NeuroRehabilitation - Volume 52, issue 2

Authors: Zasler, Nathan D.

Article Type: Book Review

DOI: 10.3233/NRE-228029

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 153-154, 2023

Authors: Muroi, Daisuke | Ohtera, Shosuke | Saito, Yutaro | Koyake, Aki | Higuchi, Takahiro

Article Type: Research Article

Abstract: BACKGROUND: High collision rates and frequency of entering the opening from non-paretic sides are associated with collision in individuals with stroke. OBJECTIVE: To identify factors associated with collision avoidance behavior when individuals with stroke walked through narrow openings. METHODS: Participants with subacute or chronic stroke walked through a narrow opening and had to avoid colliding with obstacles. Multiple regression analyses were conducted with pathophysiology, motor function, and judgment ability as predictor variables; collision rate and frequency of entering the opening from non-paretic sides were outcome variables. RESULTS: Sixty-one eligible individuals with stroke aged 63±12 …years were enrolled. Thirty participants collided twice or more and 37 entered the opening from the non-paretic side. Higher collision occurrence was associated with slower Timed Up and Go tests and left-right sway (odds ratios, 1.2 and 5.6; 95% confidence intervals, 1.1–1.3 and 1.3–28.2; p  = .008 and.025, respectively). Entering from non-paretic sides was associated with lesions in the thalamus, left-sided hemiplegia, and Brunnstrom stage 3 or lower (odds ratios, 6.6, 8.7, and 6.7; 95% confidence intervals, 1.3–52.5, 2.5–36.5, and 1.2–57.5; and p  = .038,.001, and.048, respectively). CONCLUSION: Walking ability is associated with avoiding obstacle collision, while pathophysiological characteristics and degree of paralysis are associated with a preference for which side of the body enters an opening first. Interventions to improve walking ability may improve collision avoidance. Avoidance behavior during intervention varies depending on the lesion position. Show more

Keywords: Multiple regression analysis, obstacle avoidance, pathophysiological, stroke, walking

DOI: 10.3233/NRE-220174

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 155-163, 2023

Authors: Ofek, Hadas | Alperin, Mordechai | Laufer, Yocheved

Article Type: Research Article

Abstract: Background: Explicit Sensory Retraining (SR) has been suggested for pain management in several neuropathic pain syndromes. Objectives: To study the effectiveness of SR on Central Post Stroke Pain (CPSP) symptoms. Methods: A preplanned subgroup of 23 subjects post-stroke reporting central pain were randomized within a larger study, to receive either explicit sensory discrimination retraining (SR) (in subgroup n  = 11) or implicit repeated exposure to stimuli (RE) (in subgroup n  = 12), applied to the lower limb. Pain intensity measured by VAS, measures of sensory ability; balance and gait activities; and participation were assessed by a blinded assessor …at four points in time. Results: A group*time interaction effect was demonstrated (p  = 0.04) for VAS, as for the SR treatment group VAS decreased from 56/100 to 23/100. Nine out of eleven subjects in the SR group demonstrated positive response to treatment. Pain alleviation was maintained at follow-up. A similar interaction effect was found for tactile threshold (p  = 0.03). Significant improvement was noted for all other variables with no group differences. Conclusion: This study provides preliminary evidence to the clinically relevant positive effect of explicit sensory retraining for subjects with CPSP. The positive effect on tactile threshold detection could potentially indicate pain alleviation mechanisms. Show more

Keywords: Central post stroke pain, treatment, randomized controlled trial, sensory retraining, explicit, implicit

DOI: 10.3233/NRE-220217

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 165-174, 2023

Authors: Ou, Jibing | Xu, Chunyan | Fu, Yutong | chen, Qian | Han, Yongqian | Yao, Liqing

Article Type: Research Article

Abstract: BACKGROUND: Post-stroke cognitive impairment (PSCI) has a negative effect on activities of daily living. OBJECTIVE: Although a number of studies have been published on PSCI, no quantitative studies have yet been conducted. METHOD: CiteSpace and VOSviewer were used to quantitatively analyze PSCI to illustrate the research hotspots and trends in PSCI. All relevant publications were extracted from the Science Citation Index Expanded (SCI-E) of the Web of Science (WoS). RESULTS: A total of 6536 articles were included in this study. From 349 in 2010 to 942 in 2020, the number of publications increased dramatically. …The USA maintained the top position worldwide and provided a vital influence. Harvard University was considered the leader in research collaboration among all institutions. Stroke was the most popular journal in this sector and Vincent Mok published the most articles in this area. We analyzed the keywords and identified five research hotspot clusters. By summarizing the literature on PSCI, we considered the publication information regarding different countries, institutions, authors and journals. CONCLUSION: The mechanism of PSCI is an active hotspot. Cerebral vascular disease, especially white matter lesions, also received more attention. Show more

Keywords: Stroke, cognitive impairment, CiteSpace, VOSviewer, bibliometric

DOI: 10.3233/NRE-220203

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 175-186, 2023

Authors: Chen, Liu-Zhu | Tu, Yu-Jie | Huang, Ye-Zhi | Qiu, Li-Nan | Chen, Jia-Hao | Xu, Xue-Qian | Xu, Min-Jie | Geng, Dan-Dan | Lin, Yi-Si | He, Jin-Cai

Article Type: Research Article

Abstract: BACKGROUND: In China, the current status of clinical treatment of eLVO and the factors affecting its long-term prognosis are unclear. OBJECTIVE: This study aims to explore the predictive factors of functional outcomes at one year in patients of acute ischemic stroke with emergent large vessel occlusion (eLVO). METHODS: We retrospectively collected 536 patients who underwent treatments for eLVO. Primary outcomes included one-year functional outcomes and delayed functional independence (DFI). The logistic regression was performed to predict the primary outcome. RESULTS: 431 (85%) survivors participated in the one-year follow-up. In the multivariate logistic analysis adjusted …for baseline characteristics, the following factors were found to be significant predictors of functional dependence at one year: old age (aOR = 1.042, 95% CI=1.01-1.076, p  = 0.011), low Alberta stroke program early CT score (ASPECTS) (aOR = 0.791, 95% CI=0.671-0.933, p  = 0.005), unsuccessful reperfusion (aOR = 0.168, 95% CI=0.048-0.586, p  = 0.005), poor medication compliance (aOR = 0.022, 95% CI=0.007-0.072, p  < 0.001), and complicated with stroke-associated pneumonia (SAP) (aOR = 2.269, 95% CI=1.103-4.670, p  = 0.026). We also found that men (aOR = 3.947, 95% CI=1.15-13.549, p  = 0.029) had better medication adherence (aOR = 14.077, 95% CI=1.736-114.157, p  = 0.013), and going to rehabilitation centers (aOR = 5.197, 95% CI=1.474-18.327, p  = 0.010) were independent predictors of DFI. CONCLUSION: The significant predictors of functional dependence at one year were: old age, low ASPECTS, unsuccessful reperfusion, poor medication adherence, and combination with SAP. Men, good medication adherence, and going to rehabilitation centers contributed to getting delayed functional independence. Show more

Keywords: Stroke, large vessel occlusion, endovascular therapy, thrombolysis, prognosis

DOI: 10.3233/NRE-220269

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 187-197, 2023

Authors: Heiberg, Adam Vittrup | Simonsen, Sofie Amalie | Schytz, Henrik Winther | Iversen, Helle Klingenberg

Article Type: Research Article

Abstract: BACKGROUND: Following acute ischemic stroke (AIS) many patients experience cognitive impairment which interferes neurorehabilitation. Understanding and monitoring pathophysiologic processes behind cognitive symptoms requires accessible methods during testing and training. Functional near-infrared spectroscopy (fNIRS) can assess activational hemodynamic responses in the prefrontal cortex (PFC) and feasibly be used as a biomarker to support stroke rehabilitation. OBJECTIVE: Exploring the feasibility of fNIRS as a biomarker during the Stroop Color and Word Test (SCWT) assessing executive function in AIS patients. METHODS: Observational study of 21 patients with mild to moderate AIS and 22 healthy age- and sex-matched controls (HC) …examined with fNIRS of PFC during the SCWT. Hemodynamic responses were analyzed with general linear modeling. RESULTS: The SCWT was performed worse by AIS patients than HC. Neither patients nor HC showed PFC activation, but an inverse activational pattern primarily in superolateral and superomedial PFC significantly lower in AIS. Hemodynamic responses were incoherent to test difficulty and performance. No other group differences or lateralization were found. CONCLUSIONS: AIS patients had impaired executive function assessed by the SCWT, while both groups showed an inverse hemodynamic response significantly larger in HC. Investigations assessing the physiology behind inverse hemodynamic responses are warranted before deeming clinical implementation reasonable. Show more

Keywords: Acute stroke, hemodynamics, near-infrared spectroscopy, stroop test, executive function, cognitive impairment

DOI: 10.3233/NRE-220171

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 199-217, 2023

Authors: Chae, Seung Han | Lee, Mi Young | Chung, Yijung

Article Type: Research Article

Abstract: BACKGROUND: Backward walking is considered as a newly rising method used to enhance gait abilities, but evidence remains unclear. OBJECTIVE: To identify whether backward walking with functional electrical stimulation (FES) triggered by a foot switch on the rectus femoris and tibialis anterior could be effective in improving gait parameters of stroke survivors. METHODS: This was a cross-sectional study that included fourteen subjects with chronic stroke. Three walking conditions were performed at random: backward walking with FES attached onto the rectus femoris and tibialis anterior (RF+TA), backward walking with FES attached onto the tibialis anterior (TA only), …and without electrical intervention (non-FES). The Zebris was used to assess the spatiotemporal gait parameters. Each condition was measured three times and the average value was used for analysis. RESULTS: Results showed significant increases in gait speed, cadence, step length, mid-stance percentage, maximal force in the affected midfoot (p  < 0.05), and significant decreases in the double stance phase in the RF+TA condition compared to the TA only and the non-FES conditions (p  < 0.05). CONCLUSION: Functional electrical stimulation to the rectus femoris and tibialis anterior during backward walking could be a clinically effective method to improve gait ability of stroke survivors. Show more

Keywords: Electrical stimulation, gait, rehabilitation, stroke, walking ability

DOI: 10.3233/NRE-220156

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 219-226, 2023

Authors: Zhong, Lida | Wen, Xin | Liu, Zicai | Li, Fang | Ma, Xiancong | Liu, Huiyu | Chen, Hongxia

Article Type: Research Article

Abstract: BACKGROUND: Although increasing evidence indicates that cerebellar repetitive transcranial magnetic stimulation (rTMS) may be beneficial in the treatment of dysphagia, its clinical efficacy is still uncertain. OBJECTIVE: To evaluate the effect of high-frequency cerebellar rTMS on poststroke dysphagia. METHODS: This was a randomized, sham-controlled, double-blind trial. A total of eighty-four study participants were randomly assigned into the cerebellum and control groups. The cerebellum group received bilateral 10 Hz rTMS treatment of the pharyngeal motor area of the cerebellum. The control group was administered with sham rTMS of the pharyngeal motor area of the cerebellum. All patients underwent …the same conventional swallowing rehabilitation training after the intervention 5 days a week for a total of 10 days. Assessment of swallowing function was done before treatment (baseline), after treatment (2 weeks), and during follow-up (2 weeks after treatment) using the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) and the Penetration-Aspiration Scale (PAS). RESULTS: The interaction between time and intervention had a significant effect on PAS (P  < 0.001) and FEDSS (P  < 0.001). Compared to the control group, the cerebellum group exhibited significantly improved clinical swallowing function scores (PAS: P  = 0.007, FEDSS: P  = 0.002). CONCLUSION: Bilateral cerebellar rTMS is a potential new neurorehabilitation technique for post-stroke dysphagia. Studies should aim at investigating the therapeutic mechanism of cerebellar rTMS and improve this technique. Show more

Keywords: Cerebellum, dysphagia, rehabilitation, repetitive transcranial magnetic stimulation, noninvasive brain stimulation

DOI: 10.3233/NRE-220268

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 227-234, 2023

Authors: Tyler, Carmen M. | Perrin, Paul B. | Klyce, Daniel W. | Arango-Lasprilla, Juan Carlos | Dautovich, Natalie D. | Rybarczyk, Bruce D.

Article Type: Research Article

Abstract: BACKGROUND: Older adults have the highest traumatic brain injury (TBI)-related morbidity and mortality, and rates in older adults are increasing, chiefly due to falls. OBJECTIVE: This study used hierarchical linear modeling (HLM) to examine baseline predictors of functional independence trajectories across 1, 2, 5, and 10 years after TBI in older adults. METHODS: Participants comprised 2,459 individuals aged 60 or older at the time of TBI, enrolled in the longitudinal TBI Model Systems database, and had Functional Independence Measure Motor and Cognitive subscale scores and Glasgow Outcome Scale-Extended scores during at least 1 time point. …RESULTS: Functional independence trajectories generally declined over the 10 years after TBI. Individuals who were older, male, underrepresented minorities, had lower education, were unemployed at time of injury, had no history of substance use disorder, or had difficulties with learning, dressing, and going out of the home prior to the TBI, or longer time in posttraumatic amnesia had lower functional independence trajectories across at least one of the functional independence outcomes. CONCLUSION: These predictors of functional independence in older adults with TBI may heighten awareness of these factors in treatment planning and long-term health monitoring and ultimately as a way to decrease morbidity and mortality. Show more

Keywords: Older adults, traumatic brain injury, functional independence, trajectories, outcomes

DOI: 10.3233/NRE-220165

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 235-247, 2023

Authors: Snell, Deborah L. | Silverberg, Noah D.

Article Type: Research Article

Abstract: BACKGROUND: Mild traumatic brain injury (mTBI) treatment research is hindered by lack of clinically meaningful and responsive outcome measures. One promising measure is the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), although minimal clinically important differences (MCID) for have not been established. OBJECTIVE: To estimate MCID for the WHODAS 2.0 for mTBI. METHODS: We analysed two prospectively collected mTBI datasets (n  = 225) attending adult outpatient clinics in British Columbia, Canada. Participants completed the 12-item WHODAS 2.0, Patient Global Impression of Change scale, and Rivermead Post-Concussion Symptoms Questionnaire. We used anchor- and distribution-based methods to …explore MCIDs in WHODAS 2.0 scores. RESULTS: For Study 1 (n  = 131), the anchor and distribution-based approaches produced minimal change estimates ranging from 1.3 to 2.8 interval scores. For Study 2 (n  = 94), the anchor and distribution-based approaches produced minimal change estimates from 2.2 to 3.2 interval scores. For certain subgroups based on age, sex, and post-concussion severity, minimal change estimates were slightly higher. CONCLUSION: An MCID of 3.5 interval WHODAS 2.0 points would conservatively capture meaningful change in adults of varying age, sex, and post-concussion symptom severity. Such a uniform metric will assist future mTBI intervention studies to improve standards of care and evaluation of outcomes. Show more

Keywords: WHODAS 2.0, mTBI, mild traumatic brain injury, MCID

DOI: 10.3233/NRE-220004

Citation: NeuroRehabilitation, vol. 52, no. 2, pp. 249-257, 2023