NeuroRehabilitation - Volume 28, issue 4

Authors: Schultz, Billie A. | Cifu, David X. | McNamee, Shane | Nichols, Michelle | Carne, William

Article Type: Research Article

Abstract: The ongoing wars in Iraq and Afghanistan and terrorist activity worldwide have been associated with an increased incidence of blast injuries. While blast injuries share similarities with blunt or penetrating traumatic injuries, there are unique mechanistic elements of blast injury that create increased vulnerability to damage of specific organs. This review highlights the mechanism of blast-related injury, describes the common sequelae of blast exposure that may impact rehabilitation care, and summarizes the intervention strategies for these blast-related sequelae.

Keywords: Blast injury, polytrauma, rehabilitation

DOI: 10.3233/NRE-2011-0659

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 309-320, 2011

Authors: Kieffer-Kristensen, R. | Teasdale, T.W.

Article Type: Research Article

Abstract: Introduction/Objectives: This study examines parental stress and marital relationship among patients with acquired brain injury and their spouses. Participants, Materials/Methods: The participants were 35 patients diagnosed with acquired brain injury and having school-aged children, together with their spouses recruited from out-patients from brain injury rehabilitation units across Denmark. The parents self-reported parental stress using the Parental Stress Index (PSI), marital adjustment using the Dyadic Adjustment Scale (DAS), family functioning using the Family Environment Scale (FES). Additionally, the healthy parents completed the Symptom Checklist 90 (SCL-90) measuring psychological symptoms. A matched control group consisted of parents suffering from diabetes …and their spouses, being recruited from the National Danish Diabetes Register. Results: Significantly more symptoms of parental stress were reported by the brain-injured parents when compared to the diabetic parents (p < 0.05); the brain injured parents also reported significant more family dysfunction (p < 0.05). The healthy parents in the brain injury group rated their marital satisfaction and current relationship happiness significantly lower (p < 0.05) than the healthy control group. The spouses to the brain-injured patients were also significantly more depressed (p < 0.01). Conclusions: When parents have acquired brain injury, they experience more parental stress and family dysfunction. Their spouses are less satisfied in their marital relationship and feel more depressed. These results indicate the need of a family centred supportive service to focus on the relational changes and dysfunctional family processes in families with a brain-injured parent and dependent children. Show more

DOI: 10.3233/NRE-2011-0660

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 321-330, 2011

Authors: Roosink, Meyke | Buitenweg, Jan R. | Renzenbrink, Gerbert J. | Geurts, Alexander C.H. | IJzerman, Maarten J.

Article Type: Research Article

Abstract: Post-stroke shoulder pain (PSSP), traditionally regarded as purely nociceptive pain, is often persistent and the mechanisms underlying the pain complaints are not well understood. This explorative study is the first to address the possible changes in cortical somatosensory processing in patients with PSSP. Cortical potentials were recorded following intracutaneous electrostimulaton in stroke patients with chronic PSSP (n = 6 ), pain-free stroke patients (PF, n = 14 ) and healthy controls (HC, n = 20 ) using EEG. Amplitudes and latencies of both sensory discriminative (N90) as well as cognitive evaluative (N150, P200, the …N150-P200 peak-to-peak difference and P300) evoked potential components were evaluated. Stroke was associated with reduced N150 and P300 amplitudes and increased N90, N150 and P300 latencies at both sides. Compared to PF and HC, the P200 and N150-P200 latencies were increased in PSSP patients after stimulation at both sides, even when comparing subgroups with similar lesion size and location. Stroke was associated with reduced sensory-discriminative as well as with reduced cognitive-evaluative cortical somatosensory processing. This reduction was more pronounced in patients with PSSP and may be related to the central effects of persistent nociceptive pain. Show more

Keywords: Stroke, shoulder pain, somatosensory function, evoked potentials

DOI: 10.3233/NRE-2011-0661

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 331-344, 2011

Authors: Jang, S.H.

Article Type: Research Article

Abstract: For the past decade, diffusion tensor imaging (DTI) has been used in elucidation of the motor recovery mechanisms in stroke patients. In the current study, I reviewed the DTI studies with regard to the motor recovery mechanisms in stroke patients, according to the following classification of motor recovery mechanisms; recovery of a damaged lateral corticospinal tract (CST), subcortical peri-lesional reorganization, ipsilateral motor pathway from the unaffected motor cortex to the affected extremities, and other motor recovery mechanisms. In addition, I discussed the characteristics of DTI as an evaluation tool for motor recovery mechanisms and future direction. DTI has a unique …advantage in identification and estimation of neural tracts at the subcortical level. Therefore, it could contribute much to research on the motor recovery mechanisms of stroke patients, especially, in terms of recovery of a damaged CST and subcortical peri-lesional reorganization. In spite of the advantages of DTI, fewer DTI studies on this topic have been conducted compared to studies using transcranial magnetic stimulation or functional MRI. Therefore, the total number of DTI studies on this topic should be increased. Moreover, further studies on various topics related to brain plasticity of motor function, as well as the motor recovery mechanism itself, should be encouraged; for example, DTI changes with passage of time, with rehabilitative intervention, or with motor recovery. Show more

Keywords: Stroke, diffusion tensor imaging, diffusion tensor tractography, hemiparesis, motor recovery, brain plasticity

DOI: 10.3233/NRE-2011-0662

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 345-352, 2011

Authors: Kaut, Oliver | Allert, Niels | Coch, Christoph | Paus, Sebastian | Grzeska, Agata | Minnerop, Martina | Wüllner, Ullrich

Article Type: Research Article

Abstract: Objective: To test the effects of stochastic whole body vibration (WBV) we performed a double-blind randomized controlled study. Methods: Patients were allocated either to the experimental or sham group. The experimental group received 5 cycles of stochastic WBV on three days, each cycle consisting of 5 stimulus trains of 60 seconds duration (frequency 6.5 Hz) and 60 seconds resting time between stimuli. Patients allocated to the control group received a sham treatment with 1 Hz. Unified Parkinson’s Disease Rating Scale, part III (UPDRSIII ) was performed after treatment at baseline, after the first series on day 1 …and on day 5. Results: The reduction of subscores included in UPDRS III relative to baseline served as primary outcome measure. After the five-day course bradykinesia was improved in 14 of 18 patients (77.8%) and postural stability in 8 of 18 (44.4%). Speech and facial expression remained unchanged in both groups. Tremor (p = 0.027) and postural stability (p = 0.048) showed a reduction also, but did not reached level of significance (p < 0.01); UPDRSIII sum score was improved by 26.7%. Conclusion: Stochastic whole body vibration may offer a supplementation to canonical physical treatments of PD motor symptoms. Show more

Keywords: Parkinson's disease, whole body vibration, stochastic resonance therapy

DOI: 10.3233/NRE-2011-0663

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 353-358, 2011

Authors: Al-Jarrah, Muhammed D. | Jamous, Mohammed

Article Type: Research Article

Abstract: Goals and Objectives: Parkinson’s disease (PD) is one of the most common neurodegenerative diseases in elderly. Glial fibrillary acidic protein (GFAP), calcium-binding protein (S100B), and neuron-specific enolase (NSE) are brain damage markers. The main goal of this study is to investigate the expression of these markers in the striatum (ST) of chronic/progressive mouse model of PD, and to study the effect of endurance exercise training on the expression of those markers. Materials and Methods: In this study, forty C57BL/6 albino mice were randomly divided into four groups. Sedentary control (SC, n = 10), exercise control (ExC, n …= 10), sedentary Parkinson’s (SPD, n = 10), and exercised Parkinson’s (ExPD, n = 10). Chronic Parkinsonism was induced by injecting the animals with 10 doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (25 mg/kg) and probenecid (250 mg/kg) over 5 weeks. Modified human treadmill was used to train the mice at a speed of 18 m/min, 0 degrees of inclination, 40 min/day, 5 days/week for 4 weeks. At the end of exercise training, we examined the expression of these markers on the striatum of the four animal groups using immunohistochemistry. Results and Discussion: Parkinsonism increases the expression of NSE, S100B, and GFAP in the ST, p value P < 0.001, < 0.05, and < 0.7 respectively compared with control group. Exercise training decreases the expression of NSE, S100B, and GFAP in the exercised PD mice compared with sedentary PD mice p value < 0.005, < 0.02, and < 0.40 respectively. Conclusion: Treadmill exercise training decreased the expression of brain damage markers in the striatum of chronic Parkinsonian mice, which can partially explain the beneficial neuroprotective role of exercise in patients with PD. Show more

Keywords: Parkinson's disease, striatum, exercise

DOI: 10.3233/NRE-2011-0664

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 359-363, 2011

Authors: Cortesi, Marco | Cattaneo, Davide | Jonsdottir, Johanna

Article Type: Research Article

Abstract: Objective: The aim of this study was to assess the effect of Kinesio Taping on body stability in subjects with MS. Study design: Non controlled intervention study in a Rehabilitation Unit. Intervention: A consecutive convenience sample of 15 individuals with multiple sclerosis was assessed. Kinesio Tex Tape was applied directly to the skin of both calves and kept for the next two days. Main outcome measures: Clinical and stabilometric assessments were performed at baseline, immediately after application of the tape and the day after its removal. To control for learning effect 10 subject with …multiple sclerosis were tested repeatedly under the same conditions without tape. Results: No statistically or clinically relevant differences were observed among conditions in the mediolateral plane. In the AP plane Friedman’s ANOVA showed statistically significant differences between baseline and taping condition with respect to length of sway. A trend towards statistically relevant differences were found also with respect to mean sway and velocity of sway. No learning effect was found for repeated testing within the no treated group. Conclusions: These preliminary results suggest that the use of ankle taping may be useful in immediately stabilising body posture. Show more

Keywords: Taping, standing balance, multiple sclerosis, rehabilitation, posture

DOI: 10.3233/NRE-2011-0665

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 365-372, 2011

Authors: Filipi, Mary L. | Kucera, Daryl L. | Filipi, Eric O. | Ridpath, Alanson C. | Leuschen, M. Patricia

Article Type: Research Article

Abstract: Strength and endurance data from 67 participants with multiple sclerosis (MS) were compared before, during and after a 6-month program of standardized resistance training. The hypothesis was that a standardized, structured resistance training exercise program improves strength in MS patients with different levels of disability. The range of EDSS scores was 1–8: (40% – EDSS of 1–4.5), (35% – EDSS of 5–7) (25% – EDSS of 7.5 or higher). This unique study evaluated patients with differing levels of disability for a change in strength and endurance following a 6-month training program. Data were analyzed by repeat measures and analysis of …variables using Proc GLM in SAS to account for variability between subjects, and within subjects, due to repeated measures at 3 time points. Each treatment was blocked by disability class. Every within-treatment analysis was significant. Each exercise showed significant improvement in strength for participants, despite disability levels. Increases in strength followed parallel improvement pathways, at all disability levels. All but one treatment displayed highly significant improvement (p-value < 0.0001). The results demonstrated that all individuals with MS, despite disability levels, show parallel improvement in strength and endurance. This study supports the use of exercise, including resistance programs, for all MS patients. Show more

Keywords: Resistance training, strength, multiple sclerosis, varied disability

DOI: 10.3233/NRE-2011-0666

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 373-382, 2011

Authors: Kwon, Hyeok Gyu | Jang, Sung Ho

Article Type: Research Article

Abstract: Little is known about optic radiation (OR) injury in patients with traumatic brain injury (TBI). We report on a patient who showed an OR injury on diffusion tensor imaging (DTI) following traumatic epidural hematoma (EDH). A 38 year-old man with TBI and 7 age-matched normal subjects were enrolled in this study. The patient had fallen down stairs while in an alcohol intoxicated state. He underwent a craniotomy following diagnosis of traumatic EDH in the left temporo-parietal lobe on brain CT. He complained of right bilateral homonymous hemianopsia, which was confirmed on the Humphrey visual field test. No lesion on the …left OR was observed during brain MRI. We were not able to reconstruct the fiber tractography for the left OR in this patient. We found that the left OR had been injured most severely around the midportion between the lateral geniculate body and occipital pole. We determined that DTI would be a useful technique for detection of an OR injury in patients with TBI. Therefore, we believe that DTI should be performed along with conventional brain MRI for patients with visual field defects following TBI. Show more

Keywords: Optic radiation, epidural hematoma, head trauma, brain injury, hemianopia, diffusion tensor imaging

DOI: 10.3233/NRE-2011-0667

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 383-387, 2011

Authors: Rifici, Carmela | D'Aleo, Giangaetano | D'Aleo, Piercataldo | Bramanti, Placido | Saltuari, Leopold | Kofler, Markus

Article Type: Research Article

Abstract: We describe two patients in whom serious bradycardia and arterial hypotension occurred after a small intrathecal baclofen (ITB) test bolus. Both patients suffered from severe spasticity (one due to brain injury, one due to spinal cord injury). Medical history and diagnostic examinations revealed no previous cardiological problems. Ten minutes following a 50 μ g ITB bolus, patient 1 developed bradycardia (58 bpm) and incomplete right branch block, lasting for 3 hours. In patient 2, a 20 μ g ITB bolus was followed after 5 minutes by severe bradycardia (30 bpm) and hypotension (60/30 mmHg), without loss of consciousness, lasting for …10 minutes. Exaggerated muscle tone was alleviated in both patients after 2 hours by the applied doses. Neither patient underwent implantation of a permanent pump system, both were continued on oral baclofen. Despite numerous unremarkable repeat cardiological exams, both patients suffered fatal cardiac arrest one and two months later, respectively. Our observations suggest that ITB may herald cardiovascular dysfunction in predisposed patients. Careful cardiological examination before ITB treatment, and close monitoring during ITB testing in particular, is advised. Show more

Keywords: Intrathecal baclofen, cardiovascular alterations

DOI: 10.3233/NRE-2011-0668

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 389-393, 2011

Authors: Gaber, Tarek A.-Z.K. | Basu, Bhaskar | Shakespeare, David | Singh, Rajiv | Salam, Sohail | McFarlane, John

Article Type: Research Article

Abstract: Introduction: Hyperextension of the extensor hallucis longus (EHL) muscle is a well recognised disabling sequel of either pyramidal or extrapyramidal lesions causing what is known as striated or hitchhiker’s toe. Surgery was the only effective strategy to manage EHL hyperextension before botulinum toxin’s use to manage muscular dystonia and spasticity became widely popular. Methods: A multicentre retrospective study. A standard proforma was sent to specialists in neurological rehabilitation dealing routinely with this problem. The data was analysed using descriptive statistics. Results: Four consultants and two trainees representing five separate neurological rehabilitation services agreed to participate in …the study. Full data was available from the 29 proformas completed. The subjects were 15 females with an age range between 20 and 78 years (mean 58.7). Stroke was the primary diagnosis in 18 subjects. Four subjects had bilateral involvement. 16 subjects had either an associated foot drop or equino varus deformity. Dysport® was used in 15 subjects with an average dose of 170 units per injection and Botox® in the other 14 with an average dose of 65 units. The treatment was effective in 24 subjects (83%). All patients receiving Dysport® responded to the treatment. Whilst 5 Botox® treated patients failed to respond to it (35% failure rate). Most of the non respondents seemed to receive insufficient doses of Botox® (below 60 units). Surgical management was successful in 3 out of the 5 non respondent cases. Conclusion: Botilinum Toxin is an effective and safe method to manage hitchhicker’s toe. In our study the conversion ratio between Dysport® and Botox® was 2.5:1. Third of the patients receiving Botox® failed to respond to the treatment most probably due to insufficient doses used. Show more

Keywords: Botulinum Toxin, extensor hallucis longus, hitchhiker's toe, spasticity

DOI: 10.3233/NRE-2011-0669

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 395-399, 2011

Authors: Schuler, Tabea | Brütsch, Karin | Müller, Roland | van Hedel, Hubertus J.A. | Meyer-Heim, Andreas

Article Type: Research Article

Abstract: Patient's active cooperation is essential to achieve good outcome in pediatric rehabilitation. Therefore, virtual environments were developed to enhance robotic assisted gait training. The purpose of this study was to evaluate virtual realities as motivational tools during robotic assisted gait training with children in the pediatric Lokomat® . Nine children with different gait disorders and eight healthy children participated in the study. Muscular effort of the lower leg was assessed by surface electromyography during a randomly designed training protocol with virtual realities. Self reported motivation was investigated with two questionnaires. Comparisons were drawn through repeated measurement Analysis of Variance and …paired-t-tests. The logarithmic transformed data showed that the electromyographic activity output in both groups was significantly higher during tasks with virtual realities than during normal walking conditions. These results support that virtual realities seem to be efficient motivational tools to increase children's muscular effort in the pediatric Lokomat®. The gaming aspect of virtual realities keeps children highly engaged during repetitive tasks. Show more

Keywords: Children, motor impairments, electromyography, motivation, robotic assisted gait training, virtual realities

DOI: 10.3233/NRE-2011-0670

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 401-411, 2011