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At the Frontiers of Neurorehabilitation: Series II

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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 April 2024) | Viewed by 12230

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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 affect more than 1 billion people worldwide; they are the second leading cause of death and the leading cause of disability, imposing substantial restrictions on activities and participation, such as community integration, family functioning, access to employment, and social interaction. A deeper understanding of brain functioning has opened up new perspectives for more integrative interventions, enhancing the intrinsic CNS capabilities for behavioral restitution. Given that neurorehabilitation relies on the strong neuroplastic capabilities of the CNS, it must take into account the many aspects of the individual through a comprehensive analysis of actual and potential mental, physical, emotional, and social skills, systematically including in the context of care the values and goals of the disabled person. In this sense, the approaches must be strictly tailored instead of standardized, and the boundaries and limits for moving forward must be defined well beyond the framework of biology.

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, and 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

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

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
neuroprosthetics
brain–computer interfaces
clinical trials for validation
regulatory issues
activities of daily living (ADLs) autonomy
quality of life
neurodevelopmental disorder

Published Papers (10 papers)

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Research

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15 pages, 2428 KiB

Open AccessArticle

Efficacy of a Soft Robotic Exoskeleton to Improve Lower Limb Motor Function in Children with Spastic Cerebral Palsy: A Single-Blinded Randomized Controlled Trial

by Zhichong Hui, Weihang Qi, Yi Zhang, Mingmei Wang, Jiamei Zhang, Dong Li and Dengna Zhu

Brain Sci. 2024, 14(5), 425; https://doi.org/10.3390/brainsci14050425 - 25 Apr 2024

Viewed by 215

Abstract

Purpose: Soft robotic exoskeletons (SREs) are portable, lightweight assistive technology with therapeutic potential for improving lower limb motor function in children with cerebral palsy. To understand the effects of long-term SRE-assisted walking training on children with spastic cerebral palsy (SCP), we designed a study aiming to elucidate the effects of SRE-assisted walking training on lower limb motor function in this population. Methods: In this randomized, single-blinded (outcome assessor) controlled trial, forty children diagnosed with SCP were randomized into the routine rehabilitation (RR) group (N = 20) and the SRE group (N = 20) for comparison. The RR group received routine rehabilitation training, and the SRE group received routine rehabilitation training combined with SRE-assisted overground walking training. Assessments (without SRE) were conducted pre- and post-intervention (8 weeks after the intervention). The primary outcome measures included the 10 m walk test (10MWT) and the 6 min walk test (6MWT). Secondary outcome measures comprised the gross motor function measure-88, pediatric balance scale modified Ashworth scale, and physiological cost index. Results: Both groups showed significant improvements (p < 0.01) across all outcome measures after the 8-week intervention. Between-group comparisons using ANCOVA revealed that the SRE group demonstrated greater improvement in walking speed from the 10MWT (+6.78 m/min, 95% CI [5.74–7.83]; p < 0.001) and walking distance during the 6MWT (+34.42 m, 95% CI [28.84–39.99]; p < 0.001). The SRE group showed greater improvement in all secondary outcome measures (p < 0.001). Conclusions: The study findings suggested that the integration of SRE-assisted overground walking training with routine rehabilitation more effectively enhances lower limb motor function in children with SCP compared to routine rehabilitation alone. Full article

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

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14 pages, 1545 KiB

Open AccessArticle

Is Virtual Reality Orientation Therapy Useful to Optimize Cognitive and Behavioral Functioning Following Severe Acquired Brain Injury? An Exploratory Study

by Rosaria De Luca, Andrea Calderone, Antonio Gangemi, Carmela Rifici, Mirjam Bonanno, Maria Grazia Maggio, Irene Cappadona, Isabella Veneziani, Augusto Ielo, Francesco Corallo, Angelo Quartarone, Davide Cardile and Rocco Salvatore Calabrò

Brain Sci. 2024, 14(5), 410; https://doi.org/10.3390/brainsci14050410 - 23 Apr 2024

Viewed by 305

Abstract

Introduction: Severe acquired brain injury (SABI) is a leading cause of death and disability, and it is defined as a brain injury that occurs after birth due to traumatic or non-traumatic causes. Reality orientation therapy (ROT) uses repeated time–place–person orientation and meaningful stimuli to develop a better understanding of the environment and has great potential as an effective strategy to improve cognitive and behavioral functioning. Objective: This study aims to investigate the feasibility and potential effects of virtual reality orientation therapy (VR-rot) on optimizing cognitive and behavioral functioning and depressive symptoms post-SABI. Method: Forty patients with SABI were enrolled from October 2022 to December 2023 and divided into two groups: the experimental group (EG, n = 20) received VR_rot, while the control group (CG, n = 20) received standard ROT (S_rot). All patients were evaluated with a psychometric battery, including the Mini-Mental State Examination (MMSE) and the Hamilton Rating Scale for Depression (HRS-D), administered before (T0) and after the end (T1) of rehabilitation. Results: Within-group comparisons indicated a statistically significant change in MMSE scores from T0 to T1 in the EG and CG, with the EG showing a greater improvement than the CG. Regarding HRS-D scores, the EG showed a statistically significant change. VR-ROT could be a valuable tool for improving cognitive–behavioral functioning in SABI patients. Conclusions: The VRRS can help reduce depressive symptoms and improve the reality orientation deficit caused by traumatic brain injury and stroke on brain tissue. This study highlights the benefits of virtual reality. Full article

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

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11 pages, 1883 KiB

Open AccessArticle

Does 20 Hz Transcranial Alternating Current Stimulation over the Human Primary Motor Cortex Modulate Beta Rebound Following Voluntary Movement?

by Mayu Akaiwa, Yuya Matsuda, Ryo Kurokawa, Yasushi Sugawara, Rin Kosuge, Hidekazu Saito, Eriko Shibata, Takeshi Sasaki, Kazuhiro Sugawara and Naoki Kozuka

Brain Sci. 2024, 14(1), 74; https://doi.org/10.3390/brainsci14010074 - 11 Jan 2024

Viewed by 895

Abstract

Beta frequency oscillations originating from the primary motor cortex increase in amplitude following the initiation of voluntary movement, a process termed beta rebound. The strength of beta rebound has been reported to predict the recovery of motor function following stroke, suggesting therapeutic applications of beta rebound modulation. The present study examined the effect of 20 Hz transcranial alternating current stimulation (tACS) on the beta rebound induced by self-paced voluntary movement. Electroencephalograms (EEGs) and electromyograms (EMGs) were recorded from 16 healthy adults during voluntary movements performed before and after active or sham tACS. There was no significant change in average beta rebound after active tACS. However, the beta rebound amplitude was significantly enhanced in a subset of participants, and the magnitude of the increase across all participants was negatively correlated with the difference between individual peak beta frequency and tACS frequency. Thus, matching the stimulus frequency of tACS with individual beta frequency may facilitate therapeutic enhancement for motor rehabilitation. Full article

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

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12 pages, 269 KiB

Open AccessArticle

Movement Sonification Techniques to Improve Balance in Parkinson’s Disease: A Pilot Randomized Controlled Trial

by Alfredo Raglio, Beatrice De Maria, Monica Parati, Andrea Giglietti, Stefano Premoli, Stefano Salvaderi, Daniele Molteni, Simona Ferrante and Laura Adelaide Dalla Vecchia

Brain Sci. 2023, 13(11), 1586; https://doi.org/10.3390/brainsci13111586 - 12 Nov 2023

Cited by 1 | Viewed by 1148

Abstract

Background: Movement sonification has been recently introduced into the field of neuromotor rehabilitation alongside Neurologic Music Therapy and music-based interventions. This study introduces the use of musical auditory cues encompassing the melodic-harmonic aspect of music. Methods: Nineteen patients with Parkinson’s disease were randomly assigned to the experimental (n = 10) and control (n = 9) groups and underwent thrice-weekly sessions of the same gait training program, with or without sonification. Functional and motor parameters, as well as fatigue, quality of life, and the impact of intervention on patients’ well-being, were assessed at baseline (PRE), the end of treatment (POST), and at follow-up (FU). Between-group differences were assessed for each outcome measure using linear mixed-effects models. The outcome measure was entered as the dependent variable, group and time as fixed effects, and time by group as the interaction effect. Results: Mini BESTest and Dynamic Gait Index scores significantly improved in the experimental group (p = 0.01 and p = 0.03, respectively) from PRE to FU, demonstrating a significant impact of the sonification treatment on balance. No other significant differences were observed in the outcome measures. Conclusions: Larger sample sizes are needed to confirm the effectiveness of sonification approaches in Parkinson’s disease, as well as in other neurological disorders. Full article

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

11 pages, 1070 KiB

Open AccessArticle

Treadmill Training Plus Semi-Immersive Virtual Reality in Parkinson’s Disease: Results from a Pilot Study

by Massimo Pullia, Laura Ciatto, Giuseppe Andronaco, Concetta Donato, Rosario Ermes Aliotta, Angelo Quartarone, Maria Cristina De Cola, Mirjam Bonanno, Rocco Salvatore Calabrò and Roberta Cellini

Brain Sci. 2023, 13(9), 1312; https://doi.org/10.3390/brainsci13091312 - 12 Sep 2023

Viewed by 1266

Abstract

Parkinson’s disease (PD) is one of the most common neurodegenerative disorders that causes postural instability and gait alterations, such as reduced walking speed, shorter step length, and gait asymmetry, exposing patients to a higher risk of falling. Recently, virtual reality (VR) was added to a treadmill, in order to promote motor functional recovery and neuroplastic processes. Twenty PD patients were enrolled and randomly assigned to two groups: the experimental group (EG) and the control group (CG). In particular, patients in the EG were trained with the C-Mill, an innovative type of treadmill, which is equipped with semi-immersive VR, whereas the CG performed conventional physiotherapy. Patients in both groups were evaluated through a specific motor assessment battery at baseline (T0) and after the training (T1). Comparing pre-(T0) and post-(T1) treatment scores, in the EG, we found statistical significances in the following outcome measures: 6 Minutes Walking Test (6MWT) (p < 0.0005), Timed up and go (TUG right) (p < 0.03), Berg Balance Scale (BBS) (p < 0.006), Tinetti Scale (TS) (p < 0.002), Falls Efficacy Scale- International (FES-I), (p < 0.03) Unified PD Rating Scale-III (UPDRS) (p < 0.002), and Functional Independence Measure (FIM) (p < 0.004). Also, the CG showed statistical significances after the training. Between-group (EG and CG) analysis showed significative statistical differences in 6MWT (p < 0.006), BBS (p < 0.006), TS (p < 0.008), FES-I (p < 0.01), and FIM (p < 0.009). From our results it emerges that both groups (EG and CG) achieved better outcome scores after the treatment, suggesting that both physiotherapy interventions were effective. However, the EG training using VR seemed to have induced more improvements, especially in gait and balance skills. Then, C-Mill could be a valid adjunctive treatment in the context of gait and balance disturbances, which are very common in the PD population. Full article

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

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11 pages, 1869 KiB

Open AccessArticle

Differences in Cortical Area Activity and Motor Imagery Vivid-Ness during Evaluation of Motor Imagery Tasks in Right and Left Hemiplegics

by Kengo Fujiwara, Masatomo Shibata, Yoshinaga Awano, Naoki Iso, Koji Shibayama and Toshio Higashi

Brain Sci. 2023, 13(5), 748; https://doi.org/10.3390/brainsci13050748 - 29 Apr 2023

Viewed by 1169

Abstract

The ability to develop vivid motor imagery (MI) is important for effective mental practice. Therefore, we aimed to determine differences in the MI clarity and cortical area activity between patients with right hemiplegia and left hemiplegia after stroke in an MI task. In total, 11 participants with right hemiplegia and 14 with left hemiplegia were categorized into two groups. The MI task required the flexion and extension of the finger on the paralyzed side. Considering that MI vividness changes with MI practice, we measured the MI vividness and cortical area activity during the task before and after MI practice. MI vividness was evaluated subjectively using the visual analog scale, and cerebral hemodynamics during the task were measured using near-infrared spectroscopy in cortical regions during the MI task. The MI sharpness and cortical area activity in the MI task were significantly lower in the right hemiplegia group than in the left hemiplegia group. Therefore, when practicing mental practices with right hemiplegia, it is necessary to devise ways by which to increase MI vividness. Full article

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

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Review

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18 pages, 601 KiB

Open AccessReview

Exploring Methodological Issues in Mental Practice for Upper-Extremity Function Following Stroke-Related Paralysis: A Scoping Review

by Akira Nakashima, Ryohei Okamura, Takefumi Moriuchi, Kengo Fujiwara, Toshio Higashi and Kounosuke Tomori

Brain Sci. 2024, 14(3), 202; https://doi.org/10.3390/brainsci14030202 - 22 Feb 2024

Viewed by 872

Abstract

In this scoping review, we aimed to comprehensively clarify the methodology of Mental practice (MP) by systematically mapping studies documenting the application of MP to post-stroke paralytic upper-extremity function. Specifically, when is an MP intervention most commonly applied after stroke onset? What is the corresponding MP load (intervention time, number of intervention days, and intervention period)? What are the most common methods of Motor Imagery (MI) recall and MI tasks used during the application of MP? Is MP often used in conjunction with individual rehabilitation? What are the paralyzed side’s upper-limb and cognitive function levels at the start of an MP intervention? The research questions were identified according to PRISMA-ScR. The PubMed, Scopus, Medline, and Cochrane Library databases were used to screen articles published until 19 July 2022. In total, 694 English-language articles were identified, of which 61 were finally included. Most of the studies were conducted in the chronic phase after stroke onset, with limited interventions in the acute or subacute phase. The most common intervention time was ≤30 min and intervention frequency was 5 times/week in MP. An audio guide was most commonly used to recall MI during MP, and 50 studies examined the effects of MP in combination with individual rehabilitation. The Fugl-Meyer Assessment mean for the 38 studies, determined using the Fugl-Meyer Assessment, was 30.3 ± 11.5. Additional research with the aim of unifying the widely varying MP methodologies identified herein is warranted. Full article

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

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11 pages, 650 KiB

Open AccessReview

Adults with Cerebral Palsy: Navigating the Complexities of Aging

by Devina S. Kumar, Gabriel Perez and Kathleen M. Friel

Brain Sci. 2023, 13(9), 1296; https://doi.org/10.3390/brainsci13091296 - 08 Sep 2023

Viewed by 2750

Abstract

The goal of this narrative review is to highlight the healthcare challenges faced by adults with cerebral palsy, including the management of long-term motor deficits, difficulty finding clinicians with expertise in these long-term impairments, and scarcity of rehabilitation options. Additionally, this narrative review seeks to examine potential methods for maintaining functional independence, promoting social integration, and community participation. Although the brain lesion that causes the movement disorder is non-progressive, the neurodevelopmental disorder worsens from secondary complications of existing sensory, motor, and cognitive impairments. Therefore, maintaining the continuum of care across one’s lifespan is of utmost importance. Advancements in healthcare services over the past decade have resulted in lower mortality rates and increased the average life expectancy of people with cerebral palsy. However, once they transition from adolescence to adulthood, limited federal and community resources, and health care professionals’ lack of expertise present significant obstacles to achieving quality healthcare and long-term benefits. This paper highlights the common impairments seen in adults with cerebral palsy. Additionally, it underscores the critical role of long-term healthcare and management to prevent functional decline and enhance quality of life across physical, cognitive, and social domains. Full article

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

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Other

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9 pages, 465 KiB

Open AccessBrief Report

Unveiling Neurocognitive Disparities in Encoding and Retrieval between Paper and Digital Tablet-Based Learning

by Si-An Lee, Jun-Hwa Hong, Na-Yeon Kim, Hye-Min Min, Ha-Min Yang, Si-Hyeon Lee, Seo-Jin Choi and Jin-Hyuck Park

Brain Sci. 2024, 14(1), 76; https://doi.org/10.3390/brainsci14010076 - 12 Jan 2024

Viewed by 775

Abstract

The widespread use of mobile devices and laptops has replaced traditional paper-based learning and the question of how the brain efficiency of digital tablet-based learning differs from that of paper-based learning remains unclear. The purpose of this study was to investigate the difference in brain efficiency for learning between paper-based and digital tablet-based learning by measuring activity in the prefrontal cortex (PFC) using functional near-infrared spectroscopy. Thirty-two subjects were randomly assigned to the paper-based learning or the digital tablet-based learning group. Subjects in each group performed a memory task that required memorizing a three-minute novel (encoding phase) on a paper or digital tablet, followed by a test in which they answered four multiple-choice questions based on the novel’s content. To compare both groups, behavioral performance on the test (retrieval phase) and activity in the PFC were measured. As a result, no significant difference in behavioral performance between both groups was observed (p > 0.05). However, the paper-based learning group showed significantly lower activity in the PFC in the encoding phase than the digital tablet-based learning group (p < 0.05) but not in the retrieval phase. The current study demonstrated that brain efficiency in encoding is higher in subjects with paper-based learning than those with digital tablet-based learning. This finding has important implications for education, particularly in terms of the pros and cons of electronic document-based learning. Full article

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

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17 pages, 1920 KiB

Open AccessSystematic Review

Gait Recovery in Spinal Cord Injury: A Systematic Review with Metanalysis Involving New Rehabilitative Technologies

by Giuseppe La Rosa, Marianna Avola, Tiziana Di Gregorio, Rocco Salvatore Calabrò and Maria Pia Onesta

Brain Sci. 2023, 13(5), 703; https://doi.org/10.3390/brainsci13050703 - 22 Apr 2023

Cited by 3 | Viewed by 1977

Abstract

Gait recovery is a fundamental goal in patients with spinal cord injury to attain greater autonomy and quality of life. Robotics is becoming a valid tool in improving motor, balance, and gait function in this patient population. Moreover, other innovative approaches are leading to promising results. The aim of this study was to investigate new rehabilitative methods for gait recovery in people who have suffered spinal cord injuries. A systematic review of the last 10 years of the literature was performed in three databases (PubMed, PEDro, andCochrane). We followed this PICO of the review: P: adults with non-progressive spinal cord injury; I: new rehabilitative methods; C: new methods vs. conventional methods; and O: improvement of gait parameters. When feasible, a comparison through ES forest plots was performed. A total of 18 RCTs of the 599 results obtained were included. The studies investigated robotic rehabilitation (n = 10), intermittent hypoxia (N = 3) and external stimulation (N = 5). Six studies of the first group (robotic rehabilitation) were compared using a forest plot for 10MWT, LEMS, WISCI-II, and SCIM-3. The other clinical trials were analyzed through a narrative review of the results. We found weak evidence for the claim that robotic devices lead to better outcomes in gait independence compared to conventional rehabilitation methods. External stimulation and intermittent hypoxia seem to improve gait parameters associated with other rehabilitation methods. Research investigating the role of innovative technologies in improving gait and balance is needed since walking ability is a fundamental issue in patients with SCI. Full article

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

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