NeuroRehabilitation - Volume 37, issue 1

Authors: Lou, Jau-Shin

Article Type: Editorial

DOI: 10.3233/NRE-151235

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 1-2, 2015

Authors: Mancini, Martina | El-Gohary, Mahmoud | Pearson, Sean | McNames, James | Schlueter, Heather | Nutt, John G. | King, Laurie A. | Horak, Fay B.

Article Type: Research Article

Abstract: BACKGROUND: Difficulty turning during gait is a major contributor to mobility disability, falls and reduced quality of life in patients with Parkinson’s disease (PD). Unfortunately, the assessment of mobility in the clinic may not adequately reflect typical mobility function or its variability during daily life. We hypothesized that quality of turning mobility, rather than overall quantity of activity, would be impaired in people with PD over seven days of continuous recording. METHODS: Thirteen subjects with PD and 8 healthy control subjects of similar age wore three Opal inertial sensors (on their belt and on each …foot) throughout seven consecutive days during normal daily activities. Turning metrics included average and coefficient of variation (CV) of: 1) number of turns per hour, 2) turn angle amplitude, 3) turn duration, 4) turn mean velocity, and 5) number of steps per turn. Turning characteristics during continuous monitoring were compared with turning 90 and 180 degrees in a observed gait task. RESULTS: No differences were found between PD and control groups for observed turns. In contrast, subjects with PD showed impaired quality of turning compared to healthy control subjects (Turn Mean Velocity: 43.3 ± 4.8°/s versus 38 ± 5.7°/s, mean number of steps 1.7 ± 1.1 versus 3.2 ± 0.8). In addition, PD patients showed higher variability within the day and across days compared to controls. However, no differences were seen between PD and control subjects in the overall activity (number of steps per day or percent of the day walking) during the seven days. CONCLUSIONS: We show that continuous monitoring of natural turning during daily activities inside or outside the home is feasible for patients with PD and the elderly. This is the first study showing that continuous monitoring of turning was more sensitive to PD than observed turns. In addition, the quality of turning characteristics was more sensitive to PD than quantity of turns. Characterizing functional turning during daily activities will address a critical barrier to rehabilitation practice and clinical trials: objective measures of mobility characteristics in real-life environments. Show more

Keywords: Parkinson’s disease, functional mobility, continuous monitoring

DOI: 10.3233/NRE-151236

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 3-10, 2015

Authors: Benninger, David H. | Hallett, Mark

Article Type: Review Article

Abstract: BACKGROUND AND PURPOSE: In advanced Parkinson’s disease (PD), the emergence of symptoms refractory to conventional therapy poses a therapeutic challenge. The success of deep brain stimulation (DBS) and advances in the understanding of the pathophysiology of PD have raised interest in non-invasive brain stimulation as an alternative therapeutic tool. The rationale for its use draws from the concept that reversing abnormalities in brain activity and physiology thought to cause the clinical deficits may restore normal functioning. Currently the best evidence in support of this concept comes from DBS, which improves motor deficits, and modulates brain activity and motor …cortex physiology, though whether a causal interaction exists remains largely undetermined. CONCLUSION: Most trials of non-invasive brain stimulation in PD have applied repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex and cortical areas of the motor circuit. Published studies suggest a possible therapeutic potential of rTMS and transcranial direct current stimulation (tDCS), but clinical effects so far have been small and negligible regarding functional independence and quality of life. Approaches to potentiate the efficacy of rTMS, including increasing stimulation intensity and novel stimulation parameters, derive their rationale from studies of brain physiology. These novel parameters simulate normal firing patterns or act on the hypothesized role of oscillatory activity in the motor cortex and basal ganglia in motor control. There may also be diagnostic potential of TMS in characterizing individual traits for personalized medicine. Show more

Keywords: Non-invasive brain stimulation, therapeutic study, Parkinson’s disease, repetitive transcranial magnetic stimulation (rTMS), transcranial Direct Current Stimulation (tDCS), plasticity, neurophysiology

DOI: 10.3233/NRE-151237

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 11-24, 2015

Authors: Lou, Jau-Shin

Article Type: Review Article

Abstract: BACKGROUND: Fatigue is common in patients with Parkinson’s disease (PD). It occurs at every stage of PD and affects quality of life. Fatigue severity worsens over time as PD progresses, and it is associated with other non-motor symptoms such as apathy, depression, sleep disorder, and cognitive dysfunction. PURPOSE: In this literature review, I discuss the measurement and pathophysiology of fatigue and fatigability. There are no evidence-based treatments for fatigue and fatigability available. I review several pilot studies on the effects of pharmacological agents and exercise on fatigue and fatigability. These studies provide some insights on …the design of future larger clinical trials. CONCLUSION: Fatigue inventories including The Fatigue Severity Scale, the Multidimensional Fatigue Inventory, or theParkinson Fatigue Scale are used to assess the severity of fatigue. Finger tapping and force generation are useful in quantifying physical fatigability. A reaction time paradigm such as the Attention Network Test can be used to measure cognitive fatigability. Physical fatigability is associated with the change in cortical excitability in PD measured by Transcranial Magnetic Stimulation. Cognitive fatigability is most likely associated with the neurotransmitter abnormalities (dopaminergic, cholinergic and noradrenergic) in PD. Levodopa, modafanil, methylphenidate, and rasagiline may be effective in treating fatigue and fatigability. Exercise programs may also be effective. Show more

Keywords: Parkinson’s disease, fatigue, fatigability, force generation, Attention Network Test, modafinil, methylphenidate, rasagiline, exercise

DOI: 10.3233/NRE-151238

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 25-34, 2015

Authors: Devos, Hannes | Ranchet, Maud | Emmanuel Akinwuntan, Abiodun | Uc, Ergun Y.

Article Type: Research Article

Abstract: BACKGROUND: Individuals with Parkinson’s disease (PD) experience problems with on-road driving that can be targeted in driving rehabilitation programs. OBJECTIVE: To provide a framework for driving rehabilitation in PD by identifying the critical on-road driving impairments and their associated visual, cognitive, and motor deficits. METHODS: We conducted a systematic review of the literature on on-road driving and naturalistic driving practices in PD. Relevant databases including Pubmed, Medline, PsychINFO, ISI Web of Science, Cochrane library, and ClinicalTrials.gov, were reviewed using the key words Parkinson’s disease, on-road driving, naturalistic driving, and their related entry …words. On-road driving skills were mapped onto an existing theoretic model of operational, tactical, and strategic levels. The on-road and off-road cognitive, motor, and visual predictors of global on-road driving were summarized. RESULTS: Twenty-seven studies were included. All but one study were prospective and Class II studies according to the American Academy of Neurology Classification Criteria. Participants were on average 68 years old and in the mild to moderate stages of PD. Drivers with PD were more likely to fail a driving assessment compared to age- and gender-matched controls. Compared with controls, drivers with PD experienced difficulties on all levels of driving skill. However, the compensation strategies on the strategic level showed that drivers with PD were aware of their diminished driving skills on the operational and strategic levels. Operational and tactical on-road driving skills best predicted global on-road driving. A combination of visual, cognitive, and motor deficits underlie impaired on-road driving performance in PD. CONCLUSION: Driving rehabilitation strategies for individuals with PD should include training of operational and tactical driving skills or indirect comprehensive training program of visual, cognitive, and motor skills. Show more

Keywords: Parkinson’s disease, rehabilitation, automobile driving, on-road driving, driving simulator, augmented reality, systematic review

DOI: 10.3233/NRE-151239

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 35-52, 2015

Authors: Paganoni, Sabrina | Karam, Chafic | Joyce, Nanette | Bedlack, Richard | Carter, Gregory T.

Article Type: Review Article

Abstract: BACKGROUND: Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) is a neurodegenerative disease that results in progressive muscle weakness and wasting. There is no known cure and the disease is uniformly fatal. PURPOSE: This review discusses current concepts in ALS care, from breaking the diagnosis to end-of-life care. People with ALS have several multidisciplinary needs due to a complex and dynamic disease process. They benefit from rehabilitation interventions that are individualized and have the goal of optimizing independence, function, and safety. These strategies also help minimize symptomatic burden and maximize quality of life. …CONCLUSION: Patient-centered, multidisciplinary care has a significant impact on the life of people with ALS and is thecurrent standard of care for this patient population. Show more

Keywords: Amyotrophic lateral sclerosis, rehabilitation, quality of life, function, supportive care, palliative care, braces, equipment, assistive device

DOI: 10.3233/NRE-151240

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 53-68, 2015

Authors: Fried-Oken, Melanie | Mooney, Aimee | Peters, Betts

Article Type: Review Article

Abstract: BACKGROUND: Communication supports, referred to as augmentative and alternative communication (AAC), are an integral part of medical speech-language pathology practice, yet many providers remain unfamiliar with assessment and intervention principles. For patients with complex communication impairments secondary to neurodegenerative disease, AAC services differ depending on whether their condition primarily affects speech and motor skills (ALS), language (primary progressive aphasia) or cognition (Alzheimer’s disease). This review discusses symptom management for these three conditions, identifying behavioral strategies, low- and high-tech solutions for implementation during the natural course of disease. These AAC principles apply to all neurodegenerative diseases in which common …symptoms appear. OBJECTIVES: To present AAC interventions for patients with neurodegenerative diseases affecting speech, motor, language and cognitive domains. Three themes emerge: (1) timing of intervention: early referral, regular re-evaluations and continual treatment are essential; (2) communication partners must be included from the onset to establish AAC acceptance and use; and (3) strategies will change over time and use multiple modalities to capitalize on patients’ strengths. CONCLUSIONS: AAC should be standard practice for adults with neurodegenerative disease. Patients can maintain effective, functional communication with AAC supports. Individualized communication systems can be implemented ensuring patients remain active participants in daily activities. Show more

Keywords: Augmentative and alternative communication, communication disorders, dementia, progressive aphasia, ALS

DOI: 10.3233/NRE-151241

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 69-87, 2015

Authors: Falquez, Rosalux | Dinu-Biringer, Ramona | Stopsack, Malte | Arens, Elisabeth A. | Wick, Wolfgang | Barnow, Sven

Article Type: Research Article

Abstract: BACKGROUND: Previous investigations have demonstrated the relationship between inhibitory deficits and maladaptive emotion regulation. Although several neuropsychological studies show that frontal lobe damage can lead to extreme inhibition impairments, there have been no investigations regarding the influence of frontal lobe damage and related inhibition impairments on the use of maladaptive strategies. OBJECTIVE: The goal of the current study was to examine the impact of executive functions impairments due to frontal lobe damage on cognitive emotion regulation. METHODS: Fifteen patients with frontal lobe damage were compared to twenty-two healthy controls on their reported …use of maladaptive strategies. The effect of behavioral inhibition deficits among the frontal lobe damage group was examined. RESULTS: Patients reflected a heightened use of maladaptive strategies compared to healthy controls, significantly mediated by Go/NoGo task errors, which are an indicator for response inhibition deficits. CONCLUSIONS: Results suggest that a heightened use of maladaptive strategies by patients relies to a strong extent on their impaired impulse control, highlighting the complex interplay between executive functions and emotional regulation. Show more

Keywords: Frontal lobe lesion, emotion regulation, response inhibition, maladaptive strategies

DOI: 10.3233/NRE-151242

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 89-98, 2015

Authors: Moreno, Alexander | Gan, Caron | Zasler, Nathan | McKerral, Michelle

Article Type: Research Article

Abstract: OBJECTIVE: To explore the experiences, attitudes, and needs related to service delivery regarding sexuality issues in individuals with traumatic brain injury (TBI). METHODS: Community-dwelling individuals with TBI having completed a post-acute TBI rehabilitation program. The TBI sample consisted of 16 men (42.1%) and 22 women (57.9%), with an average age of 38.9 years (SD = 9.9) and 12.8 years of education (SD = 2.8). They were on average 2.6 years post-injury (SD = 1.4). Glasgow coma scale at admission was on average 12.6 (SD = 3.5). Participants completed a questionnaire adapted to individuals with TBI addressing experiences, attitudes, and needs regarding sexuality and …service delivery. RESULTS: Individuals with TBI reported a low frequency of specific discussions with their treating clinician(s) about sexual and reproductive health issues, as well as many unmet needs regarding sexuality. None of the participants considered discussion about these issues to be inappropriate. They reported more favourable attitudes towards discussing sexual health topics compared to actual service delivery with family physicians, general practitioners, psychologists, and other health care professionals (p ’s <  0.05). CONCLUSIONS: Individuals with TBI desired more openness about discussing sexual concerns. Findings are discussed in terms of the clinical implications to meet the individuals’ needs regarding sexual concerns after TBI. Show more

Keywords: Experiences, attitudes, needs, traumatic brain injury, sexuality, service delivery

DOI: 10.3233/NRE-151243

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 99-116, 2015

Authors: Smart, Colette M. | Giacino, Joseph T.

Article Type: Research Article

Abstract: BACKGROUND: A paucity of information is available regarding how caregivers of persons with post-traumatic disorders of consciousness (DOC) approach medical decision-making. Yet for evidence-based standards of care to be established, the onus is on caregivers’ willingness to enroll their family members in clinical trials of novel tests and treatments (NTT). OBJECTIVE: To gather information regarding the beliefs and opinions of caregivers regarding NTT for DOC. METHODS: Exploratory qualitative data via focus groups from N  = 17 caregivers of persons in post-traumatic DOC at both the acute (N  = 7) and subacute (N  = 10) phases …of injury recovery. Supplemental survey data about knowledge of DOC. RESULTS: While attitudes toward NTT were generally favorable, two main themes emerged that influenced willingness to pursue NTT: patient and caregiver-specific factors, and the acquisition/use of information to guide decision-making. While survey data suggested a lack of knowledge about NTT, qualitative data revealed that this was better explained by different standards for knowledge, i.e., anecdotal versus empirical information. CONCLUSIONS: Current findings could support discussion between healthcare providers and caregivers regarding medical decision-making as well as suggestions for how to increase the likelihood of caregivers being willing to enroll their family members in clinical trials of NTT. Show more

Keywords: Disorders of consciousness, minimally conscious state, vegetative state, traumatic brain injury, caregivers, qualitative

DOI: 10.3233/NRE-151244

Citation: NeuroRehabilitation, vol. 37, no. 1, pp. 117-130, 2015