NeuroRehabilitation - Volume 54, issue 2

Authors: Rodríguez-Huguet, Manuel | Ayala-Martínez, Carmen | Vinolo-Gil, Maria Jesus | Góngora-Rodríguez, Pablo | Martín-Valero, Rocío | Góngora-Rodríguez, Jorge

Article Type: Review Article

Abstract: BACKGROUND: Stroke is a clinical syndrome that can cause neurological disorders due to a reduction or interruption in the blood flow at the brain level. Transcranial direct current stimulation (TDCS) is a non-invasive electrotherapy technique with the ability to modulate the function of nervous tissue. OBJECTIVE: The aim of this review is to analyze the effects derived from the application of the TDCS for post-stroke patients on functionality and mobility. METHODS: The data search was conducted in PubMed, PEDro, Cochrane Library, Web of Science and Scopus between July and August 2023. The search focused on randomized …clinical trials conducted in the period of 2019–2023, and according to the selection criteria, seven studies were obtained. RESULTS: The results found are mainly focused on the analysis of the scales Fugl-Meyer Assessment for Upper Extremity and Wolf Motor Function Test. CONCLUSION: The application of TDCS presents benefits in post-stroke individuals on functionality, mobility and other secondary studied variables. Show more

Keywords: Physical therapy, rehabilitation, stroke, transcranial direct current stimulation

DOI: 10.3233/NRE-230213

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 171-183, 2024

Authors: Hwang, Sujin | Song, Chiang-Soon

Article Type: Review Article

Abstract: BACKGROUND: Electrical stimulation techniques are widely utilized for rehabilitation management in individuals with stroke patients. OBJECTIVES: This review aims to summarize the rehabilitative effects of electrical stimulation therapy on gait performance in stroke patients. METHODS: This review included randomized controlled trials (RCT) investigating the therapeutic effects of electrical stimulation in stroke patients throughout five databases. This review qualitatively synthesized 20 studies and quantitatively analyzed 11 RCTs. RESULTS: Functional electrical stimulation (FES) was the most commonly used electrical stimulation type to improve postural stability and gait performance in stroke patients. The …clinical measurement tools commonly used in the three studies to assess the therapeutic effects of FES were Berg balance scale (BBS), 10-meter walk test (10MWT), 6-minute walk test (6mWT), and gait velocity. The BBS score and gait velocity had positive effects in the FES group compared with the control group, but the 10MWT and 6mWT showed the same effects between the two groups. The heterogeneity of BBS scores was also high. CONCLUSION: The results of this review suggest that electrical stimulation shows little evidence of postural stability and gait performance in stroke patients, although some electrical stimulations showed positive effects on postural stability and gait performance. Show more

Keywords: Cerebrovascular accident, electrical stimulation, gait, rehabilitation, stroke, walking

DOI: 10.3233/NRE-230360

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 185-197, 2024

Authors: Zhang, Ming | Zhu, Feilong | Jia, Fan | Wu, Yu | Wang, Bin | Gao, Ling | Chu, Fengming | Tang, Wei

Article Type: Review Article

Abstract: BACKGROUND: The recovery of upper limb function is crucial to the daily life activities of stroke patients. Brain-computer interface technology may have potential benefits in treating upper limb dysfunction. OBJECTIVE: To systematically evaluate the efficacy of brain-computer interfaces (BCI) in the rehabilitation of upper limb motor function in stroke patients. METHODS: Six databases up to July 2023 were reviewed according to the PRSIMA guidelines. Randomized controlled trials of BCI-based upper limb functional rehabilitation for stroke patients were selected for meta-analysis by pooling standardized mean difference (SMD) to summarize the evidence. The Cochrane risk of bias …tool was used to assess the methodological quality of the included studies. RESULTS: Twenty-five studies were included. The studies showed that BCI had a small effect on the improvement of upper limb function after the intervention. In terms of total duration of training, < 12 hours of training may result in better rehabilitation, but training duration greater than 12 hours suggests a non significant therapeutic effect of BCI training. CONCLUSION: This meta-analysis suggests that BCI has a slight efficacy in improving upper limb function and has favorable long-term outcomes. In terms of total duration of training, < 12 hours of training may lead to better rehabilitation. Show more

Keywords: Brain-computer interface (BCI), stroke, upper limb, motor recovery

DOI: 10.3233/NRE-230215

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 199-212, 2024

Authors: Wang, Bo | Yan, Minjun | Liu, Congyu | Yang, Zhijun | Wang, Xingchao | Zhao, Fu | Wang, Zhenmin | Li, Peng | Wang, Ying | Li, Shiwei | Liu, Gemingtian | Liu, Pinan

Article Type: Review Article

Abstract: BACKGROUND: NF2-schwannomatosis (NF2) is an autosomal dominant disorder prone to hearing loss. Auditory brainstem implants (ABIs) offer a promising solution for hearing rehabilitation in NF2. OBJECTIVE: To synthesize existing literature on ABI implantation in NF2, focusing on audiological outcomes and ABI-related complications. METHODS: The systematic review followed PRISMA guidelines and was registered in the PROSPERO database (CRD42022362155). Relevant studies were identified by searching PubMed, EMBASE, CENTRAL, CMB, and CNKI from inception to August 2023. Data on environmental sound discrimination, open-set discrimination, closed-set discrimination, and ABI-related complications were extracted and subjected to meta-analysis. Publication bias was evaluated …using funnel plots and Egger’s test. RESULTS: Thirty-three studies were included. The pooled estimate was 58% (95% CI 49–66%) for environmental sound discrimination and 55% (95% CI 40–69%) for closed-set discrimination. Regarding open-set discrimination, the pooled estimates were 30% (95% CI 19–42%) for sound only, 46% (95% CI 37–54%) for lip-reading only, and 63% (95% CI 55–70%) for sound plus lip-reading. The pooled occurrence of ABI-related complications was 33% (95% CI 15–52%). CONCLUSION: This meta-analysis underscores the effectiveness and safety of ABIs in NF2, providing valuable insights for evidence-based decision-making and hearing rehabilitation strategies. Show more

Keywords: Auditory brainstem implant, meta-analysis, NF2-schwannomatosis, audiologic rehabilitation, vestibular schwannoma

DOI: 10.3233/NRE-230198

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 213-225, 2024

Authors: Maciel, Ricardo Pires | Marchi, Bruna Samantha | Silveira, Henrique da Silva da | Rodovanski, Giovana Pascoali | Al-Rob, Aicha | Souza, Rodrigo | Costa, Marcelo Fernandes | Moran, Cristiane Aparecida | Sobieranski, Antonio Carlos

Article Type: Research Article

Abstract: BACKGROUND: Premature newborns have a higher risk of abnormal visual development and visual impairment. OBJECTIVE: To develop a computational methodology to help assess functional vision in premature infants by tracking iris distances. METHODS: This experimental study was carried out with children up to two years old. A pattern of image capture with the visual stimulus was proposed to evaluate visual functions of vertical and horizontal visual tracking, visual field, vestibulo-ocular reflex, and fixation. The participants’ visual responses were filmed to compose a dataset and develop a detection algorithm using the OpenCV library allied with FaceMesh for …the detection and selection of the face, detection of specific facial points and tracking of the iris positions is done. A feasibility study was also conducted from the videos processed by the software. RESULTS: Forty-one children of different ages and diagnoses participated in the experimental study, forming a robust dataset. The software resulted in the tracking of iris positions during visual function evaluation stimuli. Furthermore, in the feasibility study, 8 children participated, divided into Pre-term and Term groups. There was no statistical difference in any visual variable analyzed in the comparison between groups. CONCLUSION: The computational methodology developed was able to track the distances traveled by the iris, and thus can be used to help assess visual function in children. Show more

Keywords: Eye-tracking technology, eye movements, preterm birth, vision screening, dataset, software

DOI: 10.3233/NRE-230193

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 227-235, 2024

Authors: Narayan, Amitesh | Joshua, Abraham M. | Fernandes, Romita | Karnad, Shreekanth D. | Alammari, Abdulaziz | Chauhan, Namrata S. | Almgamese, Mohand Taleb D.

Article Type: Research Article

Abstract: BACKGROUND: In children with cerebral palsy (CP), fine motor skills limit forearm supination and active extension of the elbow, wrist, or fingers. Therapeutic interventions focusing on improving the ranges at these joints while facilitating active movements are the key to augmenting fine motor skills. OBJECTIVE: This pilot study examines if children with CP (with UE involvement) exposed to the Novel Hand Rehabilitation (NHR) Board will demonstrate 1) changes in spasticity and passive ROM of forearm and wrist/finger muscles, and 2) improvement in fine motor abilities. METHODS: The forearm and wrist/fingers of children with spastic CP (N … = 15; M  = 7, F  = 8) aged 49–72 months (65.33±6.355 months) were positioned on the NHR board till their tolerance limit or a minimum duration of 30 minutes. The outcome measures, i.e., spasticity (Modified Ashworth Scale), passive range of motion (PROM) of wrist and fingers, and fine motor skills (PDMS-2 - Fine motor scale), were recorded. RESULTS: The spasticity of forearm pronators (0.001) and wrist flexors (0.008) reduced significantly, but not in wrist extensors. Post-intervention improvements in wrist extension (p  = 0.005) and ulnar deviation ROM (p  = 0.007) were significant. In thumb, changes were non-significant for the CMC flexion, but extension (0.003) and abduction (0.001) as well as MCP extension (0.004) were significant. The post-intervention MCP extension ROM for the 2nd (0.001), 3rd (0.007), and 4th fingers (0.014) were also substantial, but not for PIP and DIP joints. The post-intervention percentage change in the Grasping and Visual-motor integration subtests of PDMS-2 was 11.03% (p  = 0.002) and 5.09% (p  = 0.001) respectively. CONCLUSION: The immediate effects on fine motor skills in children with CP after the NHR board application were positive and encouraging. Hence, the NHR board can be recommended as an intervention to improve the fine motor abilities of children with CP. Show more

Keywords: Cerebral palsy, hand rehabilitation, fine motor skills, peabody developmental scale (PDMS-2), novel hand rehabilitation (NHR) board

DOI: 10.3233/NRE-230286

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 237-244, 2024

Authors: Erickson, Jennifer M. | Williams, Ryan | Bombardier, Charles H. | Fann, Jesse R.

Article Type: Research Article

Abstract: BACKGROUND: The development of depression after moderate to severe traumatic brain injury (TBI) is common. Cognitive-behavioral therapy (CBT) can be used to treat post-TBI depression, but the symptoms response is poorly described. OBJECTIVE: This secondary analysis assessed: (1) the trajectory of depression symptoms up to 12 sessions of CBT, (2) which depressive symptom clusters were responsive to in-person and phone CBT, and (3) whether interim depression thresholds predict 16-week treatment response. METHOD: This secondary analysis of the IRB-approved Life Improvement Following Traumatic Brain Injury trial included 100 adults with major depressive disorder (MDD) within ten years …of moderate to severe traumatic brain injury from throughout the US. We used a combination of descriptive, graphical, and diagnostic accuracy methods. RESULTS: Cardinal and cognitive-affective symptom clusters improved most from CBT over 16 weeks. At 8 and 16 weeks, the most responsive individual symptoms were anhedonia, depressed mood, and fatigue; the least responsive were sleep and appetite. PHQ-9 thresholds with a Negative Predictive Value greater than 0.7 for sessions 6, 7, and 8 were, respectively: >15, >10, and >9. CONCLUSION: In-person and phone CBT led to similar symptom responses during treatment. Additionally, using PHQ-9 thresholds for predicting intervention response within eight sessions may help identify the need for treatment adjustments. Show more

Keywords: Depression, cognitive behavioral therapy, traumatic brain injury, head injury, assessments, symptoms, recovery

DOI: 10.3233/NRE-230218

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 245-257, 2024

Authors: Targino da Costa, Márcia Gonçalves e Silva | Maranhão-Filho, Péricles de Andrade | Santos, Izabella Costa | Luiz, Ronir Raggio

Article Type: Research Article

Abstract: BACKGROUND: Facial nerve dysfunction can be a devastating trouble for post-parotidectomy patients. OBJECTIVE: To assess rehabilitation outcomes concerning patients with post-parotidectomy facial nerve dysfunction, comparing benign versus malignant neoplasms. METHODS: Prospective study enrolling adults who underwent parotidectomy with facial nerve sparing between 2016 and 2020. The Modified Sunnybrook System (mS-FGS) was used for facial assessments. Physiotherapy began on the first post-operative day with a tailored program of facial exercises based on Neuromuscular Retraining, to be performed at home 3 times/day. From the first outpatient consultation, Proprioceptive Neuromuscular Facilitation was added to the treatment of cases with …moderate or severe facial dysfunctions. RESULTS: Benign and malignant groups had a statistically significant improvement in mS-FGS (p  < 0.001 and p  = 0.005, respectively). There was no significant difference between groups regarding treatment duration or number of physiotherapy sessions performed. The history of previous parotidectomy resulted in more severe initial dysfunctions and worse outcome. Age over 60 years and initially more severe dysfunctions impacted the outcome. CONCLUSION: Patients with benign and malignant parotid neoplasms had significant and equivalent improvement in postoperative facial dysfunction following an early tailored physiotherapy program, with no significant difference in the final facial score, treatment duration, or number of sessions required. Show more

Keywords: Parotid neoplasms/surgery, facial nerve injuries, physical therapy, physiotherapy, rehabilitation, patient outcomes assessment

DOI: 10.3233/NRE-230220

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 259-273, 2024

Authors: Goh, Hui-Ting | Stewart, Jill | Becker, Kevin

Article Type: Research Article

Abstract: BACKGROUND: Post-stroke fatigue can manifest as both physical and mental fatigue. The Fatigue Scale for Motor and Cognitive Functions (FSMC) evaluates fatigue on the motor and cognitive domains separately, however, the psychometric properties of this measure in stroke have not been reported. OBJECTIVE: To determine the internal consistency, test-retest reliability, and concurrent validity of the FSMC in chronic stroke. METHODS: Thirty-four participants with chronic stroke (55.26±12.27 years of age; 59.53±89.21 months post-stroke) completed the FSMC on two separate visits. Internal consistency and reliability of the FSMC were examined using Cronbach’s alpha and two-way mixed effects intraclass …correlation coefficients (ICC), respectively. Correlation between the FSMC and the Fatigue Severity Scale and Visual Analog Scale-Fatigue was used to assess concurrent validity. RESULTS: Internal consistency was excellent (Cronbach’s alpha > 0.9) and reliability was moderate to good (ICC = 0.72–0.81) for all FSMC scores. The FSMC demonstrated moderate to good concurrent validity with the Fatigue Severity Scale (ρ = 0.66–0.72) but only fair concurrent validity with the Visual Analog Scale-Fatigue (ρ = 0.37–0.44). CONCLUSION: The FSMC is a valid and reliable measure of post-stroke fatigue and may be a useful tool to examine physical fatigue and cognitive fatigue in chronic stroke. Show more

Keywords: Physical fatigue, mental fatigue, tiredness, pathological fatigue, exhaustion, perceived effort

DOI: 10.3233/NRE-230189

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 275-285, 2024

Authors: Kwon, Yundae | Park, Chanhee | Oh, Wonjun | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: The coronavirus disease (COVID-19) pandemic led to the implementation of wearing face masks and social distancing in stroke rehabilitation to prevent airborne transmission and contain the virus. The use of masks causes hypoxia and dyspnea in patients with stroke, predisposing them to other harmful medical conditions. Despite the clinical importance of the potential risk of wearing masks during robotic stroke rehabilitation, no clinical evidence is available in the literature. OBJECTIVE: To examine the effects of stroke robotic rehabilitation with and without using a face mask on cardiopulmonary fatigue, muscle fatigue, O2 saturation, pulse, blood pressure (BP), …and temperature in healthy adults and patients with hemiparetic stroke. METHOD: A total of 30 participants, comprising 20 males and 10 females, were enrolled in a case-control study and a cross-sectional randomized controlled trial conducted at the Center for Rehabilitation Hospital. The study population included 15 individuals with hemiparetic stroke (mean age: 57.26±8.69) and 15 healthy adult controls (mean age: 30.20±9.86). All participants underwent a 30-minute familiarization session, followed by experimental masked and unmasked robotic interactive gait training (RIGT) for at least 30 minutes. Clinical tests included the Borg Rating of Perceived Exertion, muscle fatigue via surface electromyography, O2 saturation, pulse, BP, and temperature. RESULTS: An analysis of covariance showed that compared to RIGT without a mask, RIGT with a mask showed adverse effects on BRPE, O2 saturation, and right rectus femoris muscle fatigue (P  < 0.05) in the control and experimental groups. CONCLUSION: The clinical study revealed that compared to RIGT without a mask, RIGT with a mask affected cardiopulmonary fatigue, muscle fatigue, O2 saturation, pulse, and BP in healthy adults and participants with hemiparetic stroke. Show more

Keywords: COVID-19, masks, walkbot, robotic assisted gait training

DOI: 10.3233/NRE-230150

Citation: NeuroRehabilitation, vol. 54, no. 2, pp. 287-295, 2024