NeuroRehabilitation - Volume 54, issue 4

Authors: Abdelhakiem, Nadia Mohamed | Mahmoud, Tarek H. | Saleh, Haitham M. | Alsaid, Hossam Mohammed | Salem, Shymaa | El Semary, Moataz Mohamed

Article Type: Research Article

Abstract: BACKGROUND: Spasticity is a common symptom of multiple sclerosis (MS), affecting 80% of patients. Many studies have aimed to detect methods to reduce spasticity under these conditions and found that spasticity can be efficiently reduced using cryotherapy. OBJECTIVE: To examine the impact of cryotherapy on spasticity among patients with MS. METHODS: Thirty-two participants were randomized into two groups. The study group was given airflow cryotherapy and a selected physical therapy program, whereas the control group was only given a selected physical therapy program. The treatment was administered three times each week for a total of twelve …consecutive sessions. The outcome measures were the modified Ashworth scale and the H/M ratio. RESULTS: The study group showed significant decrease in calf muscle spasticity, indicated by a reduction in spasticity grade (p  = 0.001) and a decrease in the H/M ratio of 33.81% (p  = 0.001). The control group also showed significant reduction in calf muscle spasticity, as indicated by a reduction in spasticity grade (p  = 0.001) and a reduction in the H/M ratio of 19.58% (p  = 0.001). There was a significant decrease in the spasticity grade and H/M ratio of the study group posttreatment compared with those of the control group (p  = 0.02 and p  = 0.001). CONCLUSION: The combined effect of cryotherapy and a selected physical therapy program are more effective in controlling the spasticity of calf muscles in patients with MS than a selected physical therapy program alone. Show more

Keywords: Cryotherapy, selected physical therapy program, spasticity, multiple sclerosis

DOI: 10.3233/NRE-240006

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 653-661, 2024

Authors: Vázquez-Doce, Aránzazu | Delgado, Laura García | Arriaza Gómez, María José | Spottorno Rubio, María Pía | Lallana, Virginia Meca | Muñoz, Beatriz del Rio | Bosch-Martín, María Asunción | Doce, Otón Vázquez | García, Paula Ortega | Juan, Noemí Tapiador

Article Type: Research Article

Abstract: BACKGROUND: Multiple sclerosis (MS) is the most common neurologic disease in young adults. Spasticity is one of its most disabling symptoms, with botulinum toxin A type A (BoNT-A) being one of the treatments of choice for this symptom. OBJECTIVE: We assessed the response to abobotulinumtoxinA in improving walking ability and fatigue in patients with spastic paraparesis caused by MS. METHODS: We performed a real-world, multicenter, prospective, open-label low-intervention trial in 84 patients with MS and spastic paraparesis of the lower limbs infiltrated with abobotulinumtoxinA (LINITOX study). The response of spasticity, walking ability and fatigue is analyzed …in 4 cycles of ultrasound-guided injection in the lower limbs. RESULTS: The patients improved their walking ability by an average of 11.34% meters measured with 6-Minute Walk Test (6MWT), and decreased the percentage of fatigue by 6.86% (4.66 percentage points less), in the 12-Item Multiple Sclerosis Walking Scale (MSWS-12) 4 weeks after abobotulinumtoxinA injection, both values are statistically significant. This improvement seems to persist over time, throughout the cycles. CONCLUSION: We found improved walking ability and less fatigue in patients with MS-related spastic paresis of the lower limbs after injection of abobotulinumtoxinA. Show more

Keywords: Multiple sclerosis, spasticity, fatigue, botulinum toxin, gait, quality of life

DOI: 10.3233/NRE-240038

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 663-675, 2024

Authors: Yu, Hong | Zheng, Beisi | Zhang, Youmei | Chu, Minmin | Shu, Xinxin | Wang, Xiaojun | Wang, Hani | Zhou, Siwei | Cao, Manting | Wen, Shilin | Chen, Jianer

Article Type: Research Article

Abstract: BACKGROUND: Intermittent theta burst stimulation (iTBS) has demonstrated efficacy in patients with cognitive impairment. However, activation patterns and mechanisms of iTBS for post-stroke cognitive impairment (PSCI) remain insufficiently understood. OBJECTIVE: To investigate the activation patterns and potential benefits of using iTBS in patients with PSCI. METHODS: A total of forty-four patients with PSCI were enrolled and divided into an iTBS group (iTBS and cognitive training) or a control group (cognitive training alone). Outcomes were assessed based on the activation in functional near-infrared spectroscopy (fNIRS), as well as Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the modified …Barthel Index (MBI). RESULTS: Thirty-eight patients completed the interventions and assessments. Increased cortical activation was observed in the iTBS group after the interventions, including the right superior temporal gyrus (STG), left frontopolar cortex (FPC) and left orbitofrontal cortex (OFC). Both groups showed significant improvements in LOTCA and MBI after the interventions (p  < 0.05). Furthermore, the iTBS group augmented superior improvement in the total score of MBI and LOTCA compared to the control group, especially in visuomotor organization and thinking operations (p  < 0.05). CONCLUSION: iTBS altered activation patterns and improved cognitive function in patients with PSCI. The activation induced by iTBS may contribute to the improvement of cognitive function. Show more

Keywords: Intermittent theta burst stimulation; stroke; cognitive function; activation, cognitive improvement, fNIRS

DOI: 10.3233/NRE-240068

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 677-690, 2024

Authors: Grobe-Einsler, Marcus | Bork, Friederike | Faikus, Aline | Neggers, Sebastiaan F.W. | Kaut, Oliver

Article Type: Research Article

Abstract: BACKGROUND: Cerebellar ataxia, neuropathy and bilateral vestibular areflexia (CANVAS) is a rare neurodegenerative disease affecting the cerebellum, the peripheral nervous system and the vestibular system. Due to the lack of approved drugs, therapy comprises physiotherapy and speech therapy. Transcranial magnetic stimulation is a promising non-invasive therapeutic option to complement classical symptomatic therapies. OBJECTIVE: To test feasibility of the combination of transcranial magnetic stimulation using an accelerated protocol and standard symptomatic therapy in patients with CANVAS. METHODS: Eight patients with genetically confirmed CANVAS were assigned to either verum or sham cerebellar transcranial magnetic stimulation using an accelerated …protocol. Treatment duration was limited to 5 days. Additionally, patients in both groups received symptomatic therapy (speech and physiotherapy) for the duration of the study. RESULTS: All patients completed the stimulation protocol. Adverse events were rare. Ataxia severity improved in the verum group only. CONCLUSION: The combination of transcranial magnetic stimulation and classic symptomatic therapy is feasible in a neuro-rehabilitation setting and potentially ameliorates ataxia severity. Show more

Keywords: Ataxia, movement disorders, neurodegenerative diseases, transcranial magnetic stimulation, cerebellum, neurological rehabilitation

DOI: 10.3233/NRE-240045

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 691-698, 2024

Authors: Cordani, Claudio | Mosconi, Bianca

Article Type: Other

Abstract: BACKGROUND: Parkinson’s disease (PD) is a progressive neurodegenerative disorder diagnosed by motor symptoms of bradykinesia, in combination with tremor, rigidity, or postural instability. Many studies document the effects of exercise-based interventions, but the benefit of different exercise types remains unclear. OBJECTIVE: To provide a commentary on the Cochrane Review by Ernst et al. on the effectiveness of different types of physical exercise regarding motor signs, Quality of Life (QoL), and the occurrence of adverse events. METHODS: A systematic search was performed in CENTRAL, MEDLINE, Embase, and other databases. The search was performed also in trial registries, …conference proceedings, and reference list of identified studies. RESULTS: The review included 154 RCTs (with 7837 participants). The network meta-analyses (NMAs) on the severity of motor signs and QoL included data from 60 (2721 participants) and 48 (3029 participants) trials, respectively. The evidence from the NMA suggests that dance, gait/balance/functional training probably have a moderate beneficial effect on the severity of motor signs, and multi-domain training probably has a small beneficial effect on the severity of motor signs. Endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs. In addition, aqua-based training probably has a large beneficial effect on QoL, and mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL. CONCLUSIONS: Current evidence supports the promotion of physical exercise among people with PD, identifying only small differences between exercises in influencing the severity of motor signs and QoL. Show more

Keywords: Parkinson disease, quality of life, exercise, exercise therapy, systematic review

DOI: 10.3233/NRE-246004

Citation: NeuroRehabilitation, vol. 54, no. 4, pp. 699-702, 2024