NeuroRehabilitation - Volume 53, issue 3

Authors: Wei, Tianqi | Ge, Xiangyang | Lu, Lingfeng | Li, Jing | Xu, Panpan | Wu, Qinfeng

Article Type: Review Article

Abstract: BACKGROUND: In 2021, the U.S. Food and Drug Administration (FDA) approved paired vagus nerve stimulation (VNS) for patients with moderate-to-severe upper extremity motor impairments following chronic ischemic stroke. OBJECTIVE: Previous meta-analyses have shown that VNS may impact stroke rehabilitation, but each has some limitations. METHODS: PubMed, Ovid, Cochrane Library, ScienceDirect, Web of Science and WHO ICTRP databases were searched until July 14, 2022 for randomized controlled trials (RCTs). We defined primary outcomes as Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT). Subgroup analyses included types of VNS, time since onset and long-term …effects. Secondary outcomes included adverse events of VNS. RESULTS: Eight RCTs involving 266 patients were analyzed, of which five used direct VNS and three transcutaneous auricular VNS. The results revealed that VNS enhanced upper extremity function via FMA-UE (SMD = 0.73; 95% CI: 0.48 to 0.99; P  < 0.00001) and WMFT (SMD = 0.82; 95% CI:0.52 to 1.13; P  < 0.00001) in comparison to the control group, but showed no significant change on long-term effects of FMA-UE (SMD = 0.69; 95% CI: – 0.06 to 1.44; P  = 0.07). There was no difference in adverse events between the VNS and control groups (RR = 1.16; 95% CI: 0.46 to 2.92; P  = 0.74). CONCLUSION: For stroke victims with upper limb disabilities, VNS paired with rehabilitation was significantly safe and effective. More high-quality multicentric RCTs are needed to validate this conclusion. Show more

Keywords: Vagus nerve stimulation, upper-limb function, stroke, rehabilitation, meta-analysis

DOI: 10.3233/NRE-230106

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 253-267, 2023

Authors: Mahmoud, Hayam Mahmoud | Al-Turkistani, Zenab Ibrahim | Alayat, Mohamed Salaheldien | Abd El-Kafy, Ehab Mohamed | El Fiky, Amir Abdel Raouf

Article Type: Review Article

Abstract: BACKGROUND: Freezing of gait (FOG) is one of the major debilitating motor symptoms that affect Parkinson’s disease (PD) patients’ gait, OBJECTIVE: To investigate the effect of dancing on FOG, motor symptoms, and balance in patients with Parkinsonism. METHODS: Eight databases were searched for full-text English randomized control trials (RCTs). The freezing of gait (FOG) was the primary outcome while the balance and Unified Parkinson Disease Rating Scale (UPDRS-3) were the secondary outcomes. Methodological quality was evaluated by the Physiotherapy Evidence Database (PEDro) scale. Level of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation …(GRADE) system. A random-effect model of meta-analysis was used to calculate the standardized mean difference (SMD) at a 95% confidence interval (CI), and the effect size. RESULTS: A total of nine studies (263 patients) were included. Qualitative data related to participants, dancing type, measured outcomes, and follow-up were extracted. PEDro scale showed one fair-quality and eight high-quality studies. GRADE showed a low to very low level of evidence with moderate effect size on both UPDRS (SMD –70 [–1.04, –0.36]) and Balance (SMD 0.35 [0.08, 0.63]). CONCLUSION: Dance is an effective modality on improving UPDRS and balance with small effect on FOG. Further high-quality studies with high-quality of evidence are recommended to increase the confidence to the effect estimate and support the finding results. Show more

Keywords: Freezing of gait, Parkinson’s disease, dancing therapy, systematic review, meta-analysis

DOI: 10.3233/NRE-230114

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 269-284, 2023

Authors: You, Yue | Li, Yue | Zhang, Yin | Fan, Huimin | Gao, Qiang | Wang, Ling

Article Type: Review Article

Abstract: BACKGROUND: Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation tool for improving language performance in patients with aphasia after stroke. However, it remains unclear whether it has long-term effects. After consulting a large number of relevant studies, it was found that there are no definitive conclusions about the long-term effects of tDCS on post-stroke aphasia patients. OBJECTIVE: To determine whether tDCS has long-term effects on post-stroke aphasia patients (PAPs) and which type of tDCS has the most beneficial treatment effects on language performance (especially naming ability). METHODS: A network meta-analysis was conducted by searching for …randomized controlled trials (RCTs) published until April 2023 in the following databases: Web of Science, Embase, Medline (from OVID and PubMed), PsycInfo and PsycARTICLES (from OVID). We only included RCTs published in English. PAPs treated by tDCS combined with speech-language therapy were selected. Sham tDCS was the control group. Naming ability or other language performance must be assessed at follow-up states. Two reviewers independently used checklists to assess the primary outcome (the long-term effects on naming ability) and the secondary outcome (other language performance, such as communication). Cochrane Collaboration guidelines were used to assess the risk of bias. RESULTS: Seven studies with 249 patients were included for data synthesis. For primary outcomes (naming nous), there was no obvious evidence to show a difference between interventions (C-tDCS vs. S-tDCS SMD = 0.06, 95% CI = –1.01, 1.12; A-tDCS vs. S-tDCS SMD = 0.00, 95% CI = –0.66, 0.65; D-tDCS vs. S-tDCS SMD = 0.77, 95% CI = –0.71, 2.24; A-tDCS vs. C-tDCS SMD = –0.06, 95% CI = –1.31,1.19; D-tDCS vs. C-tDCS SMD = 0.71, 95% CI = –1.11,2.53; D-tDCS vs. A-tDCS SMD = 0.77, 95% CI = –0.84, 2.39). In addition, no evidence showed differences in communication ability (C-tDCS vs. S-tDCS SMD = 0.08 95% CI = –1.77, 1.92; A-tDCS vs. S-tDCS SMD = 1.23 95% CI = –1.89, 4.34; D-tDCS vs. S-tDCS SMD = 0.70; 95% CI = –1.93, 3.34; A-tDCS vs. C-tDCS SMD = 1.15 95% CI = –2.48, 4.77; D-tDCS vs. C-tDCS SMD = 0.62 95% CI = –2.59, 3.84; D-tDCS vs. A-tDCS SMD = –0.52 95% CI = –4.60, 3.56). CONCLUSION: It seems that tDCS has no long-term effects on post-stroke aphasia patients in naming nouns and communication in terms of the results of our network meta-analysis. However, the results should be interpreted with caution. In the future, more RCTs with long follow-up times should be included in the research to conduct subgroup or meta-regression analyses to obtain a sufficient effect size. Show more

Keywords: Transcranial direct current stimulation (tDCS), stroke, aphasia, long-term effects, naming ability

DOI: 10.3233/NRE-230099

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 285-296, 2023

Authors: Kim, Yunhwan | Oh, Wonjun | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: Current therapeutic evidence suggests limited efficacy of the cognitive and exercise training in mild cognitive impairment (MCI) on depression, anxiety, memory retention, comprehension, calculation, concentration, orientation, dual-task performance, and sleep disorders. Nevertheless, the immediate effects of multimodal cognitive therapy (MCT) have recently developed and its individual effects remains unknown in MCI. OBJECTIVE: This study aimed to compare the immediate effects of MCT on cognitive and psychological measures between young healthy and older adults with MCI. METHODS: Forty young healthy and older adults with MCI underwent immediate MCT (5 minutes each), including transcranial direct current stimulation …(tDCS), light therapy, computerized cognitive therapy (CCT), robotic-assisted gait training (RAGT), core breathing exercises (CBE), and music therapy. Outcome measures included memory retention, comprehension, calculation, attention, orientation, dual-task performance, awareness, depression, anxiety, and sleep disorders. The Mann-Whitney U test and Friedman’s test were used at P  < 0.05. RESULTS: Significant differences in depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness were observed between the tDCS, CCT, and music therapy groups (P  < 0.05). CONCLUSION: MCT was beneficial for mitigating depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness. Show more

Keywords: Mild cognitive impairment, cognitive rehabilitation, transcranial direct current stimulation, light therapy, computerized cognitive therapy, robotic-assisted gait training, core breathing exercises, music therapy

DOI: 10.3233/NRE-230127

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 297-308, 2023

Authors: Azimi, Somayyeh | Troeung, Lakkhina | Martini, Angelita

Article Type: Research Article

Abstract: BACKGROUND: Acquired brain injury (ABI) can cause long-term disability and functional impairment. OBJECTIVE: This study aims to determine the prevalence of dental hospitalizations in an ABI cohort across different phases of injury and identify factors associated with such hospitalizations. METHODS: The cohort comprises patients with ABI (n  = 683), traumatic (n  = 282) and non-traumatic (n  = 401) who were admitted to a neurorehabilitation service in Western Australia between 1991 and 2016. De-identified patient data were linked to the Hospital Morbidity Data Collection. The incidence of dental hospitalizations was calculated per 1,000 person-years (PY), and associated factors were investigated …using multilevel mixed-effects logistic regression. RESULTS: Dental hospitalizations significantly increased from pre-injury (3.35/1,000PY) to acute injury (302.65, Δ +299.3) and remained elevated in the post-acute phase (23.98, Δ +20.63). Dental caries had the highest incidence rate among all diagnoses in the pre-injury and post-acute phases (0.68 and 8.93, respectively), followed by gingivitis and periodontal diseases (3.60) in the post-acute phase. Tooth extractions were performed more often than restorative and preventive treatment in the pre-and post-injury phase, p  < 0.001. Dental hospitalizations were associated with the type of ABI, age at injury, remoteness, and history of pre-injury hospitalization. CONCLUSION: Implementing comprehensive preventive dental care can reduce potentially preventable dental hospitalization among ABI patients. Show more

Keywords: Brain injuries, traumatic, stroke, disabled person, hospitalization, dental care, Australia

DOI: 10.3233/NRE-230145

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 309-321, 2023

Authors: Pilon, Louise | Frankenmolen, Nikita F. | van der Zijp, Janna | Kessels, Roy P.C. | Bertens, Dirk

Article Type: Research Article

Abstract: BACKGROUND: Sleep disturbances are common after acquired brain injury (ABI) and have a negative impact on functioning. OBJECTIVE: This study examines whether a short add-on therapy for sleep disturbances in individuals with ABI is effective in addition to rehabilitation treatment as usual. METHODS: In the randomized-controlled study, 54 adults with ABI and self-reported sleep disturbances receiving outpatient rehabilitation services were randomized in two groups: one receiving a sleep intervention (based on cognitive behavioural therapy for insomnia (CBT-I)) in addition to their rehabilitation treatment (CBT-I + TAU group) and one receiving treatment as usual (TAU). The primary …outcome was sleep quality, measured with the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included measures of anxiety, depression, fatigue and dysfunctional beliefs and attitudes about sleep. RESULTS: The short add-on sleep therapy resulted in improvements in sleep quality in the CBT-I + TAU group as compared to the TAU group (ES = 0.924). Furthermore, the CBT-I + TAU group reported less dysfunctional beliefs and attitudes about sleep and were better able to cope with fatigue compared to the TAU group. CONCLUSIONS: The application of this short add-on sleep intervention could be implemented in neuropsychological rehabilitation settings. Show more

Keywords: Acquired brain injury, stroke, traumatic brain injury, sleep disturbances, RCT, neuropsychological rehabilitation

DOI: 10.3233/NRE-230139

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 323-334, 2023

Authors: Shin, Ji Cheol | Jeon, Ha Ra | Kim, Dahn | Min, Won Kyu | Lee, June Sung | Cho, Sung Il | Oh, Da Som | Yoo, Jeehyun

Article Type: Research Article

Abstract: BACKGROUND: There is no randomized controlled study about the effects of end-effector robot-assisted gait training (RAGT) in patients with spinal cord injury (SCI). OBJECTIVE: To examine the effects of end-effector RAGT on gait and balance abilities in SCI. METHODS: Thirty-one patients were randomly assigned to the RAGT (Morning Walk® , Curexo, Seoul, South Korea) or conventional therapy (CT) group. Patients were assessed using the 10-meter walk test (10MWT), 6-minute walk test (6mWT), lower extremity motor score (LEMS) and proprioception, Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury-II (WISCI-II), and mobility category of Spinal Cord …Independence Measure-III. RESULTS: All clinical outcome measures significantly improved in both groups. The BBS and WISCI-II were significantly improved in the RAGT group compared to the CT group. In the RAGT group, pre-LEMS and pre-WISCI-II of the 10MWT improved group and pre-BBS of the 6mWT improved group were higher than those of the 10MWT non-improved and 6mWT non-improved group, respectively. CONCLUSION: End-effector RAGT and CT in patients with incomplete SCI could lead to improvements in gait ability, lower extremity muscle strength, balance, proprioception, and mobility. Additionally, end-effector RAGT could improve balance and gait abilities substantially better than CT. Show more

Keywords: Robotics, robot-assisted gait training, spinal cord injuries, proprioception, postural balance

DOI: 10.3233/NRE-230085

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 335-346, 2023

Authors: Stuerner, Jana | Sehle, Aida | Liepert, Joachim

Article Type: Research Article

Abstract: BACKGROUND: Motor imagery (MI) can serve as a treatment for stroke rehabilitation. MI abilities can be assessed by testing mental chronometry (MC) as the degree of conformity between imagined and real performance of a task. A good MC performance is supposed to indicate good MI capacities. OBJECTIVE: To explore if MC abilities can be modified by extrinsic feedback in stroke patients. METHODS: 60 subacute stroke patients were randomized into three groups. MC was evaluated by executing a modified version of the Box and Block Test (BBT) mentally and in real before and after a training session. …For Groups 1 and 2 the training consisted of repeated performance of the BBT in a mental and then a real version. The time needed to complete each task was measured. Only participants of Group 1 received feedback about how well mental and real performance matched. Group 3 executed the same number of BBTs but without MI. RESULTS: MC ability only improved in Group 1. The improvement lasted for at least 24 hours. In all groups, BBT real performance was improved post-training. CONCLUSION: External feedback was able to enhance MC capability which might be an approach for improving MI abilities. Show more

Keywords: Stroke, stroke rehabilitation, hemiparesis, upper extremity, occupational therapy

DOI: 10.3233/NRE-230093

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 347-354, 2023

Authors: Seki, Takashi | Abe, Hiroaki | Tsujimoto, Naohide | Okanuka, Toru

Article Type: Research Article

Abstract: BACKGROUND: Accurate prediction of recovery is essential to determine whether a knee-ankle-foot orthosis (KAFO) is required in the subacute phase of stroke. However, there are currently no reliable methods to predict such recovery. OBJECTIVE: This study aimed to determine whether muscle strength of the affected lower limb (affected side LL strength) in stroke patients in the subacute phase who cannot walk without a KAFO can be used to predict the continuous need for a KAFO, using a hand-held dynamometer. METHODS: We enrolled patients with severe hemiplegia (n  = 51) who were unable to walk without a KAFO …for 10 days after stroke onset. They were divided into two groups depending on the continuous need for a KAFO at 1 month after onset; the KAFO and non-KAFO groups. Logistic regression analysis was used to investigate whether the affected side LL strength was a predictor of the continuous need for a KAFO at 1 month after onset. In addition, significant predictors were analyzed using receiver operating characteristic (ROC) curves. RESULTS: The KAFO and non-KAFO groups included 23 (45.10%) and 28 (54.90%) patients, respectively. The affected side LL strength and pusher syndrome severity were identified as predictors of the continuous need for a KAFO. The predictor with the highest predictive ability was the affected side LL strength, with an area under the ROC curve of 0.80 (95% CI, 0.68–0.93). CONCLUSIONS: Affected side LL strength may be a highly accurate predictor of the need for a KAFO in the subacute phase of stroke. Show more

Keywords: Gait, hand-held dynamometer, knee-ankle-foot orthosis, muscle strength, stroke

DOI: 10.3233/NRE-230057

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 355-366, 2023

Authors: Medina-Mirapeix, Francesc | Crisóstomo, María José | Gacto-Sánchez, Mariano | Escolar-Reina, M. Pilar | Sánchez-Martínez, M. Piedad | Martín-SanAgustín, Rodrigo | García-Vidal, José Antonio

Article Type: Research Article

Abstract: BACKGROUND: The recovery of community ambulation is a common concern among individuals after stroke. OBJECTIVES: (1) To develop a potential readily applicable prognostic model able to correctly discriminate stroke patients who will not become independent community walkers at discharge; (2) To investigate the effects of early reassessment during the first month of treatment on the prediction accuracy of this model. METHODS: This was a prospective cohort study. A consecutive sample of 80 patients at ≤60 days poststroke were assessed at baseline of outpatient physical rehabilitation and reassessed one month later. Non-functional community ambulation was measured. …RESULTS: Seventy-four patients were followed until discharge. Of these, 47 patients were non-functional community walkers at discharge. A prediction model based on baseline performance in the five repetition sit-to-stand [5-STS] test was able to discriminate those patients of the sample (Area-under-curve = 0.956), and again with data from reassessment (AUC = 0.952). A time of 21 s at baseline was a highly prognostic cut-off point for discrimination (sensitivity = 87.2% and 85.1%). The combined use of baseline and reassessment data improved sensitivity (98.1%) CONCLUSION: Early findings of the 5-STS among stroke patients is an independent prognostic factor associated with independent community walking at discharge. It could discriminate individuals who will not become community walkers at discharge. Show more

Keywords: Sub-acute stroke, sit-to-stand test, community/non-community ambulators, outpatient physical rehabilitation

DOI: 10.3233/NRE-230161

Citation: NeuroRehabilitation, vol. 53, no. 3, pp. 367-375, 2023