NeuroRehabilitation - Volume 51, issue 1

Authors: Nikolaev, Vitaly A. | Nikolaev, Alexander A.

Article Type: Review Article

Abstract: BACKGROUND: Stroke is the main reason for disabilities worldwide leading to motor dysfunction, spatial neglect and cognitive problems, aphasia, and other speech-language pathologies, reducing the life quality. To overcome disabilities, telerehabilitation (TR) has been recently introduced. OBJECTIVE: The aim of this review was to analyze current TR approaches for stroke patients’ recovery. METHODS: We searched 6 online databases from January 2018 to October 2021, and included 70 research and review papers in the review. We analyzed TR of 995 individuals, which was delivered synchronously and asynchronously. RESULTS: Findings show TR is feasible improving motor …function, cognition, speech, and language communication among stroke patients. However, the dose of TR sessions varied significantly. We identified the following limitations: lack of equipment, software, and space for home-based exercises, insufficient internet capacity and speed, unavailability to provide hands on guidance, low digital proficiency and education, high cognitive demand, small samples, data heterogeneity, and no economic evaluation. CONCLUSIONS: The review shows TR is superior or similar to conventional rehabilitation in clinical outcomes and is used as complementary therapy or as alternative treatments. More importantly, TR provides access to rehabilitation services of a large number of patients with immobility, living in remote areas, and during COVID-19 pandemic or similar events. Show more

Keywords: Stroke telerehabilitation, home-based rehabilitation, motor function recovery, cognitive rehabilitation, aphasia rehabilitation, telehealth, telemedicine

DOI: 10.3233/NRE-210330

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 1-22, 2022

Authors: Tramontano, Marco | Polo, Nicoletta | Bustos, Amaranta Orejel | Lisi, Danilo | Galeoto, Giovanni | Farsetti, Pasquale

Article Type: Review Article

Abstract: BACKGROUND: The SARS-CoV-2 infection (COVID-19) has generated a threat to global health, determining the need for healthcare for large numbers of people in an extremely short time OBJECTIVE: To investigate the management changes in the neurorehabilitation services during the COVID-19 pandemic. METHODS: An electronic search was conducted in September 2021 by 2 independent reviewers in the following databases: MEDLINE (PubMed), the Physiotherapy Evidence Database, and the Cochrane Database of Systematic Reviews. All studies on organizational and welfare changes resulting from the COVID-19 pandemic in neurorehabilitation services were included. Screening of titles, abstracts, and full texts and …data extraction were undertaken independently by pairs of reviewers. RESULTS: The summary of results was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Electronic searches after the screening of title and abstract identified 80 studies, 13 studies met the inclusion criteria. A narrative summary of results of all included studies were reported in a tabular format. CONCLUSIONS: Different organizational models were adopted in neurorehabilitation during the COVID-19 pandemic impacting the therapies time frame, the physical and mental health of healthcare professionals and the caregiver’s workload. There is still uncertainty about the effectiveness of these new therapeutic strategies on the management of neurorehabilitation services and future studies should explore the effect on the patients’ needs. Show more

Keywords: Neurorehabilitation, COVID-19, SARS-CoV-2, caregivers, health professionals

DOI: 10.3233/NRE-220014

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 23-32, 2022

Authors: Sawa, Kota | Amimoto, Kazu | Ishigami, Keisuke | Miyamoto, Takuya | Setoyama, Chika | Suzuki, Rikuya | Nozomi, Kuwabara | Tamura, Miko | Miyagami, Mitsusuke

Article Type: Research Article

Abstract: BACKGROUND: The subjective postural vertical (SPV) is affected by training that requires participants to maintain balance; training to achieve sitting balance may also help SPV recovery and activities of daily living (ADLs). OBJECTIVE: This study aimed to assess the medium-term effects of balance training on the postural vertical (PV) and ADLs in patients with stroke. METHODS: Thirty-three patients with stroke were enrolled in this randomized crossover trial. The outcomes were SPV, SPV with eyes opened (SPV-EO), and the Functional Independent Measure (FIM) after the 14-day intervention of experimental or control training. Experimental training consisted of a …maximum lateral truncal tilt to the paretic side at 0.25 Hz with or without a 10° wedge, repeated 60 times. Repeated-measures two-way analysis of variance was performed with two factors: intervention and the intervention period. RESULTS: There was no interaction between the control condition and the PV, but there was interaction between the intervention period and using a wedge for SPV variability errors. FIM showed an interaction between the intervention period and the use of a wedge. CONCLUSIONS: Balance training while sitting with a wedge significantly improved the SPV and FIM. This improved cognition and perception, which facilitate difficult dynamic tasks in ADLs. Show more

Keywords: Postural vertical, balance, training, stroke

DOI: 10.3233/NRE-210255

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 33-40, 2022

Authors: Yigit, Sedat | Usgu, Serkan | Albayrak, Hatice Mutlu | Yücel, Peren Perk | Yakut, Yavuz

Article Type: Research Article

Abstract: BACKGROUND: Ataxia is a clinical syndrome characterized by coordination problems and postural disorders. OBJECTIVE: This study aimed to examine the effects of functional trunk training on trunk control and upper limb functions in autosomal recessive hereditary ataxia. METHODS: Twenty patients were randomly divided into treatment and control groups. Both groups received trunk stabilization and balance exercises, and the treatment group received additional functional trunk training sessions (3 days/week for 8 weeks). The International Cooperative Ataxia Rating Scale, Trunk Impairment Scale, Modified Functional Reach Test, Nine-Hole Peg Test and Quick-Disabilities of the Arm Shoulder and Hand questionnaire …were used for assessments. RESULTS: The treatment group showed an increase in the upper limb performance bilaterally, whereas increased performance was seen only in the dominant upper limb in the control group. While the functional reach improved in the anterior-posterior (AP) and medial-lateral (ML) directions in the treatment group, it was improved only in the AP direction in the control group. Also, the mean changes in outcomes were not significantly different between the groups except for modified functional reach test. CONCLUSIONS: Functional trunk training may be a more effective method to improve upper limb performance and dynamic trunk balance in autosomal recessive hereditary ataxia. Show more

Keywords: Ataxia, trunk control, upper extremity functions, functional training

DOI: 10.3233/NRE-210320

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 41-50, 2022

Authors: Shin, Jiwon | An, HongGi | Yang, Sejung | Park, Chanhee | Lee, Yongseok | You, Sung (Joshua) H.

Article Type: Research Article

Abstract: BACKGROUND: Robot-assisted gait training (RAGT) was initially developed based on the passive controlled (PC) mode, where the target or ideal locomotor kinematic trajectory is predefined and a patient basically ‘rides’ the robot instead of actively participating in the actual locomotor relearning process. A new insightful contemporary neuroscience and mechatronic evidence suggest that robotic-based locomotor relearning can be best achieved through active interactive (AI) mode rather than PC mode. OBJECTIVE: The purpose of this study was to compare the pattern of gait-related cortical activity, specifically gait event-related spectral perturbations (ERSPs), and muscle activity from the tibialis anterior (TA) and …clinical functional tests in subacute and chronic stroke patients during robot-assisted gait training (RAGT) in passive controlled (PC) and active interactive (AI) modes. METHODS: The present study involves a two-group pretest-posttest design in which two groups (i.e., PC-RAGT group and AI-RAGT group) of 14 stroke subjects were measured to assess changes in ERSPs, the muscle activation of TA, and the clinical functional tests, following 15– 18 sessions of intervention according to the protocol of each group. RESULTS: Our preliminary results demonstrated that the power in the μ band (8– 12 Hz) was increased in the leg area of sensorimotor cortex (SMC) and supplementary motor area (SMA) at post-intervention as compared to pre-intervention in both groups. Such cortical neuroplasticity change was associated with TA muscle activity during gait and functional independence in functional ambulation category (FAC) and motor coordination in Fugl– Meyer Assessment for lower extremity (FMA-LE) test as well as spasticity in the modified Ashworth scale (MAS) measures. CONCLUSIONS: We have first developed a novel neuroimaging experimental paradigm which distinguished gait event related cortical involvement between pre- and post-intervention with PC-RAGT and AI-RAGT in individuals with subacute and chronic hemiparetic stroke. Show more

Keywords: Walkbot, Robotic assisted gait training, gait event-related spectral perturbations, electroencephalography

DOI: 10.3233/NRE-210304

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 51-63, 2022

Authors: Cui, Wei | Huang, Lin | Tian, Yang | Luo, Hong | Chen, Shuang | Yang, Yan | Li, Yamei | Fu, Jing | Yu, Qian | Xu, Li

Article Type: Research Article

Abstract: BACKGROUND: Mirror therapy has been gradually adopted for lower limb rehabilitation, but its efficacy and neural mechanism are not well understood. OBJECTIVE: This study aims to investigate the effect and neural mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke by using resting state functional magnetic resonance imaging (rs-fMRI). METHODS: A single-blind and randomized controlled pilot study was conducted. 32 patients with ischemic stroke were included in this study and randomly divided into two groups – the control group (CT, n  = 16) and the mirror therapy group (MT, n  = 16). Both the CT and …MT groups received medication and routine rehabilitation training. In addition, mirror therapy was added to the MT group 5 times a week for 30 minutes each time over a period of 3 weeks. Patients’ motor functions, functional connectivity (FC), regional homogeneity (ReHo), and fractional amplitude of low-frequency fluctuations (fALFF) were analyzed both before and immediately after the treatment. RESULTS: Patients’ motor functions showed significant improvement in both groups compared to those before treatment (p  < 0.01). Moreover, the MT group showed significantly better improvement than the CT group after the treatment (p  < 0.05). FC, ReHo and fALFF indicated enhanced neuronal activities in motor function-related brain regions in the MT group compared to the CT group. CONCLUSION: Mirror therapy promotes the recovery of lower limb motor functions in patients with ischemic stroke. Through the comparative rs-fMRI analysis, it is found that the mirror therapy promotes the functional reorganization of the injured brain. Show more

Keywords: Ischemic stroke, mirror therapy, lower limb rehabilitation, resting-state functional magnetic resonance imaging (rs-fMRI)

DOI: 10.3233/NRE-210307

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 65-77, 2022

Authors: Ho, Hsiu-Yu | Chen, Ming-De | Tsai, Chiu-Chin | Chen, Hui-Mei

Article Type: Research Article

Abstract: BACKGROUND: Computerized cognitive training (CCT) is an emerging alternative intervention for stroke survivors. OBJECTIVE: This study investigated the effects of CCT on the cognition, activity, and participation of stroke survivors and compared the findings with those of match-dosed conventional cognitive training. METHODS: This randomized controlled trial included 39 patients with stroke who were divided into the intervention group (n  = 19; receiving CCT with Lumosity software) and the control group (n  = 20; receiving conventional cognitive training). Both the groups were trained for 20 min, twice a week, for 12 weeks. Participants were evaluated at pretest, posttest, and …4-week follow-up. Outcome measures included various cognitive function tests and the Stroke Impact Scale scores. RESULTS: The CCT group exhibited significant improvement in global cognitive function (evaluated using the Mini-Mental State Examination and Montreal Cognitive Assessment) and specific cognitive domains: verbal working memory (backward digit span test), processing speed (Symbol Digit Modalities Test), and three MoCA subtests (attention, naming, and delayed recall). CCT exerted no significant effect on activities and participation. No significant between-group differences in changes in cognitive function were noted. However, CCT significantly improved cognitive function domains immediately after training, and these effects were sustained at the 4-week follow-up. CONCLUSIONS: Cognitive function of individuals with chronic stroke could improve after administration of CCT. However, future studies with a more rigorous design and higher training dose are warranted to validate our findings. Show more

Keywords: cerebral vascular accident, computerized cognitive training, cognitive function, quality of life

DOI: 10.3233/NRE-210271

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 79-89, 2022

Authors: Salgueiro, Carina | Urrútia, Gerard | Cabanas-Valdés, Rosa

Article Type: Research Article

Abstract: BACKGROUND: Telerehabilitation has been proposed as an effective strategy to deliver post-stroke specific exercise. OBJECTIVE: To assess the effectiveness and feasibility of core stability exercises guided by a telerehabilitation App after hospital discharge. METHODS: Extension of a prospective controlled trial. Subacute stage stroke survivors were included at the time of hospital discharge where they had participated in a previous 5-week randomized controlled trial comparing conventional physiotherapy versus core stability exercises. After discharge, patients from the experimental group were offered access to telerehabilitation to perform core stability exercises at home (AppG), while those from the control group …were subject to usual care (CG). The Spanish-version of the Trunk Impairment Scale 2.0 (S-TIS 2.0), Function in Sitting Test (S-FIST), Berg Balance Scale (BBS), Spanish-version of Postural Assessment for Stroke Patients (S-PASS), the number of falls, Brunel Balance Assessment (BBA) and Gait were assessed before and after 3 months intervention. RESULTS: A total of 49 subjects were recruited. AppG showed greater improvement in balance in both sitting and standing position and gait compared with CG, although no statistically significant differences were obtained. CONCLUSION: Core stability exercises Telerehabilitation as a home-based guide appears to improve balance in post-stroke stage. Future studies are necessary to confirm the effects as well as identifying strategies to increase telerehabilitation adherence. Show more

Keywords: Telerehabilitation, exercises, core stability, balance, gait, stroke, trunk function

DOI: 10.3233/NRE-210332

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 91-99, 2022

Authors: Lasprilla, Juan Carlos Arango | Rodríguez-Irizarry, Walter | Oliveras-Rentas, Rafael E. | Ramos-Usuga, Daniela | Gonzalez, Isabel | Perez, Paula Karina | Romero-García, Ivonne

Article Type: Research Article

Abstract: BACKGROUND: Despite numerous calls throughout the years for an increase in ethnic, cultural, and racial diversity within the field of psychology, it remains an elusive reality for Hispanic neuropsychology practitioners in the United States (U.S.). OBJECTIVE: 1. Determine the background and current work situation of Hispanic clinical neuropsychologists in the U.S. (e.g., professional training, assessment and diagnostic procedures used, rehabilitation techniques employed, populations targeted, teaching responsibilities, and research activities), and 2. Examine issues related to perceived discrimination in the field of neuropsychology and what this means for our profession. METHODS: The sample consisted of 107 Hispanic …neuropsychologists residing among the 50 United States, District of Columbia, and Puerto Rico who took a survey of professional practices and experiences in clinical neuropsychology. RESULTS: Our findings confirm that Hispanic neuropsychologists in the U.S. are culturally diverse, present with varied levels of bilingualism, have been faced with discrimination during training and in their workplace, and compare favorably with non-Hispanic neuropsychologists in terms of education and clinical training. CONCLUSIONS: Transforming neuropsychology into a diverse and inclusive field requires intentional, strategic, and systematic interventions in education, academia, training, professional organizations and in research. Show more

Keywords: Hispanic, neuropsychology, United States, diversity

DOI: 10.3233/NRE-210333

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 101-121, 2022

Authors: Lee, Jeong Jae | Park, Chanhee | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: While excessive ankle plantarflexion is a common neuromuscular impairment resulting from insufficient coordination of selective ankle neuromotor control and kinematics during gait. We recently developed a wearable, inexpensive and sustainable wearable ankle-tubing gait training (WAGT) aimed at improving selective ankle motor control and kinematic coordination. OBJECTIVE: We investigated the effects of WAGT on tibialis anterior (TA) and gastrocnemius (GCM) muscle electromyography (EMG) activity, TA: GCM muscle imbalance ratio, and ankle joint kinematics during gait in hemiparetic stroke patients. METHODS: A convenience sample of 33 participants (15 non-stroke healthy adults and 18 hemiparetic stroke patients) underwent …standardized electromyography and kinematic biomechanical tests under conventional gait training (CGT) and WAGT conditions. Analysis of variance (ANOVA) was used to determine the significance of differences in the TA: GCM muscle activation, muscle imbalance ratio, and ankle joint kinematics before and after the intervention and between the two groups at P  < 0.05. RESULTS: WAGT was more effective than CGT in improving TA muscle activation (P  < 0.01), TA: GCM muscle imbalance ratio (P  < 0.01), and kinematic movement (P  < 0.01) in adults with or without hemiparetic stroke. CONCLUSIONS: This study demonstrated that WAGT is relatively ease to design, wear and affordable to most clinicians and patients, hence it is suitable for many health care applications to correct gait-related movement abnormalities presented in the hemiparetic stroke patients. Show more

Keywords: Stroke, ankle-tubing gait, wearable, electromyography, joint kinematics

DOI: 10.3233/NRE-210277

Citation: NeuroRehabilitation, vol. 51, no. 1, pp. 123-132, 2022