NeuroRehabilitation - Volume 25, issue 2

Authors: Chang, Min Chul | Ahn, Sang Ho | Cho, Yun Woo | Son, Su Min | Kwon, Yong Hyun | Lee, Mi Young | Byun, Woo Mok | Jang, Sung Ho

Article Type: Research Article

Abstract: Active execution, proprioception, and touch discrimination are important for the execution of movement. In the current study, we attempted to compare the cortical activation patterns of active exercise, proprioceptive input, and touch stimulation in the normal human brain using functional MRI. Nine subjects were recruited for this study. Functional MRI was performed using 1.5-T with three tasks at a fixed rate. The active exercise and proprioceptive input were performed at the metacarpophalangeal joint using a specially equipped apparatus, and touch stimulation was applied on the dorsum of the hand using a rubber brush. We performed analysis using the region of …interest (ROI) method, and calculated the laterality index (LI) to assess the relative activity in the ipsilateral versus the contralateral ROI. When active exercise or proprioceptive input were applied, the LI in the primary sensorimotor cortex (SM1) was significantly higher than that of touch stimulation. The supplementary motor cortex, cerebellum, and contralateral SM1 showed stronger activation during active exercise than during proprioceptive input or touch stimulation, and the opposite pattern was observed in the insula. We found that the LIs of active exercise and proprioceptive input were higher than the LI of touch stimulation. This suggest that touch stimulation may be a less lateralized function than active exercise and proprioceptive input. Show more

Keywords: Motor function, somatosensory function, movement, proprioception, functional MRI

DOI: 10.3233/NRE-2009-0502

Citation: NeuroRehabilitation, vol. 25, no. 2, pp. 87-92, 2009

Authors: Gideon, Deborah A.

Article Type: Research Article

Abstract: A cognitive-social approach to neurobehavioral rehabilitation is presented that, defined herein, refers to the integration of cognitive with emotional and social information processing strategies to enhance techniques for effective behavior change in brain-disordered patients. Research findings and theories regarding affective and social functioning in persons with brain disorders are reviewed and applied to clinical treatment.

Keywords: Social rehabilitation, emotions, cognitive rehabilitation, nonverbal communication, prosody, neuropsychotherapy, brain injury, stroke, epilepsy

DOI: 10.3233/NRE-2009-0503

Citation: NeuroRehabilitation, vol. 25, no. 2, pp. 93-100, 2009

Authors: Baek, Ji-Hye | Kim, Jun-Woo | Kim, Suhn-Yeop | Oh, Duck-Won | Yoo, Eun-Young

Article Type: Research Article

Abstract: Objective: To determine the effect of repeated passive motion (RPM) exercise on position sense of the shoulder joint in patients with hemiplegia. Methods: Shoulder flexion position sense was evaluated for the affected side of 15 patients with hemiplegia, using an assessment board set at five angles (30°, 60°, 90°, 120° and 150°). First, the affected shoulder was positioned passively, twice at each angle. Then, with the patient blindfolded, a repositioning test was performed twice at each angle, presented in random order. The assessment score was calculated as the proportion of correct responses (PCRs) for repositioning. After the testing, the …RPM exercise, consisting of scapular and shoulder motions, was performed in a supine position for 15 min, and the testing was repeated. Results: After the RPM exercise, there was a significant difference in total PCR for right hemiplegia (p < 0.05) and in total PCR and PCR at 90° for left hemiplegia (p < 0.05). However, the PCR was not significantly different between right and left hemiplegia at any angle. For all of the patients, the total PCR and the PCRs for every angle except 30° and 150° were significantly greater after the RPM exercise (p < 0.05). Conclusion: The RPM exercise was helpful in improving proprioception in patients with hemiplegia. Further studies are needed to generalize these findings. Show more

Keywords: Repeated passive exercise, Hemiplegia, Proprioception, Position sense

DOI: 10.3233/NRE-2009-0504

Citation: NeuroRehabilitation, vol. 25, no. 2, pp. 101-106, 2009

Authors: Finlayson, Marcia | Peterson, Elizabeth W. | Cho, Chi

Article Type: Research Article

Abstract: Objective: To present the outcomes of a pilot study of “Safe at Home BAASE ”, a fall risk management program designed for middle-aged and older adults with multiple sclerosis. Methods: Thirty people with multiple sclerosis (mean age = 56.7 ± 7.4) started the manualized program that was delivered by an occupational therapist over six-two hour sessions. A pre/post intervention design with a set of 6 outcome tools was used to evaluate the extent to which the program increased knowledge of fall risk factors, increased knowledge and skills to manage falls and falls risk, and promoted changes in behavior …to reduce personal fall risk. Results: Significant improvements were observed across all tools for participants attending ⩾ 5:6 program sessions as well as participants attending ⩽ 4 sessions, although some instruments exhibited poor internal consistency in this sample. Participants reported knowledge gains and using new fall prevention and management strategies after attending the program. Conclusion: “Safe at Home BAASE ” appears to have potential to foster changes in knowledge, skills and behavior associated with reduced personal fall risk. Practice implications: Findings suggest that additional research is needed on fall-related assessment tools for this population before a large scale controlled investigation of the intervention can be pursued. Show more

Keywords: Accidental falls, prevention, fall risk, behavior change

DOI: 10.3233/NRE-2009-0505

Citation: NeuroRehabilitation, vol. 25, no. 2, pp. 107-115, 2009

Authors: Kim, Dong Gyu | Kim, Seong Ho | Kim, Oh Lyong | Cho, Yun Woo | Son, Su Min | Jang, Sung Ho

Article Type: Research Article

Abstract: There have been no studies on motor recovery in severe quadriplegic patients with traumatic brain injury (TBI) resulting from combined causes of weakness; this type of patient is often seen in rehabilitation clinics. We report on a quadriplegic patient who showed long-term motor recovery from severe weakness caused by a diffuse axonal injury (DAI) on the brainstem and a traumatic intracerebral hemorrhage (ICH) on left cerebral peduncle, as evaluated by diffuse tensor imaging (DTI) and functional MRI (fMRI). A 17-year-old male patient presented with quadriparesis at the onset of TBI. Over the 28-month period following the onset of the injury, …the motor function of the four extremities slowly recovered to a range that was nearly normal. Two longitudinal DTIs (at 11 and 28 months from onset) and fMRI (at 28 months) were performed. Fractional anisotropy and an apparent diffusion coefficient were measured using the region of interest method, and diffusion tensor tractography was conducted using a DTI/fMRI combination. Fractional anisotrophy values in the brainstem, which were markedly decreased on the 11-month DTI, were increased on the 28-month DTI. On the fMRI performed at 28 months, the contralateral primary sensori-motor cortex was activated by the movement of either the right or left hand. Diffusion tensor tractography showed that fiber tracts originating from the motor-sensory cortex passed through the known corticospinal tract pathway to the pons. It seems that the weakness of this patient recovered due to the recovery of the damaged corticospinal tracts. Show more

Keywords: Motor recovery, diffusion tensor imaging, functional MRI, corticospinal tract, diffuse axonal injury, traumatic hemorrhage

DOI: 10.3233/NRE-2009-0506

Citation: NeuroRehabilitation, vol. 25, no. 2, pp. 117-122, 2009

Authors: Park, Ji-Hyuk | Yoo, Eunyoung | Chung, Boin | Jung, Minye

Article Type: Research Article

Abstract: Aim: To observe the effect of self-vocalization on the quality of movement of each arm during a reaching task in people with left hemiparetic stroke. Method: The design of this study is a single-blinded, within subject, repeated measures design. Fourteen right-handed participants with left hemiparetic stroke were requested to perform a reaching task with each arm, with and without self-vocalization. A 3-D motion analysis system measured the peak angular velocity, time to peak angular velocity, and movement unit in elbow motion. Results: In the unaffected dominant right arm, movements during the reaching task with vocalization were …faster, smoother, and more efficient than without vocalization. The peak angular velocity (p < 0.05) and time to peak angular velocity (p > 0.05) increased. The movement unit decreased significantly (p < 0.05). However, in the affected non-dominant left arm, the movement with vocalization was slower, rougher, and less efficient. The peak angular velocity decreased (p > 0.05). Time to peak angular velocity (p < 0.05) and the movement unit increased significantly (p < 0.05). Conclusion: Self-vocalization provided a positive effect on reaching movement of the dominant side but a negative effect on reaching movement of the non-dominant side in right handed persons with left hemiparetic stroke. Show more

Keywords: Stroke, reaching, motion analysis

DOI: 10.3233/NRE-2009-0507

Citation: NeuroRehabilitation, vol. 25, no. 2, pp. 123-128, 2009

Authors: Louie, Stephanie Wai-Shan | Wong, Simon Kam-Man | Wong, Cynthia Mei-Yuk

Article Type: Research Article

Abstract: The objectives of study were to identify longitudinal ADL profiles and to investigate profiles characteristics of participants in stroke rehabilitation programme. 496 stroke rehabilitation records in one year were retrieved. Patients' demographics, admission scores of Cantonese version of Mini-mental State Examination and line cancellation test were retrieved. Chinese version of the Modified Barthel Index (MBI-C) records for the first four successive weeks were also obtained for cluster analysis. Four functional profiles were yielded after cluster analysis. Repeated measures ANOVA showed that Profile 1 (n = 168) with oldest age, lowest baseline MBI-C and line cancellation test scores had improvement …only at the last two measurement points (p < 0.001). Profile 4 (n = 100) with youngest age and highest baseline MBI-C showed progress for the first two assessment points then slowing down progressively, while the other two profiles showed improvement on all measurement points (p < 0.001) but with different baseline MBI-C and increments. One-way ANOVA further revealed significant differences in demographics, cognitive-perceptual and receptive speech functions among the profiles. The present study revealed different recovery potential among people with stroke. The higher the initial ADL performance, younger age and the absence of unilateral neglect appeared to relate to better functional recovery. Show more

Keywords: Cerebrovascular diseases, functional improvement, rehabilitation

DOI: 10.3233/NRE-2009-0508

Citation: NeuroRehabilitation, vol. 25, no. 2, pp. 129-135, 2009

Authors: Hamzat, Talhatu K. | Peters, Grace O.

Article Type: Research Article

Abstract: The pattern of and relationship between motor function and participation among community-dwelling stroke survivors in Ibadan, Nigeria was studied over a 6-month period. Twenty post stroke individuals were recruited out of which 16 (9 males and 7 females) completed the study. Motor function and participation were assessed within 4 weeks after stroke (baseline) and the 2nd, 3rd, 4th and the 5th month at the respective residence of the patients using the Modified Motor Assessment Scale (MMAS) and London Handicap Scale (LHS) respectively. Results showed statistically significant increase in both motor function (Friedman's ANOVA 37.50; p …= 0.00) and participation (Friedman's ANOVA = 41.87; p < 0.001) across 6 months. Significant correlation was observed between overall total scores of the motor function and participation measures at the 1st month. The Orientation and Economic Self-Sufficiency domains of the LHS were however not significantly correlated with the MMAS items (p > 0.05). At the 6th month, LHS did not correlate with MMAS items except between physical independence and sitting to standing, occupation and sitting to standing, and physical independence and walking. The results show that recovery of motor function and increase in level of participation occurred progressively across six months post stroke. This apparent association between motor function and participation suggest that as patients were regaining motor function, their participation level was also improving. Show more

Keywords: Stroke survivors, participation, motor function, Nigerian

DOI: 10.3233/NRE-2009-0509

Citation: NeuroRehabilitation, vol. 25, no. 2, pp. 137-142, 2009