NeuroRehabilitation - Volume 28, issue 2

Authors: Bigler, Erin D. | Maxwell, William L.

Article Type: Research Article

Abstract: Neuroimaging at all stages of a traumatic brain injury (TBI) provides information about gross brain pathology. In this review, post-mortem TBI cases are matched to neuroimaging findings from TBI survivors to demonstrate the close correlation between observable pathology with in vivo neuroimaging to the underlying neuropathology. An emphasis of this review focuses on neuroimaging identification of trauma induced cortical and white matter degeneration along with hydrocephalus ex vacuo expansion of the ventricular system as the injured brain exhibits atrophic changes. The role of hippocampal atrophy and thalamic injury along with the vulnerability of the corpus callosum in TBI are also …reviewed. The aim of this review is to provide pathological confirmation of observable neuroimaging abnormalities that relate directly to trauma-induced effects of the injury. Show more

DOI: 10.3233/NRE-2011-0633

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 63-74, 2011

Authors: Kim, Min Ji | Hong, Ji Heon | Jang, Sung Ho

Article Type: Research Article

Abstract: Since development of functional MRI (fMRI), many studies have reported on cortical activation by external stimuli. However, there has been no fMRI study on the cortical effect of clapping. Using fMRI, we investigated the cortical activation effect of clapping in comparison with other motor tasks in the healthy human brain. Fourteen healthy volunteers were recruited. fMRI was performed using a 1.5-T Philips Gyroscan Intera with a standard head coil. Clapping, grasp-release movements, and sequential finger opposition of both hands were performed. Regions of interest (ROIs) were set at the primary sensori-motor cortex (SM1), supplementary motor cortex (SMA), and premotor cortex …(PMC). The activated voxel number of all ROIs was in the following order: clapping, sequential opposition, and grasp-release movements. In the SM1, clapping showed the most significant activation, followed by sequential opposition, and grasp-release movements. By contrast, the PMC was most activated by sequential opposition, and then clapping and grasp-release movements, in order. As for the SMA, clapping evoked the most significant activation, followed by clapping, and grasp-release movements. We found that clapping showed the most significant cortical activation in ROIs among three motor tasks. Clapping appears to be an effective method for stimulation of the brain. Show more

Keywords: Functional MRI, clapping, motor function, cortical activation

DOI: 10.3233/NRE-2011-0634

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 75-79, 2011

Authors: Eibach, S. | Krug, H. | Lobsien, E. | Hoffmann, K.T. | Kupsch, A.

Article Type: Research Article

Abstract: We report on a patient with tetraspasticity due to perinatal cerebral palsy requiring total hip joint endoprosthesis because of hip dysplasia. In order to minimize the risk of postoperative luxation Botulinum Toxin A was injected preoperatively into hip flexor and adductor muscles guided by CT-fluoroscopy. Outcome measures included muscle tone, limb position and self-reported pain relief. Seven days post injections the tone of the right hip flexor and adductor muscles improved from three to one points on the five-point Modified Ashworth Scale (MAS), the spastic joint position improved from 45° to 20° in flexion and from 20° to 10° …in adduction, and the patient was free of pain. Ten days after injection of Botulinum Toxin operation of total hip joint arthroplasty was performed without complication. Improvement of spasticity sustained for another eight weeks. Subsequent Botulinum Toxin A injection three months post surgery resulted in identical results. This case demonstrates a new preoperative indication for Botulinum Toxin A in patients with an increased muscle tone at the hip who have to undergo total hip joint endoprosthesis to reduce the risk of postoperative luxation. Show more

Keywords: Botulinum Toxin A, spasticity, preoperative treatment, total hip arthroplasty

DOI: 10.3233/NRE-2011-0635

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 81-83, 2011

Authors: Toledano-Zarhi, Adi | Tanne, David | Carmeli, Eli | Katz-Leurer, Michal

Article Type: Research Article

Abstract: Objective: To examine the feasibility, safety and effectiveness of an early aerobic rehabilitation program for patients after minor ischemic stroke. Design: Randomized control trial. Methods: Twenty-eight patients, 1–3 weeks post minor ischemic stroke (modified Rankin scale; mRS ⩽ 2), were randomly assigned to intervention or control groups. Measures were taken at weeks 1 and 6. All participants were instructed in home practice to achieve strength and flexibility, and were asked to continue their normal community routine. Intervention group participants performed a supervised exercise training program twice a week for 6 weeks. Exercise capacity was evaluated by …the 6-minute walk distance test (6MWD), and the modified Bruce treadmill test. Results: Eight subjects out of 14 participated in all 12 training sessions, one at less than 50% of the sessions, while five reached the highest stage of the program. No adverse events were noted during the intervention period. In the intention to treat analysis a significant improvement over time was seen for the functional parameters only. No interaction (group*time) was found. According to the per protocol analysis a significant interaction effect was found; only the intervention group participants showed a significant clinical change in the 6MWD test (412 ± 178 meters to 472 ± 196 meters, vs the control group 459 ± 116 meters to 484 ± 122 meters, p < 0.01). Conclusions: An early supervised aerobic training after minor ischemic stroke is feasible and well tolerated and, in a per-protocol analysis, was associated with improved walking endurance. Further studies with a larger sample size are needed to assess the effect of such a program on functional abilities, prevention of risk factors, and recurrent stroke. Show more

Keywords: Ischemic, stroke, aerobic, rehabilitation

DOI: 10.3233/NRE-2011-0636

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 85-90, 2011

Authors: Vanbellingen, Tim | Bohlhalter, Stephan

Article Type: Research Article

Abstract: Apraxia is a higher-order motor disorder impairing the ability to correctly perform skilled, purposive movements as the result of neurological disorders most commonly stroke, dementia and movement disorders. It is increasingly recognised that apraxia negatively influences activities of daily living (ADL). Early diagnosis and treatment should be part of the neurorehabilitation programme. The aim of the present article is to describe the most important subtypes of apraxia such as ideational and ideomotor apraxia as well as their impact on ADL and outcome. Furthermore, the relationship to associated disorders such as aphasia is discussed. Finally, strategies concerning assessment, management and treatment …of the disorder are presented. Show more

Keywords: Apraxia, classification, assessment, treatment

DOI: 10.3233/NRE-2011-0637

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 91-98, 2011

Authors: Chitambira, Benjamin

Article Type: Research Article

Abstract: Background and purpose: The objective of this case series is to report on the use of an optokinetic chart stimulation intervention to restore voluntary movement, postural control and mobility in acute stroke patients and one post intensive care polyneuropathy patient. Method: An optokinetic chart was moved in front of the patient: from side to side, up and down and finally forwards and backwards. Specific active-assisted exercises of affected shoulder anti-gravity muscles were also carried out. Results: Except for strokes involving basal ganglia, parietal and temporal lobes simultaneously, optokinetic stimulation was effective in restoring voluntary movements, postural …control and mobility. Discussion: In single lobe strokes and those that do not involve simultaneous extensive damage to the basal ganglia, parietal and temporal lobes optokinetics may be one of the neuro-modulation techniques that use cranial nerve circuits of key movement and postural control input organs to enhance neural plasticity. Extensive temporal- parietal strokes may need longer periods of rehabilitation. Further research using a combination of vestibular interventions may provide an effective intervention for severely disabling extensive temporal-parietal strokes. Further studies with this optokinetic chart intervention are also recommended for chronic stroke patients. Show more

Keywords: Acute stroke, polyneuropathy, optokinetic chart stimulation, sensory interaction for balance, temporal-parietal infarcts

DOI: 10.3233/NRE-2011-0638

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 99-104, 2011

Authors: Kong, Keng-He | Chua, Karen S.G. | Lee, Jeanette

Article Type: Research Article

Abstract: Objective: The objectives of this study are to establish frequency, clinical correlates and predictors of upper limb dexterity in patients who have survived 1 year or more after a stroke. Design: Cross-sectional study. Setting: Outpatient clinic of a tertiary rehabilitation centre. Participants: One hundred and forty patients who were more than a year after stroke onset. Interventions: Nil. Main outcome measures: Motor Assessment Scale (MAS) for measurement of upper limb dexterity, Ashworth Scale for spasticity, Upper Extremity Motricity Index (UEMI) and Lower Extremity Motricity Index (LEMI) for motor power and Modified Barthel …Index (MBI) for functional status. Spasticity was categorized as absent to moderate and severe. Potential predictors of dextrous function were chosen based on retrospective review of the patient’s medical records during admission for inpatient rehabilitation. Results: The mean age was 61.0 ± 13.3 years and patients were evaluated at 41.7 ± 35.1 months after stroke onset. Upper limb dexterity was present in 40 (28.3% patients. Sensory impairment, severe spasticity and low scores on the MBI, UEMI and LEMI were significantly correlated to poor dextrous function, with severe spasticity (p < 0.001) and UEMI score (p = 0.025) being the most important. Poor dextrous function was predicted by a severe stroke, neglect, sensory impairment, total/partial anterior circulation stroke and low MBI, UEMI and LEMI scores on rehabilitation admission. The most important predictor of dexterity was UEMI score on admission to rehabilitation (p = 0.005). Conclusion: Upper limb dexterity was present in 28.3% of a cohort of chronic stroke patients. The most important correlates of limb dexterity were upper limb strength and severe spasticity and the most significant predictor of dexterity was the severity of upper limb paresis on admission to rehabilitation. Show more

Keywords: Upper extremity, dexterity, stroke

DOI: 10.3233/NRE-2011-0639

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 105-111, 2011

Authors: Barwood, Caroline H.S. | Murdoch, Bruce E. | Whelan, Brooke-Mai | Lloyd, David | Riek, Stephan | O'Sullivan, John | Coulthard, Alan | Wong, Andrew | Aitken, Phil | Hall, Graham

Article Type: Research Article

Abstract: Introduction: The application of low frequency (1 Hz) Repetitive Transcranial Magnetic Stimulation (rTMS) to right hemisphere (RH) language homologues in non-fluent aphasic populations has yielded improvements in behavioural language function, up to 43 months post stimulation [32]. Functional imaging studies have demonstrated RH language homologue “overactivation” post left inferior frontal gyrus (IFG) damage, in chronic non-fluent aphasia. The effects of low frequency (inhibitory) rTMS are postulated to be as a result of a reduction of overactivation in RH language homologues, facilitating the reorganisation of neural language networks. Methods: Low frequency (1 Hz) rTMS was applied to the anterior …portion of a Broca’s area homologue (pars triangularis), for 20 minutes per day for 10 days, using a stereotactic neuronavigational system. Twelve non-fluent aphasic patients (six real stimulation and six sham), 2–10 years post stroke were stimulated. Behavioural language outcome measures were taken at baseline and 1 week post rTMS. Results: Comparisons between the real stimulation and sham conditions indicated significant main effects between the stimulation and sham groups to 1 week post stimulation for naming accuracy, latency and repetition. Conclusions: This study indicates that rTMS has the capacity to modulate neural language networks, to facilitate improvements in behavioural language function, 1 week post TMS. Show more

Keywords: Transcranial Magnetic Stimulation (TMS), aphasia, stroke rehabilitation, language

DOI: 10.3233/NRE-2011-0640

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 113-128, 2011

Authors: de los Angeles Hoffmann, Maria | Gall, Carolin | Kaufmann, Christian | Fydrich, Thomas | Kasten, Erich | Sabel, Bernhard

Article Type: Research Article

Abstract: Background: The relationship of spatially specific and non-lateralised attentional deficits to perceptual and premotor neglect was explored in 25 patients with chronic neglect. The association between severity of neglect and attention deficits was also studied. Methods: Alertness, selective attention and exploration performance were assessed using a battery of computerised and paper-pencil tests. Results: Perceptual and premotor neglect groups differed in the manifestation of attention deficits in the contralesional and ipsilesional hemispace. Differences in the performance time and accuracy were observed to be a function of neglect severity. Conclusion: Paper-pencil tests were more sensitive to …assess attention deficits in patients with different neglect types and severities of neglect than computerised tests. Therefore, diagnostic evaluation should include both paper-pencil and computerised assessments in order to identify spatially specific as well as non-lateralised attentional deficits. Show more

Keywords: Visual neglect, perceptual neglect, premotor neglect, attention deficits

DOI: 10.3233/NRE-2011-0641

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 129-142, 2011

Authors: Song, HoSook | Oh, HyunSoo | Kim, HwaSoon | Seo, WhaSook

Article Type: Research Article

Abstract: The present study was conducted to examine whether a sexual rehabilitation intervention program, which was developed during the present study and designed for stroke patients and their spouses, was effective in terms of sexual knowledge and satisfaction and frequency of sexual activity at 1 month after intervention. The study subjects were conveniently selected from stroke patients admitted to the neurology department at a university hospital located in Incheon, South Korea. A total of 46 subjects (12 couples for the experimental group and 11 couples for the control group) were included. Sexual knowledge, sexual satisfaction, frequency of sexual activity, level of …cognitive function, and performance with respect to daily living activities were measured. The results obtained demonstrated that the devised sexual rehabilitation intervention program significantly increased sexual satisfaction and frequency of sexual activity, but that it did not promote sexual knowledge. The present study has meaning because the intervention program could be used as a practical guideline for post-stroke sexual rehabilitation. In addition, the findings of this study provide evidence regarding the usefulness of sexual education and counseling on the sexual health of post-stroke patients and their spouses. Show more

Keywords: Rehabilitation, sexuality, stroke patients

DOI: 10.3233/NRE-2011-0642

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 143-150, 2011

Authors: Aubut, Jo-Anne L. | Mehta, Swati | Cullen, Nora | Teasell, Robert W. | ERABI Group, | SCIRE Research Team,

Article Type: Research Article

Abstract: Background: To compare the treatment of heterotopic ossification (HO) within the traumatic brain and spinal cord injured populations. Methods: MEDLINE/Pubmed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing treatment of HO post-injury. Articles were constrained to: English language and human subjects. Studies were included if: n ⩾ 50% of the subjects had a spinal cord injury (SCI) or a traumatic brain injury (TBI), n ⩾ 3 SCI or TBI subjects, and study subjects participated in a treatment or intervention. Study quality, for randomized control trials (RCTs), were assessed using the PEDro assessment scale, while non-RCTs was …assessed using the Downs and Black evaluation tool. A modified Sackett scale was used to apply levels of evidence for each intervention. Results: In total 26 studies (NTBI = 12; NSCI = 14) met inclusion criteria. The majority of studies (10/12) conducted in the TBI population were surgical interventions. Studies conducted with the SCI population investigated diverse pharmacological treatments including: bisphosphonates, non-steroidal anti-inflammatory drugs (NSAIDs) and Warfarin. Non-pharmacological studies investigated the benefits of pulse low-intensity electromagnetic field therapy, surgical excision, and radiotherapy in the treatment of HO. Conclusions: Within the SCI literature, NSAIDs showed the greatest efficacy in the prevention of HO when administered early after a SCI, and biphosphonates were found to be the most effective treatment strategy. In the TBI population, surgical excision was the most effective treatment. Show more

Keywords: Spinal cord injury, brain injury, therapeutic interventions, heterotopic ossification

DOI: 10.3233/NRE-2011-0643

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 151-160, 2011

Authors: Shavelle, Robert | Katz, Richard T. | MacKenzie, Ross | Rosenbloom, Lewis | DeVivo, Michael | Hutton, Jane | Strauss, David | Day, Steven | Brooks, Jordan

Article Type: Letter

DOI: 10.3233/NRE-2011-0644

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 161-161, 2011

Authors: Wilkinson, David | Sakel, Mohamed | Milberg, William

Article Type: Research Article

Abstract: Hemi-spatial neglect is a disabling, neuropsychological impairment that restricts the ability to attend to incoming information on one side space. Most frequently associated with a lesion to the right hemisphere, the disorder is strongly predictive of general functional recovery from stroke. Although the standard therapy is of limited effectiveness, pilot studies indicate that more effective treatments may follow. Interest in these new potential treatments is, however, beginning to wane as few have progressed to the stage of randomised, controlled clinical trials. In this brief commentary, we point out that the absence of trials data not only reflects the preliminary nature …of new treatments, but also the practical difficulties associated with meeting the target enrolment figures of large-scale trials. These problems have likewise slowed the development of treatments for other cognitive disorders. We suggest ways in which this problem may be overcome. Show more

Keywords: Visual attention, clinical intervention, participant recruitment

DOI: 10.3233/NRE-2011-0645

Citation: NeuroRehabilitation, vol. 28, no. 2, pp. 163-165, 2011