bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of robotic treadmill training on functional mobility, walking capacity, motor symptoms and quality of life in ambulatory patients with Parkinson's disease: A preliminary prospective longitudinal study
Authors: Paker Nurdan , Bugdayci Derya , Goksenoglu Goksen , Sen Aysu , Kesiktas Nur
Published: December 2019

Background:

Decreased mobility and walking capacity occur frequently in Parkinson's disease (PD). Robotic treadmill training is a novel method to improve the walking capacity in rehabilitation.

Objectives:

The primary aim of this study was to investigate the effects of robotic treadmill training on functional mobility and walking capacity in PD. Secondly, we aimed to assess the effects of the robotic treadmill training the motor symptoms and quality of life in patients with PD.

Methods:

Seventy patients with idiopathic Parkinson's disease who admitted to the outpatient clinic of the rehabilitation hospital were screened and 12 ambulatory volenteers who met the study criteria were included in this study. Patients were evaluated by Hoehn Yahr (HY) scale clinically. Two sessions robotic treadmill training per week during 5 weeks was planned for every patient. Patients were evaluated by the Timed Up and Go (TUG) test, 10 meter walking test (10 MWT), Unified Parkinson's Disease Rating Scale (UPDRS) motor section and Parkinson's Disease Questionnaire-39 (PDQ-39) at the baseline, at the 5 and 12 weeks. Cognitive and emotional states of the patients were assessed by Mini Mental State Examination (MMSE) test and Hospital Anxiety and Depression Scale (HADS) at the baseline. All patients were under medical treatment for the PD in this study and drug treatment was not changed during the study.

Results:

Ten patients completed the study. The mean age was 65.6 ± 6.6 years. Five patients (50%) were women. Disease severity was between the HY stage 1–3. Two patients did not continue the robotic treadmill training after 7 sessions. They also did not want to come for control visits. TUG test, 10 MWT and UPDRS motor subscale scores showed statistically significant improvement after robotic treadmill training (p = 0.02, p = 0.001, p = 0.016). PDQ-39 scores improved significantly after robotic treadmill training (p = 0.03), however, the scores turned back to the baseline level at the 12. week control.

Conclusion:

As a result of this preliminary study, robotic treadmill training was useful to improve the functional mobility, walking capacity and motor symptoms in mild to moderate PD. Robotic treadmill training provided a transient improvement in the quality of life during the treatment.
Lower urinary tract dysfunction in critical illness polyneuropathy
Authors: Reitz André
Published: December 2019

Background:

Critical illness polyneuropathy is a frequent complication of critical illness in intensive care units. Reports on autonomic systems like lower urinary tract and bowel functions in patients with CIP are not available in medical literature.

Objective:

This study performed during primary rehabilitation of patients with critical illness polyneuropathy explores if sensory and motor pathways controlling the lower urinary tract function are affected from the disease.

Methods:

Neurourological examinations, urodynamics, electromyography and lower urinary tract imaging were performed in 28 patients with critical illness polyneuropathy.

Discussion:

Sacral sensation was impaired in 1 patient (4%). Sacral reflexes were absent in 8 patients (30%). Anal sphincter resting tone was reduced in 3 (12%), anal sphincter voluntary contraction was absent or reduced in 8 patients (30%). Urodynamic findings were detrusor overactivity and detrusor overactivity incontinence in 9 (37.5%), incomplete voiding in 8 (30%), abnormal sphincter activity in 4 (16%), abnormal bladder sensation in 4 (16%) and detrusor acontractility in 2 patients (8.3%). Morphological abnormalities of the lower urinary tract had 10 patients (41.6%).

Conclusion:

Sensory and motor pathways controlling the lower urinary tract might be affected from CIP. During urodynamics dysfunctions of the storage as well as the voiding phase were found. Morphological lower urinary tract abnormalities were common.
Neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid analgesia
Authors: Block Cady , Cianfrini Leanne
Published: December 2019

Background:

The pervasive disease of chronic pain is a common challenge for the clinical rehabilitation professional. Concurrent with physical and emotional symptoms, pain-related cognitive impairment has been reported. Although opioid analgesics are frequently prescribed, concern exists that opioids possess adverse cognitive effects of their own.

Objectives:

To review the neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population, and to provide recommendations for clinical practice and future research.

Methods:

This non-systematic review sought to provide a comprehensive synthesis of relevant neurobiology, neuroimaging, neuropsychological, and rehabilitation research literatures. We included citations from seminal and current texts as well as relevant original and review articles from 1980–2012 in PubMed and PubMedCentral online research databases.

Discussion and summary/conclusions:

To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations.
The effect of protein and calorie intake on prealbumin, complications, length of stay, and function in the acute rehabilitation inpatient with stroke
Authors: Pellicane Anthony J. , Millis Scott R. , Barker Kim D.D. , Temme Kate E. , Sayyad Anjum , Oswald Matthew C. , Roth Elliot J.
Published: December 2019

Background:

Nutrition's impact on stroke rehabilitation outcomes is controversial. Existing studies utilize albumin without correcting for inflammation in nutritional assessments. Here, prealbumin was used and inflammation assessed to determine if nutrition impacts rehabilitation outcomes.

Objective:

Determine the effect of dietary intake on prealbumin level, number of complications, length of stay, and Functional Independence Measure (FIM) efficiency in rehabilitation stroke inpatients.

Methods:

Patients had admission and discharge prealbumin and C-reactive protein (CRP) levels drawn; and, weekly protein and calorie counts obtained. Patients were followed for number of complications, length of stay, and FIM efficiency.

Results:

Mean protein and calorie intake was 57.6 ± 16.2 g/d and 1452.2 ± 435.8 kcal/d, respectively. 77.6% of patients had normal prealbumin on admission with 94.9% on discharge. Prealbumin increased significantly from admission to discharge (22.3 ± 6.2 mg/dL vs. 24.6 mg/dL ± 5.1 mg/dL, P = 0.007). Number of complications and length of stay were predicted by CRP in regression models. Total, motor, and cognitive FIM efficiencies were not universally affected by prealbumin levels, protein intake, or calorie intake.

Conclusions:

Nearly all hypoprealbuminemic stroke rehabilitation inpatients correct their levels eating a non-supplemented diet. Number of complications, length of stay, and functional outcomes in this patient are not affected by prealbumin levels, protein intake, or calorie intake.
Effect of continuing repeated passive and active exercises on knee's position senses in patients with hemiplegia
Authors: Kwon Oh Sung , Lee Seung Won
Published: December 2019

Objective:

To determine the repeated passive movement (RPM) and repeated active movement (RAM) exercise on position sense of the knee joint in patients with hemiplegia.

Methods:

45 hemiplegia patients were randomly allocated to either the control group(no exercise), RPM group, or RAM group, with 15 subjects in each group. The exercise was repeated 60 times on the angle 10 to 100 degrees of the knee joint with an angle speed of 120°/s, with three sets for 15 minutes. Evaluation was performed using Passive Angle Repositioning (PAR) and Active Angle Repositioning (AAR).

Results:

Error of positioning sense showed a decrease in PAR and AAR in the RPM group (p < 0.01) and an increase in AAR was observed in the RAM group (p < 0.05). In comparison of knee joint position sense error value and rate of change among the three groups, the RPM group is decreased mostly in PAR and AAR (p < 0.01), and Error value (p < 0.05) and rate of change (p < 0.01) of the RAM group showed a greater increase in AAR than the control group.

Conclusion:

RAM exercise can support an increase in proprioception on the knee joint of hemiplegia; however, RAM exercise that causes fatigue can decrease proprioception.
Extracorporeal Shock Wave Therapy reduces upper limb spasticity and improves motricity in patients with chronic hemiplegia: A case series
Authors: Troncati Franco , Paci Matteo , Myftari Tefta , Lombardi Bruna
Published: December 2019

Background:

Extracorporeal Shock Wave Therapy (ESWT) has been proposed for treatment of abnormal muscle tone only in the last years. The effects on motor impairment are unknown.

Objective:

To assess the long-term effects of ESWT on muscle tone and motricity in upper limb in patients with chronic hemiplegia.

Methods:

Twelve patients were selected and treated with two sessions of ESWT. Participants were assessed at baseline, after the treatment, and at 3 and 6 months. Muscle tone of shoulder adductors, elbow, wrist and finger flexors was evaluated at all assessment points using the Modified Ashworth Scale (MAS), while motricity, passive range of motion (PROM) and pain sub-scores of upper extremity part of the Fugl-Meyer scale were used to assess motor recovery. The degree of perceived benefit from treatment was assessed on a visual analogue scale.

Results:

MAS showed a significant reduction of spasticity and Fugl-Meyer scores improved immediately after treatment. Persistent effects were observed at 3 and 6 months for MAS, and for motricity and PROM subscores of the Fugl-Meyer scale. Clinical improvement was not correlated to the patients' perceived benefit.

Conclusions:

Two sessions of ESWT seem to have long-term effects in reducing muscle tone and enhancing motor impairment.
Effects of an 1-day education program on physical functioning, activity and quality of life in community living persons with multiple sclerosis
Authors: Feys Peter , Tytgat Katrien , Gijbels Domien , De Groote Luc , Baert Ilse , Van Asch Paul
Published: December 2019

Background:

Persons with MS (pwMS) in the community show reduced physical activity while studies demonstrated beneficial effects of exercise therapy in supervised settings.

Objective:

This study investigated, in pwMS living in the community, the effects of a 1-day education program about exercises and sports, on physical activity behavior and related outcome measures as self-efficacy, perceived walking ability, fatigue, perceived impact of MS and quality of life.

Methods:

PwMS attended an education day with theoretical and practical sessions that was organized by the Flemish MS Society and professional exercise experts. Forty-two participants immediately completed questionnaires as well as after three and six months. Overall disability and physical activity level were measured using PDSS (patient determined disease steps) and PASIPD (Physical Activity Scale for Individuals with Physical Disabilities) respectively. Other outcomes were the ESES, MSWS-12, MFIS, MSIS-29 and SF-36. Analyses of variance were performed in groups distinguished by self-reported disability level (PDDS ≤1; n = 24 and PDSS >1; n = 18).

Results:

Groups differed significantly for perceived walking ability (PDDS,MSWS-12) and physical related-domains of MSIS-29 and SF-36, but not PASIPD. A trend towards significant group*time interaction effect was found for the PASIPD indicating, at 3 and 6 months, increased physical activity in the subgroup PDDS ≤1. For the MSIS-29, a significant time effect was found with reduced impact being largest for the more disabled group at 6 months. No changes were found in other outcome measures.

Conclusion:

An one-day education program had, depending on perceived disability level, some long-standing effects on physical activity and perceived impact of MS.
Muscle strength is only a weak to moderate predictor of gait performance in persons with late effects of polio
Authors: Flansbjer Ulla-Britt , Brogårdh Christina , Lexell Jan
Published: December 2019

Objective:

To assess muscle strength in the knee extensors, knee flexors and ankle dorsiflexors in persons with late effects of polio, and determine how much muscle strength, gender, age and BMI are related to gait performance.

Methods:

Ninety community-dwelling ambulant persons (47 men and 43 women; mean age 64 years SD 8) with late effects of polio participated. Isokinetic concentric knee extensor and flexor muscle strength was measured at 60°/s and ankle dorsiflexor muscle strength at 30°/s. Gait performance was assessed by the Timed “Up & Go”, the Comfortable and Fast Gait Speed tests, and the 6-Minute Walk test.

Results:

There were significant correlations between knee extensor and flexor muscle strength and gait performance (p < 0.01), and between ankle dorsiflexor muscle strength and gait performance (p < 0.05), for both lower limbs. Muscle strength in the knee extensors and flexors explained 7% to 37% and 9% to 47%, respectively, of the variance in gait performance. Strength in the ankle dorsiflexors explained 4% to 24%, whereas gender, age and BMI contributed at most an additional 9%.

Conclusion:

Knee muscle strength, and to some extent ankle dorsiflexor muscle strength, are predictors of gait performance in persons with late effects of polio, but the strength of the relationships indicates that other factors are also important.
Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation
Authors: Kammersgaard Lars Peter , Linnemann Mia , Tibæk Maiken
Published: December 2019

Objective:

To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI).

Background:

Posttraumatic hydrocephalus (PTH) may lead to clinical deterioration and poor outcome if untreated. However, PTH can be successfully treated if detected. Nevertheless, PTH is easily overlooked during rehabilitation, particularly in severe cases.

Method:

We prospectively followed all patients (n = 444) in Eastern Denmark (population 2.5 mill) sustaining severe TBI, who required lengthy rehabilitation between 2000 and 2010. All patients with PTH were tracked retrospectively. Demographics, surgery, injury severity, consciousness level, and disability were compared for patients with versus without PTH. Independent predictors of PTH during rehabilitation were identified through multiple logistic regression models.

Results:

PTH occurred in 14.2% and 3/4 emerged during rehabilitation. Patients with PTH were older, had more severe brain injuries, were more frequently in vegetative state, and needed longer rehabilitation stays. After adjusted analyses, however, only older age and low level of consciousness were independently associated with PTH.

Conclusion:

Most cases of PTH emerge during rehabilitation. Therefore, attention towards this complication should be present also beyond the acute stage after TBI, particularly among older patients and patients with severe disordered consciousness.
A feasibility study using interactive graphic art feedback to augment acute neurorehabilitation therapy
Authors: Worthen-Chaudhari Lise , Whalen Cara N. , Swendal Catherine , Bockbrader Marcia , Haserodt Sarah , Smith Rashana , Bruce Michael Kelly , Mysiw W. Jerry
Published: December 2019

Background:

Interactive arts technologies, designed to augment the acute neurorehabilitation provided by expert therapists, may overcome existing barriers of access for patients with low motor and cognitive function.

Objectives:

Develop an application prototype to present movement feedback interactively and creatively. Evaluate feasibility of use within acute neurorehabilitation.

Methods:

Record demographics and Functional Independent Measure™ scores among inpatients who used the technology during physical, occupational or recreational therapy. Record exercises performed with the technology, longest exercise duration performed (calculated from sensor data), user feedback, and therapist responses to a validated technology assessment questionnaire.

Results:

Inpatients (n = 21) between the ages of 19 and 86 (mean 57 ± 18; 12 male/9 female) receiving treatment for motor deficits associated with neuropathology used the application in conjunction with occupational, recreational, or physical therapy during 1 to 7 sessions. Patients classified on the Functional Independence Measure™ as requiring 75%+ assistance for cognitive and motor function were able to use the interactive application.

Conclusions:

Customized interactive arts applications are appropriate for further study as a therapeutic modality. In addition to providing interactivity to individuals with low motor function, interactive arts applications might serve to augment activity-based medicine among inpatients with low problem-solving and memory function.
Muscle synergies with Walkaround® postural support vs. “cane/therapist” assistance
Authors: Miljković Nadica , Milovanović Ivana , Dragin Aleksandra , Konstantinović Ljubica , Popović Dejan B.
Published: December 2019

Background:

The main clinical measures of walking recovery in stroke patients were compared for training assisted by Walkaround® postural support (WPS) and conventional (CON) support by a cane/therapist.

Objective:

We attributed the differences between the trainings to modified muscular synergies that occurred during assistance by WPS.

Methods:

We studied the muscle activities of the primary knee and ankle joint movers in the paretic and non-paretic legs of sub-acute stroke patients during assisted walking with WPS and CON. Recorded signals were compared to normative data that were recorded during speed-matched gait trials in healthy subjects. The specific measures were the relative contribution of individual muscles, levels of cocontraction, and the timing of the maximum electromyography (EMG) activity during the walking sessions.

Results:

We found that, for most patients, the individual contribution of muscles were more similar to the healthy with the WPS assistance. In parallel, the cocontraction of the rectus femoris muscles in both legs was lower (by up to 39 %) during walking assisted by WPS than by cane/therapist gait support); the results from this case series (10 patients) showed that WPS might be the superior training scheme.

Conclusions:

These findings indicated that assistance by WPS changed the motor control output relative to CON assistance in most patients.
Frequency of domain-specific cognitive impairment in sub-acute and chronic stroke
Authors: Middleton Laura E. , Lam Benjamin , Fahmi Halla , Black Sandra E. , McIlroy William E. , Stuss Donald T. , Danells Cynthia , Ween Jon , Turner Gary R.
Published: December 2019

Background:

Functional contributions of cognitive impairment may vary by domain and severity.

Objective:

(1) To characterize frequency of cognitive impairment by domain after stroke by severity (mild: −1.5 ≤ z-score < −2; severe: Z ≤ −2) and time (sub-acute: < 90d; chronic: 90d–2yrs); and (2) To assess the association of cognitive impairment with function in chronic stroke.

Methods:

Cognitive function was characterized among 215 people with sub-acute or chronic stroke (66.8 years, 43.3% female). Z-scores by cognitive domain were determined from normative data. Function was defined as the number of IADLs minimally independent.

Results:

76.3% of sub-acute and 67.3% of chronic stroke participants had cognitive impairment in ≥ 1 domain (p-for-difference = 0.09). Severe impairment was most common in psychomotor speed (sub-acute: 53.5%; chronic: 33.7%). Impairment in executive function was common (sub-acute: 39.5%; chronic: 30.7%) but was usually mild. Severe impairment in psychomotor speed, visuospatial function, and language and any impairment in executive function and memory was associated with IADL impairment (p < 0.03).

Conclusions:

Mild cognitive impairment is common after stroke but is not associated with functional disability. Impairment in psychomotor speed, executive function, and visuospatial function is common and associated with functional impairment so should be a focus of screening and rehabilitation post-stroke.
Motor imagery group practice for gait rehabilitation in individuals with post-stroke hemiparesis: A pilot study
Authors: Dickstein Ruth , Levy Sandra , Shefi Sara , Holtzman Sarit , Peleg Sara , Vatine Jean-Jacques
Published: December 2019

Background:

Stroke is the leading cause of adult disability, with walking impairment being a devastating indicator of chronic post-stroke hemiparesis. Limited resources exist for individual treatments; therefore, the delivery of safe group exercise therapy is highly desired.

Objective:

To examine whether the application of group-based motor imagery practice to community-dwelling individuals with chronic hemiparesis improves gait.

Methods:

Sixteen individuals with chronic hemiparesis from two community centers participated in the study, with eight from each center. Four participants in each center received five weeks of the experimental intervention, consisting of group-based motor imagery exercises of gait tasks, followed by five weeks of control treatment of motor imagery exercises for the affected upper extremity. Four other subjects in each center received the same treatments in reverse order. Pre- and post intervention measurements included clinical and biomechanical gait parameters.

Results:

Comparisons within (pre- vs. post) and between treatments (experimental vs. control) indicated no significant change in any gait variable. Nevertheless, the verbal reports of most participants alluded to satisfaction with the experimental intervention and to an increase in self-confidence.

Conclusions:

Despite the lack of evidence for the effectiveness of group-based motor imagery practice in improving gait among individuals with chronic hemiparesis, the contrast between the measured outcomes and the positive verbal reports merits further inquiry.
Innovative strength training-induced neuroplasticity and increased muscle size and strength in children with spastic cerebral palsy: An experimenter-blind case study – three-month follow-up
Authors: Lee Dong Ryul , Kim Yun Hee , Kim Dong A. , Lee Jung Ah , Hwang Pil Woo , Lee Min Jin , You Sung (Joshua) Hyun
Published: December 2019

Background:

In children with cerebral palsy (CP), the never-learned-to-use (NLTU) effect and underutilization suppress the normal development of cortical plasticity in the paretic limb, which further inhibits its functional use and increases associated muscle weakness.

Objective:

To highlight the effects of a novel comprehensive hand repetitive intensive strengthening training system on neuroplastic changes associated with upper extremity (UE) muscle strength and motor performance in children with spastic hemiplegic CP.

Method:

Two children with spastic hemiplegic CP were recruited. Intervention with the comprehensive hand repetitive intensive strengthening training system was provided for 60 min a day, three times a week, for 10 weeks. Neuroplastic changes, muscle size, strength, and associated motor function were measured using functional magnetic resonance imaging (MRI), ultrasound imaging, and standardized motor tests, respectively.

Results:

The functional MRI data showed that the comprehensive hand repetitive intensive strengthening training intervention produced measurable neuroplastic changes in the neural substrates associated with motor control and learning. These neuroplastic changes were associated with increased muscle size, strength and motor function.

Conclusions:

These results provide compelling evidence of neuroplastic changes and associated improvements in muscle size and motor function following innovative upper extremity strengthening exercise.
Effect of real-time cortical feedback in motor imagery-based mental practice training
Authors: Bai Ou , Huang Dandan , Fei Ding-Yu , Kunz Richard
Published: December 2019

Background:

Mental practice using motor imagery of limb movement may facilitate motor recovery in persons who have experienced cerebrovascular accident (CVA). However, the lack of a feedback mechanism that can monitor the quality of the motor imagery affects patients' engagement and motivation to participate in the mental practice training program.

Objective:

This study investigates the effect of novel real-time motor imagery-associated cortical activity feedback on motor imagery-based mental practice training.

Methods:

Ten healthy volunteers were randomly assigned into intervention and control groups. Both groups participated in a five-visit motor imagery-based mental practice training program managed over a period of two months. The intervention group received mental practice training with real-time feedback of movement-associated cortical activity—beta band (16–28 Hz) event-related desynchronization (ERD) in electroencephalography (EEG), using a novel custom-made brain-computer interface (BCI) system. The control group received the mental practice training program without EEG cortical feedback. Motor excitability was assessed by measuring the frequency power magnitude of the EEG rhythmic activity associated with physical execution of wrist extension before and after the motor imagery-based mental practice training.

Results:

The EEG frequency power magnitude associated with the physical execution of wrist extension was significantly lower (i.e. more desynchronized) after the mental practice training in the intervention group that received real-time cortical feedback (P < 0.05), whereas no significant difference in EEG frequency power magnitude associated with the physical execution of wrist extension was observed before and after mental practice training in the control group who did not receive feedback.

Conclusions:

The mental practice training program with motor imagery-associated cortical feedback facilitated motor excitability during the production of voluntary motor control. Motor imagery-based mental practice training with movement-associated cortical activity feedback may provide an effective strategy to facilitate motor recovery in brain injury patients, particularly during the early rehabilitation stage when full participation in physical and occupational therapy programs may not be possible due to excessive motor weakness.
A comparison of hemisphere-specific training pattern in Inter-limb Learning Transfer (ILT) for stroke patients with hemiparesis
Authors: Yoo In-gyu , Jung Min-ye , Yoo Eun-young , Park Ji-hyuk , Kang Dae-hyuk , Lee Jin
Published: December 2019

Background:

Stroke patients have major problems with impaired upper-extremity function. Unfortunately, many patients do not experience a full recovery from movement deficits in the upper extremities.

Objectives:

The purpose of this study was to compare the effectiveness of inter-limb learning transfer (ILT) to the contralateral upper limb after both hemisphere-specific and -unspecific ipsilateral upper limb training for stroke patients with hemiparesis.

Methods:

Twenty-four stroke patients with hemiparesis participated. The hemisphere-specific training group performed reaching movements in a customized training setting in which non-dominant limb training participants began from a single starting location and proceeded to one of three target locations (1S3T condition); the dominant limb training participants started from one of three starting locations and proceeded to a single target location (3S1T condition). The hemisphere-unspecific training group performed these movements starting under reverse-start and target conditions.

Results:

The non-dominant to dominant limb transfer, the hemisphere-specific training group performance time decreased significantly as compared with the pre-training session (p < 0.05). Also, the isolation contraction ratio was decreased significantly from that of the pre-training session in the biceps brachii muscles and increased significantly in the upper trapezius muscles (p < 0.05). And, dominant to non-dominant limb transfer in the hemisphere-specific training group significantly increased RMS amplitudes from the pre-training session in the biceps brachii and triceps muscles (p < 0.05). Also, the isolation contraction ratio was increased significantly from that of the pre-training session in the biceps brachii muscles and decreased significantly in the upper trapezius muscles (p < 0.05). However, the hemisphere-unspecific training group showed no significant differences in inter-limb learning transfer (ILT).

Conclusion:

The transfer of hemisphere-specific training from one arm to the other had a more positive influence on functional recovery than did hemisphere-unspecific training for patients with stroke and hemiparesis.
Effect of electrical stimulation to long head of biceps in reducing gleno humeral subluxation after stroke
Authors: Manigandan J. Bala , Ganesh G. Shankar , Pattnaik Monalisa , Mohanty Patitapaban
Published: December 2019

Background:

Glenohumeral subluxation is the most frequent complication in post stroke hemiplegia and its reduction has been considered an important goal. Though it has been demonstrated that cyclical electrical stimulation of posterior deltoid and supraspinatus muscles can reduce subluxation, the role of biceps has not been given due consideration.

Objective:

The purpose of this study was to determine whether electrical stimulation to the long head of biceps could more effectively reduce gleno humeral subluxation.

Methods:

24 patients were selected and consecutively assigned to group 1 (electrical stimulation to supraspinatus & posterior deltoid) and group II (electrical stimulation to supraspinatus, posterior deltoid & long head of the biceps) along with routine physiotherapy and occupational therapy for a period of 5 weeks. All patients were assessed for shoulder subluxation, pain and shoulder active abduction range of motion at the time of recruitment to study and after 5 weeks of therapy.

Results:

Both the groups showed significant improvement in parameters measured. Tukey's post hoc analysis showed the results were more significant in Group II.

Conclusions:

Electrical stimulation to biceps along with the supraspinatus and posterior deltoid can more effectively reduce shoulder subluxation.
The effects of speed-dependent treadmill training and rhythmic auditory-cued overground walking on balance function, fall incidence, and quality of life in individuals with idiopathic Parkinson's disease: A randomized controlled trial
Authors: Harro C.C. , Shoemaker M.J. , Frey O. , Gamble A.C. , Harring K.B. , Karl K.L. , McDonald J.D. , Murray C.J. , VanDyke J.M. , Tomassi E.M. , VanHaitsma R.J.
Published: December 2019

Objectives:

The purpose of this single-blinded, randomized controlled study was to examine and compare the immediate and retention effects of progressive speed-dependent treadmill training (SDTT) and rhythmic auditory-cued (RAC) training on balance function, fall incidence, and quality of life (QOL) in individuals with PD.

Methods:

Twenty participants (mean age 66.1 yrs) with idiopathic PD were randomized into either SDTT (n = 10) or RAC (n = 10) progressive, interval-based locomotor training for 6 weeks. Measures included the Berg Balance Scale (BBS), Rapid Step-Up Test (RST), Activities-specific Balance Confidence Scale, Parkinson's Disease Questionnaire-39 (PDQ), and the NeuroCom Sensory Organization Test (SOT), Motor Control Test, and Limits of Stability (LOS). Fall incidence was assessed prospectively post-training based on six monthly self-report fall calendars.

Results:

Significant gains in balance measures were observed post-training in BBS, RST and SOT for the RAC group and in RST, SOT and LOS for the SDTT group. Gains were retained at 3 months post-training in all measures for RAC group, but only the RST for the SDTT group. No clear trend in reduction in fall frequency was evident.

Conclusion:

Externally-cued locomotor training paradigms with progressive speed challenges produced significant improvements in dynamic balance function in persons with PD, with stronger retention of gains in RAC group.
Safety and feasibility of post-stroke care and exercise after minor ischemic stroke or transient ischemic attack: MotiveS & MoveIT
Authors: Boss H.M. , Van Schaik S.M. , Deijle I.A. , de Melker E.C. , van den Berg B.T.J. , Scherder E.J.A. , Bosboom W.M.J. , Weinstein H.C. , Van den Berg-Vos R.M.
Published: December 2019

Background:

Despite the beneficial effect of cardiac rehabilitation after myocardial infarction, a rehabilitation program to improve cardiorespiratory fitness and influence secondary prevention has not been implemented for ischemic stroke and transient ischemic attack (TIA).

Objective:

To investigate the safety and feasibility of a post-stroke care including an exercise program after minor ischemic stroke or TIA.

Methods:

In a randomised controlled trial, 20 patients with a recent minor stroke or TIA without cardiac contraindications were randomly assigned to one of the two interventions; post-stroke care without exercise or post-stroke care with exercise. Patients were evaluated at baseline, 6 and 12 months.

Results:

Eighteen patients completed the intervention. In none of the patients cardiopulmonary contraindications for the maximal exercise test and exercise program were found. No cardiovascular events occurred during the maximal exercise tests and exercise program. After one year, significantly more patients in the post-stroke care with exercise group achieved the composite endpoint of optimal medical therapy.

Conclusions:

Post-stroke care including an exercise program is safe and feasible in the acute phase after minor stroke or TIA and might be a way to increase effectiveness of secondary stroke prevention. We are currently conducting a larger trial to validate these results.
High doses of a new botulinum toxin type A (NT-201) in adult patients with severe spasticity following brain injury and cerebral palsy
Authors: Intiso Domenico , Simone Valentina , Di Rienzo Filomena , Iarossi Andrea , Pazienza Luigi , Santamato Andrea , Maruzzi Giuseppe , Basciani Mario
Published: December 2019

Background:

Spasticity can be a severe disabling disorder requiring high-dose injections of botulinum toxin type A (BoNT-A). Efficacy and safety of high BoNT-A doses in reducing multi-level spasticity of subjects with brain injury and cerebral palsy were investigated. Pain and functional outcome were also assessed.

Method:

High doses (up to 840 IU) of incobotulinumtoxinA were injected in adult subjects with severe spasticity of the upper and lower limbs due to brain injury (BI) and cerebral palsy (CP). The Modified Ashworth Scale, Visual Analogue scale, Glasgow Outcome Scale, Franchay Arm Test (FAT) and Barthel Scale were employed to assess spasticity, pain and functional outcome at baseline, and 4 and 16 weeks after BoNT-A injection.

Results:

Twenty-two (12 M, 10 F; mean age 38.1 ± 13.7 years) subjects – 16 subjects with BI and 6 with CP – were enrolled. Elbow, wrist, fingers and ankle muscles showed significant spasticity reduction after BoNT-A injections. The mean FAT score improved, but the benefit was not significant. Three (13.6%) subjects complained of mild adverse events.

Conclusion:

High-dose BoNT-A injections were effective and safe in reducing spasticity of BI and CP subjects. A significant reduction of the pain was also observed, but global functionality and arm dexterity were unchanged.
Effectiveness of eccentric viewing training for daily visual activities for individuals with age-related macular degeneration: A systematic review and meta-analysis
Authors: Hong Seung Pyo , Park HaeYean , Kwon Jae-Sung , Yoo Eunyoung
Published: December 2019

Background:

Eccentric viewing training can be successfully applied in the clinical setting based on positive evidence. Nonetheless, published research should be integrated to provide a conclusive perspective of the efficacy of eccentric viewing training.

Objective:

Meta-analysis was conducted to examine effectiveness of eccentric viewing training on daily visual activities for individuals with age-related macular degeneration (AMD).

Methods:

The papers used in this study were located through PubMed, Ovid, ProQuest, EBSCOhost, RISS, and KMbase on studies published between January, 1990 and December, 2012. The keywords for searching were “age-related macular degeneration” and “eccentric viewing”, “eccentric fixation”, “peripheral vision” or “preferred retinal loci”. The effect sizes were calculated using Comprehensive Meta-Analysis 2.0 and interpreted according to Cohen's criteria.

Results:

A total of 258 studies were found, among which five papers suited the main selection criteria for final analysis. The entire effect size was 0.660 (95% CI, 0.232 ~ 1.088), indicating a moderate effect size of the eccentric viewing training for individuals with AMD in their daily visual activities (p < 0.05).

Conclusions:

The results of this study demonstrated the clinical effectiveness of eccentric viewing training for individuals with AMD. This result should be interpreted cautiously, though, given the possibility of publication bias.
A new hand assessment instrument for severely affected stroke patients
Authors: Broetz Doris , Del Grosso Nicholas A. , Rea Massimiliano , Ramos-Murguialday Ander , Soekadar Surjo R. , Birbaumer Niels
Published: December 2019

Background:

Standard assessment instruments cannot differentiate patients with minimal residual hand function after stroke. As a result, changes in motor recovery are difficult to document using currently-available tests. In a controlled study with chronic stroke patients without residual finger extension, a new hand function test has been developed. This instrument, called Broetz Hand Test (BzH), allows to assess small variations in hand function in severely paralyzed stoke patients. The instrument is easy to use, and was developed using principles of motor learning and behavioral assessment.

Methods:

The instrument consists of seven daily life-oriented tasks, each of which asks for movement of the paralyzed hand. BzH of 20 patients after stroke was evaluated before and after a behavioral physiotherapy treatment. Sensitivity, inter-observer reliability, test-retest reliability and construct validity was calculated.

Results:

Two-tailed paired-samples t-test before and after treatment demonstrated sufficient sensitivity. Mean agreement between the raters resulted in an excellent interrater-reliability. Test-retest reliability between the pre- and post-treatment scores was 0.9. The correlation between BzH and standard test scores was statistically significant and demonstrated sufficient validity.

Conclusion:

The BzH is a valid and reliable tool to assess changes in hand function in severely paralyzed patients after stroke.
Spinal cord injury secondary to front rolls as part of military physical training: A case report
Authors: Bin Ayaz Saeed , Ikram Muhammad , Matee Sumeera , Ahmad Khalil
Published: December 2019

Objective:

To report an unusual case of cervical spinal cord injury.

Study design:

Case report of a 23 year old soldier who sustained spinal cord injury in front rolls during a military training program.

Settings:

Spinal Cord Injuries Unit, Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan.

Case report:

A 23 year old soldier, who voluntarily joined a military training program, suffered spinal cord injury in doing front rolls resulting in tetraplegia and incontinence for bowel and bladder corresponding to the injury level of C5 ASIA Impairment Scale C with Functional Independence Measure Score of 40/126. His Magnetic Resonance Imaging showed posterior displacement of CV3 resulting in cord compression and swelling at CV3 and CV4 levels. He was managed conservatively by comprehensive rehabilitation and improved to spinal cord injury C5 ASIA Impairment Scale D with Functional Independence Measure Score of 76/126.

Conclusion:

This case report describes spinal cord injury secondary to front-rolls. As front-rolls are part and parcel of military training, awareness and coaching to ensure safety must be exercised from the beginning of any training program.
Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: A pilot randomized controlled trial
Authors: Viana R.T. , Laurentino G.E.C. , Souza R.J.P. , Fonseca J.B. , Silva Filho E.M. , Dias S.N. , Teixeira-Salmela L.F. , Monte-Silva K.K.
Published: December 2019

Background:

Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies.

Objective:

This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals.

Methods:

Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data.

Results:

Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID.

Conclusions:

These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further.
Functional status and quality of life of stroke survivors undergoing rehabilitation programmes in a hospital setting
Authors: Tramonti Francesco , Fanciullacci Chiara , Giunti Giulia , Rossi Bruno , Chisari Carmelo
Published: December 2019

Background:

While the positive effects of rehabilitation on physical functioning are well documented in stroke literature, more controversial results arise from the evaluation of the impact on quality of life.

Objective:

The aim of the present study is to examine the associations among functional status and different measures of quality of life in a sample of inpatients undergoing rehabilitation programmes, and to consider the role of psychological distress, coping strategies and social support.

Methods:

Twenty-nine stroke survivors were evaluated at the admission to a hospital-based Rehabilitation Unit and just before discharge. Questionnaires for the evaluation of functional status, health-related QoL, individualised QoL, psychological distress, coping strategies and social support were administered to them.

Results:

While functional status improves significantly after treatment, individualised evaluations of QoL seem to be less affected. Adaptive coping strategies and social support showed significant correlations with positive outcomes on specific QoL domains, whereas psychological distress was associated with negative outcomes.

Conclusions:

The data from the present study support the evidence that different measures of QoL and functional status are not strongly associated one another, and that psychological distress, coping strategies and social support can be significantly related to specific outcome measures.
Onabotulinumtoxin-A injection for disabling lower limb flexion in hemiplegic patients
Authors: Rousseaux Marc , Daveluy Walter , Kozlowski Odile , Allart Etienne
Published: December 2019

Background:

Hemiplegic patients with supraspinal spasticity can present with a flexor pattern at the hip and knee that hampers both passive and active functions.

Objective:

To investigate the efficacy of OnabotulinumtoxinA injections on this flexor scheme.

Methods:

This open-label observational study included eleven patients who had suffered a unilateral stroke or traumatic brain injury. All had impairment in the activities of daily living caused by severe hip and knee flexion. OnabotulinumtoxinA injections of 300–400U (total dose) were administered to the iliopsoas (iliacus) and knee flexors and, when necessary, to other muscles of the hip and knee. Evaluations were performed pre-treatment (weeks −4 to −8, and day 1) and post-treatment (week 10 and week 21): spasticity, range of motion, limb positioning, passive functions and pain.

Results:

A modest improvement in hip and knee extension was observed, as evidenced by the Modified Ashworth Score and range of passive extension movements. Limb positioning was also improved. Clear benefits were found on passive functioning, including toileting, dressing and bed facilities, as well as pain levels. Active functions remained unchanged. More definite improvement was found in patients with severe difficulties.

Conclusions:

OnabotulinumtoxinA injection can contribute to reducing the consequences of disabling lower limb flexion.
Effects of galvanic vestibular stimulation combined with physical therapy on pusher behavior in stroke patients: A case series
Authors: Nakamura Junji , Kita Yorihiro , Yuda Tomohisa , Ikuno Koki , Okada Yohei , Shomoto Koji
Published: December 2019

Background:

A recent study investigated the effects of galvanic vestibular stimulation (GVS) on pusher behavior (PB) in post-stroke patients. However, there have been no reports about the effects of multisession GVS on PB.

Objective:

The purpose of this study was to investigate the feasibility and effects of multisession GVS combined with physical therapy for PB in stroke patients.

Methods:

Two stroke patients who showed PB were enrolled. The ABAB single-case design was used. Each phase lasted 1 wk. In phases A1 and A2, the patients underwent a 60-min-long physical therapy session 5 days a week. In phases B1 and B2, they underwent GVS for 20 min before each physical therapy session, and then the same physical therapy program as in phases A1 and A2 were performed. PB was evaluated using the Scale for Contraversive Pushing (SCP) and the Burke Lateropulsion Scale (BLS). Outcomes were tested at the baseline and after each phase.

Results:

In both patients, the SCP scores were reduced only during phase B2. Although the BLS scores improved at the A1 phase, a larger improvement was seen at the two B phases.

Conclusions:

Multisession GVS combined with physical therapy may have positive effects on PB in clinical setting.