NeuroRehabilitation - Volume 32, issue 3

Authors: Lin, Emerald | Aligene, Kathy

Article Type: Research Article

Abstract: Introduction: Dizziness and vertigo encompass a spectrum of balance-related symptoms caused by a variety of etiologies. Balance is affected by many systems: proprioceptive pathways, and visual, cerebellar, vestibulocochlear, and vascular/vasovagal systems. Treatment includes antihistamines, antiemetics, benzodiazepines, anti-inflammatory, anti-Meniere’s, anti-migraine, antidepressants, anticonvulsants, and aminopyridines. Many medications may cause these balance-related symptoms. Onset characteristics differ and may be reversible or irreversible. Ototoxic drugs may affect the cochlea, the vestibular system, or both. Medications, whether at “therapeutic” or toxic doses, have a spectrum of side effects, depending on the medication and individual. Purpose: The section on drugs that treat dizziness and …balance deficiencies was divided to elaborate on medications by classes and etiology specific treatment. Drugs with potential to cause balance-related symptoms were chosen to elaborate on specific medical issues encountered in rehabilitation. Background on advantages of certain drugs and methods to minimize adverse effects are reviewed. Summary: Effective treatment depends on generating an accurate diagnosis, using the appropriate drug, appropriate dosage, and for an appropriate duration. For every medication, there is a spectrum of side effects at “therapeutic” and toxic doses, depending on the medication and individual. Conclusion: Practitioners must ensure correct diagnoses and cater their treatments to the patients’ clinical scenario and medical units’ capacities. Show more

Keywords: Dizziness, vertigo, orthostatic hypotension, ototoxicity

DOI: 10.3233/NRE-130875

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 529-542, 2013

Authors: Aligene, Kathy | Lin, Emerald

Article Type: Research Article

Abstract: Objectives: The purpose of this chapter is to provide an update on the clinical management of vestibular and balance dysfunction in a concussed athlete with a focus on diagnosis, initial work-up, and initial and continuing management. Although much is still unknown about the etiology of vestibular and balance dysfunction in a concussed athlete, we briefly review current theories about neural pathophysiology to help link proposed treatment methodologies. Introduction: The treatment and management of vestibular and balance dysfunction in concussed athletes requires a multidisciplinary approach and is based on continuous reassessment of the presenting symptoms. The clinical challenge toward …managing persistent symptoms of the post-concussive athlete is discerning whether a set of symptoms match diagnostic testing and whether further neurological work up is necessary. Because there are no discrete time boundaries to make such judgment calls, we offer a guide to help with the difficult clinical decisions necessary to treat the post-concussive athlete. Methods: Literature search was performed using the following keywords: Vestibular and balance dysfunction, concussion, concussed athlete and treatment, vestibular rehabilitation therapy. Original research studies, literature reviews, and clinical guidelines were reviewed between 1997 and 2012, with the majority of articles dating beyond 2004. Although we acknowledge that post-concussive states lie within a continuum, we decided to divide treatment and management into three stages: time after initial impact, recovery, and prolonged recovery. Results: In post-concussive athletes, impairments in balance may exist as a result of transmitted force to peripheral and central neural substrates that integrate sensory information and coordinate motor function. Corroborative information, clinical examination, neuropsychological testing, and continual reassessment are means to determine severity of dysfunction and track clinical course and resolution of symptoms. Persistence of symptoms beyond initial impact may require medication trials or adjustments that are tailored to the patient’s medical history and/or neurocognitive rehabilitative techniques such as vestibular rehabilitation therapy to prevent progression of neurologic sequelae. Prolonged recovery of more than six months may require neurological consultation. Conclusion: Concussion management and treatment of vestibular and balance impairments in athletes should be assessed in a stepwise manner, from initial impact to resolution of symptoms. If symptoms are prolonged, impaired neuronal mechanisms or irreversible cerebral damage may underlie persistent symptoms and cognitive deficits seen in neurocognitive testing. Management protocols are currently focused on individualized assessment of neurocognitive assessment and comprehensive symptomatic evaluation (Reddy et al., 2008). It is widely accepted that neurocognitive and resolution of concussion-induced symptoms must be resolved prior to returning to sport or play and therefore, the athlete should be reassessed and treated until symptoms resolved. Show more

Keywords: Vestibular and balance dysfunction, concussion, concussed athlete and treatment, vestibular rehabilitation therapy

DOI: 10.3233/NRE-130876

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 543-553, 2013

Authors: Amonn, Frauke | Frölich, Jan | Breuer, Dieter | Banaschewski, Tobias | Doepfner, Manfred

Article Type: Research Article

Abstract: Background: We report the effects of a computer-based neuropsychological training in children with Attention-Deficit Hyperactivity Disorder (ADHD). We hypothesized that a specific training focusing on attentional dysfunction would result in an improvement of inattention, observable in test performance, behavior and performance during experimental school lessons and in parent and teacher ratings of the related core symptom. Method: We chose a within-subject-control-design with a 4 week baseline period and subsequent 12 to 15 weekly training-sessions. 30 children (6 to 13 years old) with a diagnosis of ADHD (ICD 10: F 90.0) and no other comorbidities participated in the study. …Results: The training revealed significant improvement in training parameters of the neuropsychological training and in the symptoms of inattention and deportment as rated during experimental school lessons. However, generalization of training effects as measured by parent and teacher ratings was not detected. Conclusions: We conclude that neuropsychological training could be helpful as one adjunct module in the complex treatment of ADHD but to prove clinical value, similar training programs must focus more strongly on individually existing neuropsychological deficits. Training programs should be more intensive and should eventually be combined with home based training access. Show more

Keywords: ADHD, neuropsychological training, neuropsychological deficits, attention control

DOI: 10.3233/NRE-130877

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 555-562, 2013

Authors: Ibrahim, Alaa I. | Alhusaini, Adel A. | Hegazy, Fatma A. | Hawamdeh, Ziad M.

Article Type: Research Article

Abstract: Aims: To investigate the effect of foot wedge and carrying weighted bag on loading the paretic lower limb in children with hemiparetic CP. Design: Cross-sectional study. Participants: A convenient sample of 18 ambulant children with spastic hemiparetic CP was evaluated. Fifteen matched normal children acted as a control group. Methods: Using two calibrated scales, measurements of weight supported on each lower limb were obtained under four different standing conditions. Results: During quiet standing, the percentage of weight supported on the paretic limb was 35.59% with symmetry index equals 0.57. Standing with the …non-paretic foot is placed on a lateral foot wedge, was the best condition that increased the percentage of weight supported on the paretic limb to 47.18% and improved the symmetry index to 0.90. Non-significant improvement of symmetry index 0.61 was recorded when carrying a weighted bag with the paretic hand, but carrying with the non-paretic hand unnecessarily loads the non-paretic limb and further decreases the symmetry index to 0.49. Conclusions: Using a lateral foot wedge beneath the non-paretic foot and carrying a weighted bag with the paretic hand improve the loading function of the paretic limb and relief the non-paretic limb from overloading. Show more

Keywords: Weight bearing, asymmetry, hemiparetic CP, foot wedge, carrying weight, paretic limb

DOI: 10.3233/NRE-130878

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 563-571, 2013

Authors: Mirowska-Guzel, Dagmara | Gromadzka, Grazyna | Seniow, Joanna | Lesniak, Marcin | Bilik, Marta | Waldowski, Konrad | Gruchala, Katarzyna | Czlonkowski, Andrzej | Czlonkowska, Anna

Article Type: Research Article

Abstract: Background: The efficacy of rehabilitation in ischemic stroke patients likely varies because of brain plasticity. One of the main neurotrophins in the central nervous system is brain-derived neurotrophic factor (BDNF). Objectives: This study aimed to determine allelic and genotypic distribution of BDNF -196 G>A and -270 C>T polymorphisms, and to assess the impact of repetitive transcranial magnetic stimulation (rTMS) on serum BDNF concentrations measured before rehabilitation, after the first 6 h of rehabilitation, and after 3 weeks of rehabilitation. Methods: Twenty-six patients with hand paresis and 20 with aphasia were randomly assigned to treatment with rTMS …or sham stimulation (placebo group). Results: In men with aphasia, after the first 6 h of rTMS-supported rehabilitation, BDNF concentration was lower among rTMS-treated patients than placebo-treated patients. A similar difference was observed in women with aphasia after 3 weeks of rTMS-supported rehabilitation. No significant differences in serum BDNF concentration were observed in patients with different BDNF -196 G>A or -270 C>T genotypes. During the observation period, BDNF concentration did not differ significantly between patients who improved and those who did not. Discussion: One possible explanation for the observed difference between rTMS-stimulated and sham-stimulated patients is the suppression of BDNF production by rTMS in the healthy brain hemisphere. Show more

Keywords: Aphasia, brain-derived neurotrophic factor (BDNF), hand paresis, ischemic stroke, rehabilitation, repetitive transcranial magnetic stimulation (rTMS)

DOI: 10.3233/NRE-130879

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 573-582, 2013

Authors: Kim, Eun Hyuk | Lee, Jun | Jang, Sung Ho

Article Type: Research Article

Abstract: Background: Middle cerebral artery (MCA) territory infarct is the most common type of cerebral vascular territory infarct. Accurate prediction of motor outcome is important for stroke rehabilitation. Objectives: We conducted an investigation of prognostic factors of motor outcome in patients with a large MCAterritory infarction, using diffusion tensor tractography (DTT) of the corticospinal tract (CST). Methods: A total of 37 consecutive hemiparetic patients with a large MCA territory infarct were recruited for this study; DTT was performed within 5âĂŞ30 days after onset. Patients were classified into three groups according to DTT findings: in group A – …CST integrity was preserved around infarct regions, in group B – CSTs were discontinuous, and, in group C – the upper ends of CSTs did not reach infarcted regions. Fractional anisotropy (FA) ratio of the affected CST (versus the unaffected ipsilateral CST) was calculated, and evaluation of motor function was performed using the Motricity Index (MI), modified Brunnstrom classification (MBC) score, and the functional ambulation category (FAC) score at onset and at six months after onset. Results: Significantly greater changes in motor function (MI, MBC, and FAC) were observed between onset and six months post-onset in group A, compared with groups B and C (p < 0.05). However, no significant difference was observed between groups B and C (p > 0.05). FA ratios showed positive correlation with six-month MIs, and scores for MBC and FAC (p < 0.05). Conclusions: Results of this study demonstrate the usefulness of early DTT findings of CSTs for prediction of motor outcome in patients with a large MCA territory infarct. Show more

Keywords: Cerebral infarct, middle cerebral artery, motor function, diffusion tensor imaging, corticospinal tract

DOI: 10.3233/NRE-130880

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 583-590, 2013

Authors: Tavernese, Emanuela | Paoloni, Marco | Mangone, Massimiliano | Mandic, Vesna | Sale, Patrizio | Franceschini, Marco | Santilli, Valter

Article Type: Research Article

Abstract: Background: Segmental muscle vibration (SMV) has been used to improve gait and to reduce spasticity in stroke patients. No data exist about the possibility to improve upper limb motor function by using SMV. Methods: Forty-four patients with hemiparesis following chronic stroke were randomized to an experimental (n = 24) and a control group (n = 20). Patients in the experimental group received two weeks of general physical therapy and SMV over the biceps brachii and flexor carpi ulnaris muscles of the paretic side, while those in the control group received two weeks of general physical therapy. …Kinematic analysis of reaching movement was performed at baseline and two weeks after treatment ended. Results: Normalized jerk, indicating the smoothness of movement, significantly improved in the experimental group, with significant difference emerging between groups at the post-treatment evaluation. Patients in the experimental group also displayed a significant improvement for mean linear velocity, mean angular velocity at shoulder, distance to target at the end of movement and movement duration. No differences emerged between baseline and post-treatment evaluations in the control group. Conclusions: when added to general physical therapy, SMV is effective in improving, in a short-term period, upper limb motor performances of reaching movement in chronic stroke patients. Show more

Keywords: Segmental muscle vibration, chronic stroke, reaching movement, rehabilitation, kinematic analysis

DOI: 10.3233/NRE-130881

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 591-599, 2013

Authors: Back, Claudio Gregório Nuernberg | Benedini-Elias, Priscila C.O. | Mattiello, Stela M. | Sobreira, Claudia | Martinez, Edson Z. | Mattiello-Sverzut, Ana Claudia

Article Type: Research Article

Abstract: The mechanical and metabolic characteristics of skeletal muscle fibers can interfere with muscle contractile performance in healthy subjects. Few studies have investigated the degree of association between muscle function and muscle fiber morphology in patients with myopathy. A biopsy was obtained from the left biceps brachii muscle of 12 subjects with myopathic disorders. The relative cross-sectional area of type 2 fibers and their subtypes was determined by the ATPase technique. Relative torque (RT) was calculated by dividing isokinetic elbow flexion peak torque (PT) values (90 and 180° s−1 ) by isometric PT values. Correlations were analyzed using Spearman's coefficient (r). …The relative cross-sectional area of type 2b fibers was positively correlated with RT90 (r = 0.71, P = 0.009) and RT180 (r = 0.73, P = 0.007). The relative cross-sectional area of type 2a fibers showed a moderate and negative correlation with RT180 (r = −0.62, P = 0.03) and a low correlation with RT90 (r = −0.57, P = 0.05). In contrast to healthy subjects, patients with myopathy presented changes in the contractile behavior of type 2a fibers and compensatory adaptations in type 2b fibers. The results suggest that RT in combination with morphometric parameters provides data regarding muscle function in patients with myopathic disorders and can contribute to the establishment of therapeutic exercises. Show more

Keywords: Myopathy, skeletal muscle, biopsy, isokinetic, peak torque

DOI: 10.3233/NRE-130882

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 601-608, 2013

Authors: Yoo, In-gyu | Jung, Min-ye | Yoo, Eun-young | Park, Soo-hyun | Park, Ji-hyuk | Lee, Jin | Kim, Han-sol

Article Type: Research Article

Abstract: Background: Therapeutic concept of interlimb transfer provides very important information relevant to patients with stroke because it can be applied to help these patients recover movement skills disrupted following unilateral damage to the brain. Objectives: The purpose of this study was to determine the transfer effects for both specialized training in each hemisphere and reversed training of a specialized task. Methods: Twenty patients (ten women and ten men) with stroke and hemiparesis participated. All participants were in Brunnstrom recovery stage five or higher for arm and hand function and had Mini-Mental State Examination scores ⩾25. We …used a training task involving a modified static cone, modified box and block, and modified pegboard tasks. The specified-training group performed the reaching movements (based on grip, reach, and release movements) in a modified training setting in which left-handed participants began from a single starting location and proceeded to one of three target locations (1S3T condition), and the right-handed participants started form one of three starting locations and proceeded to a single target location (3S1T condition). The unspecified training group performed these movements starting under reverse-start and target conditions. Results: As a result of the left-to-right limb transfer in the specified-training group differed significantly in duration from that in the pre-training group. Also, the biceps brachii and triceps (lateral head) muscles were significantly more active after performing the specified training than before. On the other hand, the activity of the upper trapezius muscle did not significantly differ after specified training compared with before training. Conclusion: Consequently, a symmetric transfer advantage was observed that depended on the characteristic resources of each hemisphere. The transfer of specified training from one arm to the other had a more positive influence on functional recovery than did unspecified training for patients with stroke and hemiparesis. Show more

Keywords: Electromyography, hemisphere, inter-limb transfer

DOI: 10.3233/NRE-130883

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 609-615, 2013

Authors: Hadoush, Hikmat | Mano, Hirofumi | Sunagawa, Toru | Nakanishi, Kazuyoshi | Ochi, Mitsu

Article Type: Research Article

Abstract: Background: Mirror illusion therapy (mirror therapy) is based on the experimental substrate of a visual illusion of active hand movement to excite ipsilateral primary motor cortex (iM1). Purpose: We tested whether iM1 excitability could be modulated by enabling or disabling vision of the active hand during mirror therapy. Method: Motor cortical activations of healthy right-handed participants were identified by magnetoencephalography. Participants performed voluntary index finger extension of their dominant and non-dominant hands, separately, while viewing mirror reflection images of their active hand superimposed upon their hidden inactive hand. This was performed either with vision of the …active hand (uncovered viewing condition) or without vision of the active hand (covered viewing condition). Results: In the covered viewing condition, the iM1could be excited in all participants (n = 10) and this excitation did not differ whether the active hand was the dominant or non-dominant hand. However, in the uncovered viewing condition, dominant and non-dominant hands were able to excite iM1 only in some participants (n = 4 and n = 7, respectively). Moreover, the participants’ responses to the illusion validation questionnaire revealed that the covered viewing condition could cause clearer visual illusion for the active hand than the uncovered viewing condition. Conclusion: Disabling vision of the active hand during mirror therapy was more effective to excite iM1 responses by creating more immersive visual illusion of the active hand. Show more

Keywords: Mirror illusion, ipisilateral motor cortex, magnetoencephalagraphy

DOI: 10.3233/NRE-130884

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 617-624, 2013