NeuroRehabilitation - Volume 53, issue 1

Authors: Wang, Duojin | Zhou, Jiankang | Huang, Yanping | Yu, Hongliu

Article Type: Review Article

Abstract: BACKGROUND: Balance support is critical to a person’s overall function and health. Previous neuroimaging studies have shown that cortical structures play an essential role in postural control. OBJECTIVE: This review aims to identify differences in the pattern of neural activity induced by balance tasks with different balance control requirements. METHODS: Seventy-four articles were selected from the field of balance training and were examined based on four brain function detection technologies. RESULTS: In general, most studies focused on the activity changes of various cortical areas during training at different difficulty levels, but more and more …attention has also begun to focus on the functional changes of other cortical and deep subcortical structures. Our analysis also revealed the neglect of certain task types. CONCLUSION: Based on these results, we identify and discuss future research directions that may contribute to a clear understanding of neural functional plasticity under different tasks. Show more

Keywords: Cortical activity, brain function detection technologies, balance training, brain regions

DOI: 10.3233/NRE-220285

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 1-18, 2023

Authors: Ito, Daisuke | Kawakami, Michiyuki | Kuwahara, Wataru | Yamada, Yuka | Kondo, Kunitsugu | Tsuji, Tetsuya

Article Type: Review Article

Abstract: BACKGROUND: Electrical stimulation (ES) of the shoulder is effective in treating subluxation and shoulder pain. However, few studies have reported on ES of the hemiplegic shoulder with motor function as an outcome; thus, the method remains unclear. OBJECTIVE: We aimed to map the existing evidence and identify the parameters for ES of the hemiplegic shoulder for motor function in stroke patients. METHODS: A literature search was performed through PubMed and Scopus to retrieve original articles from 1975 to March 2023 using the terms “stroke”, “shoulder”, and “electricity”. We selected studies in which ES was performed on …hemiplegic shoulders after stroke, parameters were described, and upper extremity motor functional assessment was included as an outcome. The extracted data included study design, phase, sample size, electrode position, parameters, intervention period, evaluation frequency, outcomes, and results. RESULTS: Of the 449 titles identified, 25 fulfilled the inclusion and exclusion criteria. Nineteen were randomized controlled trials. The most common electrode positions and parameters (frequency and pulse width) were over the posterior deltoid and the supraspinatus (upper trapezius) muscles, 30 Hz, and 250μs, respectively. The intervention period was 30–60 minutes per day, 5–7 days per week, for 4–5 weeks in over half of the studies. CONCLUSION: Stimulation positions and parameters for electrical stimulation of the hemiplegic shoulder are inconsistent. Whether ES represents a significant treatment option remains unclear. Establishing universal ES methods is necessary to improve the motor function of hemiplegic shoulders. Show more

Keywords: Stroke, shoulder, electricity, rehabilitation, review

DOI: 10.3233/NRE-220301

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 19-32, 2023

Authors: Le Sant, Guillaume | Lecharte, Thomas | Goreau, Valentin | Nordez, Antoine | Gross, Raphaël | Cattagni, Thomas

Article Type: Review Article

Abstract: BACKGROUND: Many overlapping factors impair motor performance and quality of life in neurological patients. Eccentric resistance training (ET) has potential benefits for improving motor performance and treating motor impairments better than some traditional rehabilitation approaches. OBJECTIVE: To estimate the effect of ET in neurological settings. METHODS: Seven databases were reviewed up to May 2022 according to PRSIMA guidelines to find randomized clinical trials involving adults with a neurological condition, who underwent ET as set by the American College of Sports Medicine. Motor performance (main outcome) was assessed as strength, power and capacities during activity. Secondary outcomes …(impairments) were muscle structure, flexibility, muscle activity, tone, tremor, balance and fatigue. Tertiary outcomes were risk of fall, and self-reports of quality of life. RESULTS: Ten trials were included, assessed using Risk of Bias 2.0 tool, and used to compute meta-analyses. Effective effects in favour of ET were found for strength and power, but not for capacities during activity. Mixed results were found for secondary and tertiary outcomes. CONCLUSION: ET may be a promising intervention to better improve strength/power in neurological patients. More studies are needed to improve the quality of evidence underlying changes responsible for these results. Show more

Keywords: Resistance training, physical therapy, exercise, neurological condition

DOI: 10.3233/NRE-230035

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 33-50, 2023

Authors: Bukacova, Katerina | Mana, Josef | Zakharov, Sergey | Diblík, Pavel | Pelclova, Daniela | Urban, Pavel | Klepiš, Petr | Klempíř, Jiří | Libon, David J. | Růžička, Evžen | Bezdicek, Ondrej

Article Type: Research Article

Abstract: BACKGROUND: Sensory deficits can result in limitations regarding how well neuropsychological test findings can be interpreted. Only a few studies have investigated the influence of vision alteration on neuropsychological tests. In 2012 the Czech Republic experienced mass methanol poisoning. Methanol metabolites cause histotoxic hypoxia to the optic nerve. OBJECTIVE: In the current study, the effect of the toxic damage on the parts of the visual pathway on visual and non-visual neuropsychological measures was investigated using electrophysiological methods (visual evoked potential (VEP) and optical coherence tomography (OCT) with retinal nerve fibre layer (RNFL) thickness measurement. METHODS: 53 …individuals who experienced methanol poisoning participated in this research (76% men; ages 24 to 74 years, mean = 43.8±14.6 years; education 11.9±1.4 years). Each participant underwent comprehensive neurological, ophthalmological, and neuropsychological examinations. RESULTS: The results of mixed-effect models revealed significant small to a medium association between the Stroop test weak interference and Grooved Pegboard with the left eye global, nasal and temporal RNFL thickness. Also, medium associations between the Finger Tapping test and the Stroop test weak interference and left eye temporal RNFL, right eye temporal RNFL, and the latency P1 of VEP in the left eye were significant. CONCLUSION: The results of this study found a small to medium association (r  = .15– .33; p  = .010– .046) between RNFL thickness and cognitive visual test performance. Careful interpretation is suggested regarding results obtained from visual tests of the executive or motor functioning with participants with RNFL decrease or other types of early visual processing damage. Show more

Keywords: Sensory deficit, visual impairment, neuropsychology assessment, methanol poisoning, differential diagnosis

DOI: 10.3233/NRE-220289

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 51-60, 2023

Authors: Mostofinejad, Amin | Goodman, Rachel | Loria, Tristan | Thaut, Michael | Tremblay, Luc

Article Type: Research Article

Abstract: BACKGROUND: There is equivocal evidence regarding the effectiveness of robotic guidance on the (re)learning of voluntary motor skills. Robotic guidance can improve the performance of continuous/ tracking skills, although being seldom more effective than unassisted practice alone. However, most of the previous studies employed robotic guidance on all intervention trials. Recently, we showed that mixing robotic guidance with unassisted practice (i.e., mixed practice) can significantly improve the learning of a golf putting task. Yet, these mixed practice studies involved self-paced movements in a standing posture, thus less applicable to rehabilitation contexts. OBJECTIVE: The current study aimed to investigate …the influence of mixed practice on the timing accuracy of an upper-limb, rhythmic, sequential task. The goal was to assess the feasibility of integrating mixed practice with music-based interventions. METHODS: Two groups of participants performed circle-drawing sequences in synchrony with rhythmic auditory signals. They completed a pre-test and an acquisition phase, followed by immediate retention and transfer tests. One group received robotic guidance on 50% of the acquisition trials (i.e., mixed practice), whereas another group always practiced unassisted. The pre-test, retention, and transfer tests were performed unassisted. RESULTS: Both groups significantly improved their timing accuracy and precision between the pre-test and the retention test. CONCLUSION: This study provides further evidence that mixed practice can facilitate the (re)learning of voluntary actions, especially with the type of externally paced upper-limb movements employed in music-based interventions. Show more

Keywords: Robotic guidance, motor learning, timing, upper-limb, rehabilitation

DOI: 10.3233/NRE-220286

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 61-70, 2023

Authors: Duray, Mehmet | Cetisli-Korkmaz, Nilufer | Cavlak, Ugur

Article Type: Research Article

Abstract: BACKGROUND: Management of respiratory-related functional problems using sensory rehabilitation strategies has been poorly researched in patients with stroke. OBJECTIVE: This study aimed to investigate whether whole body vibration (WBV) training has an effect on functional capacity and respiratory functions in patients with stroke. METHODS: In the randomized-controlled study, 28 participants were randomized into two groups: one receiving Neurodevelopmental Treatment (NDT; n  = 13) and one receiving both NDT and WBV (NDT + WBV; n  = 15). The primary outcome measures were 6-Minute Walking Test (6MWT) and Pulmonary Function Test which evaluate functional and respiratory capacity. Secondary outcome included …the chest circumference measurement to evaluate the thoracic expansion ability. RESULTS: Both groups showed positive significant changes in walking distance and maximum oxygen consumption volume (VO2 max), inspiratory capacity, vital capacity and chest circumference measurement scores (p  < 0.05). While the NDT +WBV group showed a significantly greater increase in walking distance and VO2 max levels than the NDT group (p  < 0.05), there were no significant group differences in respiratory function flow and volume parameters, and chest circumference measurement. CONCLUSION: The addition of WBV training to the treatment program has some incremental benefits on increasing functional capacity and thoracic expansion, and rehabilitating respiratory dysfunction. Show more

Keywords: Stroke, vibration, functional capacity, walking, respiration

DOI: 10.3233/NRE-220219

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 71-82, 2023

Authors: Zhang, Di | Tang, Hong | Li, Ting | Li, Ping | Pan, Xiangying | Jia, Qin | Wang, Lu | Zhao, Yanjun

Article Type: Research Article

Abstract: BACKGROUND: Neurogenic bowel dysfunction (NBD) is a common complication in stroke patients. OBJECTIVE: To investigate the effect of rectal balloon ice water stimulation on the rehabilitation of patients with NBD after a cerebral stroke. METHODS: Forty stroke patients with NBD were selected between March and August 2022 and randomly divided into a study group (n  = 20) and a control group (n  = 20). Based on routine rehabilitation training, rectal balloon ice water stimulation or finger rectal stimulation were performed on the study or control group, respectively. After two weeks, the changes in the NBD, self-rating depression scale …(SDS) and self-rating anxiety scale (SAS) scores were compared between the two groups. RESULTS: Before the intervention, there were no significant differences in age, sex ratio, and NBD, SDS and SAS scores between the two groups (p  > 0.05). The NBD, SDS and SAS scores of both groups were significantly decreased following intervention (p  < 0.05). After 2 weeks of intervention, the NBD score of the study group was significantly lower than that of the control group (5.50±1.28 vs 6.45±1.05; p  = 0.014). The SDS score of the study group was lower than that of the control group, and the difference was statistically significant (32.30±2.81 vs 44.05±2.19; p  = 0.014). The study group also had significantly lower SAS scores than the control group (p  = 0.024). In addition, the incidence of dizziness, headaches, nausea, vomiting and abdominal pain and distension in the study group was significantly lower than in the control group (p  < 0.05). CONCLUSION: Rectal balloon ice water stimulation can significantly improve stroke patients with NBD’s intestinal function and psychological status. Show more

Keywords: Rectal balloon ice stimulation, stroke, neurogenic bowel dysfunction, finger rectal stimulation

DOI: 10.3233/NRE-230026

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 83-90, 2023

Authors: García-Rudolph, Alejandro | Soriano, Ignasi | Becerra, Helard | Madai, Vince Istvan | Frey, Dietmar | Opisso, Eloy | Tormos, Josep María | Bernabeu, Montserrat

Article Type: Research Article

Abstract: BACKGROUND: Post-stroke arm impairment at rehabilitation admission as predictor of discharge arm impairment was consistently reported as extremely useful. Several models for acute prediction exist (e.g. the Scandinavian), though lacking external validation and larger time-window admission assessments. OBJECTIVES: (1) use the 33 Fugl-Meyer Assessment-Upper Extremity (FMA-UE) individual items to predict total FMA-UE score at discharge of patients with ischemic stroke admitted to rehabilitation within 90 days post-injury, (2) use eight individual items (seven from the Scandinavian study plus the top predictor item from objective 1) to predict mild impairment (FMA-UE≥48) at discharge and (3) adjust the top three …models from objective 2 with known confounders. METHODS: This was an observational study including 287 patients (from eight settings) admitted to rehabilitation (2009-2020). We applied regression models to candidate predictors, reporting adjusted R 2 , odds ratios and ROC-AUC using 10-fold cross-validation. RESULTS: We achieved good predictive power for the eight item-level models (AUC: 0.70-0.82) and for the three adjusted models (AUC: 0.85-0.88). We identified finger mass flexion as new item-level top predictor (AUC:0.88) and time to admission (OR = 0.9(0.9;1.0)) as only common significant confounder. CONCLUSION: Scandinavian item-level predictors are valid in a different context, finger mass flexion outperformed known predictors, days-to-admission predict discharge mild arm impairment. Show more

Keywords: Arm recovery, arm functioning, prognostic models, prediction, post-acute

DOI: 10.3233/NRE-220233

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 91-104, 2023

Authors: Diermayr, Gudrun | Greisberger, Andrea | Stadel, Maria | Garbade, Sven | Salbach, Nancy M.

Article Type: Research Article

Abstract: BACKGROUND: A contextual transferability analysis identified group-based circuit training (GCT) as an optimal intervention in German and Austrian outpatient physical therapy to improve mobility post-stroke. GCT incorporates task-oriented, high-repetitive, balance, aerobic and strength training and allows for increased therapy time without increasing personnel. OBJECTIVE: To determine the extent to which German and Austrian physical therapists (PTs) use GCT and its components in the outpatient treatment of stroke-related mobility deficits and to identify factors associated with using GCT components. METHODS: A cross-sectional online survey was conducted. Data were analyzed descriptively and using ordinal regression. RESULTS: …Ninety-three PTs participated. None reported using GCT moderately to frequently (4–10/10 patients). The percentage of PTs reporting frequent use (7–10/10 patients) of task-oriented, balance, strength, aerobic, and high-repetitive training was 45.2%, 43.0%, 26.9%, 19.4%, and 8.6%, respectively. Teaching or supervising students, time for evidence-based practice activities at work, and working in Austria was associated with using GCT components frequently. CONCLUSION: German and Austrian PTs do not yet use GCT in outpatient physical therapy for stroke. Almost half of PTs, however, employ task-oriented training as recommended across guidelines. A detailed, theory-driven and country-specific evaluation of barriers to GCT uptake is necessary to inform implementation. Show more

Keywords: Stroke, physical therapists, translational science, biomedical, circuit-based exercise, guideline adherence

DOI: 10.3233/NRE-230010

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 105-119, 2023

Authors: Shen, Jie | Ma, Lianjie | Gu, Xudong | Fu, Jianming | Yao, Yunhai | Liu, Jia | Li, Yan

Article Type: Research Article

Abstract: BACKGROUND: The balance and postural control of humans is related to the coordination of dynamic perception and movement. Multiple senses, such as vision, vestibular sense, proprioception, and/or a single sensory disorder, would lead to its integration disorder and induce imbalance and abnormal gait. OBJECTIVE: The present study aimed to determine the effects of dynamic motion instability system training (DMIST) on the balance and motor function of hemiplegic patients after stroke. METHODS: In this assessor-blinded, randomized controlled trial, the participants allocated to the intervention group (n  = 20) received 30 minutes of conventional treatment and 20 minutes of …DMIST training. Participants randomized to the control group (n  = 20) received the same dose of conventional therapy and 20 minutes of general balance training. Rehabilitation was performed 5 times per week for 8 weeks. The primary outcome was the Fugl-Meyer assessment for the lower extremity (FMA-LE), and the secondary outcomes were the Berg balance scale (BBS) and gait function. Data were collected at baseline and immediately after the intervention. RESULTS: After 8 weeks (t1), both groups showed significant post-intervention improvements in BBS, FMA-LE, gait speed and stride length (P  < 0.05); there were significant positive correlations between the increase in FMA-LE and gait speed and stride length. Compared with the control group, the DMIST group showed significant post-intervention improvements in FMA-LE, gait speed and stride length (P  < 0.05). However, no significant differences between the groups were found over time with respect to BBS (P  > 0.05). The experiences of patients with DMIST were positive, and no serious adverse events were related to the interventions. CONCLUSION: Supervised DMIST could be highly effective in treating lower-limb motor function in patients with stroke. Frequent (weekly) and medium-term (8 weeks) dynamic motion instability-guided interventions might be highly effective in enhancing motor function, and subsequently improving gait in stroke patients. Show more

Keywords: Dynamic motion, instability, motor function, balance, stroke

DOI: 10.3233/NRE-230008

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 121-130, 2023