Články v odborných impaktovaných časopisech (IF)

2021

Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized controlled trial

Vilimovsky, T.1; Chen, P.2,3; Hoidekrova, K.4,5,6; Petioky J.4,5,7; Harsa P.1

Afiliace autorů 1 Department of Psychiatry, First Faculty of Medicine, Charles University, Prague (CZE)
2 Kessler Foundation, West Orange, New Jersey (US)
3 Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey (US)
4 First Faculty of Medicine, Charles University, Prague (CZE)
5 Rehabilitation Center Kladruby (CZE)
6 Faculty of Physical Education and Sport, Charles University, Prague (CZE)
7 Neurosciences, Third Faculty of Medicine, Charles University, Prague (CZE)

PloS one, 16(1),1-17, e0245425
Dostupné on-line.

Abstract (ENG)

Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modelling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.

2020

Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury

Keller, J.1,2; Štětkářová, I.2; Macri, V.3; Kühn, S.4; Pětioký, J.5; Gualeni, S.6; Simmons, C.S.7; Arthanat, S.8; Zilber, P.3

Afiliace autorů 1 Department of Radiology, Na Homolce Hospital, Prague (CZE)
2 Department of Neurology, Third Faculty of Medicine, Charles University, Prague (CZE)
3 3D PreMotorSkill Technologies LLC, Tallahassee, FL (USA)
4 Department of Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg (GER)
5 Rehabilitation Center Kladruby (CZE)
6 Institute of Digital Games, University of Malta, Msida (Malta)
7 School of Occupational Therapy, MCPHS University, Manchester, NH (USA)
8 Department of Occupational Therapy, University of New Hampshire, Durham, NH (USA)

J NeuroEngineering Rehabil 17, 127 (2020)
Dostupné on-line.

Abstract (ENG)

Background
Individuals with acquired brain injuries (ABI) are in need of neurorehabilitation and neurorepair. Virtual anatomical interactivity (VAI) presents a digital game-like format in which ABI survivors with upper limb paresis use an unaffected limb to control a standard input device and a commonplace computer mouse to control virtual limb movements and tasks in a virtual world.

Methods
In a prospective cohort study, 35 ambulatory survivors of ABI (25/71% stroke, 10/29% traumatic brain injury) were enrolled. The subjects were divided into three groups: group A received VAI therapy only, group B received VAI and physical/occupational therapy (P/OT), and group C received P/OT only. Motor skills were evaluated by muscle strength (hand key pinch strength, grasp, and three-jaw chuck pinch) and active range of motion (AROM) of the shoulder, elbow, and wrist. Changes were analysed by ANOVA, ANCOVA, and one-tailed Pearson correlation analysis. MRI data was acquired for group A, and volumetric changes in grey matter were analysed using voxel-based morphometry (VBM) and correlated with quantified motor skills..Background Individuals with acquired brain injuries (ABI) are in need of neurorehabilitation and neurorepair. Virtual anatomical interactivity (VAI) presents a digital game-like format in which ABI survivors with upper limb paresis use an unaffected limb to control a standard input device and a commonplace computer mouse to control virtual limb movements and tasks in a virtual world. Methods In a prospective cohort study, 35 ambulatory survivors of ABI (25/71% stroke, 10/29% traumatic brain injury) were enrolled. The subjects were divided into three groups: group A received VAI therapy only, group B received VAI and physical/occupational therapy (P/OT), and group C received P/OT only. Motor skills were evaluated by muscle strength (hand key pinch strength, grasp, and three-jaw chuck pinch) and active range of motion (AROM) of the shoulder, elbow, and wrist. Changes were analysed by ANOVA, ANCOVA, and one-tailed Pearson correlation analysis. MRI data was acquired for group A, and volumetric changes in grey matter were analysed using voxel-based morphometry (VBM) and correlated with quantified motor skills. Results AROM of the shoulder, elbow, and wrist improved in all three groups. VBM revealed grey matter increases in five brain areas: the tail of the hippocampus, the left caudate, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex. A positive correlation between the grey matter volumes in three cortical regions (motor and premotor and supplementary motor areas) and motor test results (power and AROM) was detected. Conclusions Our findings suggest that the VAI rehabilitation program significantly improved motor function and skills in the affected upper extremities of subjects with acquired brain injuries. Significant increases in grey matter volume in the motor and premotor regions of affected hemisphere and correlations of motor skills and volume in nonaffected brain regions were present, suggesting marked changes in structural brain plasticity. Trial registration The trial “Limitations of motor brain activity – use of virtual reality for simulation of therapeutic interventions” has been registered under reference number ISRCTN11757651.

Results
AROM of the shoulder, elbow, and wrist improved in all three groups. VBM revealed grey matter increases in five brain areas: the tail of the hippocampus, the left caudate, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex. A positive correlation between the grey matter volumes in three cortical regions (motor and premotor and supplementary motor areas) and motor test results (power and AROM) was detected.

Conclusions
Our findings suggest that the VAI rehabilitation program significantly improved motor function and skills in the affected upper extremities of subjects with acquired brain injuries. Significant increases in grey matter volume in the motor and premotor regions of affected hemisphere and correlations of motor skills and volume in nonaffected brain regions were present, suggesting marked changes in structural brain plasticity.

Trial registration
The trial “Limitations of motor brain activity – use of virtual reality for simulation of therapeutic interventions” has been registered under reference number ISRCTN11757651.