NeuroRehabilitation - Volume 32, issue 4

Authors: Ponsford, Jennie

Article Type: Research Article

Abstract: Background: Traumatic brain injury results in some distinctive patterns of cognitive, behavioural and physical impairment which impact significantly on independent living skills and participation in work or study, social and leisure activities and interpersonal relationships. There is, however, still considerable variability in outcome across individuals in each of the reported domains. This has led to a significant body of research examining factors associated with outcome. A range of injury-related, personal and social factors have been shown to influence survival, as well as cognitive, functional and employment outcome. Methods: This paper reviews the factors associated with each of these …aspects of outcome specifically injury-related factors, including neuroimaging findings, GCS and PTA, other injuries, and cognitive and behavioural impairments; demographic factors, including age, gender, genetic status, education, pre-injury IQ and employment status; and social factors including family and other social support, cultural factors, pre-injury psychiatric history and coping style. Conclusion: The paper identifies contributions and complex interrelationships of all of these factors to outcome following TBI. It concludes with a brief discussion of the implications of these factors for the rehabilitation process. Show more

Keywords: Traumatic brain injury, outcome, prediction

DOI: 10.3233/NRE-130904

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 803-815, 2013

Authors: Agarwal, Nitin | Sarris, Christina | Hansberry, David R. | Lin, Matthew J. | Barrese, James C. | Prestigiacomo, Charles J.

Article Type: Research Article

Abstract: Objective: To evaluate the quality of online patient education materials for rehabilitation following neurological surgery. Methods: Materials were obtained from the National Institute of Neurological Disorders and Stroke (NINDS), U.S. National Library of Medicine (NLM), American Occupational Therapy Association (AOTA), and the American Academy of Orthopaedic Surgeons (AAOS). After removing unnecessary formatting, the readability of each site was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level evaluations with Microsoft Office Word software. Results: The average values of the Flesch Reading Ease and Flesch-Kincaid Grade Level were 41.5 and 11.8, respectively, which are well outside …the recommended reading levels for the average American. Moreover, no online section was written below a ninth grade reading level. Conclusion: Evaluations of several websites from the NINDS, NLM, AOTA, and AAOS demonstrated that their reading levels were higher than that of the average American. Improved readability might be beneficial for patient education. Ultimately, increased patient comprehension may correlate to positive clinical outcomes. Show more

Keywords: Readability, online, patient education, rehabilitation, neurological surgery

DOI: 10.3233/NRE-130905

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 817-821, 2013

Authors: Balconi, Michela

Article Type: Research Article

Abstract: External feedback from contextual cues allows humans to behave appropriately in their environments. In the present study, the explicit process of feedback monitoring (an explicit response to veridical vs false feedback) was explored. In addition, the contribution of the prefrontal cortex in this monitoring process was tested by administering an rTMS inhibitory paradigm. Seventeen subjects participated in the study and were required to detect correct vs. incorrect feedback. The experimental task included three main phases: the subject's performance (spatial decisional task); the system's response to the performance (external feedback); and the subject's judgment and response to this external feedback (feedback …monitoring). rTMS was performed on the DLPFC. As shown by the behavioural measures (error rate and response times), DLPFC deactivation induced worse performance (higher ER and RT) for both correct and incorrect feedback. Indeed, this prefrontal region seems to contribute to conscious monitoring functions when an explicit response is required. Possible applications to executive function analysis and rehabilitation are suggested. Show more

Keywords: Feedback monitoring, rTMS, dorsolateral prefrontal cortex, dysexecutive syndrome, consciousness

DOI: 10.3233/NRE-130906

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 823-831, 2013

Authors: Kim, Do Hyeon | Shin, Yong-Il | Joa, Kyung-Lim | Shin, Yoon Kyum | Lee, Jae Jin | You, Sung (Joshua) Hyun

Article Type: Case Report

Abstract: Purpose: The purpose of this study was to investigate the immediate effect of Walkbot gait training on knee joint stiffness in an individual with spastic hemiplegia. Method: A woman with hemiparetic stroke underwent a 30-minute Walkbot robotic-assisted gait training session. Knee flexion stiffness associated with hamstring spasticity and knee extension torques during the terminal swing phase was determined before and after the intervention using the Walkbot-STIFF measurement system. Design: Descriptive case analysis. Results: Knee joint extension kinematic at the terminal swing phase increased from 2.44° to −0.28°. Knee joint torque increased from 0.26 Nm …to 0.32 Nm. The knee flexion stiffness decreased from 0.0083 Nm/degree to 0.0022 Nm/degree following the training. Conclusions: The Walkbot robotic-assisted locomotor training was effective for reducing knee joint stiffness and improving extensor torque during functional gait. Moreover, the Walkbot-STIFF system was useful for assessing and monitoring spasticity during locomotor training. Show more

Keywords: Assistive device, cortical disinhibition, muscle stiffness, robotic-assisted gait training, stroke

DOI: 10.3233/NRE-130907

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 833-838, 2013

Authors: Facchin, Alessio | Beschin, Nicoletta | Toraldo, Alessio | Cisari, Carlo | Daini, Roberta

Article Type: Case Report

Abstract: Objectives: Prism Adaptation (PA) is a technique used in the rehabilitation of unilateral spatial neglect. Several researchers have reported positive results on a number of tasks, but negative outcomes have also been reported. These conflicting results could be due to the use of prisms of different power. The aim of this study was to investigate the amplitude and duration of the aftereffect induced by prisms of different power by different measures in a series of single cases of neglect. Methods: Five neglect patients and ten control subjects participated in the study. Prism adaptation was evaluated with Subjective Straight …Ahead (SSA), Open-Loop Pointing (OLP) and Line Bisection (LB) tasks, immediately before prism adaptation, immediately after, and 10/60 minutes after prism adaptation. The procedure was repeated with prisms of 5, 10 and 20 prismatic diopters (Δ ). Results: The OLP task provided the most sensitive measures for the size of the aftereffect. The 20Δ prism proved to be most effective in inducing an immediate aftereffect, while the aftereffect of the 5Δ prism seemed to last longer. Conclusion: We showed that the prism power and the task used for assessing PA effect are relevant variables to be consider in clinical practice of neglect rehabilitation. Show more

Keywords: Prism adaptation, neglect, neuropsychological rehabilitation, open loop pointing, straight ahead, line bisection

DOI: 10.3233/NRE-130908

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 839-853, 2013

Authors: Di Pancrazio, L. | Bellomo, R.G. | Franciotti, R. | Iodice, P. | Galati, V. | D'Andreagiovanni, A. | Bifolchetti, S. | Thomas, A. | Onofrj, M. | Bonanni, L. | Saggini, R.

Article Type: Research Article

Abstract: Background: Progressive supranuclear palsy (PSP) is an atypical parkinsonism clinically characterized by prominent axial extrapyramidal motor symptoms with frequent falls. The clinical response to L-dopa is poor and there is strong need for alternative treatment strategies. Methods: We tested the efficacy of a rehabilitative program combining a dynamic antigravity postural system (SPAD) and a vibration sound system (ViSS) on postural instability of 10 patients affected by PSP. The patients underwent SPAD and VISS treatments with a 3 sessions/week schedule for 2 months. Patients were clinically examined at baseline, every week during the 2-months treatment, and at 1 …month after the end of treatment for the following parameters: baropodometry static, baropodometry dynamic and stabilometry. PSP rating scale and PD36 quality of life scale were also administered. Results: The combined rehabilitative program produced improvement of all the parameters explored (p = 0.01–0.05) at the end of treatment as compared to baseline. Baropodometric dynamics improvement lasted until the end of follow-up. Conclusion: Our results suggest that a specific rehabilitation program could improve postural instability in PSP patients. A more continuous treatment protocol would allow stabilizations of results. Show more

Keywords: Progressive supranuclear palsy, rehabilitation, SPAD, VISS

DOI: 10.3233/NRE-130909

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 855-860, 2013

Authors: Yeo, Sang Seok | Chang, Pyung-Hun | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: Motor control of musculature of proximal and distal joints has been suggested to differ. However, no study comparing patterns of activation between movements of proximal and distal joints has been conducted. In this study, using functional near infrared spectroscopy (fNIRS), we attempted to compare patterns of cortical activation generated during movements of shoulder and hand. Methods: Nine normal subjects were recruited. fNIRS was performed using a fNIRS system with 49 channels. Flexion-extension movements of the right shoulder or hand were performed. We measured values of oxy-hemoglobin (HbO) and total-hemoglobin (HbT) in three regions of interest: the …primary sensory-motor cortex (SM1), the premotor cortex (PMC), and the prefrontal cortex (PFC). The relative activation ratio of HbO and HbT was estimated for comparison of the relative activity of the left PMC or PFC to the left SM1. Results: Mean values of HbO and HbT of the left SM1, PMC, and PFC were higher during movements of the right shoulder, compared with movements of the left hand. Relative activation ratios for movements of the right shoulder (HbO: PMC-104.5%, PFC-110.9%; HbT: PMC-136.3%, PFC-200.1%) were greater than 100%, and, by contrast, less than 100% (HbO: PMC-57.5%, PFC-84.8%; HbT: PMC-88.9%, PFC-70.3%) for movements of the right hand. Conclusions: Our results appear to indicate that movements of the shoulder require greater neural recruitment than movements of the hand. In addition, the PMC and PFC appeared to have greater involvement than the SM1 in movements of the shoulder; by contrast, the SM1 appears to have greater involvement than the PMC and PFC in movements of the hand. Show more

Keywords: Functional NIRS, motor control, corticospinal tract, corticoreticulospinal tract

DOI: 10.3233/NRE-130910

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 861-866, 2013

Authors: Radziszewski, Krzysztof

Article Type: Research Article

Abstract: Introduction: The complications of neurogenic dysfunction of the urinary bladder still constitute an important cause of death among spinal cord injury patients. Aim of study: The aim of this study was to assess transcutaneous electrical stimulation of the urinary bladder as a treatment for micturition disorders in patients after spinal cord injury (SCI) over 2 years of follow-up. Material and methods: The study involved 28 patients (22 men and 6 women) with neurogenic bladder dysfunction following a spinal cord injury. The patients were 16 to 68 years old and 2 to 26 months since their spinal …cord injury. The therapeutic programme involved 30 sessions of electrical stimulation of the urinary bladder, five sessions per week. The outcomes of electrical stimulation were assessed by comparing the results of urodynamic examinations performed before treatment, immediately on completion of the treatment and at 24 months post-treatment. Results: Transcutaneous electrical stimulation of the urinary bladder produced a significant increase in bladder capacity (p = 0.001), which was higher by a mean of 117.7 ml immediately on completion of the treatment and a mean of 101.6 ml (p = 0.018) two years after the treatment. The amount of post-void residual urine in the bladder decreased by a mean of 81.9 ml (p = 0.007) immediately after completion of the treatment and a mean of 76.9 ml (p = 0.011) two years after the treatment. Opening pressure was lower by a mean of 3.1 cm H2 O (p > 0.05) immediately on completion of the electrical stimulation treatment. Intravesical pressure at maximum flow decreased in 19 patients (68%) by a mean of 11.6 cm H2 O (p > 0.05). At the late follow-up assessment, opening pressure was lower in 17 patients (68%) by a mean of 6.7 cm H2 O. Two patients demonstrated the micturition phase, which had been absent at baseline and immediately after completion of the treatment. Opening pressure in the entire group was lower compared to baseline by 2.9 cm H2 O (p > 0.05). Also in the late follow-up assessment, intravesical pressure at maximum flow was reduced in 21 patients (79%) by a mean of 9.6 cm H2 O (p > 0.05). The maximum voiding velocity increased by a mean of 3.8 ml/s (p = 0.008) immediately after treatment completion and by a mean of 3.6 ml/s (p < 0.001) at two years post-treatment. Conclusions: Transcutaneous electrical stimulation of the neurogenic bladder in patients following spinal cord injury improves lower urinary tract function. Improved urinary tract function is seen two years following completion of the electrical stimulation treatment. Show more

Keywords: Neurogenic urinary bladder dysfunction, spinal injuries, urodynamic examination, electrical stimulation of the urinary bladder

DOI: 10.3233/NRE-130911

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 867-873, 2013

Authors: Cantor, Joshua B. | Gordon, Wayne | Gumber, Shinakee

Article Type: Research Article

Abstract: Background: Fatigue is among the most common sequelae of traumatic brain injury (TBI). Objectives: To summarize the empirical and theoretical literature on Post TBI fatigue (PTBIF) and identify some of the challenges that continue to confront clinicians, researchers and individuals with TBI. Methods: Qualitative literature review. The epidemiology, characteristics, and correlates of PTBIF are described. Challenges in the operational definition and measurement of fatigue are discussed and the empirical literature on measurement of PTBIF and theoretical models of the potential etiology of PTBIF is summarized. Existing treatments of PTBIF and the research supporting them are reviewed. …Future directions for clinical research are presented. Results: Although PTBIF is a high incidence condition after TBI that is related to significant suffering and reduced quality of life, it remains inadequately measured and treated. Its etiology and precipitants are poorly understood and intervention research is inadequate. Conclusion: Further research is necessary to develop psychometrically-sound objective and subjective measures of PTBIF and examine the efficacy of treatments for fatigue. Interventions shown to improve fatigue in other populations should be considered in treating PTBIF. Show more

Keywords: Traumatic Brain Injury, fatigue, epidemiology, assessment, treatment

DOI: 10.3233/NRE-130912

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 875-883, 2013

Authors: Copley, Jodie | Kuipers, Kathy | Fleming, Jenny | Rassafiani, Mehdi

Article Type: Research Article

Abstract: AIM: To evaluate the effect of individualized resting mitt splints on hypertonicity (spasticity and tissue stiffness) and passive range of motion (PROM). METHODS: A randomized, single blinded, single case design. Ten adults with acquired brain injury were randomized to control (no-splint) and experimental (splint) groups. The experimental group received an individualized (wrist position, wearing schedule) thermoplastic resting mitt splint. Measures included wrist and finger PROM, muscle stiffness (Modified Ashworth Scale), and spasticity (Modified Tardieu Scale) which were taken at five time points. RESULTS: Between-group analyses indicated a statistically significant effect on PROM at the wrist (d = 2.14, CI95 …= 0.57, 3.72, p < 0.05) and clinically important effects on finger PROM, and wrist and finger spasticity and stiffness. Within-group analyses indicated that splint-wear resulted in positive clinical effects ranging from zero effect (maintenance of pre-splinting status) to a large positive treatment effect. Non splint-wear resulted in negative clinical effects ranging from zero effect to a large negative treatment effect. CONCLUSION: Individualized resting splints for adults with moderate hypertonicity and no soft tissue contracture resulted in positive clinical effects to PROM, muscle stiffness and spasticity. Long-term splint-wear may be more beneficial than short-term wear, and may prevent the negative changes evident with no splint-wear. Resting hand splints should be considered for a select group where reduction in muscle stiffness and spasticity, or maintenance of PROM, is desired. Show more

Keywords: Hypertonicity, spasticity, upper limb, splinting

DOI: 10.3233/NRE-130913

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 885-898, 2013