NeuroRehabilitation - Volume 20, issue 2

Authors: West, Deborah

Article Type: Introduction

DOI: 10.3233/NRE-2005-20201

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 69-69, 2005

Authors: Cho, Yun Woo | Jang, Sung Ho | Lee, Zee Ihn | Song, Jun Chan | Lee, Hye Kyoung | Lee, Hyun Young

Article Type: Research Article

Abstract: Objective: To investigate the effect on fine motor ability and the appropriate restriction period of constraint-induced movement therapy in hemiparetic patients with brain injury. Design: Nine chronic hemiparetic patients with brain injury were studied. After confirming the cessation of further recovery of fine motor ability by Purdue pegboard test and motor function by the Medical Research Council for three consecutive weeks, the affected hand was restricted with an opposition restriction orthosis. The fine motor ability of the affected hand was assessed weekly using Purdue pegboard test and the orthosis was taken off when the Purdue pegboard score …showed no further increase over three consecutive weeks. Results: Purdue pegboard score increased in all patients. The mean post-treatment Purdue pegboard score (10.7) was significantly increased over that of pre-treatment (8.7) (p < 0.05). The mean restriction period was 3.6 weeks (range, 2 to 5 weeks). Conclusion: Constraint-induced movement therapy is an effective therapeutic method to improve the fine motor ability of the hemiparetic hand of brain-injured patients. It can be assumed that the appropriate restriction period is best decided individually, on a case by case basis, according to the time that maximizes the hand function of the affected hand. Show more

Keywords: brain injury, physical therapy, hemiparesis, fine motor ability, orthosis

DOI: 10.3233/NRE-2005-20202

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 71-74, 2005

Authors: Kulak, Wojciech | Sobaniec, Wojciech

Article Type: Research Article

Abstract: Clinical assessment and imaging studies of twenty-six children with hemiparetic cerebral palsy (HCP) were conducted. For each child 20 artifact-free EEG epochs, each of 2 s duration were selected for spectral analysis to calculate spectral power and coherence functions. A fast Fourier transformation alogorithm of signal processing was used to obtain the power spectrum of each lead. The objective of this study was to estimate EEG spectral power as well as the interhemispheric (ICoh) and intrahemispheric (Hcoh) coherence in children with hemiparetic cerebral palsy (HCP) as compared with healthy children. Significant differences between the HCP and control children were noted …in the distribution of the alpha, theta and delta rhythms over the left and right hemispheres. In this study we found significant differences between the HCP and control children in the distribution of alpha, theta, delta and beta rhythm over the left and right hemispheres. Significant differences between the HCP and control children were in the distribution of the theta rhythm over the right and left hemispheres. The lower ICoh at the temporal, parietal and occipital derivations in the alpha band implies hypoconnectivity between the right and left hemispheres. The HCoh asymmetry, which implies relative hypoconnectivity within the right and left hemispheres, suggests the functional hemispheric differentiation may be diminished in comparison with the controls. Show more

Keywords: hemiparetic cerebral palsy, EEG, spectral analysis, coherence

DOI: 10.3233/NRE-2005-20203

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 75-84, 2005

Authors: Stoykov, Mary Ellen Phillips | Stojakovich, Mark | Stevens, Jennifer A.

Article Type: Research Article

Abstract: Primary objective: This paper examined the effectiveness of postural training on upper extremity performance in an ataxic individual. The ataxia resulted from a brain stem stroke. Research design: Before-after, single-subject experimental design. Experimental intervention: Four-week course of postural training, comprised of three one-hour sessions/week. Main outcomes and results: The patient demonstrated an increase in function of the ataxic limb, as evidenced by appreciable increases in the Fugl-Meyer score and modest increases in the Postural Assessment Scale for Stroke Patients (PASS) score. Conclusions: Improvement in postural control influences upper extremity function affecting the …speed and accuracy of the movement. We demonstrate the effectiveness of using postural training as an intervention towards reducing the effects of ataxia, a movement coordination impairment for which relatively few therapeutic techniques have been specifically developed or evaluated. Show more

Keywords: ataxia, posture, brainstem stroke, rehabilitation

DOI: 10.3233/NRE-2005-20204

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 85-89, 2005

Authors: Katz-Leurer, Michal | Shochina, Mara

Article Type: Research Article

Abstract: Objective: To examine the correlation between motor impairment, aerobic capacity and HRV parameters in patients who had recently had an ischemic stroke. Design: Thirty-nine patients, after a first CVA. Measurements: motor performance (measured by the Motor Assessment Scale (MAS)), aerobic capacity (measured by Heart Rate (HR) at maximal effort and maximal workload (MWL) at graded stress test), both tested two weeks and three-month post event. Heart Rate Variability (HRV) parameters included time domain (ms) and power spectrum (ms2 ) were tested up to two weeks post event. Results: HRV parameters correlated positively with motor performance and …aerobic capacity two weeks (MAS: r p = 0.47 , p < 0.01 , maximal workload: r p = 0.26 , P < 0.05 ) and three-month (MAS: r p = 0.41 , p < 0.01 , maximal workload: r p = 0.20 , not significant) post-stroke. Conclusions: HRV in the acute phase of stroke have positive connection to motor performance and aerobic capacity two weeks post event, and may have a prognostic value to assess motor ability three-month post the event. Show more

Keywords: teart rate variability, motor impairment, aerobic capacity, stroke

DOI: 10.3233/NRE-2005-20205

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 91-95, 2005

Authors: Ng, Yee Sien | Chua, Karen S.G.

Article Type: Research Article

Abstract: Objective: To identify and characterize demographics, injury variables, complications, and functional outcomes in Asian patients presenting in States of Severely Altered Consciousness (SSAC). Design: Descriptive case series review. Setting/Subjects: Acute rehabilitation unit with intensive, comprehensive neurological rehabilitation program. Thirty consecutive patients diagnosed to be in persistent vegetative state (PVS) or minimally conscious (MCS) state over a 4-year period were included. Main Outcome Measures: Disability Rating Scale (DRS), Ranchos Los Amigos Scale (RLAS), Modified Barthel Index (MBI). Results: Seventeen (57%) were male, with a mean age of 31.8 years …(median 25y, range 15–74, SD 16.3y). Twenty-one (70%) had traumatic brain injury, and median GCS on acute admission was 5. The mean length of stays (LOS) in acute and rehabilitation facilities was 90.1 days and 106.3 days respectively. Tracheostomized patients had longer acute LOS. (p = 0.03). All patients had improvement in their DRS scores upon rehabilitation discharge. The MBI was insensitive in identifying low-level changes; though paired analyses were significant for improvement. Seventeen (57%) patients were in PVS and the rest in MCS on admission to rehabilitation. Twelve patients progressed to a state of awareness, with eye responses as the most frequent first sign. There was a greater spread of higher RLAS categories on rehabilitation discharge. Urinary tract infection (16 patients, 53%) was the most common medical complication. Nineteen (63%) had central fever and this group was more functionally disabled (p = 0.045). The mean number of medications on discharge was 6. The majority of patients (22 patients, 73%) were discharged home, and patients continued to make functional progress post-discharge. Conclusions: Despite SSAC states, the majority improve, however profound disability persists. Possible predictors of a worse outcome include tracheostomy, severity of initial disability, initial RLAS II level and presence of central fever. Show more

Keywords: rehabilitation, persistent vegetative state, minimally conscious state, traumatic brain injury, outcomes

DOI: 10.3233/NRE-2005-20206

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 97-105, 2005

Authors: Docking, Kimberley M. | Ward, Elizabeth C. | Murdoch, Bruce E.

Article Type: Research Article

Abstract: While the occurrence and management of brainstem tumours in children would not traditionally indicate potential direct structural impact on classical language centres, recent theories have implicated some involvement of the brainstem in a functional language and cognitive neural loop between the cerebellum and the cerebral hemispheres. Thus, the present paper explored the impact of treatment for brainstem tumour on the general and high-level language abilities of six children treated for brainstem tumour, in addition to phonological awareness skills. Group analysis revealed that children treated for brainstem tumour demonstrated intact language and phonological awareness abilities in comparison to an age- and …gender-matched control group. Individual analysis revealed only one of six children treated for brainstem tumour revealed evidence of language disturbances, with an additional child demonstrating an isolated mildly reduced score on one phonological awareness task. Language deficits identified in a child treated with a combination of both radiotherapy and chemotherapy were noted in the high-level language area of lexical generation. Findings highlighted that no overt language disturbances were evident in children treated for brainstem tumour. However, further analysis into higher-level language skills in the present study indicated that both general and high-level language abilities require long-term monitoring in this population. Show more

Keywords: language, brainstem, tumour, children

DOI: 10.3233/NRE-2005-20207

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 107-124, 2005

Authors: Kafri, M. | Dickstein, R.

Article Type: Research Article

Abstract: The purpose of this work was to get insight into the role of frontal trunk and proximal extremity muscles in rolling from supine to side lying. Participants were seventeen hemiparetic patients and 14 healthy subjects. Electromyographic (EMG) activity of the Sternocleidomasoid (ScM), Pectoralis Major (PM), External Oblique (ExO) and Rectus Femoris (RF) muscle pairs was recorded during rolling performance. Analysis included the establishment of EMG response times and magnitudes. For all muscles, initiation of EMG activity was delayed in the patients as compared with the controls. Among the healthy subjects, EMG activity level of the SCM was more enhanced on …the mobile than on the stable body side, while activation level of the PM muscle was larger on the stable body side. In the hemiparetic group, the SCM demonstrated similar results as the controls yet, PM activity on the paretic side was lower than on the non-paretic side regardless of rolling direction. The difference in activation level between the corresponding ExO and RF muscles showed inconsistency among the healthy subjects, whereas in the hemipareic group the muscles on the paretic side never displayed higher activation levels than on the non-paretic side. In conclusion, rolling sideways in hemiparetic subjects is characterized by a normal relationship between activation levels of the SCM muscles while the relationship between the corresponding PM, ExO and RF muscles is hampered due to reduced activation level of the muscles on the paretic body side. Show more

Keywords: stroke, hemiparesis, rolling, rotation, physical-therapy

DOI: 10.3233/NRE-2005-20208

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 125-131, 2005

Authors: Broetz, Doris | Karnath, Hans-Otto

Article Type: Research Article

DOI: 10.3233/NRE-2005-20209

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 133-138, 2005

Authors: Reistetter, Timothy A. | Spencer, Jean C. | Trujillo, Leonard | Abreu, Beatriz C.

Article Type: Research Article

Abstract: Objective: To examine instrument reliability, validity, factor structure, and conceptual underpinnings of the Community Integration Measure (CIM) with the Community Integration Questionnaire Revised (CIQ-R) and the Satisfaction with Life Scale (SWLS). Design: A replication study. Setting: Community living. Participants: Ninety-one participants: 51 individuals with a brain injury, and 40 without brain injury. Main outcomes: Internal consistency, criterion validity, construct validity, discriminant validity factor structure. Results: CIM items produced standardized alphas ranging from 0.72 to 0.83. Significant positive correlations were found among the CIM and both …the CIQ-R and SWLS, with the CIM performing better with the SWLS than did the CIQ-R. The CIM discriminated between subject samples as well as by living arrangement. The factor loading solution revealed a three-factor model that explained 63.72 percent of the variance. Conclusion: The CIM shows good promise for capturing an individual's perception of community integration. The factor structure supports the original Model of Community Integration. Further research is needed to examine the influence of objective items on the CIM and Model of Community Integration. Show more

Keywords: community integration, life satisfaction, measurement, brain injury

DOI: 10.3233/NRE-2005-20210

Citation: NeuroRehabilitation, vol. 20, no. 2, pp. 139-148, 2005