NeuroRehabilitation - Volume 31, issue 2

Authors: Nichols, Laura L. | Zasler, Nathan D. | Martelli, Michael

Article Type: Research Article

Abstract: The sodium amobarbital (amytal) (SA) interview is a technique that has been utilized in the treatment of a variety of disorders since its introduction in 1929. Since that time, there has been an assortment of research conducted showing its value in both differential diagnosis and treatment of multiple conditions. Notwithstanding the substantive amount of experience with the technique and its application to a myriad number of clinical conditions, it remains a seldom used procedure in clinical practice and certainly in neurorehabilitation. This paper will review the history of SA, as well as summarize the literature published over the past two …decades on the clinical applications of SA to provide readers with a foundation for the utility of this agent, as well as the sodium amytal interview (SAI) in neurorehabilitation clinical practice. Special emphasis will be placed on the use of the SAI in individuals with functional disorders that may be seen in the neurorehabilitation setting, as well as various classes of pain disorders. Show more

Keywords: Sodium amobarbital, amytal, sodium amytal interview

DOI: 10.3233/NRE-2012-0778

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 95-106, 2012

Authors: Kim, Se-Yun | Yoo, Eun-Young | Jung, Min-Ye | Park, Soo-Hyun | Park, Ji-Hyuk

Article Type: Research Article

Abstract: Objective: Meta-analysis was conducted to examine effects of OT interventions based on sensory stimulation, environmental modification and functional task activity on the behavioral problems and depression of individual with dementia. Search strategy: An extensive search in database such as MEDLINE, CINAHL, ProQuest Medical Library, and Cochrane and OT related 11 journals was performed. Selection criteria: Potential studies were identified through the keywords: dementia or Alzheimer, randomized controlled trials and occupational therapy or occupational therapist or ADL or sensory stimulation or Snoezelen or environmental modification or education for caregivers. Data collection and analysis: Two reviewers …independently identified studies, extracted data, assessed methodological quality of the studies. Effect size was estimated using standardized mean difference with 95% confidence intervals. Significant heterogeneity and publication bias were investigated. Main results: Nine studies including 751 people were selected. Sensory stimulation was effective intervention in improving behavioral problems (0.32; 95% CI, 0.04 to 0.59). Conclusion: This review identified that OT intervention based on sensory stimulation was effective intervention to improve behavioral problems. However, the number of studies included in this review is limited. More research is needed to enable evidence-based OT for dementia patients. Show more

Keywords: Dementia, meta-analysis, occupational therapy, randomized controlled trials

DOI: 10.3233/NRE-2012-0779

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 107-115, 2012

Authors: Intiso, Domenico | Basciani, M.

Article Type: Research Article

Abstract: In neuro-rehabilitation, botulinum toxin (BTX) as adjunct to other interventions can result in a useful therapeutic tool treating disabled people. Other than spasticity, numerous motor and non motor disorders can complicate clinical course and hamper rehabilitative process of neurological impaired patients. A review of BTX use in treating muscular imbalance of children with obstetrical brachial plexus palsy and in reducing sialorrhea following neurological diseases including amyotrophic lateral sclerosis (ASL), Parkinson disease and cerebral palsy (CP) is provided. Clinicians have to face unique and difficult to treat clinical conditions such as ulcers, sores and abnormal posture and movement disorders due to …neurological affections. BTX effectiveness in treating some of these conditions is also provided. Since, neurologically disabled subjects can show complex dysfunction, prior to initiating BTX therapy, specific functional limitations, goals and expected outcomes of treatment should be evaluated and discussed with family and caregivers. Show more

Keywords: Botulinum toxin, sialorrhea, obstetrical brachial plexus palsy, neuro-rehabilitation

DOI: 10.3233/NRE-2012-0781

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 117-129, 2012

Authors: Yeo, Sang Seok | Jang, Sung Ho

Article Type: Research Article

Abstract: Gamma knife surgery (GKS) is a proven modality for the treatment of arteriovenous malformations (AVMs), but neural degeneration is a serious complication of GKS. In this study, we report on a patient who displayed delayed neural degeneration following GKR, using diffusion tensor imaging (DTI). A 43-year-old male patient was diagnosed with an intraventricular hemorrhage (IVH) due to rupture of an AVM in the right middle cerebellar peduncle, and exhibited cognitive impairment, quadriparesis, and ataxia after IVH onset. He underwent GKS 5 weeks after onset. Brain MRIs performed at 6 weeks, 7 months, and 21 months post-onset revealed encephalomalactic lesions in …the right pons, middle cerebellar peduncle, and medulla oblongata. DTI at 6 weeks post-onset suggested neural injuries of the right corticospinal tract (CST), right middle cerebellar peduncle (MCP), and right inferior cerebellar peduncle (ICP). DTI at 7 months suggested that the right CST and right ICP had recovered to some extent, which concurred with improved clinical manifestations. However, at 21 months, four neural tracts (right CST, right MCP, and both ICPs) appeared to have degenerated, which was in-line with aggravation of corresponding clinical manifestations. Experiences of this patient suggest DTI is a useful technique for the detection of neural degeneration after GKS. Show more

Keywords: Diffusion tensor imaging, gamma knife surgery, arteriovenous malformation, neural degeneration

DOI: 10.3233/NRE-2012-0780

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 131-135, 2012

Authors: Son, Sung Min | Kwon, Jung Won | Nam, Seok Hyun | Lee, Na Kyung | Kim, Kyoung | Kim, Chung Sun

Article Type: Research Article

Abstract: Objective: Although the cane is prescribed to aid in daily living and social participation in stroke patients, this study aimed to identify whether long-term cane usage affected sensorimotor functions in the distal part of the non-affected upper limb in relation to a tracking task, a nine-hole pegboard test, and proprioceptive joint sense. Patient and method: Forty stroke patients who were divided into a cane using group (CUG) or a non-cane using group (NCUG) participated in this study. Subjects were evaluated in a tracking task for visuomotor coordination, a nine-hole pegboard test for dexterous hand motion, and a joint …reposition test for proprioceptive sense integrity. Result: Comparison of the CUG and NCUG revealed significant differences in performance of the tracking task, the nine-hole pegboard test, and the joint reposition test (p < 0.05). The CUG had more difficulty performing visuomotor coordination and dexterous hand motion tasks compared with the NCUG. Proprioceptive joint sense was also deteriorated in the CUG. Conclusion: These results suggest that stroke patients who use a cane for a long period, could experience decreased sensorimotor function in the ipsilateral upper limb of a damaged hemisphere. Therefore, it will be necessary to provide careful evaluation and appropriate therapeutic intervention for stroke patients who require the use of a cane over a long period. Show more

Keywords: Ipsilateral upper limb, cane usage, dexterity, proprioceptive sense

DOI: 10.3233/NRE-2012-0782

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 137-141, 2012

Authors: Yeo, Sang Seok | Chang, Min Cheol | Kim, Seong Ho | Son, Su Min | Jang, Sung Ho

Article Type: Research Article

Abstract: We report on a patient with traumatic brain injury who showed neural connection between injured cingulum and pedunculopontine nucleus on diffusion tensor tractography (DTT). A 74-year-old male who had suffered a traffic accident underwent conservative management for subarachnoid haemorrhage. Brain MRI which was performed 6 months after onset showed no specific lesions. On 6-month DTTs for cingulum of the patient, we observed discontinuations of both cingulums above the genu of corpus callosum. However, the left cingulum was connected to the left PPN via a neural tract that passed through the anterior corona radiata and thalamus. The neural connection between the …injured cingulum and PPN seems to be a compensatory phenomenon for the destruction of cholinergic pathways from basal forebrain. We believe that this result might suggest one of recovery mechanisms of injured cingulum following brain injury. Show more

Keywords: Cingulum, axonal injury, head trauma, diffusion tensor imaging, brain plasticity

DOI: 10.3233/NRE-2012-0783

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 143-146, 2012

Authors: Kalron, Alon | Achiron, Anat | Dvir, Zeevi

Article Type: Research Article

Abstract: Objectives: To evaluate the frequency of motor impairments in patients with recently diagnosed clinically isolated syndrome (CIS) suggestive of MS. Methods: Following a neurological examination, patients with CIS were subdivided into two groups according to the number of functional systems involved at onset. Groups consisted of monosymptomatic (n = 35, mean EDSS = 1.3 ± 0.2) and polysymptomatic (n = 17, mean EDSS = 2.6 ± 0.1) patients. Motor assessment included peak isometric torque and fatigue index (FI) measured at the knee and ankle bilaterally and spatiotemporal parameters of gait and postural control. Lesion load and …atrophy were measured on a 3.0T brain MRI using MSAnalyze computerized software. Twenty eight age- and gender-matched healthy subjects served as controls for motor assessment. Results: Polysymptomatic patients demonstrated reduced peak strength and FI, slower gait velocity, narrower base of support and increased sway rate compared to healthy subjects and mono-symptomatic patients. Furthermore, polysymptomatic and monosymptomatic patient median score in T2-weighted volume lesions (mm3 ) was 4875 and 1628, respectively. Conclusions: Evidence of two subtypes of CIS was established in context with MRI findings and motor deficits. Differentiating between these groups can potentially improve management of MS patients at the initial stages of the disease process. Show more

Keywords: Clinically isolated syndrome, gait, muscle strength, motor fatigue, multiple sclerosis, MRI

DOI: 10.3233/NRE-2012-0784

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 147-155, 2012

Authors: Lee, Shenghuo | Yan, Tiebin | Lu, Xiao

Article Type: Research Article

Abstract: Devastating intracerebral hemorrhagic stroke is rarely encountered in children, but it has a high mortality rate. The case of a 15-year-old boy who survived a major stroke at 40 days old is described. He showed no significant motor or intelligence impairment in adolescence until he was hospitalized for transient left had tremors and slight left hand weakness caused by a cyst. The patient's almost complete motor recovery highlights the power of neural plasticity in young patients. The pediatric stroke was huge, but this did not affect his adolescent movement or intelligence, demonstrating the great neuroplastic potential of the developing human …brain. These observations may help increase our knowledge about stroke in children and improve the treatment of pediatric stroke patients. Show more

Keywords: Stroke, motor skill, intelligence, neuroplasticity

DOI: 10.3233/NRE-2012-0785

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 157-160, 2012

Authors: Martins, Emerson Fachin | de Menezes, Lidiane Teles | de Sousa, Pedro Henrique Côrtes | de Araujo Barbosa, Paulo Henrique Ferreira | Costa, Abraão Souza

Article Type: Research Article

Abstract: First designed as an alternative method of assessing balance and susceptibility to falls among elderly, the Functional Reach Test (FR) has also been used among patients with hemiparesis. Then this study aimed to describe the intra- and inter-rater and the test/re-test reliability of the FR measure in subjects with and without hemiparesis while verifying anthropometric influences on the measurements. The FR was administered to a sample of subjects with hemiparesis and to a control group that was matched by gender and age. A two-way analysis of variance was used to verify the intra-rater reliability. It was calculated using the differences …between the averages of the measures obtained during single, double or triple trials. The intra-class correlation coefficient (ICC) was utilized and data plotted using the Bland-Altman method. Associations were analyzed using Pearson's correlation coefficient. In general, the intra-rater analysis did not show significant differences between the measures for the single, double or triple trials. Excellent ICC values were observed, and there were no significant associations with anthropometric parameters for the hemiparesis and control subjects. FR showed good reliability for patients with and without hemiparesis and the test measurements were not significantly associated with the anthropometric characteristics of the subjects. Show more

Keywords: Measurement, balance, stroke, hemiplegia

DOI: 10.3233/NRE-2012-0786

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 161-169, 2012

Authors: Gall, Carolin | Günther, Tobias | Fuhrmans, Franziska | Sabel, Bernhard A.

Article Type: Research Article

Abstract: Introduction: With neuropsychological rehabilitation approaches neglect patients can learn to compensate for the reduced awareness of the contralesional hemispace that is often observed after right brain damage. Here, we report contralesional “cross-over” deviations in line bisection that are hypothesized to be a result of focusing on the contralesional hemispace while the intact hemispace is “neglected”. We investigate whether this unexpected pattern of deviation is related to defects in the visual field, motor intention/hypokinesia deficits or deficits in working memory. Methods: Neglect patients with and without homonymous field defects were screened for contralesional cross-over deviations in line bisection of …long lines. During line bisection eye movements were recorded in two conditions with and without requiring hand movements in order to search for directional hypokinesia. Visual fields were tested with near-threshold perimetry and with supra-threshold campimetry. Results: Of 53 chronic neglect patients only 8 showed cross-over in line bisection. Evidence for directional hypokinesia was found in only one patient. Patients with cross-over focused more often to the left than to the right of the objective line midpoint. Patients with and without visual field defects did not differ in the extent of cross-over deviations. Cross-over deviation and inconsistent stimulus detection in left hemispace were correlated irrespective of the presence of a visual field deficit. Larger cross-over deviations were associated with poorer verbal working memory span, and disorganized patterns of eye movement were related to reduced visuo-spatial working memory capacity. Conclusion: Increasing awareness of the disorder and the use of compensatory strategies may have led to a cross-over shift of visual search dominance towards the neglected side resulting in an exploration deficit of the ipsilesional side. Show more

Keywords: Neuroophthalmology, hemispatial neglect, line bisection, eye movements, visual field defects

DOI: 10.3233/NRE-2012-0787

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 171-184, 2012

Authors: Park, Hae-Yean | Yoo, Eun-Young | Park, Soo Hyun | Park, Ji-Hyuk | Kang, Dae-Hyuk | Chung, Bo-In | Jung, Min-Ye

Article Type: Research Article

Abstract: Objectives: The aims of this study were to 1) investigate the effects of forced use combined with scheduled home exercise program compared to forced use only on increasing upper extremity functioning, 2) examine whether increased upper extremity functioning generalized to activities of daily living (ADL) functioning, and 3) explore participants’ psychosocial functioning. Methods: A single-subject A-B-A’-C research design was employed in this study. The intervention consisted of two conditions: forced use only (intervention period B), and forced use in addtion to scheduled home exercise program (intervention period C). Results: The results were as follows: 1) Forced …use combined with scheduled home exercise program compared to forced use only allowed individuals with stroke to take part in exercise programs on their own within their home setting, ultimately improving their upper extremity functioning. 2) The program’s promotion of performance in ADL tasks have the advantage of keeping participants focused so that a number of exercises can be maintained throughout the intervention. 3) Finally, forced use combined with scheduled home exercise program showed partial effects on improving the participants’ psychosocial functioning. Conclusion: The results of the present study suggest that forced use combined with scheduled home exercise program compared to forced use only has the potential to be a cost- and resource-efficient method for intensifying rehabilitation. Show more

Keywords: Activity of daily living, forced use, home exercise program, stroke, psychosocial functioning, upper extremity functioning

DOI: 10.3233/NRE-2012-0788

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 185-195, 2012

Authors: Kang, Tae-Woo | Oh, Duck-Won

Article Type: Research Article

Abstract: Purpose: To investigate the effect of whole-body tilt exercise for treating hemispatial neglect and to identify the effects of incorporating mental practice into the exercise. Methods: We used a single-subject experimental design alternating with multiple baselines. Three stroke patients with hemispatial neglect participated in this study. The severity of hemispatial neglect and balance function were measured during baseline and intervention sessions. The whole-body tilt exercise was performed by using a device that allows the body to tilt 20° from the neutral upright position. Mental practice consisted of 5 min of relaxation, main whole-body tilt imagination, and normalization phases. …Results: When the whole-body tilt exercise alone was performed, the average severity score of hemispatial neglect in subjects 1, 2, and 3 decreased by 7.54, 10.02, and 8.24, respectively; their respective average balance function score increased by 35.95%, 28.13%, and 15.33% under the open-eye condition and 34.66%, 20.33%, and 13.77% under the closed-eye condition. For subjects 1, 2, and 3, the respective average hemispatial neglect score decreased by 9.07, 11.35, and 10.13 after the whole-body tilt exercise with mental practice; their average balance function scores increased by 40.15%, 33.38%, and 24.22% under the open-eye condition and by 38.93%, 27.08%, and 11.88% under the closed-eye condition, respectively. Conclusion: These findings suggest that a whole-body tilt exercise alone may be beneficial in enhancing hemispatial neglect symptoms but the addition of mental practice produces a greater positive effect. Show more

Keywords: Mental practice, whole-body tilt exercise, hemispatial neglect, balance

DOI: 10.3233/NRE-2012-0789

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 197-206, 2012

Authors: Jo, Hae Min | Choi, Byung Yeon | Chang, Chul Hoon | Kim, Seong Ho | Lee, Jun | Chang, Min Cheol | Son, Su Min | Jang, Sung Ho

Article Type: Research Article

Abstract: Clarification of the clinical characteristics of motor function in stroke patients with complete corticospinal tract (CST) injury would be of importance in stroke rehabilitation. However, this topic has not been clearly elucidated. We conducted an investigation of the clinical characteristics of motor function in chronic hemiparetic stroke patients with complete CST injury, as confirmed by transcranial magnetic stimulation and diffusion tensor imaging. Forty-one consecutive chronic hemiparetic stroke patients who showed an absence of motor evoked potential in muscles of the upper and lower extremities upon transcranial magnetic stimulation and in whom the integrity of the CST discontinued around stroke lesion …on diffusion tensor imaging tractography were recruited. Mean Medical Research Council scores for distal musculature were lower than those for proximal musculature (P < 0.001). Mean Medical Research Council scores for upper extremity muscles were lower than those for lower extremity muscles (P < 0.001). The mean Motricity Index score for muscles of the upper extremities was lower than that for muscles of the lower extremities (P < 0.001). None of the patients had a functional hand; in contrast, 56% of patients were able to walk independently. We found that motor weaknesses of distal joint musculature and upper extremities were more severe than those of proximal joint musculature and lower extremities following complete injury of the CST in stroke, respectively. As a result, despite the absence of a functional hand in all patients, more than half were able to walk independently. Show more

Keywords: Corticospinal tract, motor function, stroke, diffusion tensor tractography

DOI: 10.3233/NRE-2012-0790

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 207-213, 2012

Authors: Ansari, Noureddin Nakhostin | Naghdi, Soofia | Mashayekhi, Masoud | Hasson, Scott | Fakhari, Zahra | Jalaie, Shohreh

Article Type: Research Article

Abstract: The aim of this study was to investigate the intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the upper limb of patients with hemiparesis and to determine the effect of pain and contracture presence on the reliability of the MMAS. For this test-retest study 30 patients with hemiparesis were included. One physiotherapist using the MMAS, randomly rated the spasticity of shoulder adductors, elbow flexors, and wrist flexors in the affected upper limb of each patient with hemiparesis twice with at least a 1 week interval between testing sessions. The presence of pain and contracture during passive stretch was …recorded. The magnitude of the contracture was measured by a goniometer. The quadratic weighted kappa statistics was very good for the upper limb spasticity (κw = 0.84). Intra-rater reliability was good for shoulder adductors (κw = 0.75), and very good for elbow flexors and wrist flexors (κw 0.86 and 0.90, respectively). There were no differences between the weighted kappa values for muscle groups (p > 0.05). The intra-rater reliability was also good in the presence of pain or contracture. The MMAS had very good intra-rater reliability in the assessment of upper limb spasticity in patients with hemiparesis. The presence of pain during shoulder abduction or contracture of the shoulder adductors had no influence on the reliability of the MMAS (κw = 0.75, 0.77, respectively). Show more

Keywords: Spasticity, reliability, pain, contracture, Modified Modified Ashworth Scale

DOI: 10.3233/NRE-2012-0791

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 215-222, 2012