NeuroRehabilitation - Volume 23, issue 3

Authors: Depedibi, R. | Ünlü, E. | Çevikol, A. | Akkaya, T. | Çakcı, A. | Çerekçi, R. | Köse, G. | Ünlüsoy, D.

Article Type: Research Article

Abstract: Objective: To determine the effect of botulinum toxin type A (BTX-A) on spasticity and functional development in children with cerebral palsy (CP) in conjunction with a physiotherapy program. Method: In this prospective study, 18 CP patients were evaluated. Multilevel BTX-A injection was applied to children at a dose of 15 U/kg. Children were assessed before and at the 5th and 12th week post-injection using Thomas test, Duncan-Ely test, passive range of motion (pROM) measurement, Distance Between Knee (DBK), Selective Motor Control (SMC) scale, modified Ashworth Scale (MAS) and modified Physician Rating Scale (mPRS). To assess functional improvement, Gross …Motor Function Measure (GMFM) and Functional Independence Measure for Children (WeeFIM) were used before and at the 12th week post-injection. Results: At 5th week post-injection, a statistically significant decrease was determined in spasticity (p < 0.01). Improvement was observed in mPRS and pROM, but not in SMC. At the 12th week post-injection, GMFM (p < 0.001) and WeeFIM improved significantly (p < 0.001). The improvement in pROM and mPRS (p < 0.01) lasted until the 12th week post-injection, but the improvement in MAS (p > 0.05) and in the Tardieu test of hip adductors (p > 0.05) did not last after the 5th week. Conclusion: BTX-A injection enhances functional and motor abilities in the development process. Show more

Keywords: Cerebral palsy, botulinum toxin a, GMFM, WeeFIM, physical therapy

DOI: 10.3233/NRE-2008-23301

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 199-205, 2008

Authors: Tamplin, Jeanette

Article Type: Research Article

Abstract: This pilot study aimed to investigate the effects of vocal exercises and singing on intelligibility and speech naturalness for subjects with acquired dysarthria following traumatic brain injury or stroke. A multiple case study design was used, involving pre, mid, and post-treatment assessments of intelligibility, rate, naturalness, and pause time for four subjects with dysarthria. Each subject participated in 24 individual music therapy sessions over eight weeks involving oral motor respiratory exercises, rhythmic and melodic articulation exercises, rhythmic speech cuing, vocal intonation therapy, and therapeutic singing using familiar songs. Results were measured using a standardized dysarthric speech assessment – the Sentence …Intelligibility Test, waveform analysis, and ratings of speech naturalness. Statistically significant improvements in functional speech intelligibility were achieved but improvements in rate of speech were not significant. Speech naturalness improved post-treatment and a reduction in the number and length of pauses was verified via waveform analysis. Preliminary findings suggest that a program of vocal exercises and singing may facilitate more normative speech production for people with acquired dysarthria and support the need for further research in this area. Show more

Keywords: Music therapy, singing, dysarthria, rehabilitation, TBI, stroke

DOI: 10.3233/NRE-2008-23302

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 207-216, 2008

Authors: Jegede, Adejoke B. | Gilbert, Christopher | Tulkin, Steven R.

Article Type: Research Article

Abstract: Purpose: To explore agonist and antagonist muscle characteristics, depression and physical functioning of patients with Fibromyalgia Syndrome (FMS). Method: Individuals with FMS (N = 34) and chronic pain (N = 36) were recruited from a chronic pain program. Normal controls (N = 37) were recruited from the general community. Measures: Demographic data (age, gender, marital status, ethnicity, and employment status), self-report physical and psychological functioning, current level of pain, level of depression, and agonist and antagonist muscle activity (SCM, Biceps/triceps, Forearm flexor/extensor, Lower leg tibialis anterior/gastrocnemius) were measured with sEMG. Results: There was a …significant difference in upper arm muscle contra-activation between the FMS patients and normal controls but not between the non-FMS chronic pain patients and normal controls. When compared to normal controls, the FMS group reported more depression and a higher level of physical functioning problems, but it was not significantly different from the mean score for the non-FMS chronic pain group. Problems with physical functioning and depression did not predict strength of contra-activation in the upper arm muscle. Conclusion: These findings suggest presence of unusual muscle activity occurring in the bicep muscle of FMS and non-FMS chronic pain patients, which establishes a possible link between muscle dysfunction, mood and pain. Show more

Keywords: Fibromyalgia, muscle activity, pain, depression, agonist muscle, antagonist muscle

DOI: 10.3233/NRE-2008-23303

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 217-230, 2008

Authors: Ansari, Noureddin Nakhostin | Naghdi, Soofia | Arab, Tahereh Khosravian | Jalaie, Shohreh

Article Type: Research Article

Abstract: The Modified Ashworth Scale (MAS) is a clinical scale used to assess muscle spasticity. While the evidence indicates that the reliability of the MAS is better in the upper limb and in certain distal muscle groups, no investigation has compared the effect of limbs and muscle groups on the MAS reliability. This study aimed to evaluate the effect of limb and muscle group on the reliability of the MAS in patients with spastic hemiplegia. Thirty subjects with upper and lower limb muscle spasticity were recruited for this trial. Two female experienced physiotherapists participated in this examination of reliability, and rated …each patient in a randomized order in a single session. For the intrarater reliability, the second rater repeated the test 1 week later. Shoulder adductor, elbow flexor, wrist flexor, hip adductor, knee extensor, and ankle plantar flexor were tested on the hemiplegic side. Results demonstrated moderate inter (κ = 0.514, SE = 0.046, p < 0.001) and intrarater (κ = 0.590, SE = 0.051, p < 0.001) reliability. For the inter and intrarater reliability, the agreement obtained for the upper and lower limb was similar. In the upper limb, the agreement between raters on the distal wrist flexor was significantly higher than the agreement on the proximal shoulder adductor. In the lower limb, there was a similar agreement between raters on the distal ankle plantar flexor and proximal hip adductor. For within rater, the agreement on the proximal and distal muscles of both limbs was not statistically significant. The Modified Ashworth Scale had moderate reliability. The limbs had no effect on the reliability. The agreement on distal wrist flexor in the upper limb was significantly higher between rater than in the proximal shoulder adductor. The agreement obtained with the MAS was not good, which questions the validity of the measurements. Show more

Keywords: Spasticity, Modified Ashworth Scale, reliability, hemiplegia

DOI: 10.3233/NRE-2008-23304

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 231-237, 2008

Authors: Kim, Dong Gyu | Cho, Yun Woo | Hong, Ji Heon | Song, Jun Chan | Chung, Hyun-Ae | Bai, Dai-seg | Lee, Chu-Hee | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: Constraint-induced movement therapy (CIMT) has been demonstrated to be effective in improving hemiparetic upper extremity function in stroke patients, but few studies have been performed to assess orthosis modification. We investigated the effect of the newly designed small orthosis named modified opposition restriction orthosis (MORO) in chronic hemiparetic patients with stroke. Design: Twenty-one stroke patients were randomly assigned to the CIMT group or control group. Thirteen patients in the CIMT group wore MORO confining the thumb and index finger for at least 5 hours of each day, 7 days a week for 8 weeks. The affected upper …extremity function was evaluated using the manual function test (MFT), Purdue Pegboard (PP) score, and motor activity log (MAL) at pre and post-CIMT. Results: Four of the 13 patients in the CIMT group dropped out due to motivational problems, and 9 patients remained in the CIMT group at the end of the study. The patients in the CIMT group showed a mean improvement of 195.8% on MAL AOU (Amount of Use), 24.6% on PP score, and 5.5% on MFT. Conclusion: This new MORO would be effective for use in a CIMT program in chronic hemiparetic patients with stroke. Show more

Keywords: Constraint-induced movement therapy, orthosis, stroke, hemiparesis

DOI: 10.3233/NRE-2008-23305

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 239-244, 2008

Authors: Shinoura, Nobusada | Suzuki, Yuichi | Watanabe, Yasuko | Yamada, Ryozi | Tabei, Yusuke | Saito, Kuniaki | Yagi, Kazuo

Article Type: Research Article

Abstract: Mirror therapy is effective in the rehabilitation of patients with hemiparesis, but its mechanism is not clear. In this study, a patient with brain tumor (patient 1) who underwent mirror therapy after surgery and showed drastic recovery of hand paresis, a patient with visual memory disturbance (patient 2), and five normal volunteers performed tasks related to mirror therapy in fMRI study. In patient 1 and all normal volunteers, right and left hand clenching with looking at a mirror (eye open) activated outside of cerebellum, while right and left hands clenching with eye closed activated inside of cerebellum. In patient 2, …mirror therapy did not activate outside of cerebellum. In patient 1, and 3 out of 5 normal volunteers, the area of right (affected) M1 activated by right and left hands clenching with eye open was more than that by right and left hands clenching with eye closed, and that right M1 was activated by right hand clenching with eye open. In conclusion, mirror therapy facilitate the paresis of patients by activating ipsilateral M1 and outside of cerebellum, which is possibly related to visual memory function. Show more

Keywords: Cerebellum, fMRI, M1, mirror therapy

DOI: 10.3233/NRE-2008-23306

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 245-252, 2008

Authors: Hoffmann, Tammy | Russell, Trevor | Thompson, Leah | Vincent, Amy | Nelson, Mark

Article Type: Research Article

Abstract: The ability to measure activities of daily living (ADL) and hand function for people with Parkinson's disease via an Internet-based telerehabilitation system would have a significant impact on the equity, accessibility, and management of the condition for patients who live in rural and remote communities. A low-bandwidth computer-based telerehabilitation system, which incorporates videoconferencing with calibrated assessment tools, has been recently developed at the University of Queensland. This study aimed to determine the validity, intra- and inter-rater reliability of the telerehabilitation system in measuring ADL and hand function in 12 people with Parkinson's disease. ADL status was assessed using the motor …component of the Functional Independence Measure (FIM) and selected items from the Unified Parkinson's Disease Rating Scale (UPDRS). The Nine Hole Peg Test, Jamar dynamometer and Preston pinch gauge were also used to assess hand function. For half of the participants, an assessor administered assessments in the traditional face-to-face manner while another assessor simultaneously scored the same assessments via the telerehabilitation system. For the remaining participants, the telerehabilitation assessor administered the assessments via the telerehabilitation system while a face-to-face assessor simultaneously scored the assessments. The telerehabilitation system was found to be a valid measure of ADL status and hand function in people with Parkinson's disease and to have a high level of intra- and inter-rater reliability (all ICCs > 0.80). These results suggest that therapists can confidently use a low-bandwidth telerehabilitation system to assess ADL status and hand function in people with Parkinson's disease. Show more

Keywords: Telerehabilitation, Parkinson's disease, occupational therapy, activities of daily living, Internet

DOI: 10.3233/NRE-2008-23307

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 253-261, 2008

Authors: Farris, Sierra M. | Giroux, Monique L.

Article Type: Case Report

Abstract: Subthalamic (STN) deep brain stimulation (DBS) is an effective treatment for advanced Parkinson's disease. We present a patient with significant gait problems due to Parkinson's disease (PD) who underwent STN DBS. Gait worsened after surgery despite significant improvement in parkinsonian signs, due to underlying spasticity previously overshadowed by his parkinsonian motor symptoms. This case illustrates an emergence of dysfunction in gait in a patient with otherwise improved function and reinforces the need for an interdisciplinary approach to care of these patients.

DOI: 10.3233/NRE-2008-23308

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 263-265, 2008

Authors: Buchanan, Robert J. | Kaufman, Michael | Zhu, Li | James, Wesley

Article Type: Research Article

Abstract: Do people with multiple sclerosis who receive the majority of their care from neurologists perceive access to and quality of their care differently than people receiving their care from medical internists, family/general practitioners, and other types of physicians? The objective of this study is to identify any patient-identified differences in MS-related care by the practice specialty of the principal care physician, as well as differences by practice specialty in satisfaction with access to physician services and differences in patient perceptions of quality. Data were collected by surveying 1,518 people with MS throughout the United States and grouped by practice specialty …of principal care physician (neurologist, internal medicine, family/general practice, and other physicians). Significant differences were observed by practice specialty of the principal care physician in physician understanding of various aspects of MS, satisfaction with access to MS-focused care, and quality of MS-focused care, with neurologists associated with better patient perceptions. Patients consider MS-related care superior when it is delivered by neurologists compared to MS patients receiving care from medical internists, family/general practitioners, and other physicians. Show more

Keywords: Multiple sclerosis, practice specialty, quality, access

DOI: 10.3233/NRE-2008-23309

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 267-272, 2008

Authors: Locke, Dona E.C. | Smigielski, Jeffrey S. | Powell, Matthew R. | Stevens, Susanna R.

Article Type: Research Article

Abstract: Recent findings suggest that compromised patient effort occurs in nonlitigious settings, but the nature and base rate of suboptimal effort in these settings remains poorly understood. In the treatment-seeking, acquired brain injury, outpatient rehabilitation sample included in this investigation, 21.8% of the patients scored below recommended cutting scores for suboptimal effort on the Test of Memory Malingering (TOMM). Disability status was the only variable explored in this study to be associated with suboptimal effort. It should be noted, however, that the proportion of patients on disability was large in both the optimal and suboptimal effort groups, suggesting that failure on …the TOMM may not be a specific predictor of disability status in this sample. Importantly, performance on the TOMM was unrelated to age, education, time from injury to evaluation, and injury severity. Depression and anxiety were also shown to be unrelated to TOMM performance in this rehabilitation sample. As expected, performance on neurocognitive testing was significantly lower in the suboptimal effort group. This study suggests that reduced effort occurs outside forensic settings, is related to neuropsychometric performance, and urges further research into effort across various settings. Show more

Keywords: Effort, neurorehabilitation, acquired brain injury

DOI: 10.3233/NRE-2008-23310

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 273-281, 2008

Authors: Park, Ji-Won | Kwon, Yong Hyun | Lee, Mi Young | Bai, Daiseg | Nam, Ki-Seok | Cho, Yoon Woo | Lee, Chu-Hee | Jang, Sung Ho

Article Type: Research Article

Abstract: The aim of this study was to compare the areas of brain activation between complex and simple exercises in a unimanual hand and to assess the possibility of an exercise task for paretic hands following stroke. The subjects included 11 healthy right-handed volunteers. The complex exercise was a wooden ball rotation task with the unimanual hand and the simple exercise was a hand grasp task performed during a functional MRI scan. Stronger activation of the left primary sensorimotor cortex, the left premotor area, and the ipsilateral cerebellum emerged when the complex movement was performed. Ipsilateral activity was located in the …primary sensory cortex and premotor area, and contralateral activity was shown in the left cerebellum. These results suggest that a unimanual ball rotation task may be appropriate for rehabilitation of a movable paretic hand in an early stage of stroke recovery, which should provide motor and sensory input using external stimuli, while the simple motor task may appropriate in a compensatory stage, and should inhibit the ipsilateral activity due to maladaptive plasticity. Show more

Keywords: Functional MRI, ball rotation task, stroke, complex exercise

DOI: 10.3233/NRE-2008-23311

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 283-288, 2008

Authors: Broetz, Doris | Hahn, Ulrich | Maschke, Evelin | Wick, Wolfgang | Kueker, Wilhelm | Weller, Michael

Article Type: Research Article

Abstract: Background: Lumbar disk prolapses are among the most common neurological conditions. In this open study, we asked whether repeated end-range spinal movements (McKenzie method) as physiotherapy in patients with lumbar disk prolapse induce early changes in location, size and signal intensity of lumbar disc material detectable by magnetic resonance imaging (MRI). We compared clinical with radiographic changes. The clinical efficacy of mechanical physiotherapy according to the McKenzie method within 5 days was documented. Methods: Eleven consecutive patients with lumbar disk prolapse were included. Patients were treated with repeated end-range spinal movements and MRI was performed before and after …2–5 treatments. Results: All patients achieved a reduction in symptoms and signs of disk prolapse during and after these procedures but none showed any change in the MRI features of the prolapses. Conclusions: Beneficial effects of specific mechanical physiotherapy in patients with radicular syndromes from lumbar disk prolapse are not paralleled by changes in the MRI appearance of the prolapses. Alternative explanations for the early clinical responses in some patients with lumbar disc prolapse treated according to the McKenzie method must be sought. Show more

Keywords: Conservative treatment, physiotherapy, lumbar disk prolapse, magnetic resonance imaging

DOI: 10.3233/NRE-2008-23312

Citation: NeuroRehabilitation, vol. 23, no. 3, pp. 289-294, 2008