Objectives
This systematic review evaluated the safety and efficacy of blood flow restriction exercise (BFRE) on skeletal muscle size, strength, and functional performance in individuals with ...neurological disorders (ND).
Methods
A literature search was performed in PubMed, CINAHL, and Embase. Two researchers independently assessed eligibility and performed data extraction and quality assessments. Eligibility criteria: Study populations with ND, BFRE as intervention modality, outcome measures related to safety or efficacy.
Results
Out of 443 studies identified, 16 were deemed eligible for review. Three studies examined the efficacy and safety of BFRE, one study focused on efficacy results, and 12 studies investigated safety. Disease populations included spinal cord injury (SCI), inclusion body myositis (sIBM), multiple sclerosis (MS), Parkinson's disease (PD), and stroke. A moderate‐to‐high risk of bias was presented in the quality assessment. Five studies reported safety concerns, including acutely elevated pain and rating of perceived exertion levels, severe fatigue, muscle soreness, and cases of autonomic dysreflexia. Two RCTs reported a significant between‐group difference in physical function outcomes, and two RCTs reported neuromuscular adaptations.
Conclusion
BFRE seems to be a potentially safe and effective training modality in individuals with ND. However, the results should be interpreted cautiously due to limited quality and number of studies, small sample sizes, and a general lack of heterogeneity within and between the examined patient cohorts.
To identify and summarize validated multivariable prognostic models for the Functional Independence Measure® (FIM®) at discharge from post-acute inpatient rehabilitation in adults with acquired brain ...injury (ABI).
This review was conducted based on the recommendations of the Cochrane Prognosis Methods Group and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were systematically searched in May 2021 and updated in April 2022. Main inclusion criteria were: a) adult patients with ABI, b) validated multivariable prognostic model, c) time of prognostication within 1-week of admission to post-acute rehabilitation, and d) outcome was the FIM® at discharge from post-acute rehabilitation.
The search yielded 3,169 unique articles. Three articles fulfilled the inclusion criteria, accounting for n = 6 internally and n = 2 externally validated prognostic models. Discrimination was estimated as an area under the curve between 0.76 and 0.89. Calibration was deemed to be assessed insufficiently. The included models were judged to be of high risk of bias.
Current prognostic models for the FIM® in post-acute rehabilitation for patients with ABI lack the methodological rigor to support clinical use outside the development setting. Future studies addressing functional independence should ensure appropriate model validation and conform to uniform reporting standards for prognosis research.
Background
Excessive jaw muscle activity is a frequent complication after acquired brain injury (ABI).
Objective
The study aimed to identify the occurrence and severity of jaw muscle activity and its ...association with altered state of consciousness in patients with ABI.
Methods
A total of 14 severe ABI patients with varied altered state of consciousness were recruited. A single‐channel electromyographic (EMG) device was used to assess the jaw muscle activity for three consecutive nights during Week 1 and Week 4 following admission. Differences in number of EMG episodes/h between Week 1 and 4 were analysed using non‐parametric tests and association between the EMG activity and altered state of consciousness were analysed using Spearman's correlation test.
Results
Nine of fourteen (64%) patients showed indications of bruxism (cutoff: >15 EMG episodes/h). The average EMG episodes/h at admission were 44.5 ± 13.6 with no significant changes after Week 4 of admission (43 ± 12.9; p = .917). The EMG episodes/h ranged from 2 to 184 during Week 1 and 4–154 during Week 4. There were no significant correlations between the number of EMG episodes/h during the three nights and the individuals altered state of consciousness during Week 1 and Week 4.
Conclusion
Patients with ABI had a conspicuously high but variable level of jaw muscle activity at admission and it tend to remain high after 4 week of hospitalisation which could potentially lead to adverse effects such as excessive tooth wear, headaches and pain in jaw muscles. The lack of associations between individuals altered level of consciousness and EMG activity could be due to low sample size and further studies are clearly warranted in this patient group with special needs. Single‐channel EMG devices can record jaw muscle activity early in the hospitalisation period and might be a helpful tools for early detection of bruxism in ABI patients.
The main finding of the study was that the patients with severe acquired brain injury (ABI) showed a very high number and wide range of jaw muscle activity. The grinding activity during sleep in the ABI patients was almost on average five times higher when compared to the healthy participants and three times higher than definite bruxers but otherwise healthy measured using the same single channel ambulatory device.
Detection of movement intention from neural signals combined with assistive technologies may be used for effective neurofeedback in rehabilitation. In order to promote plasticity, a causal relation ...between intended actions (detected for example from the EEG) and the corresponding feedback should be established. This requires reliable detection of motor intentions. In this study, we propose a method to detect movements from EEG with limited latency. In a self-paced asynchronous BCI paradigm, the initial negative phase of the movement-related cortical potentials (MRCPs), extracted from multi-channel scalp EEG was used to detect motor execution/imagination in healthy subjects and stroke patients. For MRCP detection, it was demonstrated that a new optimized spatial filtering technique led to better accuracy than a large Laplacian spatial filter and common spatial pattern. With the optimized spatial filter, the true positive rate (TPR) for detection of movement execution in healthy subjects (n = 15) was 82.5 ± 7.8%, with latency of -66.6 ± 121 ms. Although TPR decreased with motor imagination in healthy subject (n = 10, 64.5 ± 5.33%) and with attempted movements in stroke patients (n = 5, 55.01 ± 12.01%), the results are promising for the application of this approach to provide patient-driven real-time neurofeedback.
ABSTRACT
Introduction: In Guillain‐Barré syndrome (GBS), patients often develop muscle atrophy from denervation and immobilization. We, therefore, conducted a pilot study of neuromuscular electrical ...stimulation (NMES) to evaluate feasibility, safety, and effect on muscle wasting in the early phase of GBS. Methods: Seventeen patients were randomized to receive 20 min of muscle fiber stimulation followed by 40 min of NMES of the right or left quadriceps muscle with the untreated side as control. Cross‐sectional area (CSA) of the muscle measured by ultrasound and isometric knee extensor strength were the primary and secondary outcome measures. Results: No treatment related adverse effects were recorded. Change in CSA was ‐0.25 cm2 (confidence interval CI, ‐0.93–0.42) on the stimulated side versus ‐0.60 cm2 (CI, ‐1.32–0.11) on the nonstimulated side (P = 0.08). No effect was observed on muscle strength. Conclusions: NMES seems safe and feasible in the early phase of GBS. Further studies are needed to explore effect on muscle function. Muscle Nerve 59:481–484, 2019
Background
The Predict Recovery Potential algorithm (PREP2) was developed to predict upper limb (UL) function early after stroke. However, assessment in the acute phase is not always possible.
...Objective
To assess the prognostic accuracy of the PREP2 when applied in a subacute neurorehabilitation setting.
Methods
This prospective longitudinal study included patients ≥18 years old with UL impairment following stroke. Patients were assessed in accordance with the PREP2 approach. However, 2 main components, the shoulder abduction finger extension (SAFE) score and motor-evoked potentials (MEPs) were obtained 2 weeks poststroke. UL function at 3 months was predicted in 1 of 4 categories and compared with the actual outcome at 3 months as assessed by the Action Research Arm Test. The prediction accuracy of the PREP2 was quantified using the correct classification rate (CCR).
Results
Ninety-one patients were included. Overall CCR of the PREP2 was 60% (95% CI 50%-71%). Within the 4 categories, CCR ranged from the lowest value at 33% (95% CI 4%-85%) for the category Limited to the highest value at 78% (95% CI 43%-95%) for the category Poor. In the present study, the overall CCR was significantly lower (P < .001) than the 75% reported by the PREP2 developers.
Conclusions
The low overall CCR makes PREP2 obtained 2 weeks poststroke unsuited for clinical implementation. However, PREP2 may be used to predict either excellent UL function in already well-recovered patients or poor UL function in patients with persistent severe UL paresis.
Background
Calcitonin gene-related peptide (CGRP) plays an important role in migraine pathophysiology, and post-traumatic headache (PTH) frequently presents with migraine-like features. Despite ...several clinical similarities, few studies have explored CGRP in PTH and concussion. This study investigates serum CGRP levels in patients with persistent post-concussion symptoms (PPCS), including PTH.
Methods
This cohort study was based on serum samples from individuals aged 18–30 years with PPCS who participated in a previously published randomized controlled trial of a non-pharmacological intervention. The primary outcome was serum CGRP concentrations, determined at baseline before randomization and at follow-up 7 months later, using an enzyme-linked immunosorbent assay (ELISA). CGRP levels at baseline were compared with healthy anonymous blood donors in the same age group.
Results
Baseline serum samples were collected from 86 participants with PPCS. The participants were most often female (78%) and migraine-like headache was the most frequent headache phenotype (74%). Serum CGRP levels were higher in participants with PPCS than in 120 healthy individuals (median: 158.5 pg/mL vs. 76.3 pg/mL, p = 0.050). A stratified analysis revealed that females with PPCS had a fivefold higher median than healthy females (166.3 pg/mL vs. 32.1 pg/mL, p = 0.0006), while no differences were observed in males (p = 0.83). At follow-up, CGRP levels decreased with a median change of – 1.3 pg/mL (95% confidence interval: – 17.6–0, p = 0.024).
Discussion
Elevated serum levels of CGRP in patients with PPCS and a decrease over time suggest an involvement of CGRP in PTH/PPCS. If confirmed in other studies, it could pave the way for CGRP-targeted therapies, which could have clinical significance.
To estimate the prevalence of convergence insufficiency (CI) in adult patients with post-concussion syndrome and determine the impact of CI on symptom load.
Cross-sectional study of 103 patients with ...neurological symptoms 2-6 months after a concussion. Symptoms were assessed with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and CI was diagnosed using near point of convergence, vergence facility, and the Convergence Insufficiency Symptom Survey. The RPQ score for patients with and without CI was compared, and sensitivity, specificity, and area under the receiver operating characteristic curve for the two visually related RPQ questions as indicators of CI were calculated.
The proportion of patients diagnosed with symptomatic CI was 20.4% (95% confidence interval: 13.1-29.5%). The RPQ score was significantly higher for patients with symptomatic CI both before (
= .01) and after removal of the two visually related questions in the RPQ-questionnaire (
= .03). The two visually related RPQ questions were unable to detect CI.
In patients with post-concussion syndrome, the load of nonvisual symptoms is higher in the presence of CI. A prospective interventional study on CI is required to study the relationship between CI and other post-concussion symptoms.
To compare stroke-specific health related quality of life in two country-regions with organisational differences in subacute rehabilitation services, and to reveal whether organisational factors or ...individual factors impact outcome.
A prospective multicentre study with one-year follow-up of 369 first-ever stroke survivors with ischaemic or haemorrhagic stroke, recruited from stroke units in North Norway (n = 208) and Central Denmark (n = 161). The 12-domain Stroke-Specific Quality of Life scale was the primary outcome-measure.
The Norwegian participants were older than the Danish (M
age
= 69.8 vs. 66.7 years, respectively), had higher initial stroke severity, and longer stroke unit stays. Both cohorts reported more problems with cognitive, social, and emotional functioning compared to physical functioning. Two scale components were revealed. Between-country differences in the cognitive-social-mental component showed slightly better function in the Norwegian participants. Depression, anxiety, pre-stroke dependency, initial stroke severity, and older age were substantially associated to scale scores.
Successful improvements in one-year functioning in both country-regions may result from optimising long-term rehabilitation services to address cognitive, emotional, and social functioning. Stroke-Specific Quality of Life one-year post-stroke could be explained by individual factors, such as pre-stroke dependency and mental health, rather than differences in the organisation of subacute rehabilitation services.
IMPLICATIONS FOR REHABILITATION
The stroke-specific health related quality of life (SS-QOL) assessment tool captures multidimensional effects of a stroke from the perspective of the patient, which is clinically important information for the rehabilitation services.
The cognitive-social-mental component and the physical health component, indicate specific functional problems which may vary across and within countries and regions with different organisation of rehabilitation services.
For persons with mild to moderate stroke, longer-term functional improvements may be better optimised if the rehabilitation services particularly address cognitive, emotional, and social functioning.
Purpose: To develop and validate an accelerometer-based algorithm classifying physical activity in people with acquired brain injury (ABI) in a laboratory setting resembling a real home environment.
...Materials and methods: A development and validation study was performed. Eleven healthy participants and 25 patients with ABI performed a protocol of transfers and ambulating activities. Activity measurements were performed with accelerometers and with thermal video camera as gold standard reference. A machine learning-based algorithm classifying specific physical activities from the accelerometer data was developed and cross-validated in a training sample of 11 healthy participants. Criterion validity of the algorithm was established in 3 models classifying the same protocol of activities in people with ABI.
Results: Modeled on data from 11 healthy and 15 participants with ABI, the algorithm had a good precision for classifying transfers and ambulating activities in data from 10 participants with ABI. The weighted sensitivity for all activities was 89.3% (88.3-90.4%) and the weighted positive predictive value was 89.7% (88.7-90.7%). The algorithm differentiated between lying and sitting activities.
Conclusion: An algorithm to classify physical activities in populations with ABI was developed and its criterion validity established. Further testing of precision in home settings with continuous activity monitoring is warranted.
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