NeuroRehabilitation - Volume 29, issue 3

Authors: DeLuca, John | Nocentini, Ugo

Article Type: Research Article

Abstract: Multiple sclerosis (MS) is a chronic and disabling disease that attacks the central nervous system (CNS). The symptoms, progression, and severity of the disease are unpredictable and vary from one person to another. Major symptoms include fatigue, sensory-motor (e.g., visual disturbance, spasticity, locomotion), cognitive (e.g., decreased information processing speed, impaired memory), and psychiatric problems (e.g., depression). Although the etiology is unknown, MS is thought to be an autoimmune disease triggered by a viral or other infectious agent in genetically susceptible individuals. The CNS target of the disease is myelin, although it is now known that other aspects of the CNS …such as axonal and gray matter regions are also involved. Show more

Keywords: Multiple sclerosis

DOI: 10.3233/NRE-2011-0695

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 197-219, 2011

Authors: Wilms, Inge | Mogensen, Jesper

Article Type: Research Article

Abstract: In the study of the brain and how it adapts to changes or injury, researchers sometimes come across situations where apparently similar types of tests or training do not achieve similar outcome results. This is true, in particular, within the field of computer-based rehabilitation where paper-and-pencil tests and training is converted to computer. This paper raises the attention to the fact that supposedly similar settings may not, in fact, elicit similar results and caution therapists and researchers who work with rehabilitation of brain injury. The paper suggests that the underlying mechanisms behind this may be illuminated by using the REF …(Reorganization of Elementary Functions) model and suggests that further research into the use of advanced technologies such as computer-generated virtual reality is required. Show more

Keywords: Computer-based rehabilitation, cognitive rehabilitation, REF-model, after-effect, adaptive processes, brain injury, plasticity

DOI: 10.3233/NRE-2011-0696

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 221-227, 2011

Authors: Celik, Canan | Ucan, Halil | Alemdaroglu, Ebru | Oktay, Fugen

Article Type: Case Report

Abstract: Critical illness polyneuropathy (CIP) is defined as a common complication of critically ilness patients who were admitted to the intensive care unit due to sepsis, multiple trauma and/or multi-organ failure. We aimed to present a patient who was diagnosed as CIP. He was admitted to our outpatient clinic due to weakness and pain in his lower extremities. He had been followed in an intensive care unit due to suicid five months ago. There were symmetrically and predominantly muscle weakness, sensory impairment, absence of deep tendon reflexes in his lower extremities. Electrophysiological evaluation demonstrated motor and sensory axonal distal polyneuropathy predominantly …in lower extremities. At follow up, he had high fever, and elevated acute phase responses. Therefore source of infection was investigated and was suspected to a diagnosis of infective endocarditis. He was discharged to be hospitalized in cardiology clinic. With this case, we think that physiatrists should take into consideration a diagnosis of critical illness polyneuropathy in patients with symmetric motor weakness. In CIP, muscle weakness, sensory loss, neuropathic pain, and autonomic problems lengthened the rehabilitation period. Due to a diagnosis of infective endocarditis in our case, we point out that source of infection should be carefully investigated if there is acute phase responses in CIP patients even if during rehabilitation period. Show more

Keywords: Critical illness, intensive care, polyneuropathy

DOI: 10.3233/NRE-2011-0697

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 229-232, 2011

Authors: Kim, Soo Ji | Kwak, Eunmi Emily | Park, Eun Sook | Lee, Don Shin | Kim, Ki Jung | Song, Joo Eun | Cho, Sung-Rae

Article Type: Research Article

Abstract: The objective is to evaluate the changes in gait patterns with rhythmic auditory stimulation (RAS) in adults with cerebral palsy (CP). Fourteen CP with bilateral spasticity participated in this study. A repeated-measures analysis of gait was performed in the presence and absence of RAS. Thirty healthy controls were also recruited. Each subject walked 10 m at their comfortable walking speed. Temporospatial data and kinematic parameters of gait were analyzed without RAS and with RAS. RAS was provided using a combination of a metronome beat set to the individual's cadence and rhythmic cueing from a live keyboard playing. Kinematic parameters, gait …deviation index (GDI) as a measure of overall gait pathology, and asymmetry of temporospatial data were assessed. Gait analysis revealed that anterior tilt of pelvis and hip flexion during a gait cycle was significantly changed with RAS (p < 0.05), whereas there were no statistical differences in knee, ankle, and foot kinematic parameters. Additionally, the GDI exhibited a modest, but a statistically significant, improvement with RAS (p < 0.05). Based on ambulatory status, household ambulators showed that side-to-side asymmetry of step length as well as the GDI was significantly attenuated with RAS (p < 0.05). Walking with RAS resulted in kinematic changes of the pelvic and hip movement in spastic CP. Especially, the application of RAS immediately ameliorated overall gait pathology as well as temporospatial asymmetry in household ambulators. Therefore, RAS may be one of the therapeutic tools for gait training in adults with CP. Show more

Keywords: Rhythmic auditory stimulation, kinematics, gait, cerebral palsy, gait deviation index, household ambulator

DOI: 10.3233/NRE-2011-0698

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 233-241, 2011

Authors: Kwon, Hyeok Gyu | Lee, Dong Gyu | Choi, Byung Yeon | Chang, Chul Hoon | Kim, Seong Ho | Jang, Sung Ho

Article Type: Case Report

Abstract: Little is known about recovery of the corticospinal tract (CST) after injury by transtentorial herniation (TH). We present with a patient who showed recovery of the CST after injury by TH, using diffusion tensor tractography (DTT) and transcranial magnetic stimulation (TMS). A 69-year-old female underwent craniotomy and drainage of an intracerebral hemorrhage in the left corona radiata and basal ganglia. Brain CT showed left TH and brain MRI revealed a leukomalactic lesion at the left cerebral peduncle. The patient presented with complete paralysis of the right extremities at ICH onset, but slowly recovered some function to the point of being …able to move the affected extremities against gravity at about 6 months after onset. Three-week DTT showed disruption of the left CST below the cerebral peduncle; however, this disruption was recovered on 1-year DTT. Three-week TMS showed no motor evoked potential for the affected hemisphere; in contrast, motor evoked potentials that were compatible with regenerated CST were obtained from the affected hand muscle at 6 months. Using DTT and TMS in a patient with ICH, we demonstrated recovery of the CST after injury by TH. Show more

Keywords: Diffusion tensor tractography, transcranial magnetic stimulation, transtentorial herniation, corticospinal tract, motor recovery

DOI: 10.3233/NRE-2011-0699

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 243-246, 2011

Authors: Bryant, M.S. | Rintala, D.H. | Hou, J.G. | Lai, E.C. | Protas, E.J.

Article Type: Research Article

Abstract: Introduction: Backward walking is difficult for persons with Parkinson’s disease (PD). It is unknown how levodopa influences backward gait patterns, especially when compared to forward gait patterns. Purpose: Investigate the effects of levodopa on forward and backward gait patterns in individuals with PD. Design: A repeated measures design was used. Methods: The sample consisted of 21 individuals with PD (15 males, 6 females). Their mean age was 70.24 ± 8.69 yr. The average time since diagnosis was 11.81 ± 5.49 years. The median of the Hoehn and Yahr stage while ‘ON’ medication was 2.57. …Gait patterns during forward and backward walking at a self-selected comfortable speed were recorded before and after taking levodopa on the same day. Results: Levodopa significantly increased gait speed and stride length and decreased the percent of the gait cycle (%GC) spent in double support. Gait speed and stride length were greater and the %GC spent in double support was less during forward walking compared with backward walking. Cadence was not changed by levodopa or walking direction. Conclusions: Levodopa improved gait characteristics during backward walking in a manner similar to that during forward walking in persons with PD. Show more

Keywords: Parkinson's disease, gait, levodopa, backward walking, forward walking

DOI: 10.3233/NRE-2011-0700

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 247-252, 2011

Authors: Kwon, Yong-Hyun | Park, Ji-Won

Article Type: Research Article

Abstract: Concentric and eccentric muscle contractions have distinct differences in their neuromuscular and neurophysiologic characteristics. However, although many evidences regarding the features of these types of muscle contraction have emerged, there have been few neuroimaging studies to compare the two types of contractions. Therefore, we investigated whether cortical activity associated with eccentric contraction of the wrist extensors differed from that of concentric contraction, using functional MRI (fMRI). Fifteen right-handed healthy subjects were enrolled in this study. During 4 repeating blocks of eccentric and concentric muscle contraction paradigms, the brain was scanned with fMRI. The differences in the BOLD signal intensities during …the performance of eccentric and concentric exercise were compared in the predetermined regions of interest. Our findings revealed that many cortical areas associated with motor performance were activated, including the primary motor area, the inferior parietal lobe, the pre-supplementary area (pre-SMA), the anterior cingulate cortex, the prefrontal area, and the cerebellum. In addition, lower signal intensities were seen in the right primary motor cortex and right cerebellum during eccentric contractions compared with concentric contractions, whereas higher signal intensities were detected in other cortical areas during eccentric contractions. In the study, we demonstrated that eccentric and concentric muscle contractions induced quite different patterns of cortical activity respectively. These findings might be attributed to different strategy of neuro-motor processing and a higher level of cognitive demand for the performance of motor task with a higher degree of difficulty such as that required during eccentric contractions in comparison of concentric contractions. Show more

Keywords: Eccentric contraction, concentric contraction, cortical activation pattern, functional MRI

DOI: 10.3233/NRE-2011-0701

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 253-259, 2011

Authors: Dolbow, D.R. | Gorgey, A.S. | Daniels, J.A. | Adler, R.A. | Moore, J.R. | Gater Jr., D.R.

Article Type: Research Article

Abstract: Introduction: Bone loss is a common and often debilitating condition that accompanies spinal cord injury. Because bone loss after spinal cord injury is multifactorial, it can be difficult to assess and treat. This process becomes even more complex as secondary conditions associated with aging are introduced. Purpose: There are two purposes of this literature review. The first is to summarize information concerning the mechanisms of bone loss and osteoporosis after spinal cord injury. The second is to summarize existing data concerning the effects of exercise on bone loss after spinal cord injury. Method: Literature was reviewed …concerning the bone loss process and the non-pharmacological treatment options for ameliorating bone loss after spinal cord injury. Results: (Part One) Osteoporosis is universal in persons with chronic complete spinal cord injury, which increases the risk of bone fracture. Bone loss after spinal cord injury is both sublesional and regional with the greatest areas of bone demineralization being in the sublesional trabecular laden areas of the distal and proximal epiphyses of the femur and tibia. (Part Two) While passive weight bearing of paralyzed lower extremities appears to be ineffective, stressing the bones through muscular contractions initiated by electrical stimulation (FES) have yielded positive results in some cases. The intensity, frequency, and duration of stress to the bones appear to be important determinants of improved bone parameters. Although further quantification of these components is needed, some generalized guidelines can be deduced from completed research. Intensities showing positive results have been loads of one to one and a half times body weight for FES exercise or having participants FES cycle at their highest power output. Safety precautions must be used to decrease risk of bone fracture. Generally, the frequency is effective with three or more weekly exercise sessions. Studies of duration suggest that several months to one or more years of FES are necessary. Discussion: In order to promote healthy and independent aging in patients with spinal cord injury, it is important to understand the processes, consequences and effective treatments involved with bone loss. Show more

Keywords: Osteogenic osteoporosis, functional electrical stimulation, trabecular bone, cortical bone

DOI: 10.3233/NRE-2011-0702

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 261-269, 2011

Authors: Kwon, Hyeok Gyu | Kim, Oh Lyong | Kim, Seong Ho | Lee, Dong Gyu | Byun, Woo Mok | Jang, Sung Ho

Article Type: Case Report

Abstract: We report on a patient with a meningioma whose hand motor function appeared to be reorganized mainly into the face somatotopy of the primary motor cortex (M1) following meningioma removal, using functional RMI (fMRI). A 76-year-old right-handed woman showed leukomalactic lesions in the left fronto-parietal lobes and subcortical white matter, including the upper portion of the precentral knob after meningioma removal. She recovered motor function to the point that she was able to extend the affected fingers against gravity at 6 weeks and extend the affected fingers against resistance at 12 weeks. The right primary sensori-motor cortex centered on the …precentral knob was activated during movement of the unaffected (left) hand. By contrast, the face somatotopy and inferior portion of the precentral knob of the left primary motor cortex were activated during movement of the right hand. Peak activations were present at the left face somatotopy of the primary motor cortex during movement of the right hand and the right precentral knob during movement of the left hand. Motor function of the affected hand appeared to be reorganized mainly into the face somatotopy of the primary motor cortex and partially into the lower portion of the precentral knob after meningioma removal. Show more

Keywords: Functional MRI, motor recovery, cortical reorganization, brain tumor, brain plasticity

DOI: 10.3233/NRE-2011-0703

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 271-274, 2011

Authors: Gary, Kelli W. | Nicholls, Elizabeth | Shamburger, Aisha | Stevens, Lillian F. | Arango-Lasprilla, Juan C.

Article Type: Research Article

Abstract: A number of researchers have identified differences in SCI outcomes between racial and ethnic groups, but findings have never been synthesized to give clinicians and researchers a coherent picture of the problem. The goals of the current project were to (1) conduct a critical literature review of studies specifically investigating racial and ethnic disparities in spinal cord injury care, services, and outcomes; (2) explore possible causative factors that may explain these disparities; (3) propose strategies that may reduce disparities and improve access, service, and outcomes for minority patients with SCI; and (4) generate ideas for future research in this area. …A search using MEDLINE/PubMed, PsycINFO, CINAHL, and HealthSource resulted in 49 articles discussing hospital, mental health, physical functioning, employment, quality of life, and family outcomes. Results indicated that after an SCI, racial and ethnic minority groups have shorter hospital lengths of stay, higher rehospitalizations rates, higher levels of depression, more days in poor health, greater degrees of unemployment, more difficulties with mobility, lower self-reported subjective well-being and quality of life and life satisfaction, and greater risk of marital breakup. A variety of causative factors, intervention strategies, and directions for future research are presented. Show more

Keywords: Spinal cord injury, race, ethnicity, minorities, outcomes

DOI: 10.3233/NRE-2011-0704

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 275-293, 2011

Authors: van Tilborg, Ilse A.D.A. | Kessels, Roy P.C. | Hulstijn, Wouter

Article Type: Research Article

Abstract: How people suffering from dementia can be taught new motor skills for everyday household activities is an important but relatively unexplored area of research. Previous studies have demonstrated intact implicit learning abilities in patients with Alzheimer dementia (AD) on computerized motor-learning tasks and everyday activities, but explicit training strategies have been found to be beneficial in AD as well. The aim of the present study was to compare two explicit training methods, i.e. observational learning and learning by guidance, and an implicit training method in patients with AD and healthy controls. All three types of training methods resulted in statistically …significant learning. However, while improvement from baseline was similar in both groups, the absolute performance of the patients in the explicit training methods was well below that of the controls. The modest success of the explicit training methods and the slightly better results achieved with the observation method should be investigated further in studies of the acquisition of everyday activities. Show more

Keywords: Observation, guidance, Alzheimer, dementia, motor skill, learning, rehabilitation

DOI: 10.3233/NRE-2011-0705

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 295-304, 2011

Authors: Kim, Soo Hyun | Lee, Dong Gyu | You, Hee | Son, Su Min | Cho, Yun Woo | Chang, Min Cheol | Lee, Jun | Jang, Sung Ho

Article Type: Research Article

Abstract: Little is known about the clinical usefulness of diffusion tensor tractography (DTT) for the arcuate fasciculus (AF) in stroke patients with aphasia. Using DTT, we attempted to investigate the clinical usefulness of the AF in patients with aphasia. Five stroke patients and 7 age- and sex-matched normal subjects were recruited for this study. We recruited stroke patients with language dysfunction who had lesions in the left corona radiata and basal ganglia level. DTT for the AF was reconstructed using DTI-studio software. Korean-Western Aphasia Battery (K-WAB) was used for measurement of language function. Patient 1, who showed mild dysarthria, revealed a …normal left AF in terms of integrity and DTT parameters. In patient 2, with conduction aphasia, the left AF showed partial injury; however, the integrity of the left AF was spared. Patients 3 and 4, who had no brain lesions at Broca's area on conventional brain MRI, showed disruptions of the left AF over the stroke lesions after originating from Wernicke's area and they presented with Broca's aphasia. Patient 5 revealed global aphasia on K-WAB and the left AF was not reconstructed due to severe injury and Wallerian degeneration. We found that DTT for the AF could provide useful information on the presence or severity of injury of the AF, which could not be detected on conventional brain MRI in stoke patients. In addition, it could be helpful in classification of the aphasia type of stroke patients. Show more

Keywords: Diffusion tensor imaging, diffusion tensor tractography, stroke, arcuate fasciculus, aphasia

DOI: 10.3233/NRE-2011-0706

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 305-310, 2011

Authors: Akbari, Shadi | Ashayeri, Hassan | Fahimi, Malahat Akbar | Kamali, Mohamad | Lyden, Patrick D.

Article Type: Research Article

Abstract: Purpose: We aimed to investigate whether test performance in neurological and cognitive areas is able to predict daily task performance in stroke patients and if the two selected measures of stroke severity and cognitive function could be used as valid tools to predict functional outcomes after stroke. Method: We assessed 27 stroke patients (hemorrhagic and infarct) through Barthel Index (BI), Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) and National Institute of Health Stroke Scale (NIHSS) in the first 6 months after stroke. Results: The correlation of intensity of neurological impairment (NIHSS score) and ADL performance (BI score) …was significant (P < 0/05), but we found no relation between general cognitive function (the total score of LOTCA) and individual independence (total score of BI). Although ADL performance areas associated with some cognitive components. Conclusion: The dependency after stroke is more affected by physical symptoms of stroke than by cognitive disorders. Moreover, the intensity of neurological impairment could be a better explanation for a patient’s inability to perform basic ADL independently. Low direct relations in total scores of NIHS scale and BI was found, but LOTCA is not appropriate for prediction of independency in basic ADL performance after stroke. Nevertheless, further studies and confirmation are needed. Show more

Keywords: Activities of daily living, cognition, dependency, stroke

DOI: 10.3233/NRE-2011-0707

Citation: NeuroRehabilitation, vol. 29, no. 3, pp. 311-316, 2011