NeuroRehabilitation - Volume 54, issue 4

Authors: Teasell, Robert | Flores-Sandoval, Cecilia | Bateman, Emma A. | MacKenzie, Heather M. | Sequeira, Keith | Bayley, Mark | Janzen, Shannon

Article Type: Review Article

Abstract: BACKGROUND: Given the complexity of post-TBI medical, surgical, and rehabilitative care, research is critical to optimize interventions across the continuum of care and improve outcomes for persons with moderate to severe TBI. OBJECTIVE: To characterize randomized controlled trials (RCTs) of moderate to severe traumatic brain injury (TBI) in the literature. METHOD: Systematic searches of MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO for RCTs up to December 2022 inclusive were conducted in accordance with PRISMA guidelines. RESULTS: 662 RCTs of 91,946 participants published from 1978 to 2022 met inclusion criteria. The number of RCTs published …annually has increased steadily. The most reported indicator of TBI severity was the Glasgow Coma Scale (545 RCTs, 82.3%). 432 (65.3%) RCTs focused on medical/surgical interventions while 230 (34.7%) addressed rehabilitation. Medical/surgical RCTs had larger sample sizes compared to rehabilitation RCTs. Rehabilitation RCTs accounted for only one third of moderate to severe TBI RCTs and were primarily conducted in the chronic phase post-injury relying on smaller sample sizes. CONCLUSION: Further research in the subacute and chronic phases as well as increasing rehabilitation focused TBI RCTs will be important to optimizing the long-term outcomes and quality of life for persons living with TBI. Show more

Keywords: Traumatic brain injuries, randomized controlled trials, systematic review, rehabilitation, glasgow coma scale, craniocerebral trauma

DOI: 10.3233/NRE-240019

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 509-520, 2024

Authors: Fox-Hesling, Jessica | Wisseman, Darrell | Kantak, Shailesh

Article Type: Review Article

Abstract: BACKGROUND: Improvement of functional movements after supratentorial stroke occurs through spontaneous biological recovery and training-induced reorganization of remnant neural networks. The cerebellum, through its connectivity with the cortex, brainstem and spinal cord, is actively engaged in both recovery and reorganization processes within the cognitive and sensorimotor systems. Noninvasive cerebellar stimulation (NiCBS) offers a safe, clinically feasible and potentially effective way to modulate the excitability of spared neural networks and promote movement recovery after supratentorial stroke. NiCBS modulates cerebellar connectivity to the cerebral cortex and brainstem, as well as influences the sensorimotor and frontoparietal networks. OBJECTIVE: Our objective was …twofold: (a) to conduct a scoping review of studies that employed NiCBS to influence motor recovery and learning in individuals with stroke, and (b) to present a theory-driven framework to inform the use of NiCBS to target distinct stroke-related deficits. METHODS: A scoping review of current research up to August 2023 was conducted to determine the effect size of NiCBS effect on movement recovery of upper extremity function, balance, walking and motor learning in humans with stroke. RESULTS: Calculated effect sizes were moderate to high, offering promise for improving upper extremity, balance and walking outcomes after stroke. We present a conceptual framework that capitalizes on cognitive-motor specialization of the cerebellum to formulate a synergy between NiCBS and behavioral interventions to target specific movement deficits. CONCLUSION: NiCBS enhances recovery of upper extremity impairments, balance and walking after stroke. Physiologically-informed synergies between NiCBS and behavioral interventions have the potential to enhance recovery. Finally, we propose future directions in neurophysiological, behavioral, and clinical research to move NiCBS through the translational pipeline and augment motor recovery after stroke. Show more

Keywords: Stroke, cerebellum, brain, movement, neurological rehabilitation, brain stimulation

DOI: 10.3233/NRE-230371

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 521-542, 2024

Authors: Chai, Linsong | Huang, Yunshi | Guo, Xinqi | Xiong, Ailing | Lin, Bingbing | Huang, Jia

Article Type: Review Article

Abstract: BACKGROUND: Non-invasive brain stimulation has been widely used as an adjunctive treatment for aphasia following stroke. OBJECTIVE: The aim of this study was to investigate the effect of non-invasive brain stimulation as an adjunctive treatment on naming function in aphasia following stroke. METHODS: This review included randomized controlled trials (RCTs) involving 5 databases (Web of Science, Embase, Cochrane Library, OVID and PubMed) that investigated the effects of electrical stimulation on stroke patients. The search included literature published up to November 2023. RESULTS: We identified 18 studies, and the standardized mean differences (SMDs) showed that …the effect sizes of TMS and tDCS were small to medium. Moreover, the treatment effects persisted over time, indicating long-term efficacy. CONCLUSION: This study suggested that NIBS combined with speech and language therapy can effectively promote the recovery of naming function in patients with post-stroke aphasia (PSA) and that the effects are long lasting. Show more

Keywords: Meta-analysis, post-stroke aphasia, noninvasive brain stimulation, speech-language therapy, naming

DOI: 10.3233/NRE-240065

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 543-561, 2024

Authors: Shi, Changpiao | Chen, Yi | Ye, Liang | Feng, Jun | Dong, Guoli | Lu, Shangbo

Article Type: Review Article

Abstract: BACKGROUND: It has been suggested that transcutaneous spinal cord stimulation (SCS) is effective in the rehabilitation of patients with spinal cord injury (SCI). However, the evidence is mainly based on case reports. OBJECTIVE: To summarize the influence of transcutaneous SCS on extremity motor function of patients with SCI in a meta-analysis. METHODS: A systematic literature search was performed in electronic databases including PubMed, Cochrane library, Embase, Web of Science, Wanfang, and CNKI to obtain relevant randomized controlled trials (RCTs). A random-effects model was used to pool the results by incorporating the impact of the potential heterogeneity. …The most recent database search was conducted on December 31, 2023. RESULTS: Six small-scale open-label or single-blind RCTs were included. Transcutaneous SCS on the basis of conventional rehabilitation could significantly improve limb strength (mean difference: 4.82, p  = 0.004; I2  = 0%) and attenuate spasticity (MD: -0.40, p  = 0.02; I2  = 0%). The upper-extremity motor function was not significantly affected (p  = 0.75). However, transcutaneous SCS significantly improved mobility as indicated by walking speed (MD: 0.13 m/s, p  = 0.009; I2  = 0%) and walking distance (standardized MD: 0.62, I2  = 0%). CONCLUSION: Transcutaneous SCS is effective in improving limb strength, spasticity and mobility of patients with SCI. Show more

Keywords: Limb strength, meta-analysis, motor function, spinal cord stimulation, transcutaneous spinal cord stimulation

DOI: 10.3233/NRE-240057

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 563-573, 2024

Authors: Yuan, Ruyu | Wang, Qingqing | Xu, Haipeng | Yu, Hongliu | Shi, Ping

Article Type: Review Article

Abstract: BACKGROUND: Wearable trunk exoskeletons hold immense potential in fields such as healthcare and industry. Previous research has indicated that intention recognition control plays a crucial role in users’ daily use of exoskeletons. OBJECTIVE: This review aims to discuss the characteristics of intention recognition control schemes for intelligent trunk exoskeletons under different control objectives over the past decade. METHODS: Considering the relatively late development of active trunk exoskeletons, we selected papers published in the last decade (2013 to 2023) from the Web of Science, PubMed, and IEEE Xplore databases. In total, 50 articles were selected and examined …based on four control objectives. RESULTS: In general, we found that researchers focus on trunk exoskeleton devices designed for assistance and motor augmentation, which rely more on body movement signals as a source for intention recognition. CONCLUSION: Based on these results, we identify and discuss several promising research directions that may help to attain a widely accepted control methods, thereby advancing further development of trunk exoskeleton technology. Show more

Keywords: Intent recognition, trunk exoskeletons, control strategy, motion of the relevant body parts, biological signals, sensor

DOI: 10.3233/NRE-240066

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 575-597, 2024

Authors: Bae, Youngoh | Jung, Hohyun | Shin, Nakyung | Rahmati, Masoud | Udeh, Raphael | Kazemi, Abdolreza | Li, Yusheng | Solmi, Marco | Syafrudin, Muhammad | Fitriyani, Norma Latif | Fond, Guillaume | Boyer, Laurent | Lee, Seung Won

Article Type: Research Article

Abstract: BACKGROUND: An increase in the demand for quality of life following spinal cord injuries (SCIs) is associated with an increase in musculoskeletal (MSK) pain, highlighting the need for preventive measure research. OBJECTIVE: This study aimed to evaluate the incidence and hazards of MSK morbidities among Korean adults with SCIs, as well as the influence of SCI location on MSK morbidities. METHODS: Patient populations were selected from Korean National Health Insurance Service data (n  = 276). The control group included individuals without SCIs (n  = 10,000). We compared the incidences and determined the unadjusted and adjusted hazard ratios (HRs) …of common MSK morbidities (osteoarthritis, connective tissue disorders, sarcopenia, myalgia, neuralgia, rheumatoid arthritis, myositis, and musculoskeletal infections) based on the location of injury (cervical, thoracic, or lumbar). RESULTS: Adults with SCIs had a higher incidence of MSK morbidity (48.45% vs. 36.6%) and a lower survival probability than those without SCIs. The incidence of MSK morbidity and survival probabilities were not significantly different for cervical cord injuries, whereas both measures were significantly different for thoracic and lumbar injuries. CONCLUSION: SCI increases the risk of MSK morbidity. Lumbar SCI is associated with a higher incidence and risk of MSK morbidity than are cervical or thoracic SCIs. Show more

Keywords: Retrospective studies, adults, spinal cord injuries, musculoskeletal diseases, location of spinal cord injuries

DOI: 10.3233/NRE-230263

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 599-610, 2024

Authors: El Semary, Moataz Mohamed | Elrewainy, Rasha Mohamed | Nagaty, Ahmed | Maged, Mai | Abdelhakiem, Nadia Mohamed

Article Type: Research Article

Abstract: BACKGROUND: Urinary dysfunction is linked to spinal cord injury (SCI). The quality of life (QoL) declines in both neurogenic bladder impairment and non-disordered patients. OBJECTIVE: To ascertain the effectiveness of pulsed magnetic therapy on urinary impairment and QoL in individuals with traumatic incomplete SCI. METHODS: This study included forty male paraplegic subjects with neurogenic detrusor overactivity (NDO) for more than one year following incomplete SCI between T6-T12. Their ages ranged from 20 to 35 and they engaged in therapy for three months. The subjects were divided into two groups of equal size. Individuals in Group I …were managed via pulsed magnetic therapy once per week plus pelvic floor training three times a week. Individuals in Group II were managed with only three times a week for pelvic floor training. All patients were examined for bladder cystometric investigations, pelvic-floor electromyography (EMG), and SF-Qualiveen questionnaire. RESULTS: There was a noteworthy increment in individuals in Group I in volume of bladder at first desire to void and maximum cystometric capacity, detrusor pressure at Qmax , and maximum flow rate. There was a momentous increment in Group I in measures of evaluation of EMG biofeedback. There was a notable rise in Group I in SF-Qualiveen questionnaire. CONCLUSION: Magnetic stimulation should be favored as beneficial adjunct to traditional therapy in the management of bladder impairment and enhancing QoL in individuals with SCI. Show more

Keywords: SCI, neurogenic detrusor overactivity, QoL, magnetic therapy, neuromodulation

DOI: 10.3233/NRE-240060

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 611-618, 2024

Authors: Park, Seonmi | Choi, Jongeun | Kim, Yonghoon | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: Although clinical machine learning (ML) algorithms offer promising potential in forecasting optimal stroke rehabilitation outcomes, their specific capacity to ascertain favorable outcomes and identify responders to robotic-assisted gait training (RAGT) in individuals with hemiparetic stroke undergoing such intervention remains unexplored. OBJECTIVE: We aimed to determine the best predictive model based on the international classification of functioning impairment domain features (Fugl– Meyer assessment (FMA), Modified Barthel index related-gait scale (MBI), Berg balance scale (BBS)) and reveal their responsiveness to robotic assisted gait training (RAGT) in patients with subacute stroke. METHODS: Data from 187 people with subacute …stroke who underwent a 12-week Walkbot RAGT intervention were obtained and analyzed. Overall, 18 potential predictors encompassed demographic characteristics and the baseline score of functional and structural features. Five predictive ML models, including decision tree, random forest, eXtreme Gradient Boosting, light gradient boosting machine, and categorical boosting, were used. RESULTS: The initial and final BBS, initial BBS, final Modified Ashworth scale, and initial MBI scores were important features, predicting functional improvements. eXtreme Gradient Boosting demonstrated superior performance compared to other models in predicting functional recovery after RAGT in patients with subacute stroke. CONCLUSION: eXtreme Gradient Boosting may be an invaluable prognostic tool, providing clinicians and caregivers with a robust framework to make precise clinical decisions regarding the identification of optimal responders and effectively pinpoint those who are most likely to derive maximum benefits from RAGT interventions. Show more

Keywords: Machine learning, stroke rehabilitation, robotic assisted gait training

DOI: 10.3233/NRE-240070

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 619-628, 2024

Authors: Chou, Chia-Hsin | Lee, Yan-Yuh | Chen, Po-Cheng | Leong, Chau-Peng | Huang, Yu-Chi

Article Type: Research Article

Abstract: BACKGROUND: Impaired upper limb function in stroke survivors is characterized by muscle weakness, increased muscle tone, contracture, or impaired motor control. OBJECTIVE: We aimed to evaluate the effectiveness of Kinesio-taping application for functional recovery on the affected arm and forearm during rehabilitation. METHODS: Forty-one patients eligible for this study were randomly assigned to either the Kinesio-taping group (n  = 21), receiving Kinesio-taping intervention and conventional therapy, or control group (n  = 20), receiving sham Kinesio-taping intervention and conventional therapy. The whole intervention lasted for 3 weeks. Fugl-Meyer assessment of the upper extremity, Barthel Index, the Stroke Impact Scale, …and modified Ashworth scale were measured at 3 time points: baseline, post-treatment (3rd week), and follow-up (6th week). RESULTS: In the Kinesio-taping group, there were significant differences in the upper extremity (p  = 0.003), wrist (p  = 0.000) and hand (p  = 0.000) parts of the Fugl-Meyer assessment of the upper extremity between the three assessment times. On the other hand, the Barthel Index showed significant differences in both groups after therapy. CONCLUSION: Combining conventional rehabilitation with Kinesio-taping intervention may improve functional motor performance of both the proximal and distal parts of the affected upper extremity in stroke survivors, with potential benefits for activity of daily living. Show more

Keywords: Kinesiotaping, rehabilitation, stroke, hemiplegia, spasticity, occupational therapy, physical therapy

DOI: 10.3233/NRE-240047

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 629-637, 2024

Authors: Baraban, Elizabeth | Lesko, Alexandra | Still, Kyle | Anderson, Weston

Article Type: Research Article

Abstract: BACKGROUND: Little is known about how the timing of antidepressant use influences stroke outcomes. Previous research shows conflicting results on the impact of a new antidepressant prescription on stroke recovery. OBJECTIVE: The objective of this exploratory, retrospective analysis is to examine stroke outcomes by timing of antidepressant use among patients who received stroke treatment. METHODS: 12,590 eligible patients were treated for a primary or secondary diagnosis of ischemic stroke. The outcome variables were a change in ambulation or modified Rankin scale (mRs) from pre-stroke to discharge; and a change in mRS from pre-stroke to 90-days post-discharge. …The independent variable of interest was timing of antidepressant treatment. Logistic regression with generalized estimating equations was used, controlling for covariates. RESULTS: Our model predicted that a new antidepressant prescription at discharge was associated with a ∼7% decrease in the likelihood of returning to baseline functional independence at 90-days compared to patients currently using an antidepressant (AOR:0.510, CI:0.277–0.938, p  = 0.03). CONCLUSION: These results suggest that use of antidepressants was associated with stroke recovery, but the effects are moderated by sex. Further study is needed to determine if this relationship is causal and the mechanisms between timing of antidepressant treatment and outcomes. Show more

Keywords: Depression, outcome assessment, ischemic stroke, epidemiology, functional status, stroke rehabilitation

DOI: 10.3233/NRE-240037

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 639-651, 2024