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At the Frontiers of Neurorehabilitation

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A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: closed (20 January 2022) | Viewed by 44541

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Dr. Manuel Gaviria

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Institut Equiphoria, Combo Besso-Rouges Parets, 48500 La Canourgue, France
Interests: motor control; posture and gait; movement and cognition; cerebellum and neuroplasticity; CNS plasticity; movement disorders; neurodevelopmental disorders; traumatic CNS injury; brain ischemia; neurodegenerative diseases; movement analysis; neuroimaging; clinical neurosciences; integrative neurosciences; rehabilitation devices; neurorehabilitation; hippotherapy
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Special Issue Information

Dear Colleagues,

Neurological disorders often cause severe long-term disabilities with substantial day-to-day consequences. Deeper understanding of brain functioning has opened new perspectives for more integrative interventions, boosting the intrinsic CNS capabilities for behavioral restitution. Neurorehabilitation capitalizes on neuroplasticity that occurs throughout life. However, each patient has their own rhythm, and approaches need to be tailored instead of standardized. However, where are the frontiers and what are the limits for moving forward?

This Special Issue of Brain Sciences aims to gather innovative approaches for the neurorehabilitation of major neurological disorders. Authors are invited to submit cutting-edge research, reviews, and case reports addressing a broad range of studies related to this topic, for example, CNS targets eliciting neuroplasticity, endogenous and exogenous pharmacotherapy, enriched environments, new technologies for evaluation/treatment, ethical issues and innovation, adaptive versus maladaptive plasticity, identifying meaningful outcomes. Mainly, we aim to present original approaches in neurorehabilitation that may offer stable effects and increased autonomy.

Dr. Manuel Gaviria
Guest Editor

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Keywords

neurodevelopmental disorder
CNS trauma
ischemic CNS injury
neurodegenerative disorders
neurorehabilitation
neuroplasticity
personalized therapy
optimization of clinical care
motor learning
cognitive reinforcement
motivational issues
relevant outcome measures
innovative approaches
rehabilitation devices
neuro-prosthetics
brain–computer interfaces
clinical trials for validation
regulatory issues
activities of daily living (ADLs) autonomy
quality of life

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Published Papers (11 papers)

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Research

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11 pages, 1004 KiB

Open AccessArticle

Algorithm-Based Hearing and Speech Therapy Rehabilitation after Cochlear Implantation

by Theda Eichler, Wiebke Rötz, Christoph Kayser, Felix Bröhl, Michael Römer, Arne Henning Witteborg, Franz Kummert, Tobias Sandmeier, Christoph Schulte, Patricia Stolz, Katharina Meyer, Holger Sudhoff and Ingo Todt

Brain Sci. 2022, 12(5), 580; https://doi.org/10.3390/brainsci12050580 - 29 Apr 2022

Cited by 2 | Viewed by 2953

Abstract

Introduction: Due to the changes in the indication range for cochlear implants and the demographic development towards an aging society, more and more people are in receipt of cochlear implants. An implantation requires a close-meshed audiological and logopedic aftercare. Hearing therapy rehabilitation currently requires great personnel effort and is time consuming. Hearing and speech therapy rehabilitation can be supported by digital hearing training programs. However, the apps currently on the market are to a limited degree personalized and structured. Increasing digitalization makes it possible, especially in times of pandemics, to decouple hearing therapy treatment from everyday clinical practice. Material and Methods: For this purpose, an app is in development that provides hearing therapy tailored to the patient. The individual factors that influence hearing outcome are considered. Using intelligent algorithms, the app determines the selection of exercises, the level of difficulty and the speed at which the difficulty is increased. Results: The app works autonomously without being connected to local speech therapists. In addition, the app is able to analyze patient difficulties within the exercises and provides conclusions about the need for technical adjustments. Conclusions: The presented newly developed app represents a possibility to support, replace, expand and improve the classic outpatient hearing and speech therapy after CI implantation. The way the application works allows it to reach more people and provide a time- and cost-saving alternative to traditional therapy. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

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10 pages, 288 KiB

Open AccessArticle

Finding the Way to Improve Motor Recovery of Patients with Spinal Cord Lesions: A Case-Control Pilot Study on a Novel Neuromodulation Approach

by Antonino Naro, Luana Billeri, Tina Balletta, Paola Lauria, Maria Pia Onesta and Rocco Salvatore Calabrò

Brain Sci. 2022, 12(1), 119; https://doi.org/10.3390/brainsci12010119 - 17 Jan 2022

Cited by 2 | Viewed by 2384

Abstract

Robot-assisted rehabilitation (RAR) and non-invasive brain stimulation (NIBS) are interventions that, both individually and combined, can significantly enhance motor performance after spinal cord injury (SCI). We sought to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with active transvertebral direct current stimulation (tvDCS) (namely, NIBS) in association with RAR (RAR + NIBS) improves lower extremity motor function more than RAR alone in subjects with motor incomplete SCI (iSCI). Fifteen adults with iSCI received one daily session of RAR+NIBS in the early afternoon, six sessions weekly, for eight consecutive weeks. Outcome measures included the 6 min walk test (6MWT), the 10 m walk test (10MWT), the timed up and go (TUG) to test mobility and balance, the Walking Index for Spinal Cord Injury (WISCI II), the Functional Independence Measure-Locomotion (FIM-L), the manual muscle testing for lower extremity motor score (LEMS), the modified Ashworth scale for lower limbs (MAS), and the visual analog scale (VAS) for pain. The data of these subjects were compared with those of 20 individuals matched for clinical and demographic features who previously received the same amount or RAR without NIBS (RAR − NIBS). All patients completed the trial, and none reported any side effects either during or following the training. The 10MWT improved in both groups, but the increase was significantly greater following RAR + NIBS than RAR − NIBS. The same occurred for the FIM-L, LEMS, and WISCI II. No significant differences were appreciable concerning the 6MWT and TUG. Conversely, RAR − NIBS outperformed RAR + NIBS regarding the MAS and VAS. Pairing tvDCS with rTMS during RAR can improve lower extremity motor function more than RAR alone can do. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

8 pages, 227 KiB

Open AccessCommunication

Decreased Balance Function in School-Aged Children with Behavioral Problems

by Naomichi Matsunaga, Tadashi Ito, Yuji Ito, Jun Mizusawa, Yingzhi Gu, Shota Sanada, Yuya Shirai, Daiki Takahashi, Nobuhiko Ochi, Koji Noritake and Hideshi Sugiura

Brain Sci. 2022, 12(1), 117; https://doi.org/10.3390/brainsci12010117 - 16 Jan 2022

Cited by 4 | Viewed by 2153

Abstract

Children with behavioral problems have a high risk of impaired motor performance. However, the characteristics of balance functions and their associations with behavioral traits are unclear in this population. This study aimed to evaluate balance functions and their relationships with the degree of behavioral problems in school-aged children. A total of 209 children, aged 6–10 years, were divided into two groups, those with and those without behavioral problems, using the Strengths and Difficulties Questionnaire (SDQ). Physical assessments included the one-leg standing test (OLST), the two-step test, and the five-times-sit-to-stand test. We compared the data between groups and assessed for correlations in terms of total difficulties and the SDQ subscale scores. Children with behavioral problems showed significantly reduced the OLST results (p < 0.001) and the two-step test results (p = 0.008). The five-times-sit-to-stand test results did not show significant differences between groups. The OLST results were significantly correlated with emotional symptoms (r = −0.22, p < 0.001), hyperactivity/inattention (r = −0.29, p < 0.001), peer relationship problems (r = −0.22, p < 0.001), and total difficulties (r = −0.32, p < 0.001). Meanwhile, the two-step test results showed no significant correlation with the SDQ scores. Children with behavioral problems have poor balance function, thereby increasing the risk for instability. This suggests that the balance function of children with behavioral problems needs to be considered. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

12 pages, 1035 KiB

Open AccessArticle

Does Etiology Matter? Comparative Analysis of a Singing-Enhanced Swallowing Protocol for Patients with Neurological Impairment versus Head and Neck Cancer

by Myung Sun Yeo, Ga Eul Yoo, Sung-Rae Cho and Soo Ji Kim

Brain Sci. 2021, 11(8), 997; https://doi.org/10.3390/brainsci11080997 - 28 Jul 2021

Cited by 5 | Viewed by 2379

Abstract

Swallowing difficulties are a common complaint among patients with a variety of diseases. To address these concerns, a singing-enhanced swallowing protocol was constructed, and its differential benefits for two patient populations were investigated. Two patients with Parkinson’s disease (PD) and two patients with head and neck cancer (HNC) participated in this study. Each patient participated in 30-min individual sessions of a singing-enhanced swallowing protocol two times per week for 12 weeks. Following the intervention, laryngeal diadochokinesis and quality-of-life measurements were found to be higher in all four patients. However, the Videofluoroscopic Dysphagia Scale showed this improvement was associated with different swallowing tasks for each patient group. In addition, the maximum phonation time decreased for patients with HNC, while it increased for patients with PD. The findings support the use of a singing-enhanced swallowing protocol for patients whose swallowing difficulties are due to neurological or structural impairment. In addition, the study results suggest that different intervention components should be considered depending on the etiology of the patient’s swallowing difficulties. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

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8 pages, 961 KiB

Open AccessArticle

Brain Connectivity Affecting Gait Function after Unilateral Supratentorial Stroke

by Hyun-Ah Lee and Dae-Hyun Kim

Brain Sci. 2021, 11(7), 870; https://doi.org/10.3390/brainsci11070870 - 29 Jun 2021

Cited by 2 | Viewed by 2170

Abstract

Gait dysfunction is a leading cause of long-term disability after stroke. The mechanisms underlying recovery of gait function are unknown. We retrospectively evaluated the association between structural connectivity and gait function in 127 patients with unilateral supratentorial stroke (>1 month after stroke). All patients underwent T1-weighted, diffusion tensor imaging and functional ambulation categorization. Voxel-wise linear regression analyses of the images were conducted using fractional anisotropy, mean diffusivity, and mode of anisotropy mapping as dependent variables, while the functional ambulation category was used as an independent variable with age and days after stroke as covariates. The functional ambulation category was positively associated with increased fractional anisotropy in the lesioned cortico-ponto-cerebellar system, corona radiata of the non-lesioned corticospinal tract pathway, bilateral medial lemniscus in the brainstem, and the corpus callosum. The functional ambulation category was also positively associated with increased mode of anisotropy in the lesioned posterior corpus callosum. In conclusion, structural connectivity associated with motor coordination and feedback affects gait function after stroke. Diffusion tensor imaging for evaluating structural connectivity can help to predict gait recovery and target rehabilitation goals after stroke. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

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19 pages, 1746 KiB

Open AccessArticle

Serum BDNF’s Role as a Biomarker for Motor Training in the Context of AR-Based Rehabilitation after Ischemic Stroke

by Ekaterina S. Koroleva, Ivan V. Tolmachev, Valentina M. Alifirova, Anastasiia S. Boiko, Lyudmila A. Levchuk, Anton J. M. Loonen and Svetlana A. Ivanova

Brain Sci. 2020, 10(9), 623; https://doi.org/10.3390/brainsci10090623 - 9 Sep 2020

Cited by 20 | Viewed by 3522

Abstract

Background: brain-derived neurotrophic factor (BDNF) may play a role during neurorehabilitation following ischemic stroke. This study aimed to elucidate the possible role of BDNF during early recovery from ischemic stroke assisted by motor training. Methods: fifty patients were included after acute recovery from ischemic stroke: 21 first received classical rehabilitation followed by ‘motor rehabilitation using motion sensors and augmented reality’ (AR-rehabilitation), 14 only received AR-rehabilitation, and 15 were only observed. Serum BDNF levels were measured on the first day of stroke, on the 14th day, before AR-based rehabilitation (median, 45th day), and after the AR-based rehabilitation (median, 82nd day). Motor impairment was quantified clinically using the Fugl–Meyer scale (FMA); functional disability and activities of daily living (ADL) were measured using the Modified Rankin Scale (mRS). For comparison, serum BDNF was measured in 50 healthy individuals. Results: BDNF levels were found to significantly increase during the phase with AR-based rehabilitation. The pattern of the sequentially measured BDNF levels was similar in the treated patients. Untreated patients had significantly lower BDNF levels at the endpoint. Conclusions: the fluctuations of BDNF levels are not consistently related to motor improvement but seem to react to active treatment. Without active rehabilitation treatment, BDNF tends to decrease. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

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23 pages, 711 KiB

Open AccessReview

After 55 Years of Neurorehabilitation, What Is the Plan?

by Hélène Viruega and Manuel Gaviria

Brain Sci. 2022, 12(8), 982; https://doi.org/10.3390/brainsci12080982 - 26 Jul 2022

Cited by 5 | Viewed by 5125

Abstract

Neurological disorders often cause severe long-term disabilities with substantial activity limitations and participation restrictions such as community integration, family functioning, employment, social interaction and participation. Increasing understanding of brain functioning has opened new perspectives for more integrative interventions, boosting the intrinsic central nervous system neuroplastic capabilities in order to achieve efficient behavioral restitution. Neurorehabilitation must take into account the many aspects of the individual through a comprehensive analysis of actual and potential cognitive, behavioral, emotional and physical skills, while increasing awareness and understanding of the new self of the person being dealt with. The exclusive adoption by the rehabilitator of objective functional measures often overlooks the values and goals of the disabled person. Indeed, each individual has their own rhythm, unique life history and personality construct. In this challenging context, it is essential to deepen the assessment through subjective measures, which more adequately reflect the patient’s perspective in order to shape genuinely tailored instead of standardized neurorehabilitation approaches. In this overly complex panorama, where confounding and prognostic factors also strongly influence potential functional recovery, the healthcare community needs to rethink neurorehabilitation formats. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

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18 pages, 1998 KiB

Open AccessReview

Effectiveness of Shock Wave Therapy as a Treatment for Spasticity: A Systematic Review

by Isabel María Martínez, Nuria Sempere-Rubio, Olga Navarro and Raquel Faubel

Brain Sci. 2021, 11(1), 15; https://doi.org/10.3390/brainsci11010015 - 24 Dec 2020

Cited by 17 | Viewed by 6354

Abstract

Background: The purpose of this study was to collect and analyse the available scientific evidence on the effectiveness of shock wave therapy as a treatment for spasticity. Methods: the search was performed in the following databases: PubMed, PEDro, Cochrane, Embase, and the Virtual Health Library. All publications from November 2009 to November 2019 were selected that included a sample of patients with spasticity and prior suspension of botulinum toxin, to whom shock wave therapy was applied. The methodological quality of the articles was evaluated using the Jadad scale and the pyramid of quality of scientific evidence. Results: 25 studies involving 866 participants with spasticity were selected. The results obtained suggest that shock wave therapy appears to be effective in reducing spasticity levels irrespective of the age of the participants, the type of injury, and the tool used to measure the effect. Conclusions: shock wave therapy reports evidence of improvement in motor function, motor impairment, pain, and functional independence, applied independently of botulinum toxin. However, due to the heterogeneity of the protocols, there is no optimum protocol for its application, and it would be appropriate to gain more high-quality scientific evidence through primary studies. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

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14 pages, 751 KiB

Open AccessProtocol

Neurorehabilitation through Hippotherapy on Neurofunctional Sequels of Stroke: Effect on Patients’ Functional Independence, Sensorimotor/Cognitive Capacities and Quality of Life, and the Quality of Life of Their Caregivers—A Study Protocol

by Hélène Viruega, Carole Imbernon, Nicolas Chausson, Tony Altarcha, Manvel Aghasaryan, Djibril Soumah, Edwige Lescieux, Constance Flamand-Roze, Olivier Simon, Arnaud Bedin, Didier Smadja and Manuel Gaviria

Brain Sci. 2022, 12(5), 619; https://doi.org/10.3390/brainsci12050619 - 9 May 2022

Cited by 6 | Viewed by 4847

Abstract

Background: Stroke is a high burden illness and the second leading cause of worldwide disability with generally poor recovery rates. Robust benefits of hippotherapy, a novel neurorehabilitation approach, in functional recovery following various severe neurological disabling conditions has been shown. In the present study, we will analyze the effect of a hippotherapy program on the outcome of post-stroke patients in the first year post-stroke. Method: A randomized controlled clinical trial on the effectiveness of hippotherapy (4 weeks/18 weeks hippotherapy/conventional neurorehabilitation) versus conventional neurorehabilitation alone (22 weeks) will be conducted over 48 weeks. In the treated group, one-hour daily hippotherapy sessions will be exclusively conducted during the hippotherapy’s cycles, alternated with periods of conventional neurorehabilitation. A test battery will measure both the functional and psychological outcomes. The primary endpoint will be the patient’s functional independence. The secondary endpoints will measure the sensorimotor function, autonomy, and quality of life, as well as the caregivers’ quality of life. Results and conclusion: Individual brain connectome, life history and personality construct influence the brain’s functional connectivity and are central to developing optimal tailored neurorehabilitation strategies. According to our current practice, hippotherapy allows the enhancement of substantial neuroplastic changes in the injured brain with significant neurological recovery. The protocol aims to confirm those issues. Trial registration in ClinicalTrials.gov NCT04759326 accessed on 19 February 2021. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

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19 pages, 14319 KiB

Open AccessSystematic Review

Upper Limb Motor Planning in Individuals with Cerebral Palsy Aged between 3 and 21 Years Old: A Systematic Review

by Ophélie Martinie, Catherine Mercier, Andrew M. Gordon and Maxime T. Robert

Brain Sci. 2021, 11(7), 920; https://doi.org/10.3390/brainsci11070920 - 12 Jul 2021

Cited by 10 | Viewed by 6034

Abstract

Individuals with cerebral palsy have difficulties performing activities of daily living. Beyond motor execution impairments, they exhibit motor planning deficits contributing to their difficulties. The objective of this review is to synthesize the behavioral evidence of motor planning deficits during an upper limb motor task in children, adolescents and young adults with cerebral palsy aged between 3 and 21 years. Methods: The inclusion criteria were: (1) including individuals with cerebral palsy from 3 to 21 years old; (2) assessing upper limb motor planning. Six databases were screened. The quality assessment of the studies was performed. Results: Forty-six studies and 686 participants were included. Five articles have been identified as very high quality, 12 as high, 20 as moderate, six as low, three as very low. Force planning studies reported a deficit for the more affected hand but adequate performances for the less affected hand. Object-manipulation studies reported hand posture planning deficits irrespectively of the hand assessed. Conclusions: Motor planning deficits has been shown in the more affected hand for force scaling, while the results for other variables showed overall deficits. Hence, variables affected by motor planning deficits in both hands should be considered in children with cerebral palsy to optimize intervention. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

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15 pages, 12922 KiB

Open AccessCase Report

Neurophysiological Changes Induced by Music-Supported Therapy for Recovering Upper Extremity Function after Stroke: A Case Series

by Shashank Ghai, Fabien Dal Maso, Tatiana Ogourtsova, Alba-Xifra Porxas, Myriam Villeneuve, Virginia Penhune, Marie-Hélène Boudrias, Sylvain Baillet and Anouk Lamontagne

Brain Sci. 2021, 11(5), 666; https://doi.org/10.3390/brainsci11050666 - 20 May 2021

Cited by 7 | Viewed by 5097

Abstract

Music-supported therapy (MST) follows the best practice principles of stroke rehabilitation and has been proven to instigate meaningful enhancements in motor recovery post-stroke. The existing literature has established that the efficacy and specificity of MST relies on the reinforcement of auditory-motor functional connectivity in related brain networks. However, to date, no study has attempted to evaluate the underlying cortical network nodes that are key to the efficacy of MST post-stroke. In this case series, we evaluated changes in connectivity within the auditory-motor network and changes in upper extremity function following a 3-week intensive piano training in two stroke survivors presenting different levels of motor impairment. Connectivity was assessed pre- and post-training in the α- and the β-bands within the auditory-motor network using magnetoencephalography while participants were passively listening to a standardized melody. Changes in manual dexterity, grip strength, movement coordination, and use of the upper extremity were also documented in both stroke survivors. After training, an increase in the clinical measures was accompanied by enhancements in connectivity between the auditory and motor network nodes for both the α- and the β-bands, especially in the affected hemisphere. These neurophysiological changes associated with the positive effects of post-stroke MST on motor outcomes delineate a path for a larger scale clinical trial. Full article

(This article belongs to the Special Issue At the Frontiers of Neurorehabilitation)

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