NeuroRehabilitation最新文献

BackgroundPain is a non-motor symptom (NMS) of Parkinson's disease (PD) present in up to 85% of patients. Fatigue is another highly prevalent NMS. Presence of both is detrimental for the individual's well-being, but their association remains largely unexplored.ObjectivesTo assess the relationship between pain, fatigue, and mediating variables in PD.MethodsFifty-three PD patients with pain participated in a cross-sectional study. Correlation analyses were performed between clinical, self-reported measures of pain (Spanish-King's-Parkinson-Pain-Scale (S-KPPS) and Brief-Pain-Inventory (BPI) and fatigue (Fatigue-Severity-Scale (FSS), Daily-Fatigue-Impact-Scale (DFIS)). Partial correlations were performed considering these confounders: Levodopa-equivalent daily dose (LEDD), years from PD diagnosis, UPDRS-III score, anxiety, depression and kinesiophobia.ResultsFatigue severity (FSS) was positively and moderately correlated with pain interference (BPI; ρ = 0.351, p = 0.045) and symptomatic burden (S-KPPS; ρ = 0.367, p = 0.042), but not intensity (BPI; ρ = 0.122, p = 0.446). DFIS did not correlate with any dimension of pain (p > 0.05). Motor symptoms, anxiety, depression and kinesiophobia changed correlation significance, but LEDD and disease duration didn't.ConclusionA moderate correlation was found between fatigue severity and both pain interference and symptomatic burden, influenced by other non-motor symptoms (NMS) like anxiety and depression. Although anxiety and depression have previously been associated with fatigue, this study adds pain to a tetrad of interrelated NMS prevalent in PD.

ObjectiveThe objectives of this study were to evaluate functional outcomes of cervical motor control, strength and endurance following active transcranial direct current stimulation (tDCS) with exercise therapy (ET) compared to sham tDCS/+ET in patient with cervicogenic headache (CGH),DesignThis was a pilot sham-controlled, participant and assessor blinded, randomized controlled trial.MethodsThirty-two participants with CGH were randomized to active tDCS/+ET or sham tDCS/+ET. Participants completed 6-weeks of daily ET concurrently combined with 3 sessions per week of tDCS. Assessments included: craniocervical flexion test (mmHg), cervical isometric strength (N), cervical flexor and extensor endurance (seconds), and range of motion (degrees) pre-treatment, post-treatment, 6-weeks and 12-weeks post treatment. Linear mixed effect models evaluated group-time interactions at each follow-up while accounting for exercise program adherence and sex.ResultsThere were significant group-time interactions for activation scores on the craniocervical flexion test from pre-treatment to post-treatment (β = 1.571; 95%CI[0.155, 2.988]; p = 0.030), 6-weeks (β = 1.571; 95%CI[0.155, 2.988]; p = 0.030), and 12-weeks (β = 1.954; 95%CI[0.465, 3.443]; p = 0.011) favoring the active tDCS/+ET group.ConclusionsActive tDCS/+ET demonstrated significant benefits in deep cervical flexor motor control compared to sham tDCS/+ET that remained improved up to 12 weeks post-treatment. This suggests tDCS/+ET may improve of functional outcomes for patients with CGH.

BackgroundThe of upper extremity closed kinetic chain exercise combined with biofeedback requires evidence-based guidelines to elucidate its impact on the proprioception, muscle strength, and function of stroke patients.ObjectiveThe aim of this study is to compare the effects of upper extremity closed kinetic chain exercise combined with biofeedback on the proprioception, muscle strength, and function of stroke patients.MethodsThe 24 stroke patients were randomly divided into two groups: the upper extremity closed kinetic chain exercise combined with biofeedback group (UCKCBG; n = 11) and the control group (CG; n = 13). Training was conducted five times a week for four weeks. Outcome measures included the Thumb Localization Test (TLT), Medical Research Council Score (MRC), Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), and Fugl-Meyer Assessment (FMA).ResultsThe result showed that the UCKCBG demonstrated significant effects on TLT, MRC, CKCUEST, and FMA compared to the CG (p < 0.05).ConclusionThis study showed that repetitive upper extremity closed kinetic chain exercise with biofeedback can be considered as a training method in clinical practice for stroke patients with decreased proprioceptive sensation, muscle strength, stability, and upper limb function.

BackgroundPituitary dysfunction (PD) and mild traumatic brain injury (mTBI) can affect neuropsychological and psychological functioning.ObjectiveThe aim of the study was to report neuropsychological and psychological outcomes in female athletes with PD following mTBI. To the best of our knowledge, it is the first study to report these findings in an all-female population.Materials and methodsFemale athletes (n = 508) participated by answering online questionnaires regarding mTBI history and mental health. Women reporting one or more mTBI (n = 308) were invited to participate in neuropsychological tests with 166 (53.8%) accepting. Of these 166 women, 151 (90.9%) accepted further participation in a medical interview and 133 (88.1%) of them participated in pituitary hormone screening blood tests (SBT). If SBT were repeatedly outside the reference value, detailed endocrinological tests were performed.ResultsSixteen women (12.2%) were diagnosed with PD (hypopituitarism n = 6, hyperprolactinemia n = 10) after mTBI. Women with PD had a significantly higher mean Sustained Attention to Response Task (SART) error score than women with normal pituitary function (nPF) (16.7 and 12.8 respectively; p = 0.04).ConclusionSustained attention or inhibitory performance is affected in women with PD compared to women with nPF following mTBI.

BackgroundTask-oriented training (TOT) is a commonly used intervention to improve upper extremity function after stroke. However, predictors of response to rehabilitation for performance and participation remain poorly understood.AimTo identify baseline predictors of clinically significant upper extremity (UE) recovery across impairment, performance, and participation in individuals post-stroke following TOT.MethodsThis is a retrospective study. Sixty-four individuals with stroke were enrolled and received five weeks of inpatient TOT for UE. Baseline characteristics and outcome measures were assessed using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) for impairment, the Action Research Arm Test (ARAT-15) for performance, and the QuickDASH-9 for participation. Participants were classified as responders and non-responders to the intervention, and binary logistic regression models were developed to predict responsiveness to impairment, performance, and participation measures.ResultsAll outcome measures showed significant improvement post-intervention. The baseline FMA-UE score, chronicity, and dominance of the involved UE predicted responsiveness for impairment. The FMA-UE score was the main predictor of responsiveness in performance, while no predictors were identified for participation.ConclusionsTOT improved UE impairment and performance in stroke patients, particularly those with moderate baseline impairment. Baseline UE function, chronicity, and dominance were key predictors of responsiveness in impairment and performance.This study highlights the importance of personalized TOT after a stroke. It demonstrates that baseline function, chronicity, and affected limb dominance predict impairment and performance responsiveness to TOT while emphasizing the need to incorporate strategies that facilitate real-world skill transfer and address personal and environmental factors to maximize participation.

BackgroundLong COVID patients report various cognitive and affective symptoms that are poorly understood.ObjectiveThis study analyzed cognitive and affective performance in 208 Long COVID patients pre and post psychoeducational rehabilitation using a standardized screening test of higher cerebral functions. Identifying persistent difficulties may help guide future rehabilitation efforts.MethodsThe sample was comprised by a subset of 208 who completed psychoeducational rehabilitation from 614 Long COVID patients seeking rehabilitation. Performance on specific items was analyzed and compared to a reference sample of 114 educationally matched normal functioning adults.ResultsDetailed item analyses in 208 patients revealed persistent difficulties in the efficiency of learning and memory, affective expression, and the ability to accurately predict verbal memory performance compared to a reference sample. Long COVID patients showed variable performance deficits on attention, visual-spatial problem solving and memory measures. Language and related functions were consistently at a level commensurate with normally functioning individuals.ConclusionsPersistent cognitive and affective impairments were identified in Long COVID patients post-rehabilitation. Future programs should aim on to improve the efficiency of learning and memory, enhance the range of affective expression, and improve self-awareness of functional capacities. Rehabilitation should consider the multifactorial causes of these neuropsychological symptoms.

BackgroundSpinocerebellar ataxia (SCA) is a neurodegenerative disease causing weakness and balance disorders that affected quality of life. Whole body vibration (WBV) had been reported to facilitate neuromuscular contraction in healthy people and athletes.ObjectiveThe purpose of this study was to investigate whether four weeks of WBV training can enhance central and peripheral muscle strength and balance performances in patients with SCA.MethodsThirteen individuals with diagnosed SCA were randomly assigned into WBV and control groups. Subjects in the training group received four weeks of WBV training at semi-squatting position for 3 sessions per week; whereas subjects in the control group performed semi-squatting position for the same duration. The maximum voluntary contraction (MVC), voluntary activation level (VA), twitch force, Berg balance scale (BBS), and one-leg standing time were evaluated before and after training. All subjects in the training group could tolerate the WBV training.ResultsThe MVC of soleus, the VA of plantar flexors and knee extensors, the score of BBS (p < 0.05) and one-leg standing time improved (p < .05) only in the training group.ConclusionsWBV training is a feasible rehabilitation strategy which can improve general and central origin force and balance performance in individuals with SCA.

BackgroundAbobotulinumtoxinA (aboBoNT-A) is approved worldwide in indications related to excessive muscle activity, including focal upper and lower limb spasticity.ObjectiveWe evaluated real-world outcomes associated with on-label use of aboBoNT-A for adult focal spasticity in UK routine clinical practice.MethodsThis was a multicenter, retrospective, 52-week study analyzing data from patients who had received ≥1 injection of aboBoNT-A in line with the Summary of Product Characteristics. Primary endpoints were the average aboBoNT-A dose received per treatment cycle and average interval between cycles.ResultsFor the 108 patients included, the median (Q1, Q3) age was 52.5 (41.0, 69.0) years and the most common underlying neurological condition was stroke (61.1%). The mean (SD) total dose of aboBoNT-A received was 540.8 (268.5) U (cycle 1), 586.1 (279.4) U (cycle 2), 558.0 (258.5) U (cycle 3), and 464.3 (209.6) U (cycle 4). The mean (SD) interval between cycles was 153.8 (56.9) days. Of 82 goals assessed, 71 (86.6%) were achieved. Seven patients (5.8%) in the safety population (N = 121) experienced adverse events, none of which were considered related to aboBoNT-A treatment.ConclusionsThese data further document aboBoNT-A as an effective and well-tolerated treatment for adult focal spasticity, supporting use in clinical practice.

BackgroundStroke recovery is influenced by genetics, biochemical markers, and rehabilitation. This study examines their combined impact on early upper limb recovery in stroke patients.MethodsForty-eight ischemic or hemorrhagic stroke patients were assessed using the Purdue Pegboard Score (PPS) and Fugl-Meyer Assessment (FMA) at admission and discharge. Genetic analysis included selected SNPs (APOE, CRP, PTGS2, IGF1, etc.). Biochemical markers (vitamin B12, folate, homocysteine, cholesterol, and vitamin D) were measured. Patients with PPS < 5 received robotic rehabilitation.ResultsNo significant link was found between genetic markers and recovery. However, faster recovery was associated with higher vitamin B12, homocysteine, and cholesterol but lower folate levels. Higher initial FMA scores correlated with better outcomes after robotic rehabilitation.ConclusionsMetabolic markers may have a stronger influence on post-stroke recovery than genetics. Robotic rehabilitation, especially in patients with higher initial FMA scores, may enhance hand function recovery. These findings emphasize the importance of metabolic and rehabilitation strategies in stroke recovery.

BackgroundMotor imagery (MI) and action observation (AO) are promising interventions in the rehabilitation of people with Parkinson's disease (PD), especially in motor symptoms.ObjectiveSystematically review studies using MI and AO protocols to assess motor symptoms in people with PD.MethodsThe search was performed in the principal databases, including randomized controlled trials (RCTs) and pilot studies published in the last 10 years. Studies should include the Unified Parkinson's Disease Rating Scale (UPDRS) part III - motor assessment as the primary outcome. The PEDro Scale was used to assess the methodological quality. Data were reported as mean difference (MD) and 95% confidence interval (CI).ResultsSix studies were included, 152 participants with PD (63.8% men, with ages ranging from 45.3 to 88 years). In the meta-analysis, no differences were found in the main outcome either in the "on" medication state (MD = -0.81; 95% CI = -6.20 to 4.58; p = 0.77; n = intervention: 43/comparator: 43; studies = 4; I2 = 28%) or "off" state (MD = 0.53; 95% CI = -2.74 to 3.79; p = 0.75; n = intervention: 47/comparator: 47; studies = 3; I2 = 0).ConclusionThe applicability of MI and AO is diverse, but there is a lack of studies combining both interventions, especially with outcomes for the upper limbs.