NeuroRehabilitation - Volume 29, issue 1

Authors: West, Steven L.

Article Type: Research Article

Abstract: This paper provides a review of the current literature in the area of substance use and traumatic brain injury (TBI). Collectively, these studies demonstrate that substance use and SUD are common in the TBI population both pre- and post-injury, are a frequent causative factor in injury acquisition, complicate the rehabilitation process, and have substantial negative impact on individual health and well being. Further, individuals with a demonstrated SUD and concurrent TBI are likely to be severely limited in their ability to access SUD care due to physical barriers. This literature is reviewed and then considered in terms of its general …weaknesses. Finally, a brief outline of future research needs is provided. Show more

Keywords: Substance abuse, substance use disorders, brain injury

DOI: 10.3233/NRE-2011-0671

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 1-8, 2011

Authors: Arango-Lasprilla, Juan Carlos | Ketchum, Jessica M. | Starkweather, Angela | Nicholls, Elizabeth | Wilk, Amber R.

Article Type: Research Article

Abstract: Objectives: Estimate changes in prevalence of Major Depressive Disorder (MDD) 1 to 5 years post spinal cord injury (SCI); Identify demographic, injury, and discharge factors associated with MDD at 1 and 5 years post-injury; Identify modifiers of changes in MDD. Design: Retrospective. Setting: Model Spinal Cord Injury System. Participants: 2,256 adult participants enrolled in the National Spinal Cord Injury Statistical Center between 1999 and 2004. Main Outcome Measure: MDD as determined by the Patient Health Questionnaire-9 (PHQ-9). Results: Prevalence of MDD was 11.9% at 1 year and 9.7% at 5 years post SCI. Odds of MDD …decreased significantly 1 to 5 years post-injury (odds ratio = 1.26, 95% confidence interval = 1.02, 1.56). At 1 year post-injury, the odds of MDD was greater for persons 35âĂŞ55 years old at injury, unemployed, having an indwelling catheter or voiding bladder management at discharge, and higher scores on ASIA motor index. At 5 years post-injury, the odds of MDD were greater for females, persons 35âĂŞ55 years old at injury, those with a high school education or less, those having an indwelling catheter, voiding, and no bladder management at discharge, and higher scores on ASIA motor index. Sex was the only significant modifier. Conclusions: MDD occurs commonly 1 to 5 years post SCI. Sociodemographic, injury, and discharge factors are associated with the development and changes in depression. Future research should expand upon current findings in order to identify, prevent, and reduce the prevalence of MDD after SCI. Show more

Keywords: SCI, depression

DOI: 10.3233/NRE-2011-0672

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 9-21, 2011

Authors: Lee, Dong Ryul | Lee, Nam Gi | Cha, Hyun Jung | O, Yun Sung | You, Sung (Joshua) Hyun | Oh, Jin Hwan | Bang, Hyo Seong

Article Type: Research Article

Abstract: Purpose: This case study was conducted to highlight the clinical and radiological features of a patient with progressive neuromuscular scoliosis before and after robo-horseback riding therapy (HBRT). Design: A clinical, laboratory, and radiological analysis of a single case. Subject: An 11-year-old child, dignosed right thoracolumbar neuromuscular scoliosis secondary to cerebral palsy. Method: The child received a 5-week course of robo-HBRT, comprising of 60-minute periods a day, five times a week. Postural alignment was determined by Cobb’s method. A real-time magnetic resonance imaging (MRI) was performed to determine the robo-HBRT-induced changes in cross-sectional area (CSA) …of bilateral thoracic (T2) and lumbar (L2) paraspinalis. Clinical tests including the standard Gross Motor Function Measure (GMFM) and manual muscle testing (MMT) with the Lafayette Manual Muscle Tester were used to compare the intervention-related changes in motor performance and power. The surface EMG was also used to examine therapy-induced changes in muscle activity amplitude for bilateral T2 and L2 paraspinalis and rectus abdominis muscles. Results: Clinical motor and strength scores increased after the intervention. Radiographic Cobb’s angle, MRI, and electromyographic amplitude data demonstrated notably enhanced spinal alignment and muscle fiber CSA and symmetry, respectively. Conclusions: This is the first study to provide evidence of the therapeutic efficacy of a novel form of robo-HBRT on motor function and associated structural and motor control improvements, thus suggesting a method of augmenting therapy in neuromuscular scoliosis. Show more

Keywords: Robotic horseback riding therapy, scoliosis, cerebral palsy, electromyography (EMG), magnetic resonance imaging (MRI)

DOI: 10.3233/NRE-2011-0673

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 23-27, 2011

Authors: Cohen-Holzer, Marilyn | Katz-Leurer, Michal | Reinstein, Rachel | Rotem, Hemda | Meyer, Shirley

Article Type: Research Article

Abstract: Aim: To examine the influence of combining restraint therapy with bimanual intensive therapy on the unimanual and bimanual function among children with hemiparetic cerebral palsy (CP). Included were nine children (ages 6–9 yr), with Manual Ability Classification System scores of 2–3, Gross Motor Functional Classification System 1–2; Intervention: 10 days, six hours per day including one hour of restraint followed by five hours of bimanual activities. Evaluations: One month and immediately prior to the intervention (as the control period), immediately, two months and six months post-intervention. The Assisting Hand Assessment was the primary outcome measure, along with the …Jebsen-Taylor Test of Hand Function, the Jamar pinch gauge for grip and pinch, and the Pediatric Evaluation of Disability Inventory (PEDI). Results: No significant change was observed during the pre-intervention control period in any of the outcome measures; a significant improvement in all outcome parameters was noted after the intervention as compared to the control period. These achievements were still significantly higher than baseline values at six months post-intervention. Conclusion: Children with hemiparetic CP at this level of impairment might benefit from a short daily intervention program of combining restraint with bimanual training in order to improve unimanual and bimanual function. Show more

Keywords: Cerebral palsy, hemiparetic, bimanual hand therapy, restraint, rehabilitation, self control study

DOI: 10.3233/NRE-2011-0674

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 29-36, 2011

Authors: AlAbdulwahab, Sami Saleh

Article Type: Research Article

Abstract: Background: Electrical stimulation (ES) of proximal muscles during gait training has not previously been reported as a management option for improving muscle tone and gait in spastic diplegic children. Objective: To investigate the effects of simultaneous continuous ES of both hip abductors and adductors during walking on muscle tone, knee alignment and gait characteristics in children with spastic diplegic cerebral palsy (CP). Subject: Three groups of children participated in this project: the study group, consisting of 17 ambulant children with spastic diplegic CP; a control group of 15 ambulant children with spastic diplegic CP; and another …control group, with 17 healthy children. Methods: The study group underwent two different ES management programs. The first was a one-time trial management program that involved ongoing ES of bilateral hip adductor and abductor muscles at the sensory and motor levels, respectively, during walking for a predetermined distance. The second ES program lasted for one week and involved 15 minutes of ongoing ES of bilateral hip adductor and abductor muscles at the sensory and motor levels, respectively, during walking for three sessions a day for the week. Results: Marked improvement in gait performance (p < 0.001), muscle tone (p < 0.01) and knee position of the study group was observed. Conclusion: ES to the hip adductor and abductor muscles simultaneously at the sensor and motor levels, respectively, improved gait in spastic diplegic CP children. Show more

Keywords: CP, gait, electrical stimulation

DOI: 10.3233/NRE-2011-0675

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 37-43, 2011

Authors: Katz-Leurer, Michal | Rotem, Hemda | Keren, Ofer | Meyer, Shirley

Article Type: Research Article

Abstract: The goal of the present study was to assess the effect of various walking modes on dynamic gait characteristics and to evaluate the possible differences in the adaptation reactions between children post severe traumatic brain injury (TBI) and typically developed (TD) controls. Methods: Thirteen children post severe TBI, mean of 3.5 years post trauma, independent walkers, with a walking velocity > 1.1 m/sec, and 15 TD controls participated in this study. Ages were 7–13 years. Gait speed, step time and length and step time and length variability were assessed by an electronic walkway. The children completed three cycles on …the walkway for each of the following situations: comfortable walking, walking as fast as possible, as slow as possible and walking on a straight line. Results: Despite a similar walking performance while walking at a “regular” speed, children post severe TBI exhibit a significantly reduced range of walking speeds (73–154 cm/sec), about half, as compared to TD children (54–193 cm/sec) across the study assignments. In addition, while “walking on a straight line” children post TBI walk slower, with increased step variability as compared to their peers. Conclusion: Children post severe traumatic brain injury may achieve independent walking at a comparable rate to typically developed controls; however their impairments will be exacerbated as the demands increase. Since a variety of walking speeds is crucial for independent daily living at any age and for children in particular, and since adequate balance is an inherent element of walking, these issues need repeated assessments and the children should receive appropriate treatment. Show more

Keywords: Traumatic brain injury, walking speed, balance, step variability

DOI: 10.3233/NRE-2011-0676

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 45-51, 2011

Authors: Jung, Yong Jae | Hong, Ji Heon | Kwon, Hyeok Gyu | Song, Jun-Chan | Kim, Chulseung | Park, SoHyun | Ki Kim, Yeung | Ahn, Sang Ho | Jang, Sung Ho

Article Type: Research Article

Abstract: We attempted to evaluate the effect of a stretching device for treatment of hand spasticity in chronic stroke patients. We recruited 21 chronic hemiplegic stroke patients with severe finger flexor spasticity and randomly assigned them to the intervention group (10 patients) and control group (11 patients). The stretching device consisted of a resting hand splint, finger stretcher, and frame. The stretching state was maintained for 30 seconds and relaxed for the next 30 seconds. This stretching and relaxation were repeated for 20 minutes (one session). The stretching program was practiced 2 sessions/day and 6 days/week for 3 weeks for the …patients of the intervention group. The effect of this stretching device was assessed using the modified Ashworth scale (MAS) score of finger flexor muscles. Patients in both groups were assessed six times within an interval of one week and patients in the intervention group were assessed two times before starting the stretching program. The two-way repeated measures analysis of variance (ANOVA) test for evaluation of the effect of intervention across all time-points between the two groups showed a significant interaction between time and effect of intervention (P < 0.001). Within the intervention group, the average of mean MAS score at Pre-1 and Pre-2 were 2.83 and 2.93, respectively (the difference between Pre-1 and Pre-2 was not significant (P > 0.05)), and this improved significantly to 1.97 at Inter-1, 1.55 at Inter-2, 1.20 at Inter-3, and 1.97 at Post-1 (P < 0.001) using the one-way repeated measures ANOVA test for evaluation of the effect of intervention across all time-points. We found that our stretching device was effective in relieving hand spasticity in chronic stroke patients. Show more

Keywords: Spasticity, hand, stretch, stroke, hemiparesis

DOI: 10.3233/NRE-2011-0677

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 53-59, 2011

Authors: Sahin, Nilay | Ugurlu, Hatice | Karahan, Ali Yavuz

Article Type: Research Article

Abstract: The purpose of this study was to investigate the effect of ultrasound (US) on the spasticity occurring in the ankle plantar flexor muscles after a cerebrovascular event. According to the modified Ashworth scale (MAS), the hemiplegic patients with stage 2–3 spasticity on the ankle plantar flexor muscles were enrolled in the study and divided into two groups. Passive stretching exercise was applied to both groups. Additionally, 10-minute US was applied to one of the groups, using the mode of continuous wave of 1.5w/cm2 to the calf muscles before stretching. In order to monitor the efficacy of the treatment in …the patients, MAS, Hmax/Mmax ratio, the ankle range of motion (ROM), Functional Independence Measure and Brunnstrom Motor Recovery Stage were evaluated. While a significant recovery was monitored in the MAS and ankle ROM measurements after treatment in both groups, no change was obtained in the other parameters. No significant difference was detected in any of the measurements between the groups. In this study, US treatment applied in combination with the ankle plantar flexor muscles passive stretching exercise was determined to have no effect on the stretching treatment in minimizing the spasticity. Show more

Keywords: Spasticity, electrophysiological, ultrasound, randomized controlled study

DOI: 10.3233/NRE-2011-0678

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 61-66, 2011

Authors: Solopova, I.A. | Tihonova, D.Y. | Grishin, A.A. | Ivanenko, Y.P.

Article Type: Research Article

Abstract: Objective: Here we developed and tested a novel system for early motor rehabilitation in acute stroke when patients are unable to stand and walk without assistance. Stepping performance may be largely facilitated by providing treatment in the supine position on a tilt table using step-synchronized functional electrical stimulation (FES) with assisted leg movements and progressive limb loading. Methods: Sixty-one individuals with acute stroke were randomly assigned to two groups, experimental and control. The first group received both a conventional therapy and FES-therapy combined with progressive limb loading, whereas the control group received a conventional therapy only. Changes after …treatment were assessed using clinical scores and neurophysiological measurements of movement performance. Results: After treatment, there was an improvement of the clinical scores, muscle forces and everyday life activity performance in both groups, however, significantly higher in the experimental group. Active rhythmic movements of the non paretic leg often provoked muscle activity in the paretic leg as well as there was a reduction of the contralateral leg muscle contraction during paretic leg movements. Conclusion: The developed FES and leg displacement-assisted therapy facilitates a smooth transition to walking in the vertical position and increases the patient’s functional abilities and the effectiveness of rehabilitation. Show more

Keywords: Neuromotor rehabilitation, locomotor movements, EMG patterns, functional electrical stimulation, acute period of stroke

DOI: 10.3233/NRE-2011-0679

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 67-77, 2011

Authors: Gorgey, Ashraf S. | Poarch, Hunter | Harnish, Christopher | Miller, Joshua M. | Dolbow, David | Gater, David R.

Article Type: Research Article

Abstract: Objectives: Locomotor training (LT) enhances walking in individuals with spinal cord injuries (SCIs). We tested the acute effects of 4 days of LT using BWSTT combined with Robotic Locomotor therapy compared to BWSTT twice weekly. Design: Two non-ambulatory participants with an American Spinal Injury Association Impairment Scale (AIS) D. Both received LT for 2 weeks as a portion of their clinical inpatient rehabilitation program and both used wheelchairs as their primary method of mobility. Over a 2 week period, one participant received a total of 8 visits consisting of manual BWSTT (twice weekly) combined with Robotic locomotor therapy …(twice weekly). The other participant preformed manual BWSTT (twice weekly) for a total of 4 visits. Resting energy expenditure, body composition, muscle strength, submaximal oxygen consumption (VO2 ) and blood lactate during LT were measured pre and post-training. Results: The average maximum voluntary contraction of both knee extensor muscle groups increased by 28–34% with associated reduction in spasticity to the BWSTT participant. Two week interventions resulted in a downward shift of the lactate concentrations for both participants, increase in resting energy expenditure and shift in substrate utilization. Discussion and conclusion: A clinical paradigm of incorporating BWSTT with robotic locomotor therapy for 4 days/ week did not provide additional physiological benefits to skeletal muscle strength, spasticity or metabolic profile compared to twice weekly of LT using BWSTT. Show more

Keywords: Spinal cord injury, locomotor training, body weight supported treadmill training, robotic therapy, rehabilitation

DOI: 10.3233/NRE-2011-0680

Citation: NeuroRehabilitation, vol. 29, no. 1, pp. 79-83, 2011