NeuroRehabilitation

Autism spectrum disorders are complex neurodevelopmental disorders. Early intervention training is a very important treatment strategy. Under the current background of rehabilitation supply in China, the long-term efficacy of intervention is unexplored.

This study aimed to investigate the effects of long-term rehabilitation and related factors affecting the recovery of autistic children.

A total of 137 autistic children were followed up for 3 years. They received two neuropsychological assessments at the first visit and 3 years after referral. Assessments included Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC), and Developmental Diagnostic Scale of Children Aged 0–6 Years. All children were asked to visit rehabilitation centers for rehabilitation training. In the study, 105 children with autism spectrum disorders (ASD) received rehabilitation training according to the physician’s orders (the rehabilitation group), and 32 patients did not receive rehabilitation training (the nonrehabilitation group).

The ABC, CARS, and developmental quotient scores of the rehabilitation group were statistically significant between initial assessment and reassessment. No significant difference was observed in the nonrehabilitation group.

Rehabilitation training significantly improved the core symptoms and cognitive function in children with ASD, exerting a long-term rehabilitation effect. The initial language development quotient, children’s training time, and parental participation time of autistic children significantly impacted the change in ABC.

Children with hemiparetic cerebral palsy are often characterized by reduced speed progression, shorter step length, and increased support base. These kinematic alterations result in inefficient gait.

To assess the immediate effects of treadmill training with additional lower limb loading on kinematic gait parameters in children with Cerebral Palsy (CP).

This cross-sectional, observational study, involved 20 children with hemiparetic CP that underwent single treadmill session with ankle loading. Kinematic gait data were collected by the Qualisys Motion Capture System during baseline (PRE), immediately after training (POST) and 5 minutes after post session (FOLLOW UP).

The results demonstrated increase in knee (p = 0.001) and hip (p = 0.005) range of motion, maximum knee (p <.0.001) and hip (p =.001) flexion in swing and paretic foot height during swing (p <0.001) when PRE x POST were compared.

Treadmill gait training with additional lower limb loading was a disturbance capable of modifying the locomotor strategy of these population. The increase in hip flexion during swing phase allowed higher paretic foot clearance which may favor the improvement of gait function.

The effect of tacit learning systems (TLSs) on brain plasticity are as of yet unknown. We developed a myoelectric hand prosthesis equipped with a TLS to auto-regulate forearm rotation in response to upper extremity movement patterns.

To evaluate the effects of tacit learning on the central nervous system during a prosthesis control exercise.

The experienced prosthetic user performed a series of simple mechanical tasks with the TLS inactivated (the baseline condition) and then with it activated (the enhanced, experimental condition). The process was video recorded. Subsequently, the participant viewed video recordings of each condition (baseline and experimental) during magnetoencephalography and electroencephalography recordings.

Stronger connections between the motor area and other cortical areas were observed, as indicated by a significant increase in coherence values.

Integration and interoperability may underlie tacit learning and promote motor function-related adaptive neuroplasticity.

Intermanual transfer of learning is an important movement basis for a keyboard and instrument playing movement. However, the issue of where neural plastic mechanism occurs in the brain after intermanual transfer training remains both controversial and unresolved.

The aim of present study is to investigate the neuroplastic mechanism associated with the interlimb transfer learning from non-dominant hand to dominant hand.

Twenty healthy right-handed adults were classified into either the control group (no-training) or the experimental group (training serial button-press motor task, SPMT), 5 days a week for two consecutive weeks. SPMT involved pressing the numbers 1, 2, 3, and 4 in a random sequence, which was presented in the monitor screen. Outcome measures included movement accuracy (MA), movement time (MT), and the fMRI data using a 3T MRI scanner. Repeated measures of analysis of variance (ANOVA) and non-parametric tests were used at p <0.05.

Motor performances in the MA and MT were significantly more improved in the experimental group than in the control group (p <0.05). Neuroimaging data revealed a distributed subcortical and cortical motor network including the SMA–thalamus (VL/VL)–basal ganglia–cerebellum loop, suggesting a differential and time-dependent neural network utilized during intermanual transfer learning.

Pre-training intermanual transfer learning involved a form of declarative (or explicit) motor learning, which was primarily mediated by the cortical motor network, whereas post-training involved a form of procedural knowledge, which activated subcortical and cortical motor network regions, including the SMA–thalamus (VL/VL)–basal ganglia–cerebellum loop.

Stroke patients have a lower quality of life than other people.

The purpose of this study was to examine the effect of balance and gait function of stroke patients on their quality of life.

Twenty-seven subjects participated in the experiment. Balance ability was assessed using a SpaceBalance 3D and a Berg Balance Scale (BBS). Gait function was measured with a Biodex Gait Trainer 2 treadmill system. The quality of life of the subjects was assessed through the Stroke specific Quality of Life Scale (SS-QOL).

Correlation analysis between balance and quality of life showed that weight bearing distribution and BBS are positive correlated with quality of life. In addition, gait speed, step length of the paretic limb, and step length of the non-paretic limb were also found to be correlated with quality of life.

Balance and gait function must all be considered in order to improve the quality of life of stroke patients.

During gait training in persons with central nervous system (CNS) movement disorders, virtual reality (VR) can offer added value by providing task-specific gait training in more interactive and motivating environments.

To summarize current evidence for the effectiveness of VR-enhanced gait training in persons with CNS movement disorders.

PubMed, Web of Science and CENTRAL were systematically searched for studies using VR during walking to improve gait outcomes (spatiotemporal, functional, kinematic and kinetic). Meta-analyses were performed to estimate pooled effects.

Eighteen studies with in total 337 patients were included (12 studies with people post-stroke, 4 with multiple sclerosis, 1 with Parkinson’s disease, 1 with traumatic brain injury). Spatiotemporal and functional parameters significantly improved in each population after the VR training. Compared to gait training without VR, differences in favor of VR were found for spatiotemporal and functional parameters only in people post-stroke.

VR-enhanced gait training is an effective method to improve spatiotemporal and functional parameters in persons with CNS movement disorders. Current evidence supports that, in comparison to training without VR, for people post-stroke VR-enhanced gait training is more effective to improve gait function. Future research regarding other outcome measures and other CNS movement disorders is necessary.

Balance disorders cause disability in stroke and increase risk of falls. The Balance Evaluation Systems Test (BESTest), examines balance, determines parameters causing balance disorders, provides information on risk factors for falls.

To investigate the sensitivity and specificity of the BESTest in determining the risk of falls in stroke patients.

Fifty patients with chronic stroke were included in the study. Balance was assessed using BESTest, Berg Balance Scale (BBS), Activity Specific Balance Confidence scale (ABC) and Biodex-BioSway Balance System. To examine the content validity of BESTest, the relationship between BESTest and other balance assessment methods was examined. The internal consistency reliability of BESTest was evaluated by Cronbach’s α coefficient. Analysis of receiver operating characteristics (ROC) was performed to determine cut-off point, sensitivity and specificity.

BESTest, BBS, ABC and Biodex-BioSway Balance System results of faller stroke patients were worse than that of non-faller (p <0.05). Internal consistency of BESTest was found to be Cronbach’s α = 0.960. The BESTest value of area under curve (AUC) was 0.844, with a cut-off point of 69.44%, a sensitivity of 75% and a specificity of 84.6% (p < 0.01).

BESTest is reliable and valid with high sensitivity and specificity in determining the risk of fall in stroke patients.

Trunk alignment is thought to contribute to neck function. However, this common assumption is not clear in patients with Parkinson’s disease (PwPD) suffering from different postural deformities such as: Pisa syndrome (PS), Camptocormia & Antecollis (C&A).

to investigate the effect of different postural deformities including PS and C&A on neck function and pain in patient (PwPD).

Forty-five participants belonging to three groups: 15 PD patients without postural disorders (PD), 15 with PS, and 15 with C&A. The function, disability and pain were assessed by Neck Disability Index (NDI), and Brief Pain Inventory (BPI) which used to assess the pain severity (BPI-PS) and Pain Interference (BPI-PI). All groups completed clinical assessments by the Unified Parkinson’s Disease Rating Scale (UPDRS), Modified Hoenh & Yahr (mH&Y) staging and the Levodopa Equivalent Daily Dose (LEDD).

PD group compared with PS and C&A groups showed differences in NDI, BPI-PS, BPI-PI, LEDD and mH&Y staging (P < 0.001), but no differences found in PD duration, UPDRS-II and III in the same groups. Moreover, no differences were observed between PS and C&A groups in the mentioned scales.

These results demonstrated that PS and C&A are associated with severe impairment of neck functions, and pain in PwPD.

Persons diagnosed with Amyotrophic Lateral Sclerosis (ALS) often demonstrate neurological deficits that predispose them to repeated falls and associated adverse consequences. Determining contributing factors to falls in this population is critical to improve safety and patient outcomes.

The purpose of this study was to correlate clinical measures of gait speed, balance, strength, spasticity, and a self-reported rating scale of function with fall incidence in individuals with ALS.

Thirty-one participants with a confirmed ALS diagnosis were recruited from an outpatient clinic. Each participant performed the following tests: timed gait speed, Berg Balance Scale (BBS), manual muscle testing (MMT) for lower extremity (LE) strength, Modified Ashworth Scale (MAS) for LE spasticity, and the ALS Functional Rating Scale-Revised (ALSFRS-R). Each participant reported number of falls that occurred in the past three months. Pearson correlation coefficients were calculated to determine correlations between variables.

Significant correlation was found between fall incidence and composite LE strength score (r_p = 0.385, p = 0.032).

There is a relationship between LE weakness and number of falls in the ALS population. Preventing disuse-related LE muscle weakness and education of need for external support may decrease the number of falls experienced by individuals with ALS.

The minimal number of studies have documented the impact of Vestibular rehabilitation (VR) on the recovery rate of patients with Chronic Unilateral Vestibular Hypofunction (CUVH) and Bilateral Vestibular Hypofunction (BVH).

The goal of the study was to show and compare the impact of vestibular rehabilitation (VR) in patients with CUVH and BVH.

We analysed the data of 30 patients with CUVH and 20 with BVH treated with VR. The patients with CUVH during their eight-week treatment were controlled every two weeks, while the patients with BVH were controlled every three months during their one-year treatment; they filled in the DHI and ABC questionnaires every time.

In both groups of patients, there was significantly less disablement between the initial and final DHI scores (from 59-20 in CUVH and 74-41 in BVH group). There was a significant increase in the balance confidence between the initial and final ABC Scale in both groups of patients (from 49.5-90% in CUVH and 42-73% in BVH group).

Well-planned and individually adjusted system of vestibular exercises leads to a significant decrease in clinical symptoms and improvement of functioning and confidence in activities in both the CUVH and the BVH patients.

Oropharyngeal dysphagia is a common problem in subacute stroke patients leading to aspiration pneumonia and malnutrition. Non-invasive neuromuscular electrical stimulation (NMES) coupled with traditional therapy could be best treatment option for patients with post-stroke dysphagia, however results are still inconclusive and more studies are requested.

The aim of the study was to investigate the effect of laryngopharyngeal neuromuscular electrical stimulation on dysphagia caused by stroke.

Thirty-three patients affected by subacute stroke and dysphagia participated in this study. The subjects were divided into NMES plus traditional dysphagia training (n = 17) and traditional dysphagia training alone in a time matched condition (n = 16). Both groups were treated 5 days/week for 8 weeks. All patients were evaluated before and after the treatment. The study was designed as a single blind randomized controlled trial. Primary outcomes were considered the status of swallowing function according to the Functional Oral Intake Scale (FOIS), the instrumental Fiberoptic Endoscopic Examination of Swallowing examination, the Penetration Aspiration Scale and the Pooling score and the presence of oropharyngeal secretion. Secondary outcomes were the type of diet taken by mouth; the need for postural compensations and the duration of the dysphagia training.

A functional improvement was observed in both groups but treatment group showed a significant improvement for primary outcome with the exception of the pooling Score (p = 0.015, p = 0.203; p = 0.003; p = 0.048 respectively) and for secondary outcome p <0.005. The results confirm that laryngopharyngeal neuromuscular electrical stimulation in post-stroke patients with dysphonia improve outcome of the training.

Laryngopharyngeal neuromuscular electrical stimulation may be considered as an additional and effective treatment option for dysphagia after stroke.

Temporal features of swallowing physiology vary with age in healthy normals and have the potential to impact swallow safety and efficiency in patients with dysphagia. We conducted a meta-analysis to assess the relation between temporal features of swallowing with penetration, aspiration and residue in adult patients with dysphagia regardless of etiology.

Operational definitions of relevant terms were defined a priori. A search of 5 databases was conducted to November 2016 without restriction to language. Two independent raters reviewed abstracts and full articles, with discrepancies resolved by consensus. All accepted articles advanced to data extraction and critical appraisal according to Cochrane standards. Analysis of pooled data compared measures between groups.

Of the 11 articles accepted, the temporal measures used in three or more studies were grouped into morphofunctional categories: bolus transit time; pharyngeal response time; laryngeal closure time; and upper esophageal opening time. Across all selected articles, definitions varied for abnormal swallow and only 4 articles reported rater blinding and reliability for measures related to timing. Pooled data identified two main findings: a. longer pharyngeal response time was associated with penetration and/or aspiration (MD = 0.40 95% CI 0.59 – 0.22), and longer upper esophageal opening duration was associated with only aspiration (PAS ≥ 6) (MD = 0.09 95% CI 0.16 – 0,02). No studies were found that related temporal measures and residue.

Our pooled findings identified an association of two temporal measures with penetration and/or aspiration but none with residue. The current evidence remains limited due to the heterogeneity across studies in how swallow measures were operationalized. Future work with a standardized and reproducible approach is direly needed.

Pusher syndrome (PS) is a clinical disorder that causes decreased postural balance and active pushing away from the non-hemiparetic side in patients with right or left brain damage. Therapists are challenged by needing to manage both the hemiparetic and the pushing/non-hemiparetic sides. There is a minimal amount of evidence about effective treatment interventions for PS.

To describe treatment interventions that reduce pushing behavior and improve functional outcomes in patients with PS.

Five individuals (aged 42–76, admitted 5–16 days post-stroke) with PS participated in this case series. The participants received 90 minutes of physical therapy (5 days/week) with an average length of stay of 27 days. Treatment focused on regaining their sense of midline (balance and transfers), mobility retraining, and neuro re-education activities. Outcome measures examined pushing behavior, transfer ability, and sitting balance.

All five participants demonstrated improvements in pushing behavior, balance and transfer status.

These outcomes provide preliminary evidence of decreased pushing behavior, and improved balance and transfers following a program of interventions designed to improve the functional outcomes of patients with PS. Larger studies are needed to confirm these findings, and whether these interventions are effective for patients with less severe pushing behavior.

Patients suffering brain injury may experience paroxystic sympathetic hyperactivity, presenting diagnostic and therapeutic challenges in neurointensive rehabilitation. The syndrome has been modelled as peripheral and central excitatory:inhibitory ratios of autonomous nervous activity. Another model represents the symptoms as oscillations of the two components of the autonomous nervous system. In therapeutic framework, the syndrome is perceived as the patient misconstruing sensory input relating to body positioning.

To investigate whether changes in frequency domain of heart rate variability reflect pharmacological and/or therapeutic measures in rehabilitation.

ECG was recorded before and after pharmacological and therapeutic interventions in eight patients with high probability of the syndrome in a neurointensive step-down unit. Recordings were analysed off-line in frequency parameters. Appropriate statistical methods were applied.

Low, high frequency and the LF/HF ratio changed significantly following therapeutic as well as pharmacological interventions.

The cohort was small, the setting the immediate postictal period of intensive care with multidisciplinary rehabilitation. Still, changes in frequency domain were detected following therapeutic efforts. This opens up the venue of on-line monitoring of the intended therapeutic effect.

Spasticity is a frequent symptom after traumatic brain injury.

To assess the effects of different interventions used for muscle spasticity after TBI.

To summarize a rehabilitation perspective “Cochrane Review” conducted by Synnot et al.

Nine studies were involved for the Cochrane review. Poor report on the results of the studies that tested the effectiveness of interventions in spasticity are responsible for the low quality of the evidence. Most of the studies reported results in terms of decreasing spasticity and limiting effects in terms of how the decrease spasticity and no reports on the beneficial effects in terms of improving activities and participation.

High quality adequately powered trials in patients with TBI should be encouraged.