NeuroRehabilitation - Volume 18, issue 3

Authors: West, Deborah

Article Type: Introduction

DOI: 10.3233/NRE-2003-18301

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 187-187, 2003

Authors: Bounds, Thomas A. | Schopp, Laura | Johnstone, Brick | Unger, Clarinda | Goldman, Herb

Article Type: Research Article

Abstract: Because traumatic brain injury affects between 1.5 and 2 million individuals per year and results in long term vocational and financial difficulties, there is growing interest in determining those factors that predict successful outcomes for specific groups of individuals with TBI. An NIH consensus panel on TBI has suggested that women are one group that needs more attention, particularly given the studies indicating that men and women experience different cognitive [14], emotional [19], and vocational outcomes following TBI [5]. The current study evaluated differences in injury severity, demographics, neuropsychological abilities, and vocational and financial outcomes for 78 persons with TBI …(55 male, 23 female) who received services from a state Vocational Rehabilitation Division (DVR). Despite similar injury severity, neuropsychological and demographic characteristics, more men (43.6%) received Maintenance services from MO-DVR than women (21.7%). Of note, only 4.4% of the women were successfully employed through DVR, compared to 23.6% of the men. In addition, 73.9% of the women had services terminated after being accepted by DVR but before services were initiated, compared to 56.4% of the men. The significance of these results is discussed, as are the limitations of the current project. Show more

DOI: 10.3233/NRE-2003-18302

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 189-196, 2003

Authors: Johnstone, Brick | Price, Terrie | Bounds, Thomas | Schopp, Laura H. | Schootman, Mario | Schumate, Duane

Article Type: Research Article

Abstract: Objective: To evaluate differences in demographics, injury severity, and vocational outcomes for persons with TBI based on rural vs. urban residency. Participants: 78 individuals with TBI (28 from rural counties, 50 from urban counties) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a two year period. Measures: Demographics (i.e., age, race, education), injury severity (i.e., loss of consciousness, post traumatic amnesia, length of hospitalization, neuropsychological test scores), VR services provided (e.g., transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs. unsuccessfully employed; cost per case). Procedure: …All participants completed a standard neuropsychological evaluation and completed VR services (i.e., were followed from enrollment to case closure). Rural and urban residency was determined using U.S Office of Management and Budget definitions of metropolitan and non-metropolitan areas. Analyses: Chi-squares, Fisher's Exact tests, Wilcoxon Rank Sums test, and MANOVAs. Results: Few if any differences were found between the groups in demographics (i.e., more African Americans in urban areas), injury severity (i.e., more rural residents with multiple TBIs), or neuropsychological test scores. However, individuals from urban areas received significantly more maintenance funds (46% vs. 21%), transportation services (36% vs. 11%), and on-the-job training (28% vs. 7%), and had more spent on them ($1,816 vs $1,242). Although statistically non-significant (p < 0.15), 24% of individuals from urban areas were successfully employed at VR case closure, compared to only 7% of individuals from rural areas. Conclusions: Individuals with TBI from rural and urban settings have generally similar demographic, injury severity, and neuropsychological abilities, although they appear to differ in terms of vocational outcomes and number of VR services received, possibly related to limited availability of resources in rural areas. Show more

Keywords: traumatic brain injury, vocational rehabilitation, rural

DOI: 10.3233/NRE-2003-18303

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 197-203, 2003

Authors: Krieger, Deborah | Hansen, Keith | McDermott, Colleen | Matthews, Roy | Mitchell, Rachel | Bollegala, Natasha | Bhalerao, Shree

Article Type: Research Article

Abstract: The use of typical neuroleptics has always been the mainstay of treatment for delirium following traumatic brain injury (TBI). Given the recent application of atypical neuroleptics to various psychiatric conditions formerly treated with typical neuroleptics, one questions whether this new class of drugs is superior to its predecessor in treating delirium post-TBI. We present a case of one patient with TBI-induced delirium where in fact the use of the typical mid-potency neuroleptic, loxapine, appeared to have a better clinical effect over the atypical neuroleptic, olanzapine.

Keywords: delirium, brain injury, neuroleptic, loxapine, olanzapine

DOI: 10.3233/NRE-2003-18304

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 205-208, 2003

Authors: Bhatia, Sangeeta | Gupta, Ashum

Article Type: Research Article

Abstract: Parkinson's disease (PD) is a neurodegenerative disorder with progressive impairment in motor and cognitive functioning. A review of past research shows that individuals experience not only physical discomfort brought on by the illness, but also considerable psychological distress. Increased dependency on a caregiver due to impairments in activities of daily living (e.g., walking, eating, dressing) may bring on feelings of being a burden and strain relationships. However, since PD is a chronic illness, it necessitates family caregiving throughout the life-span. This has implications for the family members who need to redefine their roles within the family to manage the circumstances …brought on by the illness. Such strains may include finances, threats to employment, social isolation or health strain. Thus, it becomes imperative to provide unrelenting support to the affected family and individual, to enable them to refocus and learn to manage new illness-related, task-oriented, and affective roles. This enhances the integrity and self-esteem of the patient and helps the family's adjustment to illness of a member. This paper outlines, the role of mental health professionals in providing counseling and psychoeducational approaches to helping patients and their families. Show more

Keywords: Parkinson's disease, caregiving, cognition, counseling, psychoeducation

DOI: 10.3233/NRE-2003-18305

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 209-214, 2003

Authors: Alon, Gad | Sunnerhagen, Katharina Stibrant | Geurts, Alexander C.H. | Ohry, Avi

Article Type: Research Article

Abstract: Objectives: To test if a combined stimulation-training program can improve selected hand functions and impairments of chronic stroke survivors. Design: Pretest-Posttest, multi-site 5-week training program. Stroke survivors (N = 77) with chronic upper limb paresis completed a home-based stimulation program combining activation of the wrist-fingers flexors and extensors with functional grasp, hold and release training. Subjects trained 2–3 times each day, 7 days a week. Outcome measures included: the Jebsen-Taylor simulated feeding (S-feed); light object lift (J-T light); heavy object lift (J–T heavy); Box and Blocks test (B&B); Nine-Hole Peg (9-HP); Ashworth scale (Spasticity); Visual analog scale-VAS …(Pain). Paired t-tests (α < 0.01) were performed on each study outcome. Results: Simulated feeding time decreased from 39.1 ± 30.9 sec to 25.5 ± 23.3 sec (34.8% improvement). The task time of the J–T light decreased by 13.3 sec and the J–T heavy by 11.5 sec (44.9% and 40.9% improvement respectively). The number of blocks moved increased from 19.4 ± 11.6 to 24.5 ± 12.5 (26.3% improvement) and the time to complete the 9-HP decreased from 178.8 ± 170.8 to 105.0 ± 117.1 sec (58.7% improvement). Mean reduction of spasticity was 0.87 and 0.78 points at the elbow and wrist respectively. Patients with persistent pain (N = 33) reported mean reduction from 3.5 ± 2.5 to 1.9 ± 1.8. Conclusions: Five weeks of daily home training with a task-specific stimulation program improved selected hand functions and upper limb impairments associated with chronic post-stroke paresis. Show more

Keywords: stroke, hand, functional electrical stimulation, pain, spasticity

DOI: 10.3233/NRE-2003-18306

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 215-225, 2003

Authors: Widdig, Walter | Pleger, Burkhard | Rommel, Oliver | Malin, Jean-Pierre | Tegenthoff, Martin

Article Type: Research Article

Abstract: Cortical visual disturbances can occur after traumatic or ischemic brain lesion. Patients mostly suffer from hemianopia. Different treatment approaches in patients with hemianopia are being debated with respect to their effectiveness. For more severely disabled patients with cortical blindness or residual rudimentary vision (RRV) no systematic therapeutic approaches have been reported. In a case study the positive effects of a recently developed repetitive photic stimulation therapy in a patient with RRV after a bioccipital ischemic infarction are presented. The application of this new therapy over several months, supported by treatment with amphetamines led to a statistically significant improvement of different …visual functions and a reoccurrence of visual abilities important in daily life. The pathophysiological basis and possible neurorehabilitative consequences that arise from these results are discussed with respect to similar findings in animal experiments. Show more

Keywords: cortical blindness, tachistoscopic stimulation, photic stimulation, cortical plasticity, treatment of visual disorders

DOI: 10.3233/NRE-2003-18307

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 227-237, 2003

Authors: Bilbao, Alvaro | Kennedy, Cille | Chatterji, Somnath | Üstün, Bedirhan | Barquero, José Luis Vásquez | Barth, Jeffrey T.

Article Type: Research Article

Abstract: The traditional disease and diagnostic medical model is not always useful to brain injury professionals who need to describe, measure, and compare deficits associated with neurologic insult. Professionals in neurorehabilitation are in need of new systems that will assist them in identifying impairments and areas of intervention. The aim of this article is to present the International Classification of Functioning, Disability and Health (ICF), and its applications to brain injury rehabilitation. This taxonomy, developed by the WHO, allows the classification and assessment of functioning and disability in everyday activities and social involvement for individuals with medical conditions. Multi-disciplinary …teams from 65 countries have collaborated in the development of the ICF to develop a tool that serves different purposes and disciplines with high trans-cultural validity. It can be of great value for professionals working in the field of brain injury who need to describe and quantify in detail neurocognitive, emotional, and sensory-motor functions as well as their impact on activities and participation in life situations. Its applications also extend to the domains of epidemiology, public health and public policy. Show more

Keywords: ICF, brain injury rehabilitation, WHO, classification, participation, contextual factors

DOI: 10.3233/NRE-2003-18308

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 239-250, 2003

Authors: Matjačić, Zlatko | Hesse, Stefan | Sinkjaer, Thomas

Article Type: Research Article

Abstract: In this paper we present a mechanical apparatus and methods named BalanceReTrainer for standing-balance training in neurologically impaired individuals. BalanceReTrainer provides an impaired individual with a fall-safe balancing environment, where the balancing efforts of a standing individual are augmented by stabilizing forces acting at the level of pelvis in the sagittal and frontal planes of motion, assisting the balancing activity ankle and hip muscles and at the level of shanks, assisting the knee extensor muscles. A range of different levels of supporting forces is generated by passive, compliant means. Additionally, movement in the sagittal and frontal planes, acquired by transducers …is fed to an electronic interface which transforms the current inclinations into a computer mouse signals, which are interfaced to a personal computer (PC) where balance training and evaluation program is running. The level of stiffness support and level of difficulty of computer task can be selected according to current balancing abilities of the impaired individual. We further present results of a case study where an ambulatory chronic hemiparetic subject with neglect syndrome received ten days of balance training on BalanceReTrainer. Biomechanical evaluation of weight-shifting activity before and after treatment shows a substantial functional improvement. Show more

Keywords: standing-balance training, neurological rehabilitation, stroke

DOI: 10.3233/NRE-2003-18309

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 251-259, 2003

Authors: Katz, Richard T.

Article Type: Research Article

Abstract: Objectives: Physicians may be asked by attorneys or other patient advocates to help plan for the long-term needs of children with cerebral palsy (CP) and developmental disability (DD). The first step in such planning is to thoroughly examine the literature dealing with life expectancy in these populations. This review paper comprehensively reviews the literature relating to survival in children with cerebral palsy and developmental disability. Study Selection: A Medline data search was completed using the terms cerebral palsy, life expectancy, survival, as well as other pertinent terms. Further articles were gleaned from bibliographies of pertinent literature. …Data Synthesis: Certain key disabilities can be used to accurately predict life expectancy in children with cerebral palsy and mental retardation. These include: (1) presence and severity of mental retardation, (2) inability to speak intelligible words, (3) inability to recognize voices, (4) inability to interact with peers, (4) severity of physical disability, (5) use of tube feeding, (6) incontinence, and (7) presence and severity of seizures. Conclusions: Literature review definitively shows that children with CP and DD have a diminished life expectancy, which can be assessed based on simple clinical examination findings. Show more

Keywords: life care planning, cerebral palsy, life expectancy

DOI: 10.3233/NRE-2003-18310

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 261-270, 2003

Authors: Müller, Thomas | Voß, Birgit | Hellwig, Kerstin | Przuntek, Horst

Article Type: Research Article

Abstract: Background: There is a move towards treatment of Parkinson's disease (PD) patients in specialized units, however, data on the outcome and on daily antiparkinsonian drug costs are rare. Objective: The objective of this study was to elucidate relationships between costs of drug treatment and efficacy of drug titration in a PD clinic. Subjects and methods: We calculated costs of drug therapy and scored severity of PD of 63 consecutively referred in-patients initially and at the end of their hospital stay under standardized conditions. Results: Titration of antiparkinsonian drugs significantly induced a decrease of PD …symptoms and an increase of daily drug costs. There were significant correlations between the degree of (i) improvement of the UPDRS score, (ii) increase of dopaminergic agents and (iii) change of corresponding daily antiparkinsonian drug costs. Conclusion: Our results demonstrate the effectiveness of treatment in PD clinics, which results in increased daily antiparkinsonian drug costs due to elevated dopaminergic substitution. Show more

Keywords: Parkinson's disease, pharmacoeconomics, tapping, peg insertion

DOI: 10.3233/NRE-2003-18311

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 271-275, 2003

Authors: LaRuffa, Gia M.

Article Type: Book Review

DOI: 10.3233/NRE-2003-18312

Citation: NeuroRehabilitation, vol. 18, no. 3, pp. 277-277, 2003