NeuroRehabilitation - Volume 18, issue 4

Authors: West, Deborah

Article Type: Introduction

DOI: 10.3233/NRE-2003-18401

Citation: NeuroRehabilitation, vol. 18, no. 4, pp. 279-279, 2003

Authors: Glueckauf, Robert L. | Blonder, Lee X. | Ecklund-Johnson, Eric | Maher, Lynn | Crosson, Bruce | Gonzalez-Rothi, Leslie

Article Type: Research Article

Abstract: Objective: To perform a preliminary evaluation of a questionnaire designed to assess functional outcomes of treatment for aphasia. Methods: The Functional Outcome Questionnaire for Aphasia (FOQ-A) is an inventory consisting of 32 caregiver-completed items rating the person with stroke's ability to perform various communication behaviors on a 5-point scale. The total score for the FOQ-A is reported as a mean of all completed items. The FOQ-A was administered by research assistants to caregivers of patients with left hemisphere stroke (n = 18). Results: The FOQ-A showed acceptable initial reliability and validity properties. As …predicted, the FOQ-A displayed high positive correlations with standardized functional communication measures. The FOQ-A also showed only weak associations with other measures (health-related quality of life, caregiver strain). Conclusions: Overall results of our preliminary psychometric examination of the FOQ-A were promising. The findings suggested that the FOQ-A may be a sensitive measure of functional communication abilities and does not appear to be biased heavily by caregiver strain. Plans for further evaluation of the FOQ-A are discussed. Show more

Keywords: aphasia, communication, rehabilitation outcome, stroke

DOI: 10.3233/NRE-2003-18402

Citation: NeuroRehabilitation, vol. 18, no. 4, pp. 281-290, 2003

Authors: Wilson, F.C. | Harpur, J. | Watson, T. | Morrow, J.I.

Article Type: Research Article

Abstract: Over 16 years, Wilson [31] saw and assessed 567 patients, 18 (3.2%) had a primary diagnosis of cerebral hypoxia. The present patient survey includes all referrals for assessment, management/advice and neuropsychological rehabilitation to a part-time clinical neuropsychology service, who were seen by the first author over a five year period (October 1995–2000). Of the total patient sample (n = 168), 13 (7.7%) had incurred hypoxic damage from a variety of causes; [3] carbon monoxide poisoning (smoke inhalation), [3] cardiac arrest, [1] accidental alcohol and drug overdose, [1] near (partial) drowning, [1] near hanging (suffocation), [2] respiratory arrest following prolonged …status epilepticus, [1] respiratory arrest following severe pneumonia and [1] following Addisonian crisis. The survey includes a sub-group of patients in vegetative and minimally responsive states on referral. Wilson [31] highlighted that considerable variation in cognitive functioning is likely to be observed depending on (a) nature or cause of the hypoxic insult and (b) the degree of anoxia/hypoxia experienced itself. The results of the present survey when compared with Wilson's earlier work provide a larger total data-set from which to draw conclusions and has implications for practitioners who see such patients and are involved in their multidisciplinary management and rehabilitation. Show more

Keywords: cerebral hypoxia, cognitive status, long-term outcome, neuropsychological impairments

DOI: 10.3233/NRE-2003-18403

Citation: NeuroRehabilitation, vol. 18, no. 4, pp. 291-298, 2003

Authors: Cruz, Vitor Tedim | Nunes, Belina | Reis, Ana Mafalda | Pereira, Jorge Resende

Article Type: Research Article

Abstract: Objectives: To investigate motor cortex function in upper and lower limb amputees and dysmelic patients using fMRI. Material and methods: Five amputees and two dysmelic patients were examined. Motor and imagery tasks were defined according to each patient limb deficiency. Cortical activation patterns were analysed for each patient and compared between groups, integrating patients clinical data. Results: There is a consistent pattern of cortical reorganization in all amputees: predominance of activation in the ipsilateral motor cortex and extension to premotor and sensory areas of the contralateral cortex. On the contrary, cortical maps of dysmelic …patients were similar to those of healthy volunteers, predominantly with activation of contralateral primary motor cortex areas. Conclusions: fMRI discloses specific patterns of cortical reorganization on amputees and dysmelic patients, suggesting influence by prosthesis adaptation or stump use with dexterity. These findings could be further applied in influencing neurorehabilitation and development of prosthetic devices. Show more

Keywords: limb amputation, amputees, dysmelia, limb prosthesis, sensorimotor cortex, cortical reorganization, cortical mapping, fMRI

DOI: 10.3233/NRE-2003-18404

Citation: NeuroRehabilitation, vol. 18, no. 4, pp. 299-305, 2003

Authors: Antepohl, Wolfram | Kiviloog, Liisa | Andersson, Jan | Gerdle, Björn

Article Type: Research Article

Abstract: Aim: To verify the occurrence of cognitive impairment in patients with chronic whiplash-associated disorder (WAD) and to provide a more detailed description of the impairment's character and context. Methods: Thirty (30) patients with chronic WAD and 30 matched healthy controls completed a cognitive test battery. Four computerised tests were used: a) two different types of cognitive tasks (reaction time vs. working memory) and b) two types of information processing (verbal vs. spatial). Before testing and after every randomised subtest, subjects rated their pain level on a visual analogue scale. Results: A worse overall performance …among patients with WAD and, specifically, worse results concerning working memory tasks were found. Post-hoc testing revealed a statistically significant difference concerning the single variable “verbal reaction time”. Pain intensity among patients increased significantly during testing. Pain intensity after the subtest for verbal mental reaction time (independent of test sequence) was significantly correlated with results in this subtest, the more pain, the more time was needed. Conclusion: Compared to healthy controls, patients performed worse overall. Concerning verbal reaction time, the impairment was correlated with pain intensity. The findings support the hypothesis that pain might be one important factor leading to cognitive impairment in patients with chronic WAD. Show more

Keywords: cognition, pain, whiplash

DOI: 10.3233/NRE-2003-18405

Citation: NeuroRehabilitation, vol. 18, no. 4, pp. 307-315, 2003

Authors: Tzvetanov, Plamen | Rousseff, Rossen T.

Article Type: Research Article

Abstract: Objective: To assess the predictive value of median somatosensory evoked potentials (SSEP) in the acute phase of brain infarction or hemorrhage regarding long-term prognosis. Materials and methods: Ninety-four stroke patients mean age 61.2, SD 11.8) were included. CT confirmed diagnoses were: cortical middle cerebral artery (MCA) infarction in 35; subcortical MCA 11; mixed 25. By size, infarctions were: massive, 29; restricted, 33; and lacunar, 9. The number of patients with thalamic hemorrhage was 8; putamenal hemorrhage, 7; other, 8. All patients presented with severe hemiparesis (54) or hemiplegia (40) with hemihipoesthesia in 89 patients. Median SSEP were …recorded early (up to 7th day, mean 5.2 days, SD 0.72). SSEP parameters (presence/absence of SSEP, absolute and relative latency, amplitude of early waveforms) were compared to motor (Medical Research Council scale) and functional ability (Barthel index) at 3 and 12 months after stroke. Results: Absolute N20 amplitudes and amplitude ratio evidenced almost similar predictive values that reached 66.4% at 12 months. Combined application of N20 and MRC gains provided significantly stronger prognostic information which reached 72%. Conclusions: Median SSEP parameters may serve as independent predictors of outcome. Most informative in prognosis in the early stage of stroke was the combined assessment of MRC and N20-P25 amplitude ratio. Show more

Keywords: stroke prognosis, somatosensory evoked potentials, functional recovery

DOI: 10.3233/NRE-2003-18406

Citation: NeuroRehabilitation, vol. 18, no. 4, pp. 317-324, 2003

Authors: Pearson, Erin J. | Sapienza, Christine M.

Article Type: Research Article

Abstract: Adductor-type spasmodic dysphonia (ADSD) is a voice disorder of uncertain, though likely neurogenic origin. Symptoms of the disorder include mild to profound “strain and strangle” sensations during voiced speech tasks that, in the most severe form, are physically and psychologically debilitating. Over the years, treatment approaches have evolved from behavioral attempts at voice modification, to surgical and, most recently, pharmacological treatments involving partial and temporary paralysis of muscle fibers within the larynx following injection of botulinum toxin or Botox™. The most current research hints at the potential benefits of a multi-faceted approach to symptom management, combining behavioral with pharmacological treatments. …The following is intended as a review and tutorial of treatment approaches for ADSD. The tutorial is intended for practicing clinical professionals with an interest in the treatment of neurogenic disorders of voice and speech. Show more

Keywords: spasmodic dysphonia, ADSD, voice disorder, dystonia

DOI: 10.3233/NRE-2003-18407

Citation: NeuroRehabilitation, vol. 18, no. 4, pp. 325-338, 2003

Authors: Jones, D.G. | Anderson, E.R. | Galvin, K.A.

Article Type: Research Article

Abstract: The failure of the adult human spinal cord to regenerate following injury is not absolute, but appears to be amenable to therapeutic manipulation. Recent work has shown that the provision of a growth permissive environment by the neutralization of inhibitory influences, or the grafting of fetal tissue, peripheral nerve, Schwann cells, or olfactory ensheathing cells can enhance regeneration in animal models of spinal cord injury. Stem cells are gaining ever-increasing favour as a treatment option for spinal cord injury. The potential of neural stem cells, embryonic stem cells, and bone marrow stromal cells is discussed. Additional treatment options such as …pharmacological interventions, functional electrical stimulation and physiotherapy approaches are also explored. Basic science insights are used as a foundation for a discussion of a variety of clinical perspectives including repair of the chronically injured spinal cord, animal models of human spinal cord injuries and clinical trials. A more holistic approach towards spinal cord injury is suggested, one where a hierarchy of needs is recognised and quality of life is paramount. Finally, this review cautions against overly grandiose claims of an imminent miracle cure for human spinal cord injury. Show more

Keywords: animal model, bone marrow stromal cell, chronic injury, clinical trial, functional electrical stimulation, grafting, olfactory ensheathing cell, Schwann cell, stem cell

DOI: 10.3233/NRE-2003-18408

Citation: NeuroRehabilitation, vol. 18, no. 4, pp. 339-351, 2003