NeuroRehabilitation

Children with traumatic brain injury (TBI) usually displayed substantial neuropsychological impairment at short and long term after injury.

To compare the course of cognitive functioning among children with TBI and healthy controls over the first-year post-injury in Guadalajara, Mexico.

A sample of 46 children with TBI and 46 healthy controls from Guadalajara, Mexico were recruited. Both groups received a comprehensive neuropsychological evaluation at three-time (3, 6, and 12 months) with measures of memory, attention, executive function, processing speed, language, perceptual reasoning, visuo-spatial abilities, and intellectual functioning. Sixteen hierarchical linear models (HLMs) were performed to examine whether linear trajectories of cognitive functioning differed over time between groups.

Trajectories of neuropsychological performance were significantly worse over time among children with TBI than healthy controls across every cognitive domain. HLMs suggested that cognitive performance increased over time in both groups, however, TBI group scored significantly lower at each time point compare to the control group, except in Stroop-Interference.

Cognitive deficits are common during the first-year after pediatric TBI. Thus, it is imperative to implement early rehabilitation programs to mitigate the consequences of these problems in the social, academic, and family reintegration of these children.

Individuals with extensive neuro-motor impairment and lack of speech tend to remain passive and isolated, and to rely on others for communication and leisure. While their problems are known, only limited evidence is available about intervention tools that could help them curb those problems.

This study was aimed at upgrading and assessing a smartphone-based technology package, which was recently developed to help those individuals to independently engage in basic communication and leisure.

The study included 11 non-ambulatory participants who had no speech or functional active communication. They were provided with (a) a Samsung A3 smartphone with Android 6.0 Operating System, which was fitted with WhatsApp Messenger and programmed via MacroDroid, and (b) cards fitted with radio frequency identification (RFID) tags. By bringing those cards in contact with the back of the smartphone, the participant could start a communication event (e.g., sending a message to a friend) or activate a leisure event (e.g., a song). The smartphone would automatically read to the participant any incoming messages.

During the baseline (i.e., when a standard smartphone was available), the participants were unable to engage in communication or leisure. Once the aforementioned technology package was introduced, the participants spent between about 65 and 85% of their session time engaging in communication and leisure.

The smartphone-based technology package seems to be a useful tool to support basic communication and leisure in individuals like those involved in this study.

Repetitive transcranial magnetic stimulation (rTMS) and Repetitive facilitative exercise (RFE) improves motor impairment after stroke.

To investigate whether neuromuscular electrical stimulation (NMES) can facilitate the effects of rTMS and RFE on the function of the hemiparetic hand in stroke patients.

This randomized double-blinded crossover study divided 20 patients with hemiparesis into two groups and provided treatment for 4 weeks at 5 days/week. NMES-before-sham group and NMES-following-sham group performed NMES sessions and sham NMES sessions for each 2 weeks. Patients received NMES or sham NMES for the affected extensor muscle concurrently with 1 Hz rTMS for the unaffected motor cortex for 10 min and performed RFE for 60 min. The Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Box and Block Test (BBT) and Modified Ashworth Scale (MAS) were used for evaluation.

FMA and ARAT improved significantly during both sessions. The gains in the BBT during an NMES session were significantly greater than those during a sham NMES session. MAS for the wrist and finger significantly decreased only during an NMES session.

NMES combined with rTMS might facilitate, at least in part, the beneficial effects of RFE on motor function and spasticity of the affected upper limb.

The aim of this study was to evaluate the internal consistency and validity of the Italian version of the Jebsen– Taylor Hand Function Test (JTHFT-IT) in Italian post-stroke adults with chronic hemiplegia or hemiparesis.

The test’s internal consistency and validity were assessed by following international guidelines. Its internal consistency was examined using Cronbach’s alpha (α) coefficient. Pearson’s correlation coefficient was calculated for concurrent validity in comparison with a dynamometer instrument, whereas for construct validity, it was calculated in comparison with the mean execution time of the Wolf Motor Function Test time subscale (WMFT-IT-TIME).

The test was administrated to 48 people with chronic stroke. Cronbach’s alpha reported a value of 0.96 for the dominant hand and 0.92 for the non-dominant hand. To define the validity of the scale, Pearson’s correlation as measured using the WMFT-IT-TIME, and the dynamometer showed statistically significant results.

The present study supports the use of the JTHFT-IT as a measure of hand functionality in post-stroke adults with chronic hemiplegia or hemiparesis. It is an important tool for Italian professionals, and it can be useful both in clinical practice to evaluate improvement after rehabilitation treatments and for research in hand rehabilitation.

Reduced walking speed (WS) may lead to restrictions in participation of individuals with stroke, however, the relationships between WS and participation still need to better clarified.

To evaluate the relationships between WS and participation and compare the levels of participation of individuals with chronic stroke, who were stratified according to their walking status.

One-hundred and five individuals with stroke (58±12 years; 61 men) participated. WS was measured by the 10-meter walking test and reported in m/s. The participants were stratified into three walking status groups: household (WS <0.4 m/s), limited-community (0.4 m/s–0.8 m/s), and full-community ambulation (>0.8 m/s). Participation was assessed by the Brazilian version of the Assessment of Life Habits 3.1 (LIFE-H 3.1-Brazil).

Between-group analyses revealed statistically significant differences between the household, limited-community, and full-community ambulators regarding the LIFE-H 3.1 total (F = 17.5; p < 0.0001), as well the daily activity (F = 12.3; p < 0.0001) and social role (F = 19.0; p < 0.0001) domain scores. Measures of WS were correlated with the daily activity (r = 0.50, p < 0.0001), social role (r = 0.53, p < 0.0001), total LIFE-H scores (r = 0.53, p < 0.0001), and most of the LIFE-H categories (r = 0.23–0.56).

WS was significantly correlated with participation and was able to distinguish between individuals with stroke, who had different levels of participation.

Memory impairments commonly afflict individuals with MS. While evidence-based cognitive rehabilitation treatments are available in English, the lack of such interventions in Spanish is an important barrier to care for Hispanics with MS. There is class I evidence that the modified Story Memory Technique (mSMT) improves learning in English. This intervention has been translated and adapted into Spanish.

To examine the preliminary efficacy of the Spanish mSMT to improve learning in Mexicans with MS.

Twenty individuals with relapsing-remitting MS were randomized to treatment (n = 10) or placebo control (n = 10) groups. The Spanish mSMT is a 10-session intervention that teaches imagery and context to facilitate learning. The control condition was matched to the treatment condition in treatment duration, and stimulus content and presentation. Participants completed baseline and post-treatment neuropsychological assessments.

Individuals who received the Spanish mSMT showed significant improvements in learning and life satisfaction relative to the control group. Also observed were a near-moderate effect size on perceived memory complaints and a moderate-to-large effect size on the family’s perception of the patient’s competency.

The Spanish mSMT showed preliminary efficacy in improving learning deficits in Mexicans with MS, and such improvements may extend to other domains.

Although exercise training has benefits for individuals with multiple sclerosis (MS), research regarding the type of exercise equipment that requires the greatest aerobic demand, and consumer-based preferences, is lacking.

To determine the aerobic demands of various pieces of accessible exercise equipment and consumer-based preferences on several domains.

Ten individuals with moderate-severity MS had their VO₂ measured during 10 minutes of moderate-intensity arm ergometry (AE), body-weight support treadmill training (BWSTT), recumbent arm-leg exercise (NuStep), FES-arm exercise (RT300), FES-leg exercise (RT300) and FES arm-leg exercise (RT200). VO_2peak test was also measured on the NuStep and the RT200. Equipment preferences were determined by questionnaire after moderate exercise sessions.

AE required a lower VO₂ compared to the NuStep (p = 0.02), and FES-arm exercise required a lower VO₂ compared to the NuStep (p = 0.01) and FES arm-leg exercise (p = 0.04). There was no difference in VO_2peak when using the NuStep or FES arm-leg exercise. AE was perceived as safer than BWSTT, but otherwise there were no preferences for any equipment.

For individuals with moderate-severity MS, arm-only exercise requires less aerobic demands than combined arm-leg exercise at a moderate intensity. Perceived risks may be greater when exercise requires a transfer, upright positioning, or assistance.

Transcranial direct current stimulation (tDCS) has been investigated as a therapeutic neuromodulation tool in several neurological disorders. However, evidence supporting its efficacy in disorders such as amyotrophic lateral sclerosis (ALS) is limited possibly due to limited patient accessibility for research, particularly for individuals with advanced disease progression. Telerehabilitation using home-based protocols allows for remote supervision of tDCS over longer durations, thereby increasing participation, compliance and adherence. In this study, we explored the safety, feasibility and preliminary effects of a remotely supervised tDCS (RS-tDCS) protocol in ALS.

In this pre-post case series study, two individuals with ALS completed 24 remotely supervised anodal tDCS sessions (20 minutes, 2 mA). Outcomes included adherence, compliance, disease progression, walking speed, risk of fall, endurance, fatigue and depression.

Both participants successfully completed the study without any major adverse effects. Minor side effects included mild sensations of itching and throbbing under the electrodes during stimulation. Clinical outcomes showed minimal to no change for any of the measures.

Preliminary findings suggest that the RS-tDCS protocol is safe and feasible in individuals with ALS. Our protocol serves as a model for future long-term studies to evaluate the clinical and neurophysiological effects of tDCS using a telerehabilitation protocol in ALS.

Balance impairment is a major clinical concern in patients with parkinsonism. Balance training with tetra-ataxiometric posturography (Tetrax) is known to improve balance function through visual biofeedback effects.

In this study, we evaluated the effects of balance training with Tetrax in patients with parkinsonism.

Patients with parkinsonism (idiopathic Parkinson’s disease, multiple systemic atrophy, and multiple systemic atrophy) who were able to stand with or without an assistive device were recruited for the study. Twenty patients with parkinsonism were randomly assigned to one of the following two groups: (1) the Tetrax group, in which patients received Tetrax biofeedback balance training for 30 min/day for 2 weeks (10 sessions); and (2) the control group, in which patients received conventional balance training for 30 min/day for 2 weeks (10 sessions). One day before and after training, we measured patients’ balance parameters using the Berg balance scale (BBS) and fall index (FI).

The BBS and FI scores of the Tetrax group showed significant improvements after compared to before training. However, the scores in the control group were not significantly changed after vs. before conventional balance training.

For patients with parkinsonism, Tetrax biofeedback balance training had a positive effect on balance function.

Intimate couples can become cognitively interdependent over time. If one member of the couple has a neurological condition with associated cognitive impairments, their partner can support or ‘scaffold’ their cognitive functioning through collaboration.

We explored the phenomenon of ‘collaborative memory’ in a case series of 9 couples in which one member had a neurological condition, specifically an acquired brain injury (ABI; n = 7) or epilepsy (n = 2).

To investigate collaborative memory, we compared the performance of the patient when remembering alone versus their performance in collaboration with their partner on three memory tasks, assessing anterograde, semantic, and autobiographical memory.

We found that across all tasks and participants, collaboration typically increased overall memory performance (total score), but the patient’s contribution to the task was typically lower when they collaborated compared with when they performed the task alone. We identified two distinct styles of collaboration which we termed ‘survival scaffolding’ (where the healthy partner ‘takes over’ memory recall) and ‘stability scaffolding’ (where the healthy partner cues and structures the patient’s recall).

This exploratory case series contributes to the sparse literature on memory collaboration in people with neurological conditions. Our findings suggest that there are different styles of collaboration that can both help and hinder memory performance.

Subjective organization (SO) facilitates storage and retrieval of information but is often impaired following traumatic brain injury. No study has compared measures of SO using association rule analyses to clustering analyses. Moreover, there have been no studies investigating whether patients post-brain injury subjectively organize non-verbal information.

This study investigates the relationship between SO and recall of words and symbols with participants discordant for traumatic brain injury. Additionally, the authors explored the conditions under which clustering or association rule measures of SO were best used.

Two female monozygotic twins discordant for traumatic brain injury completed a multi-trial free recall test of words and symbols. The authors examined whether measures of SO derived from clustering analysis or association rule modeling could differentiate organizational abilities between participants’ data.

The twin following sequential traumatic brain injuries demonstrated significantly less SO and recall relative to the twin without a traumatic brain injury. Both twins subjectively organized verbal and non-verbal information and each measure could differentiate the twins’ performance.

The quantitative analysis of SO can provide clinicians with valuable information concerning a patient’s recall performance. This study illustrates practical issues that may influence a clinician’s choice of these techniques.

Previous studies examining insomnia in populations with traumatic brain injury (TBI) have not distinguished between transient insomnia symptoms and insomnia disorder and associations have been confounded by other highly prevalent sleep disorders post-TBI.

To investigate the associations between affective symptoms and somatoform symptoms in patients with TBI and insomnia, sleep apnoea and hypersomnolence.

Twenty-four participants from a multidisciplinary brain injury rehabilitation service with TBI were assessed for insomnia disorder, using Diagnostic and Statistical Manual Fifth Edition (DSM-5) criteria. Associations with affective and somatic symptoms were assessed, using the DASS-21 and PHQ-15 respectively. The same cohort was divided for Obstructive Sleep Apnoea (OSA) and hypersomnolence and analysed for the same outcomes. Associations were assessed using Pearson’s correlation and a logistic binary regression model was developed to predict insomnia in patients with brain injury.

The insomnia disorder group (n = 11) had significantly higher rates somatoform symptoms (p < 0.05), compared to those without insomnia disorder (n = 13). These factors were not significantly associated with OSA or hypersomnolence. Pain was significantly associated with insomnia disorder.

Insomnia disorder, not OSA or hypersomnolence, may be related to the presence of somatoform symptoms in people with TBI. Addressing insomnia disorder may potentially improve recovery.

To explore associations between psychosocial factors and pain intensity and pain interference in a population with a new neurological injury on admission to rehabilitation, and after six months.

A longitudinal, prospective cohort study with participants with stroke or Spinal Cord Injury (SCI) completing questionnaires for pain intensity and interference, mental health, pain coping strategies and pain attitudes and beliefs within two weeks of admission to inpatient rehabilitation. After six months, participants completed measures of pain intensity and pain interference only.

In all 32 participants completed the questionnaires at baseline and 19 after six months. Several associations between a person’s mental health and certain beliefs were associated with pain outcomes. Additionally, poorer baseline mental health was associated with greater pain intensity and pain interference after six months, and a stronger belief in a medical cure for pain at baseline was associated with less pain intensity and pain interference after six months.

Psychosocial factors are associated with pain early after stroke and SCI. Psychosocial factors are also associated with pain outcomes several months after stroke and SCI. This highlights the importance of psychosocial factors in both of these populations and their relationship with pain outcomes.