NeuroRehabilitation - Volume 55, issue 1

Authors: Kim, Heejun | Shin, Jiwon | Kim, Yunhwan | Lee, Yongseok | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: Despite the promising effects of robot-assisted gait training (RAGT) on balance and gait in post-stroke rehabilitation, the optimal predictors of fall-related balance and effective RAGT attributes remain unclear in post-stroke patients at a high risk of fall. OBJECTIVE: We aimed to determine the most accurate clinical machine learning (ML) algorithm for predicting fall-related balance factors and identifying RAGT attributes. METHODS: We applied five ML algorithms— logistic regression, random forest, decision tree, support vector machine (SVM), and extreme gradient boosting (XGboost)— to a dataset of 105 post-stroke patients undergoing RAGT. The variables included the Berg Balance …Scale score, walking speed, steps, hip and knee active torques, functional ambulation categories, Fugl– Meyer assessment (FMA), the Korean version of the Modified Barthel Index, and fall history. RESULTS: The random forest algorithm excelled (receiver operating characteristic area under the curve; AUC = 0.91) in predicting balance improvement, outperforming the SVM (AUC = 0.76) and XGboost (AUC = 0.71). Key determinants identified were knee active torque, age, step count, number of RAGT sessions, FMA, and hip torque. CONCLUSION: The random forest algorithm was the best prediction model for identifying fall-related balance and RAGT determinants, highlighting the importance of key factors for successful RAGT outcome performance in fall-related balance improvement. Show more

Keywords: Balance, machine learning, neurorehabilitation, prediction models, robot-assisted gait training

DOI: 10.3233/NRE-240116

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 1-10, 2024

Authors: Han, Soojeong | Park, Jeong-Jun | Suh, Jee Hyun

Article Type: Research Article

Abstract: BACKGROUND: Perioperative stroke is a devastating complication of coronary artery and aortic surgery, resulting in significantly increased mortality and morbidity rates. As such, predicting rehabilitation outcomes after perioperative stroke would be valuable in establishing rehabilitation plans. OBJECTIVE: To identify prognostic factors of rehabilitation outcomes in perioperative stroke after surgery of the aorta and coronary arteries. METHODS: This study included patients who experienced perioperative stroke after coronary artery bypass grafting and aortic surgery, and underwent 3-weeks of rehabilitation. Demographic data included age, sex, diagnosis, brain lesions, and Charlson Comorbidity Index (CCI). To identify prognostic factors and the …effectiveness of rehabilitation, the Modified Barthel Index (MBI), National Institutes of Health Stroke Scale (NIHSS), Medical Research Council (MRC) sum score, modified Rankin Scale (mRS) score, and Mini-Mental State Examination (MMSE) scores were investigated before and after a three-week rehabilitation period. Spearman rank correlation analyses were performed. RESULTS: Statistically significant improvements were observed in NIHSS, MBI, and MMSE scores after rehabilitation. Spearman rank correlation analysis revealed a significant correlation between sex, stroke type, and improvement in MRC sum score. CONCLUSION: The most crucial factors influencing the prognosis of perioperative stroke occurring after coronary artery or aortic surgery included sex and stroke type. Show more

Keywords: Perioperative stroke, CABG, aortic surgery, rehabilitation outcome, sex, stroke type

DOI: 10.3233/NRE-240106

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 11-15, 2024

Authors: Wang, Yijun | Liu, Chang | Wang, Zhangmin | Li, Yongjian | Jiang, Hai | Zhang, Yi | Xie, Youhong

Article Type: Research Article

Abstract: BACKGROUND: The traditional method of post-hospital intervention and guidance of stroke patients has some limitations. OBJECTIVE: To investigate the effects of Internet + wearable device training on limb function recovery and the levels of serum neurocytokines (BDNF, NT-3, and NGF) in stroke patients. METHODS: 80 stroke patients with hemiplegia were randomly selected from the Department of Neurorehabilitation, Affiliated Rehabilitation Hospital of Chongqing Medical University. They were divided into a control group and an observation group, with 40 patients in each group. The control group received routine post-hospital follow-up guidance, while the observation group received Internet remote home rehabilitation …guidance combined with wearable device training. The interventions were compared between the two groups. RESULTS: At 4 weeks and 12 weeks after discharge, the observation group showed higher scores on the Fugl-Meyer scale (FMA), Berg Balance Scale (BBS), modified Barthel Index (MBI), stride length, gait speed, gait frequency, and higher levels of BDNF, NT-3, and NGF. Additionally, the observation group had lower scores on the Hamilton Anxiety and Depression Scale (HADS) (P  < 0.05). CONCLUSIONS: The application of Internet remote home rehabilitation guidance combined with wearable device training in stroke patients with hemiplegia can improve limb function recovery. It effectively increases the levels of BDNF, NT-3, and NGF, promoting the nutritional repair of damaged nerves. These findings hold clinical significance. Show more

Keywords: Internet, wearable device training, stroke, hemiplegia, limb function, neurocytokines

DOI: 10.3233/NRE-230347

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 17-28, 2024

Authors: Cho, Myunggi | Lee, Miyoung | Jeong, Taewoong | Chung, Yijung

Article Type: Research Article

Abstract: BACKGROUND: Evidence-based guidelines are needed to inform rehabilitation practice including the effect of non-paralytic lower limb resistance exercise with abdominal drawing-in technique (ADIM) on recovery of trunk control, balance and daily living after stroke survivors. OBJECTIVE: The purpose of this study was to compare the effects of trunk control strengthening performed in non-paralytic lower limb resistance exercise with ADIM on trunk control, balance, daily living in stroke survivors. METHODS: The 24 participants with stroke were randomly divided into three groups: lower limb resistance exercise group (LRAG; n  = 8), lower limb exercise group (LAG; n  = 8), and …control group (CG; n  = 8). The training sessions were conducted three times a week for four weeks. Outcome measures included the Korean version Trunk Impairment Scale (K-TIS), Postural Assessment Scale of Stroke (PASS), Modified Functional Reach Test (mFRT), Berg Balance Scale (BBS), Foot print and Modified Barthel’s Index (MBI). RESULTS: The results showed that the LRAG had a significant effect on the K-TIS, PASS, mFRT, Foot print and MBI than the LAG and CG (p  < 0.05). The BBS results showed a significant difference the CG (p  < 0.05). CONCLUSION: This study showed that repeated non-paralytic lower limb resistance exercises with ADIM can be used clinically as a training method for general physiotherapy in patients with reduced postural control, balance and daily living. Show more

Keywords: Activities of daily living, postural balance, resistance training, stroke

DOI: 10.3233/NRE-240117

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 29-39, 2024

Authors: Kawakami, Kenji | Tanabe, Shigeo | Omatsu, Sayaka | Kinoshita, Daiki | Hamaji, Yoshihiro | Tomida, Ken | Koshisaki, Hiroo | Fujimura, Kenta | Kanada, Yoshikiyo | Sakurai, Hiroaki

Article Type: Research Article

Abstract: BACKGROUND: The impact of different stroke types on specific activities of daily living (ADL) is unclear. OBJECTIVE: To investigate how differences between intracerebral hemorrhage (ICH) and cerebral infarction (CI) affect improvement of ADL in patients with stroke within a hospital by focusing on the sub-items of the Functional Independence Measure (FIM). METHODS: Patients with first-stroke hemiplegia (n  = 212) were divided into two groups: ICH (86 patients) and CI (126 patients). Primary assessments included 13 motor and 5 cognitive sub-items of the FIM assessed at admission and discharge. Between-group comparisons and multiple regression analyses were performed. …RESULTS: Upon admission, the ICH group exhibited significantly lower FIM scores than those of the CI group across various activities, including grooming, dressing (upper body and lower body), toileting, bed/chair transfer, toilet transfer, walking/wheelchair, and stairs. Age and FIM motor scores at admission influenced both groups’ total FIM motor scores at discharge, whereas the duration from onset affected only the CI group. CONCLUSION: Several individual FIM motor items were more adversely affected by ICH than by CI. Factors related to ADL at discharge may differ depending on stroke type. Recognizing these differences is vital for efficient rehabilitation practices and outcome prediction. Show more

Keywords: Hemorrhagic stroke, cerebral infarction, cerebrovascular disorder, activities of daily living, functional status, recovery of function

DOI: 10.3233/NRE-240182

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 41-49, 2024

Authors: El Semary, Moataz Mohamed | Elbalawy, Youssef M. | El Shorbagy, Radwa T. | Nagaty, Ahmed | El Rewainy, Rasha Mohamed

Article Type: Research Article

Abstract: BACKGROUND: Radiculopathy can cause pain and numbness along a pinched nerve. OBJECTIVE: To investigate how people with cervical radiculopathy respond to intense cervical traction in terms of depression, sleeplessness, and quality of life (QoL). METHODS: Two equal groups of forty male patients with unilateral cervical radiculopathy were randomly assigned. In addition to transcutaneous electrical nerve stimulation (TENS) and other treatments, twenty individuals in group I received mechanical cervical traction. Group II consisted of twenty individuals who received only TENS treatment. Before and after treatment, every participant completed the Arabic versions of the Hospital Anxiety and Depression …Scale (HADS), the Insomnia Severity Index (ISI), and Short-Form 36 Health Survey (SF-36). RESULTS: While there was no significant difference in group II, there was a significant decline in group I visual analog scale (P  = 0.001), depression subscale of the hospital anxiety and depression score (P  = 0.001), and ISI (P  = 0.001). Eight domains of SF-36 showed a significant increase in group I. These domains included physical functioning (P  = 0.001), role limitations due to physical health (P  = 0.001), role limitations due to emotional problems (P  = 0.001), and energy (P  = 0.001). In group II, there was a non-significant increase nevertheless. CONCLUSION: Cervical traction improved individuals’ QoL, depression, and insomnia, suggesting the effectiveness of it with TENS for cervical radiculopathy patients. Show more

Keywords: Cervical traction, depression, insomnia, QoL, cervical radiculopathy

DOI: 10.3233/NRE-240133

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 51-58, 2024

Authors: Tsou, Hsi-Kai | Chen, Hsiao-Yu | Shih, Kuan-Chung | Lin, Yueh-Chiang

Article Type: Research Article

Abstract: BACKGROUND: Although rehabilitation exercise is known to be beneficial for cardiovascular and mental health, it remains a daunting challenge for patients with spinal cord injury (SCI) who rely on wheelchairs for mobility. OBJECTIVE: This study aimed to examine the effectiveness of a 4-week para table tennis program in enhancing self-efficacy and health outcomes in adults with SCI. METHODS: A total of 39 SCI patients were included and divided into the experimental group (n  = 18, a 4-week para table tennis training program) and the control group (n  = 21). Frequency domain indices of heart rate variability (HRV) were …used to evaluate the function of the autonomic nervous system. RESULTS: Following para table tennis training, there was a significant reduction in the physical stress index (PSI, P  < 0.001), accompanied by shifts in autonomic regulation of vagal dominance. Additionally, the para table tennis training led to significant improvements in vessel state, differential pulse wave index, atrial elasticity, eccentric constriction power, remaining blood volume, and self-efficacy (all P  < 0.05). CONCLUSION: Para table tennis training results in favorable changes in sympathetic tone, enhanced self-efficacy, improved cardiovascular well-being, and an overall positive transformation in HRV. Show more

Keywords: Spinal cord injury, wheelchair, para-table tennis, autonomic nervous system, cardiovascular health

DOI: 10.3233/NRE-240083

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 59-68, 2024

Authors: Corallo, Francesco | Maggio, Maria Grazia | Bonanno, Lilla | De Luca, Rosaria | Cardile, Davide | Cappadona, Irene | Todaro, Antonino | Calabrò, Rocco Salvatore

Article Type: Research Article

Abstract: BACKGROUND: Acquired brain injuries (ABI) represent neurological disorders that can arise after traumatic and non-traumatic events. In addition to the physical, emotional and cognitive challenges that patients face, these injuries can bring changes in the life of the patient and his or her family. OBJECTIVE: This study aims to understand how the occurrence of an ABI condition can disrupt and reshape family functioning by examining certain dimensions such as role in the family, gender and age, which may have a major influence on family dynamics. METHODS: We enrolled 86 caregivers of patients with ABI. Two experienced …psychologists examined family functioning with Olso’s Family Adaptability and Cohesion Rating Scale (FACES IV). RESULTS: The correlation between groups by generics showed a significant difference only for flexibility (p  = 0.05). Specifically, flexibility was greater in male caregivers, particularly in sons. Most of the constructs defining family functioning, such as communication, remained unchanged despite the ABI event. CONCLUSION: This study provides an in-depth understanding of how families face the challenges posed by the ABI and the role caregivers play within the system. Show more

Keywords: ABI, neurological disorders, caregiver, family functioning, psychological function, FACES IV

DOI: 10.3233/NRE-240056

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 69-76, 2024

Authors: Kuppelin, Marie | Goetsch, Antoine | Choisel, Régine | Isner-Horobeti, Marie-Eve | Goetsch, Thibaut | Krasny-Pacini, Agata

Article Type: Research Article

Abstract: BACKGROUND: Challenging behaviours and emotional dysregulation are common sequelae of acquired brain injury (ABI), but treatment remain underdeveloped. Dialectical behaviour therapy is an evidence-based therapy for emotional dysregulation. OBJECTIVE: To explore the feasibility and preliminary efficacy of dialectical behaviour therapy for ABI. METHODS: An exploratory longitudinal study that compared thirty adults with brain injury presenting persistent emotion dysregulation or challenging behaviours. Control group received a personalized multidisciplinary program only (n  = 13). The dialectical behaviour therapy group received five months of emotion regulation skills learning as an add-on (n  = 17). Preliminary efficacy was measured on Difficulties in …Emotion Regulation Scale-16 and Quality of Life after Brain Injury total score and emotion subscore. RESULTS: Fourteen participants completed the dialectical behaviour therapy. This study provided preliminary evidence for the feasibility and acceptability of dialectical behaviour therapy. Repeated measures revealed improvement on the Difficulties in Emotion Regulation Scale-16 (–7.6 [–17.3; 1.7]; Pr = 0.95) and on the Quality Of Life emotion subscore (13.5 [–3.8; 30.9]; Pr = 0.94). CONCLUSION: This study raises important questions regarding the type of patients who can benefit from this intervention, necessary adaptations of dialectical behaviour therapy and the way it can help post-traumatic growth and identity reconstruction after ABI. Show more

Keywords: Acquired brain injury, challenging behaviours, emotion regulation, dialectical behaviour therapy

DOI: 10.3233/NRE-230383

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 77-94, 2024

Authors: Gözaçan Karabulut, Demet | Maden, Çağtay | Yiğit, Sedat

Article Type: Research Article

Abstract: BACKGROUND: Hand dexterity is important with Duchenne muscular dystrophy (DMD). OBJECTIVE: The aim of this study was to compare hand dexterity and hand laterality task assessments in patients with DMD with typically-developing peers. METHODS: The study included 25 DMD with a mean age of 10.2±2.38 and 21 typically-developing peers with a mean age of 10.33±2.26. Functional levels of DMD patients were determined by Brooke Upper Extremity Functional Classification Scale and Brooke Lower Extremity Functional Scale. The ABILHAND-Kids and 9-hole peg test were used to assess the hand dexterity of all participants, and assess the hand laterality …task. RESULTS: Patients with DMD had lower ABILHAND-Kids scores than their typically-developing peers (p  < 0.001). Patients with DMD had higher 9-hole peg test duration on the dominant and non-dominant extremity compared to typically-developing peers (p  < 0.001). Patients with DMD were found to be different from their typically-developing peers (p  < 0.001) in lateralization response time and accuracy. CONCLUSION: Patients with DMD were found to have lower manual dexterity and hand laterality task skills compared to their typically-developing peers. It is recommended that hand dexterity and upper extremity recognition capacities should be considered in assessment and intervention programs for physiotherapists and clinicians working in this field. Show more

Keywords: Assessment, patient outcome, duchenne muscular dystrophy, hand, physical therapy, typically developing, upper extremity

DOI: 10.3233/NRE-240125

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 95-102, 2024

Authors: Braga, Lucia Willadino | Oliveira, Sandro Barbosa | Souza, Lígia Maria do Nascimento

Article Type: Research Article

Abstract: BACKGROUND: It is important to investigate satisfaction and perception of the effectiveness of telerehabilitation and its outcomes post-COVID-19 pandemic. OBJECTIVE: Evaluate the patients’ and healthcare providers’ level of satisfaction with telerehabilitation and perception of its efficacy and describe how it became an established resource in a network of rehabilitation hospitals post-pandemic. METHODS: The online survey about their experience with telerehabilitation was completed by 2,755 patients (322 new patients and 2,433 existing patients), and 668 providers from 26 different specialties. RESULTS: Most patients and providers rated remote care as effective. There were no differences in …scores between existing patients and new patients and the majority reported that their expectations were met. Most patients described their remote consults as good as or better than in-person, while providers mostly preferred in-person sessions. Despite most modalities having returned to in-person practice, there is still a significant percentage of telerehabilitation consults. CONCLUSION: Three years after the start of the pandemic, despite a return to in-person treatment, we see a telerehabilitation culture being constructed as a resource to supplement the rehabilitation process, with potential for establishing this model in a network of rehabilitation hospitals. Show more

Keywords: Telemedicine, telerehabilitation, rehabilitation, telehealth, patient satisfaction

DOI: 10.3233/NRE-230385

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 103-115, 2024

Authors: Oh, Sejun | Gu, Yeonji | Kim, Inbeom | Kwon, Euha | Lee, Sangheon | Kim, Kyounghae

Article Type: Research Article

Abstract: BACKGROUND: Healthcare professionals deliver pain education, yet their perception of pain experiences is not well understood, which can affect their interactions with patients in pain. OBJECTIVE: This study explored Korean healthcare professionals’ perceptions of the usefulness of assessing pain concepts and beliefs and the importance of domains identified in the pain literature. METHODS: This descriptive cross-sectional study employed an online survey administered to nurses, physical therapists, and physicians, including the Neurophysiology of Pain Questionnaire, Tampa Scale for Kinesiophobia, and related optional open-ended questions. RESULTS: Most participants acknowledged the importance and usefulness of assessing understanding …of pain concepts but anticipated patients’ difficulty comprehending items assessing biological mechanisms underlying pain. Participants questioned the items’ accuracy, indicating their limited pain knowledge and the necessity of reducing literacy demands. The critical domains of pain education were learning about pain, external factors influencing pain, and pain as a form of protection. CONCLUSION: Participants had suboptimal pain knowledge but emphasized decreasing literacy demands of pain neurophysiology items. Additionally, it is necessary to develop and implement a pain education program to improve pain-related knowledge and provide educational content for healthcare professionals encountering patients in pain. Show more

Keywords: Neurophysiology of pain, pain, fear of movement, healthcare professional, survey

DOI: 10.3233/NRE-240081

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 117-125, 2024

Authors: Algabbani, Maha F. | Fagehi, Jaber Mohammed | Aljosh, Muzaynah | Bawazeer, Manal | Aldaihan, Mishal M. | Abdulrahman, Tariq A. | Alhusaini, Adel A.

Article Type: Research Article

Abstract: BACKGROUND: Gait training programs are commonly used to improve gait in children with cerebral palsy (CP). OBJECTIVE: To compared the effects of robotic-gait assistant training (RAGT) and conventional body weight support treadmill training (CBWSTT) on gait parameters among ambulatory children with CP. METHODS: The study is a randomized controlled trial of 36 children (17 in the RAGT group and 19 in the CBWSTT group) aged 5 to 14. Gait training involved 30—to 35-minute sessions three times per week over eight weeks. RESULTS: Mixed ANCOVA showed no main effect of time or group on all …gait parameters (P  > .05). Gross motor function measure dimensions D (GMFM D) and E (GMFM E) show main effects on step width. Stride length, step length, speed, swing phase, and double support phase interacted with GMFM D and E. There was a negative correlation between motor function level and the change from baseline. Children with lower motor function show a greater change from baseline. CONCLUSION: There were no significant differences between CBWSTT and RAGT for children with CP; however, with gait training interventions, the level of motor function should be considered. Show more

Keywords: Robotic, gait, child, cerebral palsy, treadmill, rehabilitation

DOI: 10.3233/NRE-240156

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 127-136, 2024

Authors: Abd-Elfattah, Hanaa M. | Galal, Dina O. Shokri M. | Abdelmageed, Shaima M. | Aly, Sobhy M. | Ameen, Fairouz H. | Sayed, Asmaa O. | Abd-Elmonem, Amira M.

Article Type: Research Article

Abstract: BACKGROUND: Cerebral palsy is the most frequent condition affecting the central nervous system and causing large disability. OBJECTIVE: To determine the impact of touch screen tablet upon fine motor functions in children with hemiparesis. METHOD: This was a randomized controlled trial involving 60 children, ranging in age from 5 to 7 years old, randomized into two groups: intervention or control group (30 children per group). Both groups were given 12 consecutive weeks of designed fine motor tasks. Additionally, for thirty minutes, the intervention group was given a fine motor exercise program on a touch screen tablet. …Upper limb function, finger dexterity and pinch strength were measured pre and post the recommended treatment program using the quality of upper extremity skill test (QUEST), Nine-Hole Peg Test and Jamar hydraulic pinch gauge, respectively. RESULTS: All outcome measures were equivalent between intervention groups at admission (P  > 0.05). Significant improvements were found in all assessed variables within the two groups. Meanwhile, the intervention group had significantly higher improvements (P  < 0.05) in finger dexterity, pinch strength, and upper limb function when compared with the control groups. CONCLUSION: Including a touch screen smart tablet application with a specially designed fine motor program is an effective method that helps children with U-CP perform more effectively with their fine motor skills. Show more

Keywords: Cerebral palsy, hemiplegia, fine motor tasks, touch screen tablet, unilateral cerebral palsy

DOI: 10.3233/NRE-240134

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 137-146, 2024

Authors: Capan, Nalan

Article Type: Other

Abstract: BACKGROUND: Pediatric cervical spine injuries (CSIs) from blunt trauma carry a high risk of neurological damage. Accurate diagnosis is vital for preventing harm and aiding recovery, yet the diagnostic accuracy of clinical decision rules (CDRs) remains unclear. OBJECTIVE: To assess the effectiveness of triage tools for detecting CSI in pediatric trauma patients. METHODS: A summary of the Cochrane Review by Tavender et al. (2024), with comments from a rehabilitation perspective. RESULTS: Five studies with 21,379 participants assessed seven CDRs. Direct comparisons showed high sensitivity but low specificity across different CDRs. Indirect comparison studies also …demonstrated varying sensitivities and specificities. CONCLUSIONS: Insufficient evidence exists to determine the best tools for deciding if imaging is necessary for diagnosing potential CSI in children. Better quality studies are needed to assess the accuracy of CDRs for cervical spine clearance in this population. Show more

Keywords: Cervical spine injury, triage tool, pediatric trauma

DOI: 10.3233/NRE-246005

Citation: NeuroRehabilitation, vol. 55, no. 1, pp. 147-149, 2024