NeuroRehabilitation - Volume 22, issue 2

Authors: Cho, Sang-Hyun | Shin, Hwa-Kyung | Kwon, Yong-Hyun | Lee, Mi Young | Lee, Young-Hee | Lee, Chu-Hee | Yang, Dong Suk | Jang, Sung-Ho

Article Type: Research Article

Abstract: Objectives: We tried to examine whether visual biofeedback tracking training (VBTT) can improve both the gait performance and cortical activation pattern in chronic stroke patients. Design: We enrolled 10 chronic hemiparetic patients with stroke(mean age 46.3 ± 5.19 years). The patients were randomly assigned to the training group (5 patients) or the control group (5 patients). VBTT was to follow the PC-generated sine waves with the knee joint electrogoniometer, and the two sine waves should appear as close to overlapping as possible on the PC monitor. The training was performed for 39 minutes/day, 5 days/week, for 4 …weeks. Pre-training and post-training accuracy of tracking, functional status of gait, and functional MRI (fMRI) were measured. fMRI was performed at 1.5 T in parallel with timed knee flexion-extension movements at a fixed rate. Results: The accuracy of the tracking performance, walking speed, and motor scale for gait improved in the training group. Primary sensorimotor cortex (SM1) cortical activation shifted significantly from the unaffected to the affected hemisphere in the training group. Conclusions: We demonstrated that cortical activation changes occurred with gait function improvement in chronic stroke patients throughout the 4-week VBTT program. It seems that the cortical reorganization was induced by VBTT. Show more

Keywords: Functional MRI, gait, stroke, cortical reorganization, tracking training

DOI: 10.3233/NRE-2007-22201

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 77-84, 2007

Authors: Blonder, Lee X. | Langer, Shelby L. | Pettigrew, L. Creed | Garrity, Thomas F.

Article Type: Research Article

Abstract: Objective: To examine the effects of unilateral stroke patients' neurobehavioral characteristics on spousal psychosocial function. Participants: The sample consisted of twenty unilateral stroke patients and their spousal caregivers. Methods: Patient assessments included mood, affect perception, sensorimotor and cognitive function, marital satisfaction, and activities of daily living. Spousal assessments included mood, marital satisfaction, and perceived stress. Results: To avoid the risk of committing a type I error, the alpha-level of 0.05 was corrected for multiple comparisons involving the three outcome measures, resulting in an adjusted alpha of 0.017 (0.05/3). Using this criterion, the …negative correlation between patient depression and spousal marital satisfaction was statistically significant (rs = −0.585, p = 0.007). There was also a trend for hemispheric side of stroke to correlate with spousal stress (rs = 0.498, p = 0.025), such that strokes in the left hemisphere were associated with greater stress, whereas strokes in the right hemisphere were associated with less stress. Conclusion: These results show that patient depression in particular constitutes a risk factor for marital dissatisfaction in the first few months following stroke. Given that spousal partners provide a large portion of informal support to stroke patients, successful treatment of patient depression may have benefits at the level of the individual, family, and community. Show more

DOI: 10.3233/NRE-2007-22202

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 85-92, 2007

Authors: Moiyadi, Aliasgar V. | Devi, B. Indira | Nair, K.P. Sivaraman

Article Type: Research Article

Abstract: Aim: To detect presence of urodynamic abnormalities in patients with traumatic brain injuries. Materials and Methods: A prospective study was conducted recruiting patients sustaining moderate or severe head injuries. Clinical and radiological evaluation was done. Neurocognitive and functional outcomes were assessed. Patients then underwent standardized urodynamic studies. The urodynamic findings were correlated with outcome and statistically analyzed. Results: 11 of 20 patients recruited had urodynamic abnormalities, in spite of only two being symptomatic. An overactive detrussor was detected in 8 (one with sphincter dyssynergia) and reduced detrussor compliance was found in 3. Only presence of …motor deficits correlated statistically with the occurrence of these abnormalities. Conclusions: Asymptomatic urodynamic abnormalities may be common in patients with moderate/severe traumatic brain injury. Presence of motor deficits may predict the occurrence of such abnormalities. Show more

Keywords: Traumatic brain injury, urinary disturbances, urodynamics, overactive bladder, rehabilitation

DOI: 10.3233/NRE-2007-22203

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 93-98, 2007

Authors: Farrell, John F. | Hoffman, Henry B. | Snyder, Janet L. | Giuliani, Carol A. | Bohannon, Richard W.

Article Type: Research Article

Abstract: This was a phase 1 investigation of an upper limb training program using the SaeboFlex dynamic orthosis to improve upper limb motor status. Thirteen individuals with chronic hemiparesis from stroke (age 26–71 years) participated. After being fitted with a SaeboFlex orthosis, each participant was engaged in 5 days of training (6 hours per day) that consisted of repetitive, task oriented activities with the SaeboFlex, exercises, and functional electrical stimulation. Individuals demonstrated improvements in movement at the shoulder and elbow. Wrist extension also improved, but wrist flexion and finger movement did not. Two more global measures of upper limb status improved. …Muscle tone decreased. All participants remained pain free. This investigation demonstrates that a program using the orthosis was accompanied by many desirable changes and no untoward consequences. Show more

Keywords: Stroke, arm, hand, recovery, rehabilitation

DOI: 10.3233/NRE-2007-22204

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 99-103, 2007

Authors: Kwon, Yong-Hyun | Lee, Chu-Hee | Ahn, Sang Ho | Lee, Mi Young | Yang, Dong Suk | Byun, Woo Mok | Park, Ji-Won | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: Diffusion tensor image tracography (DTT) could be useful for exploration of the state of the corticospinal tract at the subcortical white matter level. We investigated the neural pathway associated with motor recovery in the patients with corona radiata infarct (CR) using DTT. Design: Three hemiparetic patients who showed severe weakness of the affected upper extremity at stroke onset, were recruited. DTT was performed twice (subacute and chronic stage) using 1.5-T system. Three-dimensional reconstructions of the fiber tracts were obtained with FA <0.2, angle >45° as termination criteria. Results: In all patients, the motor …function of the affected upper extremity has recovered to be functional state at second DTT scanning. The motor tracts of the affected hemisphere were observed to pass along the posterior portion of the CR infarct on both the first and second DTT. Conclusions: It seems that the motor function of the affected upper extremity of the patients recovered via the posterior portion of infarct. This finding may reflect functional reorganization of the motor pathway following damage to the corticospinal tract. Show more

Keywords: Diffusion tensor image, stroke, motor recovery, corona radiata

DOI: 10.3233/NRE-2007-22205

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 105-108, 2007

Authors: van 't Hooft, Ingrid | Andersson, Karin | Bergman, Barbro | Sejersen, Thomas | von Wendt, Lennart | Bartfai, Aniko

Article Type: Research Article

Abstract: The overall aim of the present study was to assess in greater detail the sustained effects of a broad-based cognitive training programme on the neuropsychological performance of children with acquired brain injury. In particular, the long term (6 months) effects on cognitive functions, as well as how various moderators (gender, age at the time of injury/diagnosis, time since injury/diagnosis, age at the training) might influence outcome were investigated. A group of 38 children, 9–16 years of age, with various types of acquired brain injury had earlier been randomly assigned into treatment and control groups. These two groups …had first been assessed directly after completion of the training and were now reassessed 6 months later. The treatment group exhibited significantly more persistent improvements with respect to complex tasks of attention and memory in comparison to the control group. In contrast there were no differences on simple reaction time tests. We conclude that the long term effects on cognitive functions of this broad-based neuro-cognitive training is encouraging. These positive results should be further investigated in larger more specific diagnostic groups and in different settings. Show more

Keywords: Cognitive training, training effects, acquired brain injuries, children

DOI: 10.3233/NRE-2007-22206

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 109-116, 2007

Authors: Jang, Sung Ho | You, Sung H. | Ahn, Sang Ho

Article Type: Research Article

Abstract: Purpose: This study highlights the effects of a comprehensive neurorehabilitation (CN) on neuroplasticity and motor recovery in a 25 years old adult with right hippocampal sclerosis and the temporal lobectomy and amygdalotomy. Methods: The patient received 8-month course of comprehensive neurorehabilitation, comprised of five times/week. Motor behavioral and 1.5 T functional magnetic resonance imaging (fMRI) tests were implemented to determine the restoration of motor function and neuroplasitic changes, respectively. In fMRI measure, a laterality index (LI) was used to determine any shift in the symmetry of cortical activation between the hemispheres. Additionally, motor behavioral changes were measured …to probe long-term retention of learned motor skills at the 6-month post-treatment follow-up test. Results: Motor behavioral tests showed that comprehensive neurorehabilitation enhanced functional reaching, grasping, and hand manipulation skills, which were well retained even at the 6-month post-treatment. Baseline fMRI showed asymmetry of the contralesional sensori-motor cortex (SMC) activation (Laterality index score: 0.54), but was restored to normal symmetry (Lateral index: 1.0) during affected hand movement after comprehensive neurorehabilitation. Conclusions: Our novel findings suggest that comprehensive neurorehabilitation may facilitate restitution of normal symmetry of cortical activation, thereby enhancing motor function. This case provides the first neuroimaging evidence about a long-term comprehensive neurorehabilitation -induced neuroplasticity of the individual with a complex brain injury in the literature. Show more

Keywords: Functional MRI, brain injury, hemiplegia, rehabilitation

DOI: 10.3233/NRE-2007-22207

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 117-122, 2007

Authors: Mount, Julie | Pierce, Samuel R. | Parker, Janet | DiEgidio, Rebecca | Woessner, Russell | Spiegel, Lenore

Article Type: Research Article

Abstract: Objective: To compare the effectiveness of errorless learning versus trial and error learning for teaching activities of daily living to patients with acute stroke with or without explicit memory impairments. Design: Randomized crossover. Setting: Rehabilitation hospital. Participants: Thirty-three adult subjects following an acute stroke. Intervention: Subjects were taught to prepare a wheelchair for a transfer and to put on a sock with a sock-donner. Tasks were taught using errorless learning or trial and error learning. Explicit memory was assessed using the Neurobehavioral Cognitive Status Exam. Main …Outcome Measures: Days until subject was able to demonstrate retention of the task, and success or failure at carry-over to a similar task. Results: No significant differences were found in days to retention for either functional task when taught using errorless learning or trial and error learning in subjects with or without explicit memory impairments. Carry-over was significantly better when trial and error learning was used for learning sock donning. Conclusions: When choosing the best learning method for patients undergoing rehabilitation for stroke, the nature of the task should be considered. Additional research is needed to identify the best approach for teaching activities of daily living and facilitating carry-over of learning in individuals with acute stroke. Show more

Keywords: Cerebrovascular accident, errorless learning, activities of daily living, rehabilitation

DOI: 10.3233/NRE-2007-22208

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 123-132, 2007

Authors: Yildiz, S. | Bademkiran, F. | Yildiz, N. | Aydogdu, I. | Uludag, B. | Ertekin, C.

Article Type: Research Article

Abstract: Hand motor representation area expands towards the area of the perioral facial motor cortex in patients with peripheral facial paralysis (PFP) and in hemifacial spasm cases treated with botulinum toxin. In this current study, we aimed to investigate the changes both in the ipsilateral and contralateral facial motor cortex areas in patients with PFP with transcranial magnetic stimulation (TMS). Thirty healthy individuals and 41 patients with unilateral PFP with partial or total axonal degeneration participated in this study. Motor evoked potentials (MEPs) of perioral muscles elicited by TMS of the intracranial portion of the facial nerve and motor …cortex, were recorded. TMS was delivered through a figure-of-eight coil. Mapping of the cortical representation of perioral muscles were also studied in 13 of 41 patients and in 10 of control subjects. Mean amplitude of the intact perioral MEPs elicited by the ipsilateral hemisphere TMS, was significantly higher in patients than the control subjects. There was also a mild enlargement of the mean cortical representation area of intact perioral muscles on both hemispheres though it was not significant. We have concluded that there was a cortical reorganization in the hemisphere contralateral to the paralytic side resulting in an increase at corticofugal output related to intact perioral muscles. Show more

Keywords: Peripheral facial paralysis, plasticity, motor cortex, motor evoked potentials, mapping

DOI: 10.3233/NRE-2007-22209

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 133-140, 2007

Authors: Jang, Sung Ho | Kim, Seong Ho | Cho, Soo Ho | Choi, Byung Yun | Cho, Yun Woo

Article Type: Research Article

Abstract: Objectives: Little is known about the mechanism of motor recovery for patients with intracerebral hemorrhage (ICH). We attempted to demonstrate the motor recovery mechanism in a hemiparetic patient with ICH using diffusion tensor tractography (DTT), transcranial magnetic stimulation (TMS), and functional MRI (fMRI). Subjects: A 37-year-old female patient and twelve age-matched control subjects were evaluated. The patient presented with complete paralysis of the left extremities, which occurred at the onset of a spontaneous ICH in the left corona radiata and basal ganglia. Over the 16 month period following onset, motor function of the affected extremities slowly recovered …to a nearly normal state. Three longitudinal evaluations (at 1 month, 4 months, and 16 months from onset) were conducted for the patient. Results: DTT showed that the origin of the corticospinal tract (CST) had changed from the posterior parietal cortex, primary sensory cortex, and primary motor cortex. Additionally, TMS and fMRI demonstrated the recovery process of the damaged lateral CST. Conclusions: It seems that, in this patient, the affected motor function was recovered through the normalization process of the damaged lateral CST of the affected hemisphere. We conclude that this may be one of various motor recovery mechanisms for patients with ICH. Process of the damaged lateral CST. Show more

Keywords: Diffusion tensor imaging, magnetic stimulation, functional MRI, stroke

DOI: 10.3233/NRE-2007-22210

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 141-145, 2007

Authors: Shin, Yong-Il | Yang, Chung-Yong | Joo, Min-Cheol | Moon, Seong-Keun | Park, Jong-Tae | Kim, Tai-Jin

Article Type: Case Report

Abstract: Spontaneous spinal epidural hematoma (SSEH) is a rare space-occupying disease. The pathogenesis of SSEH is unclear, but anticoagulant therapy, arteriovenous malformation, coagulopathy, tumors and infection are risk factors. Ventral SSEH is even more rare, as the ventral sac is fixed firmly to the posterior longitudinal ligament. The authors report a very rare case, a 16-year-old previously healthy female who had repeated relapse of cervico-thoracic SSEH. This occurred three times in the ventral epidural space with subsequent syringomyelia, without structural abnormality and coagulopathy. The patient underwent conservative care twice, and two operations. The diagnosis was made by magnetic resonance imaging. In …rapidly progressing SSEH, the clinician should make the diagnosis as early as possible to enable spinal decompression surgery. Show more

Keywords: Hematoma, epidural, recurrence, syringomyelia, spinal cord

DOI: 10.3233/NRE-2007-22211

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 147-150, 2007

Authors: Han, Bong Soo | Kim, Seong Ho | Kim, Oh Lyong | Cho, Soo Ho | Kim, Yun-Hee | Jang, Sung Ho

Article Type: Case Report

Abstract: Objectives: The purpose of this study is to identity the recovery process of the corticospinal tract with diffuse axonal injury (DAI) using diffusion tensor imaging (DTI). Design: A 47-year-old female patient and six age-matched control subjects were evaluated. The patient presented with quadriparesis (more severe in the right extremities than the left ones) due to DAI at the onset of traumatic brain injury. Over the 24-month period following the onset of the injury, motor function of the four extremities slowly recovered to range which was close to normal. Two longitudinal DTIs were acquired from the patient (at …10 weeks and 24 months from onset) and from the control subjects. Fractional anisotropy (FA) and an apparent diffusion coefficient were measured using the region of interest (ROI) method. Results: On the 10-week DTI, FAs of ROIs of the brainstem in both hemispheres of the patient were significantly lower than those of the control subjects. Compared to normal controls, the patient showed significantly increased FA in both sides of the brainstem at 24 months after the onset, which occurred in parallel with the improvement in motor function. Conclusions: Recovery in this patient could be attributed to the recovery of the corticospinal tract with diffuse axonal injury. Show more

Keywords: Motor recovery, diffusion tensor image, corticospinal tract, diffuse axonal injury

DOI: 10.3233/NRE-2007-22212

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 151-155, 2007

Article Type: Correction

DOI: 10.3233/NRE-2007-22213

Citation: NeuroRehabilitation, vol. 22, no. 2, pp. 157-157, 2007