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NeuroRehabilitation, an international, interdisciplinary, peer-reviewed journal, publishes manuscripts focused on scientifically based, practical information relevant to all aspects of neurologic rehabilitation. We publish unsolicited papers detailing original work/research that covers the full life span and range of neurological disabilities including stroke, spinal cord injury, traumatic brain injury, neuromuscular disease and other neurological disorders.
We also publish thematically organized issues that focus on specific clinical disorders, types of therapy and age groups. Proposals for thematic issues and suggestions for issue editors are welcomed.
Authors: Ragsdale, Katie A. | Nichols, Anastacia A. | Mehta, Mansi | Maples-Keller, Jessica L. | Yasinski, Carly W. | Hyatt, Courtland S. | Watkins, Laura E. | Loucks, Laura A. | Carbone, Elizabeth | Rauch, Sheila A. M. | Rothbaum, Barbara O.
Article Type: Research Article
Abstract: BACKGROUND: The Emory Healthcare Veterans Program (EHVP) is a multidisciplinary intensive outpatient treatment program for post-9/11 veterans and service members with invisible wounds, including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorders (SUD), and other anxiety- and depression-related disorders. OBJECTIVE: This article reviews the EHVP. METHODS: The different treatment tracks that provide integrated and comprehensive treatment are highlighted along with a review of the standard, adjunctive, and auxiliary services that complement individualized treatment plans. RESULTS: This review particularly emphasizes the adjunctive neurorehabilitation service offered to veterans and service members with a …TBI history and the EVHP data that indicate large reductions in PTSD and depression symptoms across treatment tracks that are maintained across 12 months follow up. Finally, there is a discussion of possible suboptimal treatment response and the pilot programs related to different treatment augmentation strategies being deploying to ensure optimal treatment response for all. CONCLUSION: Published data indicate that the two-week intensive outpatient program is an effective treatment program for a variety of complex presentations of PTSD, TBI, SUD, and other anxiety- and depression-related disorders in veterans and active duty service members. Show more
Keywords: Posttraumatic stress disorder, traumatic brain injury, military psychiatry, veterans, mental health, therapy
DOI: 10.3233/NRE-230235
Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-10, 2024
Authors: Hinds II, Sidney R. | Cifu, David X.
Article Type: Research Article
Abstract: BACKGROUND: Conducting mild traumatic brain injury (mTBI) longitudinal studies across multiple sites is a challenging endeavor which has been made more challenging because of COVID-19. OBJECTIVE: This article briefly describes several concerns that need to be addressed during the conduct of research to account for COVID-19’s impact. METHODS: The recent actions and steps taken by the Long-term Impact of Military-relevant Brain Injury Consortium (LIMBIC)-Chronic Effects of Neurotrauma Consortium (CENC) researchers are reviewed. RESULTS: COVID-19’s effects on the conduct of LIMBIC-CENC for the short-term and long-term were considered to ensure the study continued safely for …participants and researchers. COVID-19 may have long-lasting health and especially neurological effects which may confound the quantitative and qualitative measures of this any comparable longitudinal studies. CONCLUSION: The recognition, understanding, and preparation of COVID-19’s impact on a longitudinal military and veteran mTBI population is crucial to successfully conducting LIMBIC-CENC and similar neurological research studies. Developing a plan based on the best available information while remaining agile as new information about COVID-19 emerge, is essential. Research presented in this special issue underscores the complexity of studying long-term effects of mTBI, in a population exposed to and symptomatic from COVID-19. Show more
Keywords: Traumatic brain injury, COVID-19, military, veteran, neurotrauma, neurorehabilitation, neurodegeneration
DOI: 10.3233/NRE-230272
Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-6, 2024
Authors: Olowoyo, Paul | Dhamija, Rajinder K. | Owolabi, Mayowa O.
Article Type: Review Article
Abstract: BACKGROUND: Telerehabilitation as a new subdiscipline of telehealth is the application of information technology to support and deliver rehabilitation services via two-way or multipoint interactive online telecommunication technology. This enables the therapist to optimize the timing, intensity, and duration of therapy which is often not possible within the constraints of face-to-face treatment protocols in current health systems. OBJECTIVE: To review the historical perspective and conceptual framework of telerehabilitation in neurological disorders. METHODS: A narrative review of the literature was performed for the historical perspective and a systematic review of the conceptual framework was performed using the …PRISMA guidelines on chronic neurological disorders; multiple sclerosis, spinal cord injury, stroke, Parkinson’s disease, cognitive impairment, and headaches. The search included articles from the past 20 years (2004 to 2024). RESULTS: Telerehabilitation dates back to the 1960s and early 1970s. Documented effective interventions were mostly on therapies for speech disorders. The conceptual framework consisted of three major components of telerehabilitation programmes including development, implementation, and evaluation. The COVID-19 pandemic suddenly made telerehabilitation come to the limelight because physical distancing became necessary. Out of the 110,000 articles downloaded, 43 met the inclusion criteria for review on the conceptual framework of telerehabilitation in relation to neurological disorders. The articles discussed multiple sclerosis (2), spinal cord disorders (1), stroke (17), Parkinson’s disease (15), headaches (3), and cognitive disorders (5). All articles reviewed assessed the effectiveness of telemedicine except for the articles on multiple sclerosis and spinal cord disorders which examined the interphase between the technology and the end users. CONCLUSION: The future of telerehabilitation looks promising with the subsequent integration of innovative tools and applications. This will require the adaption of technology, continuous capacity building, education, and training of healthcare professionals to ensure that they are adequately equipped with the necessary skills to provide quality virtual reality rehabilitation care. Show more
Keywords: Telerehabilitation, historical perspectives, conceptual framework
DOI: 10.3233/NRE-240079
Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-13, 2024
Authors: Springer, Shauna | Whitmer, Paul | Steinlin, Morgan | Gray, Lindsey | Blankfield, Jason
Article Type: Review Article
Abstract: BACKGROUND: For decades, thousands of active-duty service members have sought treatment for trauma exposure. Stellate ganglion block (SGB) is a fast-acting nerve block documented in medical literature for nearly a century that has shown promise as a potentially life-altering treatment for post-traumatic stress (PTS). OBJECTIVE: This review aims to answer the practical questions of those who support individuals suffering from trauma: (1) SGB’s safety profile (2) efficacy data (3) potential advantages and limitations, (4) a cross-cultural application example, (5) and the use of SGB in combination with talk therapy to optimize clinical outcomes. METHODS: The current …body of literature, to include several large case series, meta-analyses, and a sufficiently powered randomized controlled trial, were reviewed, and presented to describe the history of SGB for emotional trauma symptoms and address the objectives of this review. RESULTS: Critical consideration is given to the safety and efficacy data on SGB and the evolution in safety-related technologies. Advantages such as decreased barriers to care, rapid onset, and decreased dropout and limitations such as treatment non-response, potential adverse effects, and misconceptions about the treatment are then described. Finally, the cross-cultural application of SGB is explored based on the deployment of SGB in Israel. CONCLUSION: Stellate Ganglion Block is associated with level 1B evidence and a reassuring safety profile. Evolving the model of care through the combined use of effective biological treatments like SGB with trauma informed talk therapy offers a hopeful path forward for supporting those who suffer from post-traumatic stress. Show more
Keywords: Stellate ganglion block, SGB, Post-traumatic stress disorder, PTSD, combat stress disorder, nerve block, Military health, Veterans health
DOI: 10.3233/NRE-230236
Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-12, 2024
Authors: Barnett, Nathan | Ljubic, Milica | Chung, Joyce | Capizzi, Allison
Article Type: Research Article
Abstract: BACKGROUND: U.S. Special Operations Forces (SOF) are at increased risk of multiple mild traumatic brain injury (mmTBI). Testosterone was prescribed for several participants in a VA program designed to address sequelae of mmTBI for SOF. OBJECTIVE: To determine testosterone prevalence in the Palo Alto VA Intensive Evaluation and Treatment Program (IETP) and observe for association between testosterone and neurobehavioral outcomes. METHODS: A retrospective cohort study included patients in the Palo Alto VA IETP. Sociodemographic data, testosterone blood levels, and neurobehavioral outcomes were collected from medical records. RESULTS: 55 IETP participants were included: six were …testosterone users; the rest were classified as non-users. Testosterone use in this population is 11%, higher than reported national averages in the U.S. Of the 6 testosterone users, 2 (33%) had a formal diagnosis of hypogonadism prior to initiation of testosterone. Neurobehavioral outcome scores between testosterone users and non-users failed to show statistically significant differences, except for the PROMIS pain score, which was higher in the testosterone user population. CONCLUSION: The current study did not find an association between mmTBI, testosterone use, or testosterone level and neurobehavioral outcomes. This study highlights a need to further examine the relationship between hypogonadism, mmTBI, SOF culture around testosterone, and the effects of testosterone use in this population. Show more
Keywords: Traumatic brain injury, TBI, neuroendocrine dysfunction, hypogonadism, multiple mild traumatic brain injury, testosterone, special operations forces
DOI: 10.3233/NRE-230291
Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-9, 2024
Authors: Kim, Heejun | Shin, Jiwon | Kim, Yunhwan | Lee, Yongseok | You, Joshua (Sung) H.
Article Type: Research Article
Abstract: BACKGROUND: Despite the promising effects of robot-assisted gait training (RAGT) on balance and gait in post-stroke rehabilitation, the optimal predictors of fall-related balance and effective RAGT attributes remain unclear in post-stroke patients at a high risk of fall. OBJECTIVE: We aimed to determine the most accurate clinical machine learning (ML) algorithm for predicting fall-related balance factors and identifying RAGT attributes. METHODS: We applied five ML algorithms— logistic regression, random forest, decision tree, support vector machine (SVM), and extreme gradient boosting (XGboost)— to a dataset of 105 post-stroke patients undergoing RAGT. The variables included the Berg Balance …Scale score, walking speed, steps, hip and knee active torques, functional ambulation categories, Fugl– Meyer assessment (FMA), the Korean version of the Modified Barthel Index, and fall history. RESULTS: The random forest algorithm excelled (receiver operating characteristic area under the curve; AUC = 0.91) in predicting balance improvement, outperforming the SVM (AUC = 0.76) and XGboost (AUC = 0.71). Key determinants identified were knee active torque, age, step count, number of RAGT sessions, FMA, and hip torque. CONCLUSION: The random forest algorithm was the best prediction model for identifying fall-related balance and RAGT determinants, highlighting the importance of key factors for successful RAGT outcome performance in fall-related balance improvement. Show more
Keywords: Balance, machine learning, neurorehabilitation, prediction models, robot-assisted gait training
DOI: 10.3233/NRE-240116
Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-10, 2024
Authors: Kuppelin, Marie | Goetsch, Antoine | Choisel, Régine | Isner-Horobeti, Marie-Eve | Goetsch, Thibaut | Krasny-Pacini, Agata
Article Type: Research Article
Abstract: BACKGROUND: Challenging behaviours and emotional dysregulation are common sequelae of acquired brain injury (ABI), but treatment remain underdeveloped. Dialectical behaviour therapy is an evidence-based therapy for emotional dysregulation. OBJECTIVE: To explore the feasibility and preliminary efficacy of dialectical behaviour therapy for ABI. METHODS: An exploratory longitudinal study that compared thirty adults with brain injury presenting persistent emotion dysregulation or challenging behaviours. Control group received a personalized multidisciplinary program only (n = 13). The dialectical behaviour therapy group received five months of emotion regulation skills learning as an add-on (n = 17). Preliminary efficacy was measured on Difficulties in …Emotion Regulation Scale-16 and Quality of Life after Brain Injury total score and emotion subscore. RESULTS: Fourteen participants completed the dialectical behaviour therapy. This study provided preliminary evidence for the feasibility and acceptability of dialectical behaviour therapy. Repeated measures revealed improvement on the Difficulties in Emotion Regulation Scale-16 (–7.6 [–17.3; 1.7]; Pr = 0.95) and on the Quality Of Life emotion subscore (13.5 [–3.8; 30.9]; Pr = 0.94). CONCLUSION: This study raises important questions regarding the type of patients who can benefit from this intervention, necessary adaptations of dialectical behaviour therapy and the way it can help post-traumatic growth and identity reconstruction after ABI. Show more
Keywords: Acquired brain injury, challenging behaviours, emotion regulation, dialectical behaviour therapy
DOI: 10.3233/NRE-230383
Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-18, 2024
Authors: Corallo, Francesco | Maggio, Maria Grazia | Bonanno, Lilla | De Luca, Rosaria | Cardile, Davide | Cappadona, Irene | Todaro, Antonino | Calabrò, Rocco Salvatore
Article Type: Research Article
Abstract: BACKGROUND: Acquired brain injuries (ABI) represent neurological disorders that can arise after traumatic and non-traumatic events. In addition to the physical, emotional and cognitive challenges that patients face, these injuries can bring changes in the life of the patient and his or her family. OBJECTIVE: This study aims to understand how the occurrence of an ABI condition can disrupt and reshape family functioning by examining certain dimensions such as role in the family, gender and age, which may have a major influence on family dynamics. METHODS: We enrolled 86 caregivers of patients with ABI. Two experienced …psychologists examined family functioning with Olso’s Family Adaptability and Cohesion Rating Scale (FACES IV). RESULTS: The correlation between groups by generics showed a significant difference only for flexibility (p = 0.05). Specifically, flexibility was greater in male caregivers, particularly in sons. Most of the constructs defining family functioning, such as communication, remained unchanged despite the ABI event. CONCLUSION: This study provides an in-depth understanding of how families face the challenges posed by the ABI and the role caregivers play within the system. Show more
Keywords: ABI, neurological disorders, caregiver, family functioning, psychological function, FACES IV
DOI: 10.3233/NRE-240056
Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-8, 2024
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