NeuroRehabilitation - Volume 53, issue 4

Authors: Xie, Yulong | Pan, JuanHong | Chen, Jia | Zhang, Di | Jin, Song

Article Type: Review Article

Abstract: BACKGROUND: Upper limb motor dysfunction after stroke is an important factor affecting patients’ motor function and daily life. Acupuncture and repetitive transcranial magnetic stimulation are effective methods for stroke rehabilitation. However, a systematic and comprehensive overview of the combined efficacy of the two is lacking. OBJECTIVE: Through a systematic review and meta-analysis of randomized controlled trials, this study aimed to assess the effectiveness of acupuncture combined with repetitive transcranial magnetic stimulation on upper extremity motor function in post-stroke patients. METHODS: The relevant randomized controlled trials on acupuncture combined with repetitive transcranial magnetic stimulation in the treatment …of upper limb motor disorders after stroke were searched in PubMed, Embase, Cochrane Library, Web of Science CNKI, VIP, Wanfang, and CBM databases. After screening clinical trials that met the inclusion criteria, data extraction was conducted independently by two investigators. Meta-analysis was performed using RevMan 5.4 software. RESULTS: After the screening, 18 articles were included, with a total of 1083 subjects. The results of meta-analysis showed that combination therapy could effectively improve the patients’ upper limb motor function (MD = 7.77, 95%CI [6.32, 9.22], P  < 0.05), ability of daily living (MD = 8.53, 95%CI [6.28, 10.79], P  < 0.05), and hemiplegic shoulder pain (MD = – 1.72, 95%CI [– 2.26, – 1.18], P  < 0.05). Meanwhile, for neurophysiological indexes, combined treatment could significantly shorten the latency of motor evoked potential and central motor conduction time (MD = – 1.42, 95%CI [– 2.14, – 0.71], P  < 0.05); (MD = – 0.47, 95%CI [– 0.66, – 0.29], P  < 0.05), and also could increase the amplitude of motor evoked potential (SMD = 0.71, 95%CI [0.28, 1.14], P  < 0.05). CONCLUSION: According to the results of the meta-analysis, we can conclude that acupuncture combined with repeated transcranial magnetic stimulation can significantly improve the upper limb motor function and daily living ability of stroke patients. Show more

Keywords: Stroke, acupuncture, repetitive transcranial magnetic stimulation, upper limb, daily living ability, meta-analysis

DOI: 10.3233/NRE-230144

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 423-438, 2023

Authors: Macchitella, Luigi | Amendola, Simone | Barraco, Giulia | Scoditti, Sara | Gallo, Ivana | Oliva, Maria Carmela | Trabacca, Antonio

Article Type: Review Article

Abstract: BACKGROUND: Virtual reality (VR) interventions have been increasingly used in the rehabilitation of a wide range of neurological and neuropsychological dysfunctions. Findings of previous reviews showed positive and promising effects of VR-based interventions. However, they summarized findings on VR-based intervention carried out through different VR systems and tasks. OBJECTIVE: We carried out a narrative review with the aim of qualitatively synthesising the results of previous studies that used specific VR systems, i.e. the Khymeia –Virtual Reality Rehabilitation System, for treatment purposes. METHODS: We searched the literature in various databases (i.e. EMBASE, Web of Science, SCOPUS, PubMed …and PubMed Central) for studies published until November 23, 2023. RESULTS: 30 studies were selected. The VRRS was used for neuromotor rehabilitation only in 13 studies, for cognitive rehabilitation in 11 studies, and for both neuromotor and cognitive rehabilitation in six studies. The study design was heterogeneous including 15 randomised controlled trials. CONCLUSION: After discussing each study according to the type of rehabilitation we concluded that the use and efficacy of VRRS rehabilitative intervention for increasing the neurological and neuropsychological functioning of patients are promising but more evidence is needed to make a comparison with conventional treatment. Future studies should also include long-term follow-up as well as cost-effectiveness analysis. Show more

Keywords: Virtual reality-based rehabilitation, telerehabilitation, telehealth

DOI: 10.3233/NRE-230066

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 439-457, 2023

Authors: Bachar Kirshenboim, Yishai | Weitzer, Tal | Rand, Debbie

Article Type: Review Article

Abstract: BACKGROUND: Dual-task involves performing cognitive and motor tasks together, which requires executive functions that may be impaired in individuals with neurological conditions. Therefore, it is important to accurately assess executive functions to plan a therapeutic intervention. OBJECTIVE: To characterize the use of upper extremity-cognitive dual-task assessment and to describe variables correlated with dual-task ability. METHODS: An electronic search of databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) was carried out using a combination of the following terms: upper-extremity, dual/concurrent task, and cognitive/motor tasks. Two reviewers independently completed data extraction and assessed study quality. RESULTS: 1,946 studies …were identified; 25 studies met the inclusion criteria. The purpose of using an upper extremity-cognitive dual-task assessment varied between studies as well as the upper extremity motor tasks used: pegboard (N = 14), arm curl (N = 9), finger-tapping (N = 3), and reaching (N = 1) tests. Dual-task ability was reported as the motor-cognitive interference (N = 15) and as motor cost (N = 12). Dual-task ability was correlated to cognition, brain activity, and daily function, and was significantly different between healthy and neurological individuals. CONCLUSION: Upper extremity cognitive dual-task paradigm is gaining popularity in clinical research, but lacks standardized tools, testing procedures, and calculations. A structured assessment procedure is needed for clinical use and future research. Show more

Keywords: Upper extremity, dual-task, motor-cognitive interference, motor cost, executive functions

DOI: 10.3233/NRE-230076

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 459-471, 2023

Authors: Bevilacqua, Zachary W. | Rich, Jason | Henry, Timothy J.

Article Type: Research Article

Abstract: BACKGROUND: College faculty are receiving attention as influential members of the Return-to-Learn (RTL) process for students with concussion. Investigators continue to learn more about how faculty can assist students throughout recovery, yet we must also strive to determine whether such evidence is isolated or is in fact exhibited by faculty elsewhere. OBJECTIVE: We sought to determine if successive faculty cohorts demonstrate similar perspectives and RTL decision-making profiles as those from initial investigations. METHODS: Two universities in New York State were recruited to participate in a two-stage cross-sectional study. College faculty with teaching responsibilities were given the …opportunity to complete an online Qualtrics survey followed by a private interview discussing their thoughts, perspectives, and/or experiences with managing students with concussion. RESULTS: Accommodations for students were allowed more often when some form of documentation was present (disability services note = 100%; multiple types of proof = 91%; doctor/medical notes = 90%; and no note = 75%). Three factors consistently scored as influential to faculty RTL decision-making: documentation, teacher-student relationship, and empathy. No significant differences in scoring were seen between male and female faculty participants. Follow-up interviews revealed two themes: legitimacy and empathy. Legitimacy outlines why faculty seek verification of concussion prior to allowing accommodations and includes two subthemes: i) note/documentation, and ii) fairness/protecting integrity. Empathy discusses how and why faculty empathetically assist students with concussion, and includes two subthemes: i) personality, and ii) past experiences/understanding of concussion. CONCLUSION: Our findings indicate that faculty from different universities display similar RTL decision-making tendencies and perspectives towards students with concussion as those from initial investigations. These data allow RTL stakeholders to better understand and appreciate the potential for faculty to act as facilitators to concussion support. As gatekeepers of the classroom environment, understanding how to produce faculty cooperation will ensure a reproducible and positive outcome for students recovering from concussion. Show more

Keywords: Brain concussion, universities, return to school, faculty, education, neurological rehabilitation, health services for persons with disabilities

DOI: 10.3233/NRE-230177

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 473-489, 2023

Authors: Zheng, Ruizhe | Qi, Zengxin | Thibaut, Aurore | Wang, Zhe | Xu, Zeyu | Di, Haibo | Wu, Xuehai | Mao, Ying | Laureys, Steven

Article Type: Research Article

Abstract: BACKGROUND: The number of patients with disorders of consciousness (DoC) has increased dramatically with the advancement of intensive care and emergency medicine, which brings tremendous economic burdens and even ethical issues to families and society. OBJECTIVE: To evaluate the effectiveness of neuromodulation therapy for patients with DoC. METHODS: First, we conducted a literature review of individual patient data (IPD) on PubMed, EMBASE, and Cochrane-controlled trials following PRISMA guidelines. Then, we collected neuromodulation cases from our institution. Finally, we conducted a pooled analysis using the participants from the medical literature (n  = 522) and our local institutions (n … = 22). RESULTS: In this pooled analysis of 544 patients with DoC with a mean age of 46.33 years, our results revealed that patients have improved CRS-R scores [1.0 points (95% CI, 0.57–1.42)] after neuromodulation. Among them, patients have better effectiveness in traumatic than non-traumatic etiology (P  < 0.05). The effectiveness of consciousness improvement could be affected by the age, baseline consciousness state, and duration of stimulation. Compared with non-invasive intervention, an invasive intervention can bring more behavioral improvement (P  < 0.0001) to MCS rather than UWS/VS patients. Importantly, neuromodulation is a valuable therapy even years after the onset of DoC. CONCLUSION: This pooled analysis spotlights that the application of neuromodulation can improve the behavioral performance of patients with DoC. A preliminary trend is that age, etiology, baseline consciousness state, and stimulation duration could impact its effectiveness. Show more

Keywords: Neuromodulation, brain injury, disorder of consciousness, pooled analysis

DOI: 10.3233/NRE-230103

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 491-503, 2023

Authors: Çelik, Samet | Yıldırım, Vural | Güler, Züleyha Damla | Kadam, Hüseyin Tuğra

Article Type: Research Article

Abstract: BACKGROUND: Computerized neuropsychological tests provide advantages to clinicians with cost, administration, and time. However, studies have pointed out performance differences between manual and computerized versions of some neuropsychological tests. One of these is the Wisconsin Card Sorting Test (WCST). Due to the performance difference, the normative data of manual tests cannot be used for their computerized versions. Therefore, normative data searches are needed for computerized versions. OBJECTIVE: This study aimed to determine the norm values of WCST-CV in a healthy sample. METHODS: 422 healthy adults aged 18–78 participated in this study. WCST-CVsub-scores are modeled by Regression …Analysis based on Age and Education level to generate normative data. Among the 13 WCST scores, the regression models for WCST 2, WCST 3, WCST 4, WCST 10, and WCST 11 are significant. WCST 2, WCST 4, and WCST 11 scores are estimated with Ordinary Least Squares (OLS). However, WCST 3 and WCST 10 scores are estimated with Weighted Least Squares (WLS) due to the violation of the homoscedasticity assumption. RESULTS: The regression results show that p -values calculated from error increase as age and education level increase. CONCLUSION: As a result of our research, norm values between 18–78 years of age were produced using RA. It was determined that gender was not significant for any sub-score. Therefore, only age and education level from socio-demographic variables were included in the model. Show more

Keywords: Regression modelling, WCST-CV, Turkish population, normative data, neuropsychological tests

DOI: 10.3233/NRE-230164

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 505-515, 2023

Authors: Braga, Lucia Willadino | Oliveira, Sandro Barbosa | Moreira, Andrea Suhet | Martins Pereira, Maria Eloá Moreira da Silva | Serio, Andrea Simoes Serra | Carneiro, Virgínia da Silva | Freitas, Luciana de Figueiredo Pereira | Souza, Lígia Maria do Nascimento

Article Type: Research Article

Abstract: BACKGROUND: Duration of neuropsychological disorders caused by long COVID, and the variables that impact outcomes, are still largely unknown. OBJECTIVE: To describe the cognitive profile of patients with long COVID post-participation in a neuropsychological rehabilitation program and subsequent reassessment and identify the factors that influence recovery. METHODS: 208 patients (mean age of 48.8 y.o.), mostly female, were reevaluated 25 months after their first COVID infection and 17 months after their initial evaluation. Patients underwent subjective assessment, Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing Tests (NEUPSILIN) for executive functions, …Hospital Anxiety and Depression Scale (HADS) and WHOQol-Bref. RESULTS: We noted a discrete improvement of neuropsychological symptoms 25 months after the acute stage of COVID-19; nonetheless, performance was not within the normative parameters of standardized neuropsychological testing. These results negatively impact QoL and corroborate patients’ subjective assessments of cognitive issues experienced in daily life. Improvement was seen in those who participated in psychoeducational neuropsychological rehabilitation, had higher levels of education, and lower depression scores on the HADS. CONCLUSION: Our data reveal the persistence of long-term cognitive and neuropsychiatric disorders in patients with long COVID. Neuropsychological rehabilitation is shown to be important, whether in-person or online. Show more

Keywords: COVID-19, post-acute COVID-19 syndrome, neuropsychological tests, cognitive dysfunction, cognitive training

DOI: 10.3233/NRE-230212

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 517-534, 2023

Authors: Conklin, Jessica P. | McCauley, Katherine L. | Breitenstein, Jackie | Edelman, Lyndsey | Gore, Russell K. | Wallace, Tracey

Article Type: Research Article

Abstract: BACKGROUND: The COVID-19 pandemic necessitated the implementation of telehealth and hybrid service delivery models and provided an opportunity to study the impact of this care model in military populations with history of traumatic brain injury (TBI). OBJECTIVE: To present telehealth service utilization rates across rehabilitation specialties, treatment outcome indicators, and patient satisfaction outcomes from a retrospective clinical sample. METHODS: The study sample consists of 34 patients who underwent telehealth/hybrid Intensive Outpatient Programming (IOP) at a major rehabilitation hospital. Retrospective chart review and clinical data extraction were performed. A historical cohort receiving in-person care was used as …a comparison group. Statistical analyses included partial correlations, mixed method analysis of variance (ANOVA), and independent sample t -tests. RESULTS: Medical, behavioral health, physical, occupational, and speech-language therapy providers exhibited similar rates of telehealth service delivery (35 to 41% of all sessions). No significant association was found between percent telehealth sessions and the global treatment outcome indicator. Comparison of treatment effects across cohorts revealed similar benefits of IOP. No between-group differences were noted in satisfaction ratings. CONCLUSION: The comparable treatment-related gains and reports of positive patient experience support the use of a telehealth and hybrid delivery model for military service members and veterans with TBI. Show more

Keywords: Military, telehealth, interdisciplinary, rehabilitation, brain injury, outcome, satisfaction

DOI: 10.3233/NRE-230154

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 535-545, 2023

Authors: Abd-Elmonem, Amira M. | Ali, Hazem A. | Saad-Eldien, Sara S. | Rabiee, Ahmed | Abd El-Nabie, Walaa A.

Article Type: Research Article

Abstract: BACKGROUND: Children with spastic diplegia experience tonicity, lack of selective motor control, subnormal postural stability and delayed motor development. Selective dorsal rhizotomy followed by physical therapy is a permanent procedure aimed to alleviate hypertonicity. OBJECTIVE: To explore the efficacy of selective dorsal rhizotomy (SDR) followed by a physical training on gross motor function (GMF), functional balance, walking capacity, selective motor control (SMC) and energy cost of walking (ECW) of ambulant children with spastic diplegia. METHODS: Forty-two children with spastic diplegia aged 5 to 8 years were randomly assigned into the control or SDR-group. Both groups received …a designed physical training of progressive functional strength training and standard orthotic management (SOM) 3 times a week for 6 months. GMF, functional balance, ECW, functional capacity and SMC were assessed by gross motor function measure (GMfM-88), pediatric balance scale (PBS), energy expenditure index (EEI), six-minute walking test (6MWT) and selective control assessment of lower extremity (SCALE), respectively. Assessment was carried out before the treatment (baseline), after 6 months (post I) and 1-year follow-up (post II). RESULTS: From baseline to post I and post II assessments, changes of GMF, functional balance, ECW, functional capacity and SMC within the control and SDR groups showed significant improvements (P  < 0.001). Moreover, group comparison showed significant differences in favor of the SDR group. CONCLUSION: Integrated physical training followed SDR demonstrated qualitative changes and enhancement in motor function, achieved by spasticity reduction. Show more

Keywords: Dorsal rhizotomy, energy cost of walking, progressive resistance exercise, selective motor control, spastic cerebral palsy

DOI: 10.3233/NRE-230098

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 547-556, 2023

Authors: Nomoto, Masahiro | Miyata, Kazuhiro | Kohno, Yutaka

Article Type: Research Article

Abstract: BACKGROUND: White matter hyperintensity (WMH) is reported to have a potential prevalence in healthy people and is a predictor of walking disability. However, WMH has not been adequately considered as a predictor of independent walking after stroke. OBJECTIVE: To investigate the effects of WMH severity on walking function in patients with acute stroke. METHODS: The retrospective cohort study included 422 patients with acute stroke. The WMH severity from magnetic resonance images was evaluated using the Fazekas scale. Age, type of stroke, Fazekas scale, Brunnstrom motor recovery stage, Motricity Index, and Mini-Mental State Examination were used as …independent variables. Multivariable logistic regression analysis was conducted on the factors of independent walking at discharge and 6 months after onset, respectively. RESULTS: Multivariable analysis revealed that the Fazekas scale is not a predictive factor of independent walking at discharge (odds ratio [OR] = 0.89, 95% confidence intervals [CI] = 0.65–1.22), but at 6 months (OR = 0.54, 95% CI = 0.34–0.86). CONCLUSION: The WMH severity was a predictive factor of independent walking in patients with acute stroke after 6 months. WMH is a factor that should be considered to improve the accuracy of predicting long-term walking function in patients with stroke. Show more

Keywords: Cerebral small vessel disease, stroke rehabilitation, hemiparesis, muscle weakness, prognostic factor, acute stroke

DOI: 10.3233/NRE-230225

Citation: NeuroRehabilitation, vol. 53, no. 4, pp. 557-565, 2023