the variety of non-pharmacological therapeutic interventions in the management of pain in patients with MS. OBJECTIVE: The study aimed to conduct a systematic …review with meta-analysis to assess the effectiveness of the non-pharmacological rehabilitation interventions in pain management in patients with MS. METHODS: A comprehensive search using PubMed, Cochrane, and Science Direct databases was performed and included all randomized controlled trials, randomized cross-over trials, and quasi-experimental trials assessing the effect of non-pharmacological interventions for managing pain in patients with MS. This study was conducted according to PRISMA guidelines of a systematic review and pair-wise meta-analysis. Meta-analyses were performed by calculating the standardized mean difference at a 95% confidence interval using Review Manager software. RESULTS: Twenty-nine papers were included in the systematic review, and only 22 of them were included in the meta-analysis. The pooled analysis showed a significant effect of neuromodulation and transcranial direct current stimulation on pain intensity reduction in patients with MS (SMD –0.51, 95% CI –0.51 to –0.09, P  = 0.02), (SMD –0.67, 95% CI –1.18 to –0.16 P  = 0.01), respectively. The analysis showed significant improvement in pain intensity in patient with MS after mind-body therapies (SMD –0.45, 95% CI –0.82 to –0.7, P  = 0.02), mindfulness (SMD –0.55, 95% CI –0.96 to –0.14, P  = 0.009), hypnosis (SMD –0.88, 95% CI –1.30 to –0.46, P  = 0.0001), trigger point therapies (SMD –0.83, 95% CI –1.65 to –0.01, P  = 0.05) and cognitive behavioral therapy (SMD –0.64, 95% CI –1.18 to –0.11, P  = 0.02). However, there is no significant effect of relaxation therapy on pain reduction in patients with MS (SMD –0.82, 95% CI –1.94 to 0.31, P  = 0.15). CONCLUSIONS: The results indicated that the majority of the non-pharmacological rehabilitation interventions showed potential therapeutic effects in reducing pain intensity in patients with MS. Show more

Keywords: Multiple sclerosis, neurodegenerative diseases, pain, rehabilitation, non-pharmacological interventions, meta-analysis

DOI: 10.3233/NRE-210328

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 347-365, 2022

Authors: Meng, Qiaoling | Zeng, Qingxin | Xie, Qiaolian | Fei, Cuizhi | Kong, Bolei | Lu, Xuhua | Wang, Haibin | Yu, Hongliu

Article Type: Review Article

Abstract: BACKGROUND: As an emerging exoskeleton robot technology, flexible lower limb exoskeleton (FLLE) integrates flexible drive and wearable mechanism, effectively solving many problems of traditional rigid lower limb exoskeleton (RLLE) such as higher quality, poorer compliance and relatively poor portability, and has become one of the important development directions in the field of active rehabilitation. OBJECTIVE: This review focused on the development and innovation process in the field of FLLE in the past decade. METHOD: Related literature published from 2010 to 2021 were searched in EI, IEEE Xplore, PubMed and Web of Science databases. Seventy target research …articles were further screened and sorted through inclusion and exclusion criteria. RESULTS: FLLE is classified according to different driving modes, and the advantages and disadvantages of passive flexible lower limb exoskeletons and active flexible lower limb exoskeletons are comprehensively summarized. CONCLUSION: At present, FLLE’s research is mainly based on cable drive, bionic pneumatic muscles followed and matured, and new exoskeleton designs based on smart material innovations also trend to diversify. In the future, the development direction of FLLE will be lightweight and drive compliance, and the multi-mode sensory feedback control theory, motion intention recognition theory and human-machine interaction theory will be combined to reduce the metabolic energy consumption of walking. Show more

Keywords: Lower extremity exoskeleton, soft exoskeleton, wearable robotics, walking assistance, gait assistance

DOI: 10.3233/NRE-210300

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 367-390, 2022

Authors: Braga, L.W. | Oliveira, S.B. | Moreira, A.S. | Pereira, M.E. | Carneiro, V.S. | Serio, A.S. | Freitas, L.F. | Isidro, H.B.l. | Souza, L.M.N.

Article Type: Research Article

Abstract: BACKGROUND: There has been a significant increase in number of patients seeking neuropsychological rehabilitation months after the acute phase of COVID-19 infection. OBJECTIVE: Identify the cognitive and psychiatric disorders in patients with long COVID or Post-Acute Sequelae of COVID (PASC) and explore the association between disease severity during the acute phase and persistent neuropsychological manifestations. METHODS: 614 adults were assessed an average of eight months post-infection. Participants were, on average, 47.6 y.o., who sought rehabilitation for neuropsychological problems. Patients were evaluated using the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and …Clock Drawing tests (NEUPSILIN) for executive functions, and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The BNIS score was significantly below reference values in all subscales, especially affect and memory. Verbal Fluency and Clock Drawing subtest results were also lower. Patients with PASC tested high for anxiety/depression, but there was no statistically significant relationship between HADS and BNIS scores. Neuropsychological evaluations showed no differences in cognitive or psychiatric profiles between hospitalized and non-hospitalized patients. CONCLUSIONS: Neuropsychological results suggest executive function problems and high incidence of anxiety/depression, irrespective of acute-phase severity, underscoring a need for neurorehabilitation programs while providing data for public policy initiatives. Show more

Keywords: Coronavirus, COVID-19, cognitive dysfunction, depression, anxiety

DOI: 10.3233/NRE-228020

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 391-400, 2022

Authors: Tanaka, Naoki | Ebihara, Kazuaki | Ebata, Yasuhiko | Yano, Hiroaki

Article Type: Research Article

Abstract: BACKGROUND: Gait rehabilitation using a footpad-type locomotion interface has been reported as effective in improving gait ability in chronic stroke patients. However, the effect on subacute stroke patients is unknown. OBJECTIVE: To compare the effect of gait rehabilitation using a footpad-type locomotion interface (Gait Training with Locomotion Interface group; GTLI group) with conventional gait rehabilitation (control group) in subacute stroke patients. METHODS: Twenty-one stroke patients (GTLI group: n  = 13, control group: n  = 8) participated in the study. All participants received gait rehabilitation using the footpad-type locomotion interface or conventional gait rehabilitation for 20 minutes x 20 …sessions. Outcome measures were functional ambulation Category (FAC), gait speed, gait endurance and lower muscle strength. Measures were taken at baseline and 1, 2, 3 and 4 weeks. RESULT: The GTLI group significantly improved gait speed and gait endurance compared with the control group. However, FAC and lower limb muscle strength were not significantly different. CONCLUSIONS: The results suggest that gait rehabilitation using the footpad-type locomotion interface can improve gait ability better than conventional gait rehabilitation. Show more

Keywords: Robotics, footpad-type locomotion interface, gait rehabilitation, subacute stroke

DOI: 10.3233/NRE-210317

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 401-407, 2022

Authors: Hayashi, Yusuke | Yamazaki, Kota | Takeda, Kouichi | Ueda, Shujiro | Mikawa, Saiko | Hatori, Kozo | Honaga, Kaoru | Takakura, Tomokazu | Hayashi, Akito | Fujiwara, Toshiyuki

Article Type: Research Article

Abstract: BACKGROUND: The assessment of gait function is important for stroke rehabilitation. Gait function of patients with stroke often depends on the type of orthosis. There are however few gait assessments that assess the type of orthosis. OBJECTIVE: The purpose of this study was to investigate the reliability and validity of our newly developed Ambulation Independence Measure (AIM), which assesses the gait function, type of orthoses and physical assistance, for acute stroke patients. METHODS: A total of 73 acute stroke patients participated in this prospective study. The AIM discriminates 7 levels of gait ability on the basis …of the amount of physical assistance required and orthoses that are used during walking. Interrater reliability, concurrent validity with the Functional Ambulation Category (FAC) and predictive validity were examined. RESULTS: The weighted kappas of AIM at the start of gait training (baseline) and discharge were 0.990 and 0.978, respectively. The AIM scores were significantly correlated with the FAC scores at both baseline (r  = 0.808) and discharge (r  = 0.934). Multiple regression analyses showed that the AIM at baseline was a stronger predictor of the FAC at discharge (R2  = 0.80). CONCLUSIONS: The AIM has excellent reliability, concurrent validity, predictive validity, and good responsiveness in acute stroke patients. Show more

Keywords: Cerebrovascular disorders, gait, orthosis, assessment, rehabilitation, stroke

DOI: 10.3233/NRE-210289

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 409-416, 2022

Authors: Igarashi, Tatsuya | Takeda, Ren | Hayashi, Shota

Article Type: Research Article

Abstract: BACKGROUND: The Brief-Balance Evaluation Systems Test (Brief-BESTest) has the potential to be used effectively for interventions on specific balance components. However, it has not been utilized for acute stroke cases. OBJECTIVE: This study determined the characteristics of the distribution of the Brief-BESTest scores of patients who suffered acute stroke and examined its relationship with physical function and activities of daily living ability. METHODS: The Brief-BESTest, sub-items of Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) were conducted among 41 hospitalized acute stroke patients (71.3±9.5 years, 32 males). The skewness of the Brief-BESTest and Spearman’s …rank correlation (ρ) between Brief-BESTest, SIAS, and FIM were analyzed. RESULTS: The skewness of the total score of the Brief-BESTest was -0.038. There were no ceiling or floor effects. The total score of the Brief-BESTest had a weak positive correlation with the SIAS lower extremity motor function (ρ= 0.457) and muscle tone (ρ= 0.374), and the total score on FIM (ρ= 0.365). Each sub-item of the Brief-BESTest was associated with different physical functions. CONCLUSIONS: The Brief-BESTest was unaffected by floor and ceiling functions among hospitalized acute stroke patients, and different physical functions were associated with each balance component. Show more

Keywords: Balance, validity, stroke, ADL

DOI: 10.3233/NRE-210295

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 417-423, 2022

Authors: Kang, Tae-Woo | Lee, Nam-Gi | Park, Hyun-Ju

Article Type: Research Article

Abstract: BACKGROUND: The aging process is related to cerebrovascular dysfunction and physiological changes, such as reduced pulmonary function. This ultimately induces cognitive impairment or dementia. OBJECTIVE: This study aimed to determine the relationship between aging-related pulmonary function, cognition, motor function, and activities of daily living (ADLs) in older adults with dementia. METHODS: This cross-sectional study included 69 older adults diagnosed with dementia. Aging-related pulmonary function and cognition were measured using a hand-held spirometer and the Korean version of the Mini-Mental State Examination (MMSE-K), respectively. To assess motor function and ADLs, the Berg Balance Scale (BBS), 10-meter walk …test (10-MWT), 6-minute walk test (6-MWT), and modified Barthel index (MBI) were used to measure balance, walking speed, physical functional capacity (or walking tolerance), and ADLs, respectively. All data were analyzed using the Pearson’s product correlation coefficient (r ). RESULTS: Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1 ) as measures of aging-related pulmonary function correlated only with the 6-MWT (FVC: r  = 0.483, p  = 0.002; FEV1 : r  = 0.512, p  = 0.001). In cognitive function, MMSE-K was associated with BBS (r  = 0.283, p  = 0.022) and MBI (r  = 0.454, p  = 0.000). Additionally, there were significant correlations (r  = 0.425–0.671, p  = 0.000) between all motor function and ADLs measures in older adults with dementia. CONCLUSIONS: Our findings demonstrated that aging-pulmonary function was related to a lower physical functional capacity, and hence, suggested that the reduced pulmonary function were unable to walk for longer distance in older adults with dementia. Show more

Keywords: Aging, cognition, dementia, motor function, pulmonary function

DOI: 10.3233/NRE-210297

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 425-432, 2022

Authors: Sznajder, Jan | Barć, Krzysztof | Kuźma-Kozakiewicz, Magdalena

Article Type: Research Article

Abstract: BACKGROUND: There are no recommendations for physical activity in amyotrophic lateral sclerosis (ALS) patients. OBJECTIVE: (i) To describe the prevalence and pattern of physical activity (PA) in ALS patients; (ii) to explore patients’ attitude towards PA; and (iii) to investigate the relationship between PA at home environment and the rate of functional decline. METHODS: 96 ALS patients were followed for 6 months at 3-month intervals and assessed by site of disease onset, disease duration, diagnosis delay, functional status, muscle strength, fatigue and prevalence of PA. RESULTS: Over 70% of patients performed regular exercise and …reported a positive effect of PA on functional status and mood. Regularly exercising individuals showed a higher ALSFRS-R bulbar score (11.0 vs 9.0, p  = 0.011 ) and a lower decline of respiratory sub-score of ALSFRS-R compared to non-regularly exercising patients (0 vs 1.0, p  = 0.026 ). Bulbar onset was a negative prognostic factor for regular exercise (odds ratio [OR]: 5.2, p  = 0.004 ). CONCLUSION: The majority of ALS patients perform regular PA and find it positively influence their motor performance and mood. Bulbar disease onset, but not functional status, is a negative prognostic factor for regular exercise in ALS patients. Regular mild PA may result in a slower deterioration of functional status, especially the respiratory function. Show more

Keywords: Physical activity, amyotrophic lateral sclerosis, exercise, functional status

DOI: 10.3233/NRE-210312

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 433-443, 2022

Authors: Taniguchi, Seira | D’cruz, Nicholas | Nakagoshi, Miho | Osaki, Toshinori | Nieuwboer, Alice

Article Type: Research Article

Abstract: BACKGROUND: Although most patients with Parkinson’s disease (PD) present difficulties of bed mobility, the contributing factors to impaired bed mobility in PD are unknown. OBJECTIVE: To compare bed mobility and muscle strength between PD patients and healthy controls, and investigate the determinants of bed mobility in PD. METHODS: Sixteen patients with PD and ten age- and sex-matched healthy controls (HC) were enrolled. Time and pattern to get out of bed to their preferred side at usual speed, muscle torque in lower extremities and motor symptom burden were also measured. RESULTS: PD exhibited significantly slower …speed in bed mobility and lower torque in the hip adductor/abductor/flexor muscle than HC. Slower movement time in PD was correlated with weaker hip adductor torque on the more affected side (Rs = –0.56, p  < 0.05) and with higher score in arm rigidity both sides (Rs≥0.79, p  < 0.01). There were no significant differences between the categorised movement patterns and movement time in PD (p  = 0.31). CONCLUSIONS: Reduced hip adductors torque and severe arm rigidity are associated with slowness of getting out of bed, implying that these components could be used as targets for rehabilitation practice to improve bed mobility in PD. Show more

Keywords: Parkinson’s disease, bed mobility, hip muscle strength, rigidity, rehabilitation, quality of life

DOI: 10.3233/NRE-210301

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 445-452, 2022

Authors: García-Rudolph, Alejandro | Saurí, Joan | Cegarra, Blanca | Madai, Vince Istvan | Frey, Dietmar | Kelleher, John D. | Cisek, Katryna | Opisso, Eloy | Tormos, Josep María | Bernabeu, Montserrat

Article Type: Research Article

Abstract: BACKGROUND: Stroke is a major worldwide cause of serious long-term disability. Most previous studies addressing functional independence included only inpatients with limited follow-up. OBJECTIVE: To identify novel classes of patients having similar temporal patterns in motor functional independence and relate them to baseline clinical features. METHODS: Retrospective observational cohort study, data were obtained for n  = 428 adult patients with ischemic stroke admitted to rehabilitation (March 2005–March 2020), including baseline clinical features and follow-ups of motor Functional Independence Measure (mFIM) categorized as poor, fair or good. Growth mixture models (GMMs) were fitted to identify classes of patients …with similar mFIM trajectories. RESULTS: GMM identified three classes of trajectories (1,664 mFIM assessments): C1 (11.2 %), 97.9% having poor admission mFIM, at 4.93 years 61.1% still poor, with the largest percentage of hypertension, neglect, dysphagia, diabetes and dyslipidemia of all three classes. C2 (23.1%), 99% had poor admission mFIM, 25% poor discharge mFIM, the largest percentage of aphasia and greatest mFIM gain, at 4.93 years only 6.2% still poor. C3 (65.7%) the youngest, lowest NIHSS, 37.7% poor admission mFIM, 73% good discharge mFIM, only 4.6% poor discharge mFIM, 90% good at 4.93 years. CONCLUSIONS: GMM identified novel motor functional classes characterized by baseline features. Show more

Keywords: Ischemic stroke, functional independence, trajectories, latent class modeling, growth mixture modeling

DOI: 10.3233/NRE-210293

Citation: NeuroRehabilitation, vol. 50, no. 4, pp. 453-465, 2022