Neurorehabilitation: Looking Back and Moving Forward

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 35012

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Guest Editor
Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
Interests: cognitive and behavioral neurology; neurorehabilitation; multiple sclerosis; dementias; cognitive communication disorders
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1. Neuropsychology Section, Department of Psychiatry, University of Patras Medical School, Rio 265 04, Greece
2. Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece
Interests: clinical neuropsychology; cognitive/neuropsychological rehabilitation; cognitive neuroscience; multiple sclerosis; cognitive communication disorders
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Guest Editor
Department of Anatomy, Faculty of Medicine, University of Thessaly, 382 21 Larissa, Greece
Interests: rehabilitation medicine
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Special Issue Information

Dear Colleagues,

Neurorehabilitation is a complex, medically driven, set of therapeutic-targeted actions, applied to persons who live with neurological diseases, in order to restore or/and compensate for their disabilities. Progress in neurorehabilitation has been impressive over the years, but mainly in the last two decades. It follows the progress of clinical neurosciences in general, which is accelerated by a number of factors, technology being a major one. Looking back, we are satisfied by the transition of experienced-based, empirical neurorehabilitation, to an era of evidence-based practice, in which multidisciplinary approaches and translational research are applied even from the acute phase, through the disease course to an increasing number of people who need them, worldwide. However, despite this progress, there are still many limitations and restrictions. Nervous system damage frequently poses difficult recovery issues, and research still has a lot to clarify about the system’s neuroplasticity and reorganization dynamics. Additionally, more treatment approaches and combinations of therapeutic interventions need to be standardized, offered on a widespread basis, and individualized by a new generation of potent, skilled clinical neuroscientists, physicians, neuroradiologists neuropsychologists, and other therapists. Furthermore, these interventions must be organized under a fresh “patient-centric” approach, with home-based and tele-rehabilitation protocols replacing long stays in medical centers. In other words, we have to move forward to a new era, where medical, basic research, engineering and high technology advances can develop more efficacious approaches, which can be widely applied to all people that need them.

In this Special Issue of Healthcare, we welcome empirical, clinical, basic research and review papers covering the whole range of neurorehabilitation. Emphasis will be given, among others, to new technologies, cognitive rehabilitation, cognitive communication disorders (as a target of—but also as a hurdle for—rehabilitation), tele-rehabilitation approaches, the role of neuroimaging in designing and conducting relevant interventions, and neuromodulation techniques, mainly non-invasive (such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation).  

Dr. Grigorios Nasios
Prof. Dr. Lambros Messinis
Dr. Efthimios Dardiotis
Dr. Markos Sgantzos
Guest Editors

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Keywords

  • neurorehabilitation
  • neuropsychological rehabilitation
  • stroke
  • multiple sclerosis
  • neurocognitive disorders
  • traumatic brain injury
  • neuromodulation
  • cognitive communication disorders
  • tele-rehabilitation
  • neuroimaging in neurorehabilitation

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Published Papers (12 papers)

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Editorial

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6 pages, 206 KiB  
Editorial
Neurorehabilitation: Looking Back and Moving Forward, 1st Edition
by Grigorios Nasios, Lambros Messinis, Efthimios Dardiotis and Markos Sgantzos
Healthcare 2023, 11(10), 1452; https://doi.org/10.3390/healthcare11101452 - 17 May 2023
Cited by 1 | Viewed by 759
Abstract
Rehabilitation is “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”, according to the recent report from the World Health Organization (WHO), released in January 2023 [...] Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)

Research

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14 pages, 1615 KiB  
Article
Oxidative Stress Status in Post Stroke Patients: Sex Differences
by Mariacristina Siotto, Marco Germanotta, Massimo Santoro, Raffaella Canali, Simona Pascali, Sabina Insalaco, Valeria Cipollini, Dionysia Papadopoulou, Erika Antonacci and Irene Aprile
Healthcare 2022, 10(5), 869; https://doi.org/10.3390/healthcare10050869 - 09 May 2022
Cited by 8 | Viewed by 1693
Abstract
After a cerebral stroke insult, there is an overproduction of Reactive Oxygen Species (ROS), which overcome the antioxidant defenses, causing further tissues damage. The status of oxidative stress in stroke patients over time, particularly in those undergoing rehabilitation treatments, has been poorly investigated. [...] Read more.
After a cerebral stroke insult, there is an overproduction of Reactive Oxygen Species (ROS), which overcome the antioxidant defenses, causing further tissues damage. The status of oxidative stress in stroke patients over time, particularly in those undergoing rehabilitation treatments, has been poorly investigated. We analyzed the oxidative stress status in 61 subacute stroke patients (33 females and 28 males) admitted to our rehabilitation center by measuring, in serum: hydroperoxides levels (d-ROMs), antioxidant activity (BAP test), and the relative antioxidant capacity (OSI index). We also analyzed patients for glucose levels and lipid profile. In addition, we analyzed the correlation between oxidative stress status biomarkers and motor deficits, disability, and pain. Almost all patients showed high or very high levels of d-ROMs, while BAP levels were apparently in the reference range of normality. Females had lower BAP values (females: 2478 ± 379; males: 2765 ± 590; p = 0.034) and lower OSI index (females: 5.7 ± 1.9; males: 6.8 ± 1.9; p = 0.043). Moreover, in the male group, the correlation with motor impairment and disability showed a worsened motor performance when oxidative stress is higher. Female group, on the other hand, had an unexpected different trend of correlation, probably due to an unbalanced systemic oxidative stress. Further research is needed to see if sex differences in oxidative stress status in subacute stroke patients persist after rehabilitation. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
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12 pages, 4102 KiB  
Article
Effects of Cognitive Exercise Therapy on Upper Extremity Sensorimotor Function and Activities of Daily Living in Patients with Chronic Stroke: A Randomized Controlled Trial
by Wonho Choi
Healthcare 2022, 10(3), 429; https://doi.org/10.3390/healthcare10030429 - 24 Feb 2022
Cited by 4 | Viewed by 3458
Abstract
This study investigated the effects of cognitive exercise therapy on upper extremity sensorimotor function and daily activity in patients with chronic stroke and compared these effects to those of conventional occupational therapy. The 30 patients with chronic stroke (mean age: 63.6 ± 12.7 [...] Read more.
This study investigated the effects of cognitive exercise therapy on upper extremity sensorimotor function and daily activity in patients with chronic stroke and compared these effects to those of conventional occupational therapy. The 30 patients with chronic stroke (mean age: 63.6 ± 12.7 years; height: 162.8 ± 8.1 cm; weight: 60.6 ± 7.6 kg; body mass index: 22.8 ± 1.9 kg/m2) were divided into two treatment groups with 15 patients in each. The respective interventions were provided for 30 min per day, five times weekly for 4 weeks. Manual and sensory function tests were conducted to evaluate the sensorimotor function, while the Korean-Modified Barthel Index was used to assess daily activities. All outcome variables were assessed before and after the interventions. A significant interaction was observed in sensory function (p = 0.001) but not motor function or daily activities (p > 0.05). No significant main group effects were found for any outcome variables (p > 0.05). The experimental group showed significant improvements in motor function (p < 0.001), sensory function (p < 0.001), and daily life activities (p = 0.001) after cognitive exercise therapy, whereas the control group showed significant improvement only in daily life activities post-intervention (p = 0.012). These results demonstrated the positive effects of cognitive exercise therapy on upper extremity sensorimotor function and daily life activities and the lack of improvement in motor and sensory function following conventional occupational therapy in patients with chronic stroke. Thus, the combination of cognitive exercise and conventional occupational therapies may be an effective way to improve sensory function and upper extremity motor function in patients with chronic stroke. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
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11 pages, 907 KiB  
Article
Cost-Effectiveness of Upper Extremity Dry Needling in Chronic Stroke
by Daniel Fernández-Sanchis, Natalia Brandín-de la Cruz, Carolina Jiménez-Sánchez, Marina Gil-Calvo, Pablo Herrero and Sandra Calvo
Healthcare 2022, 10(1), 160; https://doi.org/10.3390/healthcare10010160 - 14 Jan 2022
Cited by 9 | Viewed by 2395
Abstract
Introduction: Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. Objective: The aim of this study was to evaluate the cost-effectiveness of a single dry needling session in patients with chronic stroke. Methods: A cost-effectiveness analysis [...] Read more.
Introduction: Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. Objective: The aim of this study was to evaluate the cost-effectiveness of a single dry needling session in patients with chronic stroke. Methods: A cost-effectiveness analysis was performed based on a randomized controlled clinical trial. The results obtained from the values of the EuroQol-5D questionnaire and the Modified Modified Ashworth Scale were processed in order to obtain the percentage of treatment responders and the quality-adjusted life years (QALYs) for each alternative. The cost analysis was that of the hospital, clinic, or health center, including the equipment and physiotherapist. The cost per respondent and the incremental cost-effectiveness ratio of each alternative were assessed. Results: Twenty-three patients with stroke were selected. The cost of DN treatment was EUR 14.96, and the data analysis showed a favorable cost-effectiveness ratio of both EUR/QALY and EUR/responder for IG, although the sensitivity analysis using limit values did not confirm the dominance (higher effectiveness with less cost) of the dry needling over the sham dry needling. Conclusions: Dry needling is an affordable alternative with good results in the cost-effectiveness analysis—both immediately, and after two weeks of treatment—compared to sham dry needling in persons with chronic stroke. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
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9 pages, 3392 KiB  
Article
A Backward Walking Training Program to Improve Balance and Mobility in Children with Cerebral Palsy
by Ji-Young Choi, Sung-Min Son and Se-Hee Park
Healthcare 2021, 9(9), 1191; https://doi.org/10.3390/healthcare9091191 - 09 Sep 2021
Cited by 5 | Viewed by 3969
Abstract
Background: We studied the effects of motor tasks using backward walking training on balance and gait functions of children with cerebral palsy. This was a single-blinded, randomized controlled trial with a crossover design conducted at a single facility. Methods: Among 12 children with [...] Read more.
Background: We studied the effects of motor tasks using backward walking training on balance and gait functions of children with cerebral palsy. This was a single-blinded, randomized controlled trial with a crossover design conducted at a single facility. Methods: Among 12 children with cerebral palsy, the forward (FWG) (n = 6) and backward walking groups (BWG) (n = 6) underwent training three times a week for 4 weeks, 40 min a day. After a 6-week break, the crossover training was conducted. Functional walking variables were measured. Time-Up-and-Go (TUG) test, Figure-8 Walk Test (FW8T), and Pediatric Balance Scale (PBS) were used for measuring balance. Results: Both groups showed significant improvement in walking speed, stride length, and step length. The BWG demonstrated significant improvement in walking speed (p < 0.05) compared with the FWG. The TUG test, FW8T, and PBS showed significant improvement. After the 4-week intervention, both groups displayed a remarkable decrease in TUG duration and FW8T. Both groups also exhibited improvement in the PBS; more so in the BWG. Conclusions: Backward walking training with motor dual tasks could be a more effective interventional approach than forward walking training to improve balance and walking functions of children with spastic hemiplegia. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
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10 pages, 868 KiB  
Article
A Greek Validation Study of the Multiple Sclerosis Work Difficulties Questionnaire-23
by Christos Bakirtzis, Artemios Artemiadis, Elli Nteli, Marina Kleopatra Boziki, Maria-Valeria Karakasi, Cynthia Honan, Lambros Messinis, Grigorios Nasios, Efthimios Dardiotis and Nikolaos Grigoriadis
Healthcare 2021, 9(7), 897; https://doi.org/10.3390/healthcare9070897 - 15 Jul 2021
Cited by 3 | Viewed by 2371
Abstract
The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a self-report instrument developed to assess barriers faced by People with Multiple Sclerosis (PwMS) in the workplace. The aim of this study was to explore the psychometric properties of the Greek version of the MSWDQ-23. [...] Read more.
The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a self-report instrument developed to assess barriers faced by People with Multiple Sclerosis (PwMS) in the workplace. The aim of this study was to explore the psychometric properties of the Greek version of the MSWDQ-23. The study sample consisted of 196 PwMS, all currently working in part- or full-time jobs. Participants underwent clinical examination and cognitive screening with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and completed self-report measures of fatigue, psychological functioning, and quality of life, along with the MSWDQ-23 questionnaire. Confirmatory Factor Analysis (CFA) was performed, and goodness-of-fit measures were used to evaluate construct validity. Convergent validity was checked by correlating MSWDQ-23 scores with study measures. Cronbach’s alpha value was produced to assess internal consistency. CFA yielded a model with a fair fit confirming the three-factor structure of the instrument. Higher work difficulties were associated with higher Expanded Disability Status Scale (EDSS) scores, poorer cognitive function, more fatigue, stress, anxiety, and depression, and poorer health status, supporting the convergent validity of MSWDQ-23. Internal consistency (Cronbach’s alpha = 0.94) and test–retest reliability (ICC = 0.996, 95%, CI = 0.990–0.998) were excellent. The Greek MSWDQ-23 can be considered a valid patient-reported outcome measure and can be used in interventions aiming to improve the vocational status of PwMS. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
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Review

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8 pages, 268 KiB  
Review
Pathophysiology and Symptomatology of Drooling in Parkinson’s Disease
by Sotirios Polychronis, Grigorios Nasios, Efthimios Dardiotis, Lambros Messinis and Gennaro Pagano
Healthcare 2022, 10(3), 516; https://doi.org/10.3390/healthcare10030516 - 11 Mar 2022
Cited by 4 | Viewed by 2774
Abstract
Drooling can present in patients with Parkinson’s disease (PD), and it is manifested as an excessive pooling of saliva inside the oral cavity. Currently, the exact pathophysiological mechanism of drooling in PD is not yet fully explicated. Thus, it becomes crucial to understand [...] Read more.
Drooling can present in patients with Parkinson’s disease (PD), and it is manifested as an excessive pooling of saliva inside the oral cavity. Currently, the exact pathophysiological mechanism of drooling in PD is not yet fully explicated. Thus, it becomes crucial to understand if some clinical characteristics may emphasize drooling or if they are just concomitant. In PD, excessive drooling has been associated with a higher burden of non-motor symptoms, such as cognitive impairment, sleep problems, autonomic dysfunction, constipation and orthostatic hypotension, and of worse severity of motor fluctuations and bradykinesia. PD patients with excessive drooling also showed a reduction of striatal DAT availability at DaTSCAN imaging. Excessive drooling in patients with Parkinson’s cannot be attributed to a single factor but to a mixture of factors, including but not limited to impaired nigrostriatal pathways. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
9 pages, 532 KiB  
Review
Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature
by Ioanna Alexandratou, Panayiotis Patrikelis, Lambros Messinis, Athanasia Alexoudi, Anastasia Verentzioti, Maria Stefanatou, Grigorios Nasios, Vasileios Panagiotopoulos and Stylianos Gatzonis
Healthcare 2021, 9(9), 1156; https://doi.org/10.3390/healthcare9091156 - 03 Sep 2021
Cited by 7 | Viewed by 2483
Abstract
We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neuropsychological function in adult patients undergoing resective TLE surgery [...] Read more.
We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neuropsychological function in adult patients undergoing resective TLE surgery and followed for a mean/median > five years period. Two independent reviewers screened citations for eligibility and assessed relevant studies for the risk of bias. We found eleven studies fulfilling the above requirements. Cognitive function remained stable through long-term follow up despite immediate post-surgery decline; a negative relation between seizure control and memory impairment has emerged and a possible role of more selective surgery procedures is highlighted. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
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22 pages, 2659 KiB  
Review
Repetitive Transcranial Magnetic Stimulation in the Treatment of Alzheimer’s Disease and Other Dementias
by Athina-Maria Aloizou, Georgia Pateraki, Konstantinos Anargyros, Vasileios Siokas, Christos Bakirtzis, Markos Sgantzos, Lambros Messinis, Grigorios Nasios, Eleni Peristeri, Dimitrios P. Bogdanos, Triantafyllos K. Doskas, Georgios Tzeferakos and Efthimios Dardiotis
Healthcare 2021, 9(8), 949; https://doi.org/10.3390/healthcare9080949 - 28 Jul 2021
Cited by 9 | Viewed by 3584
Abstract
Dementia is a debilitating impairment of cognitive functions that affects millions of people worldwide. There are several diseases belonging to the dementia spectrum, most prominently Alzheimer’s disease (AD), vascular dementia (VD), Lewy body dementia (LBD) and frontotemporal dementia (FTD). Repetitive transcranial magnetic stimulation [...] Read more.
Dementia is a debilitating impairment of cognitive functions that affects millions of people worldwide. There are several diseases belonging to the dementia spectrum, most prominently Alzheimer’s disease (AD), vascular dementia (VD), Lewy body dementia (LBD) and frontotemporal dementia (FTD). Repetitive transcranial magnetic stimulation (rTMS) is a safe, non-invasive form of brain stimulation that utilizes a magnetic coil to generate an electrical field and induce numerous changes in the brain. It is considered efficacious for the treatment of various neuropsychiatric disorders. In this paper, we review the available studies involving rTMS in the treatment of these dementia types. The majority of studies have involved AD and shown beneficial effects, either as a standalone, or as an add-on to standard-of-care pharmacological treatment and cognitive training. The dorsolateral prefrontal cortex seems to hold a central position in the applied protocols, but several parameters still need to be defined. In addition, rTMS has shown potential in mild cognitive impairment as well. Regarding the remaining dementias, research is still at preliminary phases, and large, randomized studies are currently lacking. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
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15 pages, 781 KiB  
Review
Telerehabilitation of Post-Stroke Patients as a Therapeutic Solution in the Era of the Covid-19 Pandemic
by Paulina Magdalena Ostrowska, Maciej Śliwiński, Rafał Studnicki and Rita Hansdorfer-Korzon
Healthcare 2021, 9(6), 654; https://doi.org/10.3390/healthcare9060654 - 31 May 2021
Cited by 21 | Viewed by 4968
Abstract
(1) Background: Due to the pandemic caused by the SARS-CoV-2 virus, rehabilitation centres have become less available for neurological patients. This is the result of efforts to physically distance society, to try to slow the spread of the pathogen. Health care facilities [...] Read more.
(1) Background: Due to the pandemic caused by the SARS-CoV-2 virus, rehabilitation centres have become less available for neurological patients. This is the result of efforts to physically distance society, to try to slow the spread of the pathogen. Health care facilities were mainly restricted to urgent cases, while most physiotherapy treatments, mainly for patients with chronic conditions, were suspended. Some countries have seen a reduction in acute stroke hospital admissions of from 50% to 80%. One solution to the above problem is the use of telerehabilitation in the home environment as an alternative to inpatient rehabilitation. (2) Aim of the study: The purpose of this review is to analyse the benefits and limitations of teletherapy in relation to the functional condition of post-stroke patients. (3) Methods: Selected publications from 2019 to 2021 on the telerehabilitation of stroke patients were reviewed. The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. (4) Results: Studies have proven that teletherapy significantly improves the functional condition of post-stroke patients, resulting in improved quality of life and faster return to independence (while maintaining maximum possible precautions related to the SARS-CoV-2 virus pandemic). (5) Conclusions: Analysis of the study results showed comparable effectiveness of rehabilitation in the tele system to inpatient therapy. However, it should be emphasised that patients undergoing telerehabilitation must meet strict conditions to be eligible for this type of treatment program. However, the strength of the evidence itself supporting the effectiveness of this method ranks low due to the limited number of randomised control trials (RCT), small number of participants, and heterogeneous trials. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
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Other

11 pages, 287 KiB  
Brief Report
The Association between Mental Motor Imagery and Real Movement in Stroke
by Ana Poveda-García, Carmen Moret-Tatay and Miguel Gómez-Martínez
Healthcare 2021, 9(11), 1568; https://doi.org/10.3390/healthcare9111568 - 17 Nov 2021
Cited by 5 | Viewed by 2119
Abstract
Background: Stroke is the main cause of disability in adults; the most common and long-term sequela is upper-limb hemiparesis. Many studies support the idea that mental motor imagery, which is related to the visualization of movement patterns, activates the same areas of the [...] Read more.
Background: Stroke is the main cause of disability in adults; the most common and long-term sequela is upper-limb hemiparesis. Many studies support the idea that mental motor imagery, which is related to the visualization of movement patterns, activates the same areas of the cortex as if the movement occurred. Objectives: This study aims to examine the capacity to elaborate mental motor images, as well as its relationship to loss of movement in the upper limbs after a stroke. Method: An observational study, in a sample of 39 adults who suffered a stroke, was carried out. The upper limb movement and functionality, cognitive disorders, the ability to visualize mental images, and activities of daily living were examined. Results: The results depicted a statistically significant correlation between the ability to visualize upper limb mental motor images with movement, functionality, and strength. In addition, a correlation between visual–spatial skills and mental visualization of motor ability and upper limb movement was found. Conclusions: These results suggest that the rehabilitation approach focused on the improvement of mental motor imagery could be of interest for the upper limb rehabilitation of movement and functionality. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
17 pages, 806 KiB  
Systematic Review
Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review
by Aida Agost-González, Isabel Escobio-Prieto, Azahara M. Pareja-Leal, María Jesús Casuso-Holgado, María Blanco-Diaz and Manuel Albornoz-Cabello
Healthcare 2021, 9(7), 879; https://doi.org/10.3390/healthcare9070879 - 13 Jul 2021
Cited by 14 | Viewed by 2998
Abstract
Background: Percutaneous electrical stimulation and transcutaneous electrical stimulation (PTNS and TTNS) of the posterior tibial nerve are internationally recognized treatment methods that offer advantages in terms of treating patients with overactive bladder (OAB) who present with urinary incontinence (UI). This article aims to [...] Read more.
Background: Percutaneous electrical stimulation and transcutaneous electrical stimulation (PTNS and TTNS) of the posterior tibial nerve are internationally recognized treatment methods that offer advantages in terms of treating patients with overactive bladder (OAB) who present with urinary incontinence (UI). This article aims to analyze the scientific evidence for the treatment of OAB with UI in adults using PTNS versus TTNS procedures in the posterior tibial nerve. Methods: A systematic review was conducted, between February and May 2021 in the Web of Science and Scopus databases, in accordance with the PRISMA recommendations. Results: The research identified 259 studies, 130 of which were selected and analyzed, with only 19 used according to the inclusion requirements established. The greatest effectiveness, in reducing UI and in other parameters of daily voiding and quality of life, was obtained by combining both techniques with other treatments, pharmacological treatments, or exercise. Conclusions: TTNS has advantages over PTNS as it is more comfortable for the patient even though there is equality of both therapies in the outcome variables. More research studies are necessary in order to obtain clear scientific evidence. Full article
(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)
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