NeuroRehabilitation - Volume 54, issue 3

Authors: García-Rudolph, Alejandro | Wright, Mark Andrew | Devilleneuve, Emilien Amar | Castillo, Eulalia | Opisso, Eloy | Hernandez-Pena, Elena

Article Type: Research Article

Abstract: BACKGROUND: Most studies focus on the risk factors associated with the development of pressure ulcers (PUs) during acute phase or community care for individuals with spinal cord injury (SCI). OBJECTIVES: This study aimed to i) compare clinical and demographic characteristics of inpatients after SCI with PUs acquired during rehabilitation vs inpatients without PUs and ii) evaluate an existing PU risk assessment tool iii) identify first PU predictors. METHODS: Individuals (n  = 1,135) admitted between 2008 and 2022 to a rehabilitation institution within 60 days after SCI were included. Admission Functional Independence Measure (FIM), American …Spinal Injury Association Impairment Scale (AIS) and mEntal state, Mobility, Incontinence, Nutrition, Activity (EMINA) were assessed. Kaplan-Meier curves and Cox proportional hazards models were fitted. RESULTS: Overall incidence of PUs was 8.9%. Of these, 40.6% occurred in the first 30 days, 47.5% were sacral, 66.3% were Stage II. Patients with PUs were older, mostly with traumatic injuries (67.3%), AIS A (54.5%), lower FIM motor (mFIM) score and mechanical ventilation. We identified specific mFIM items to increase EMINA specificity. Adjusted Cox model yielded sex (male), age at injury, AIS grade, mFIM and diabetes as PUs predictors (C-Index = 0.749). CONCLUSION: Inpatients can benefit from combined assessments (EMINA + mFIM) and clinical features scarcely addressed in previous studies to prevent PUs. Show more

Keywords: Pressure ulcers, pressure injuries, wounds and injuries, spinal cord injuries, inpatients, risk assessment, spinal cord, diabetes mellitus

DOI: 10.3233/NRE-230234

Citation: NeuroRehabilitation, vol. 54, no. 3, pp. 457-472, 2024

Authors: Savoie, Félix-Antoine | Benoit, Simon | Riesco, Eléonor | Tanguay, Andréanne

Article Type: Research Article

Abstract: BACKGROUND: Adapted boxing can help improve the physical functioning and health-related quality of life (HRQoL) of individuals with Parkinson’s disease (PD). Whether these benefits persist longitudinally is unclear. OBJECTIVE: The purpose of this retrospective study was to evaluate the impact of a community-based adapted boxing program on the physical functioning and HRQoL of individuals with PD over 1–1.5 years. METHODS: Twenty-six individuals with PD agreed to share their results on tests administered upon enrollment in the program (PRE) and ∼431 days later (POST). The tests included the Fullerton Advanced Balance scale, (FAB), the …Timed Up-and-Go test (TUG), the 30-second Sit-to-Stand test (30-STS), and the PD questionnaire-39 (PDQ-39). RESULTS: From PRE to POST, performance significantly improved on the TUG and 30-STS tests (both p  < 0.001), but not on the FAB (p  = 0.79). Over the same period, PDQ-39 scores significantly increased (p  = 0.05). No PRE to POST changes surpassed the minimal detectable change threshold. CONCLUSION: The results of this study suggest that adapted boxing is at worst non-detrimental and at best potentially beneficial for muscle strength, endurance, and functional mobility in individuals with PD. However, adapted boxing probably cannot fully counteract the HRQoL decrements that accompany PD progression. Show more

Keywords: Community-based adapted boxing, Parkinson’s disease, exercise, functional capacity, health-related quality of life, physical functioning

DOI: 10.3233/NRE-230382

Citation: NeuroRehabilitation, vol. 54, no. 3, pp. 473-484, 2024

Authors: Ito, Shun | Abe, Hiroaki | Okanuka, Toru | Nanka, Kosuke | Nagasawa, Takuma | Oki, Kazuto | Suzukamo, Yoshimi | Izumi, Shin-Ichi

Article Type: Research Article

Abstract: BACKGROUND: Stroke often induces gait abnormality, such as buckling knee pattern, compromising walking ability. Previous studies indicated that an adequate trailing limb angle (TLA) is critical for recovering walking ability. OBJECTIVE: We hypothesized that correcting gait abnormality by immobilizing the knee joint using a knee orthosis (KO) would improve walking patterns and increase the TLA, and investigated whether walking training using a KO would increase the TLA in post-stroke patients. METHODS: In a randomized controlled trial, thirty-four participants were assigned to KO (walking training using a KO) and non-KO (without using a KO) …groups. Twenty-nine completed the three-week gait training protocol. TLA was measured at baseline and after training. A two-way repeated ANOVA was performed to evaluate TLA increases with training type and time as test factors. A t -test compared TLA changes (Δ TLA) between the two groups. RESULTS: ANOVA showed a main effect for time (F = 64.5, p  < 0.01) and interaction (F = 15.4, p  < 0.01). Δ TLA was significantly higher in the KO group (14.6±5.8) than in the non-KO group (5.0±7.0, p  < 0.001). CONCLUSION: Walking training using a KO may be practical and effective for increasing TLA in post-stroke patients. Show more

Keywords: Trailing limb angle, gait training, gait abnormality, Knee brace, walking pattern

DOI: 10.3233/NRE-230372

Citation: NeuroRehabilitation, vol. 54, no. 3, pp. 485-494, 2024

Authors: Yan, Jie | Zha, Fubing | Zhou, Juan | Zhou, Jing | Zhao, Jingpu | Zhang, Qingfang | Long, Jianjun | Hou, Dianrui | Song, Zhenhua | Wang, Yulong

Article Type: Research Article

Abstract: BACKGROUND: Patients with prolonged disorders of consciousness (pDOC) pose significant challenges to healthcare workers due to their severe motor impairments and limited interaction with the environment. Non-invasive brain stimulation such as high-definition transcranial direct current stimulation (HD-tDCS) and music stimulation show promise in awakening this population. OBJECTIVE: In this study, we present a protocol aiming at investigating the efficacy of combined HD-tDCS and music stimulation in awakening patients with pDOC through a single-blind, randomized controlled trial. METHODS: Ninety patients with pDOC will be randomly divided into three groups: active HD-tDCS with music stimulation, …active HD-tDCS, and sham HD-tDCS. All participants will receive 20 treatment sessions over a period of 10 days and the Coma Recovery Scale-Revised, Glasgow Outcome Scale and electroencephalogram will be used as assessment measures to evaluate their level of consciousness throughout the study. Adverse events and complications will be recorded during treatment. Within-group pre-post comparisons and between-group efficacy comparisons will be conducted to identify the most effective intervention approach. Statistical analysis will be performed using SPSS software with a significance level set at P  < 0.05. CONCLUSION: The pursuit of awakening therapy for patients with pDOC remains a clinical research challenge. This study protocol is designed with the aim of introducing an innovative non-pharmacological approach which combined HD-tDCS and music stimulation to facilitate the reinstatement of consciousness in patients with pDOC. Show more

Keywords: High-definition transcranial direct current stimulation, music stimulation, disorders of consciousness, randomized controlled trial, electroencephalography, neuromodulation

DOI: 10.3233/NRE-230282

Citation: NeuroRehabilitation, vol. 54, no. 3, pp. 495-504, 2024

Authors: Sen, Ekin Ilke

Article Type: Other

Abstract: BACKGROUND: Post-stroke depression (PSD) is a prevalent condition that can significantly influence the recovery process. OBJECTIVE: To assess the effects of pharmacological, non-invasive brain stimulation and psychological interventions, and their combination on PSD. METHODS: A summary of the Cochrane Review by Allida et al. (2023) , with comments from a rehabilitation perspective. RESULTS: Sixty-one studies with 5831 participants were included in the Cochrane Review. Very low-certainty evidence indicated favorable treatment effects of pharmacological interventions, psychological therapies, and the combination of pharmacological intervention and non-invasive brain stimulation on PSD. Pharmacological intervention has resulted in increased …side effects associated with the central nervous system and gastrointestinal system, with very low-certainty evidence. CONCLUSION: Evidence for the effectiveness of pharmacological, psychological, and combination therapies for the management of PSD is uncertain, as the quality of the evidence has been assessed as very low. Therefore, further studies with improved methods should investigate pharmacological and non-pharmacological interventions for the treatment of depression in stroke survivors. Show more

Keywords: Depression, stroke, drug intervention, non-invasive brain stimulation, psychological intervention

DOI: 10.3233/NRE-246003

Citation: NeuroRehabilitation, vol. 54, no. 3, pp. 505-508, 2024