NeuroRehabilitation - Volume 39, issue 3

Authors: Haarbauer-Krupa, Juliet

Article Type: Other

DOI: 10.3233/NRE-161365

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 343-344, 2016

Authors: Baldwin, Grant | Breiding, Matt | Sleet, David

Article Type: Article Commentary

Abstract: Traumatic brain injury (TBI) can have long term effects on mental and physical health, and can disrupt vocational, educational, and social functioning. TBIs can range from mild to severe and their effects can last many years after the initial injury. CDC seeks to reduce the burden of TBI from unintentional injuries through a focus on primary prevention, improved recognition and management, and intervening to improve health outcomes after TBI. CDC uses a 4-stage public health model to guide TBI prevention, moving from 1) surveillance of TBI, 2) identification of risk and protective factors for TBI, 3) development and testing of …evidence-based interventions, to 4) bringing effective intervention to scale through widespread adoption. CDC’s unintentional injury prevention activities focus on the prevention of sports-related concussions, motor vehicle crashes, and older adult falls. For concussion prevention, CDC developed Heads Up – an awareness initiative focusing on ways to prevent a concussion in sports, and identifying how to recognize and manage potential concussions. In motor vehicle injury prevention, CDC has developed a tool (MV PICCS) to calculate the expected number of injuries prevented and lives saved using various evidence-based motor vehicle crash prevention strategies. To help prevent TBI related to older adult falls, CDC has developed STEADI, an initiative to help primary care providers identify their patients’ falls risk and provide effective interventions. In the future, CDC is focused on advancing our understanding of the public health burden of TBI through improved surveillance in order to produce more comprehensive estimates of the public health burden of TBI. Show more

Keywords: Traumatic brain injury, unintentional injury, injury causes, injury prevention

DOI: 10.3233/NRE-161366

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 345-349, 2016

Authors: Carlson, Kathleen F. | O’Neil, Maya E. | Forsberg, Christopher W. | McAndrew, Lisa M. | Storzbach, Daniel | Cifu, David X. | Sayer, Nina A.

Article Type: Research Article

Abstract: BACKGROUND: Traumatic brain injury (TBI) was deemed the ‘signature injury’ of the Iraq and Afghanistan Wars (OEF/OIF/OND). Civilians with severe TBI have increased risks of motor vehicle crashes (MVCs). Little is known about MVC risk among Veterans with TBI, many of whom incurred TBIs that were mild in severity. OBJECTIVE: To examine associations between TBI and MVC-related hospitalizations among OEF/OIF/OND Veterans who use Veterans Health Administration (VA) healthcare. METHODS: Using national VA data, we identified 277,330 Veterans who enrolled in VA within one year of deployment. MVC, TBI, and other diagnoses were identified using ICD-9-CM …codes. We estimated risk of subsequent MVC hospitalization for those with, versus without, TBI using time-to-event analyses. Time-varying Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) while controlling for potential confounders, including psychiatric diagnoses. RESULTS: There were 28,551 Veterans diagnosed with TBI; 130 were subsequently hospitalized for MVC. In adjusted models, those with TBI were four times more likely to be hospitalized for MVC than those without (HR = 4.2; CI = 3.3–5.3). CONCLUSION: Veterans with TBI had substantially greater risk of MVC-related hospitalizations. These Veterans may benefit from enhanced driving safety interventions to reduce risk. Show more

Keywords: Traumatic brain injury, motor vehicle crash, injury, health services use, veterans

DOI: 10.3233/NRE-161367

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 351-361, 2016

Authors: Kolakowsky-Hayner, Stephanie A. | Bellon, Kimberly | Yang, Yvonne

Article Type: Research Article

Abstract: BACKGROUND: The top three causes of fatal unintentional injuries are falls, motor vehicle crashes, and being struck against or struck by objects or persons. These etiologies also happen to be the leading causes of TBI, a serious public health problem, in the US. Reduced cognitive functioning, poor decision making, increased risk taking, disinhibition, diminished safety skills and substance use, place individuals with TBI at an increased risk for subsequent unintentional injuries. The caregiving, psychological, social and financial burden of initial injuries is enormous. Unintentional injuries post-TBI add to that burden significantly. Many unintentional injuries can be prevented with simple …education and environment and lifestyle changes. Injury prevention requires collaboration among many. OBJECTIVE: This literature review will share information regarding potential triggers or causes of unintentional injuries after TBI to identify potential issues. The many impacts of these injuries will be reviewed. Best practices in prevention will be presented. CONCLUSION: Ultimately, education, discussion, and awareness across multiple stakeholders can aid in preventing unintentional injuries after TBI. Show more

Keywords: Traumatic brain injury, unintentional injury prevention, repeat TBI, seizure, lack of balance and coordination, fatigue, alcohol and drug abuse

DOI: 10.3233/NRE-161368

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 363-370, 2016

Authors: Seel, Ronald T. | Macciocchi, Stephen | Velozo, Craig A. | Shari, Kimether | Thompson, Nicole | Heinemann, Allen W. | Sander, Angelle M. | Sleet, David

Article Type: Research Article

Abstract: BACKGROUND: Persons with moderate to severe TBI are at increased risk for unintentional injury or harm in the home and community; however, there is currently no standard measure of safety risk they face now and in the future. OBJECTIVE: To develop comprehensive and content valid scales and item pools for assessing safety and risk for persons with moderate to severe traumatic brain injuries. METHOD: Qualitative psychometric methods for developing scales and items were used including literature review, item development and revision, focus groups with interdisciplinary rehabilitation staff (n  = 26) for rating content validity, and cognitive …interviewing of TBI family members (n  = 9) for assuring item clarity. RESULTS: The Safety Assessment Measure is comprised of 6 primary scales – Cognitive Capacity, Visuomotor Capacity, Wheelchair Use, Risk Perception, Self-Regulation, and Compliance Failures with Safety Recommendations – in which family caregivers or clinicians rate the risk for unintentional injury or harm in adults who have sustained moderate or severe TBI. The scale item pools encompass a broad spectrum of everyday activities that pose risk in the home and community and were rated as having excellent levels of content validity. CONCLUSIONS: The Safety Assessment Measure scales and items cover a broad range of instrumental activities of daily living that can increase the risk of unintentional injuries or harm. Empirical evidence suggests that the Safety Assessment Measure items have excellent content validity. Future research should use modern psychometric methods to examine each scale unidimensionality, model fit, and precision. Show more

Keywords: Unintentional injuries, brain injuries, cognition, diagnosis, rehabilitation

DOI: 10.3233/NRE-161369

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 371-387, 2016

Authors: Colantonio, Angela | Salehi, Sara | Kristman, Vicki | Cassidy, J. David | Carter, Angela | Vartanian, Oshin | Bayley, Mark | Kirsh, Bonnie | Hébert, Debbie | Lewko, John | Kubrak, Olena | Mantis, Steve | Vernich, Lee

Article Type: Research Article

Abstract: BACKGROUND: Work-related traumatic brain injury (wrTBI) comprises up to 24% of TBIs, yet relatively little is known about it even though wrTBI incurs high costs to employers, insurers, and injured. OBJECTIVES: To compare demographic, clinical, and occupation-related factors following mild-to-moderate TBI of those who successfully returned to work (RTW) versus those who did not, and to determine perceived facilitators of and barriers to RTW. METHODS: Retrospective cohort study from a consecutive sample of persons with TBI seen in an outpatient assessment clinic. Surveys were mailed to eligible potential participants. Consenting participants were interviewed by telephone …or returned a completed survey via mail. RESULTS: Fifty of 116 eligible individuals participated in the study. Half of the participants returned to work. Participants in this group were significantly younger and had more years of education than the no-RTW group. The most common factors perceived to assist the RTW group were support of family and friends (92%) and of treatment providers (80%), and employers who provided accommodations (76%). Difficulty thinking and concentrating (94%) and fatigue (94%) were the most common barriers to RTW. CONCLUSIONS: This study highlights the importance of support from family, friends and employers as RTW facilitators. These factors merit further investigation in TBI rehabilitation studies. Show more

Keywords: Traumatic brain injury, return to work, facilitators, barriers

DOI: 10.3233/NRE-161370

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 389-399, 2016

Authors: Yozbatiran, Nuray | Keser, Zafer | Davis, Matthew | Stampas, Argyrios | O’Malley, Marcia. K. | Cooper-Hay, Catherine | Frontera, Joel | Fregni, Felipe | Francisco, Gerard E.

Article Type: Research Article

Abstract: BACKGROUND: After cervical spinal cord injury, current options for treatment of upper extremity motor functions have been limited to traditional approaches. However, there is a substantial need to explore more rigorous alternative treatments to facilitate motor recovery. OBJECTIVE: To demonstrate whether anodal-primary motor cortex (M1) excitability enhancement (with cathodal-supra orbital area) (atDCS) combined with robot-assisted arm training (R-AAT) will provide greater improvement in contralateral arm and hand motor functions compared to sham stimulation (stDCS) and R-AAT in patients with chronic, incomplete cervical spinal cord injury (iCSCI). METHODS: In this parallel-group, double-blinded, randomized and sham-controlled trial, …nine participants with chronic iCSCI (AIS C and D level) were randomized to receive 10 sessions of atDCS or stDSC combined with R-AAT. Feasibility and tolerability was assessed with attrition rate and occurrence of adverse events, Changes in arm and hand function were assessed with Jebson Taylor Hand Function Test (JTHFT). Amount of Use Scale of Motor Activity Log (AOU-MAL), American Spinal Injury Association Upper Extremity Motor Score and Modified Ashworth Scale (MAS) at baseline, after treatment, and at two-month follow-up. RESULTS: None of the participants missed a treatment session or dropped-out due to adverse events related to the treatment protocol. Participants tended to perform better in JTHFT and AOU-MAL after treatment. Active group at post-treatment and two-month follow-up demonstrated better arm and hand performance compared to sham group. CONCLUSION: These preliminary findings support that modulating excitatory input of the corticospinal tracts on spinal circuits may be a promising strategy in improving arm and hand functions in persons with incomplete tetraplegia. Further study is needed to explore the underlying mechanisms of recovery. Show more

Keywords: Spinal cord injury, arm, motor recovery, non-invasive brain stimulation, rehabilitation-robotics

DOI: 10.3233/NRE-161371

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 401-411, 2016

Authors: Moriyama, Hiroshi | Hayashi, Shogo | Inoue, Yuriko | Itoh, Masahiro | Otsuka, Naruhito

Article Type: Research Article

Abstract: BACKGROUND: The elucidation of the relationship between the morphology of the peripheral nerves and the diseases would be valuable in developing new medical treatments on the assumption that characteristics of the peripheral nerves in females are different from those in males. METHODS: We used 13 kinds of the peripheral nerve. The materials were obtained from 10 Japanese female and male cadavers. We performed a morphometric analysis of nerve fibers. We estimated the total number of myelinated axons, and calculated the average transverse area and average circularity ratio of myelinated axons in the peripheral nerves. RESULTS: …There was no statistically significant difference in the total number, average transverse area, or average circularity ratio of myelinated axons between the female and male specimens except for the total number of myelinated axons in the vestibular nerve and the average circularity ratio of myelinated axons in the vagus nerve. CONCLUSIONS: The lower number of myelinated axons in the female vestibular nerve may be one of the reasons why vestibular disorders have a female preponderance. Moreover, the higher average circularity ratio of myelinated axons in the male vagus nerve may be one reason why vagus nerve activity to modulate pain has a male preponderance. Show more

Keywords: Peripheral nerve, sex difference, morphometry, axon, human, neurological disorder

DOI: 10.3233/NRE-161372

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 413-422, 2016

Authors: McLafferty, Fred S. | Barmparas, Galinos | Ortega, Alicia | Roberts, Pamela | Ko, Ara | Harada, Megan | Nuño, Miriam | Black, Keith L. | Ley, Eric J.

Article Type: Research Article

Abstract: OBJECTIVE: To determine factors associated with response to inpatient rehabilitation treatment among TBI patients. SETTING: Inpatient rehabilitation service at a Level I trauma center. PARTICIPANTS: Moderate-severe TBI patients ages ≥ 18years old admitted between January 1, 2002 and December 31, 2012. MAIN MEASURES: Response to inpatient rehabilitation, measured by the Functional Independence Measure (FIM) score. DESIGN: Retrospective cohort study. RESULTS: Of 1,984 patients treated for TBI, 184 (10.8%) underwent inpatient rehabilitation. The largest proportion of patients improved in mobility (98.9%), followed by self-care (93.7%), communication/social cognition (84.0%), and sphincter …control (65.7%). Of these, 99 (53.8%) improved by 2 or more levels of functional independence and were considered rehabilitation responders. Responders were younger (53.1 years vs. 63.8, p  < 0.01), had longer average rehabilitation stays (15.4 days vs. 12.2, p  < 0.01), and were less likely to have an admission SBP <100 mmHg (7.1% vs. 17.1%, p  = 0.01). On multivariate analysis, normotension at admission (AOR 0.06, p  = 0.01) and longer rehabilitation LOS (AOR 1.11, p  < 0.01) were associated with a response to inpatient rehabilitation. CONCLUSION: Of the TBI patients who qualified for same-center inpatient rehabilitation, approximately half responded to treatment. Longer rehabilitation time and normotension at admission predicted response to rehabilitation. Further efforts are necessary to identify and optimize TBI patients for inpatient rehabilitation. Show more

Keywords: Traumatic brain injury (TBI), inpatient rehabilitation, hypotension, Glasgow Coma Scale (GCS), rehabilitation responder

DOI: 10.3233/NRE-161373

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 423-430, 2016

Authors: Serrada, Ines | McDonnell, Michelle N. | Hillier, Susan L.

Article Type: Review Article

Abstract: OBJECTIVE: To investigate the amount of time and types of interventions used during therapy sessions in the acute setting following stroke. METHODS: A systematic search of relevant databases was conducted. Studies were eligible if they were observational studies of adults with a confirmed diagnosis and within 4 weeks post-stroke; receiving Physiotherapy (PT) and/or Occupational Therapy (OT); and the outcome included amount of therapy time devoted to UL and/or types of interventions. Two authors independently selected studies for inclusion, assessed methodological quality and extracted data. This review is reported according to the Preferred Reporting Items for Systematic Reviews …and Meta-Analyses (PRISMA) statement. RESULTS: From the 94 studies reviewed, seven studies involving 3236 participants met the inclusion criteria. Pooled results indicated that 7.9 min/day (21.4%) of a total 36.7 min/day combined PT and OT session was devoted to UL therapy. Two of the seven studies reported types of interventions, predominantly upper limb activity and control. CONCLUSIONS: A small proportion of total PT and OT time is directed to the involved UL during acute rehabilitation. Given the evidence for early and intense rehabilitation, there is a need to explore the reasons for this low intensity of UL therapy in the acute stage post-stroke. Show more

Keywords: Stroke, systematic review, rehabilitation, behavioural mapping, upper limb

DOI: 10.3233/NRE-161374

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 431-438, 2016

Authors: Powell, Elizabeth S. | Carrico, Cheryl | Westgate, Philip M. | Chelette, Kenneth C. | Nichols, Laurie | Reddy, Lakshmi | Salyers, Emily | Ward, Andrea | Sawaki, Lumy

Article Type: Research Article

Abstract: BACKGROUND : Intensive motor training is a therapeutic intervention that supports recovery of movement function after stroke by capitalizing on the brain’s capacity for neuroplastic change. Peripheral nerve stimulation and transcranial direct current stimulation are neuromodulation techniques that can upregulate neuroplasticity and, in turn, enhance outcomes of motor training after stroke. Few studies have investigated possible adjuvant effects between peripheral nerve stimulation, transcranial direct current stimulation, and intensive motor training. OBJECTIVE: This proof-of-concept study investigated whether timing variations in neuromodulation paired with robot-assisted motor training effect differential outcomes for subjects with chronic, moderate-to-severe upper extremity impairment after stroke. …METHODS: Ten subjects in the chronic phase (>12 months after stroke) of recovery completed the study. Subjects received 10 daily sessions of transcranial direct current stimulation either at the start (n  = 4) or at the end (n  = 6) of peripheral nerve stimulation preceding intensive motor training. Pre-post changes in motor function (Fugl-Meyer Assessment; Stroke Impact Scale) and neuroplasticity (transcranial magnetic stimulation) were assessed by condition. RESULTS: Significant improvement in Stroke Impact Scale (p  = 0.02) and no change in Fugl-Meyer Assessment were associated with the start condition. No changes in Stroke Impact Scale and Fugl-Meyer Assessment were associated with the end condition. Only 1 subject in the start group had measurable neuroplastic responses and demonstrated an increase in ipsilesional cortical map volume. Only 1 subject in the end group had measurable neuroplastic responses and demonstrated a decrease in ipsilesional cortical map volume. Opposite shifts in ipsilesional cortical centers of gravity occurred relative to condition. CONCLUSION: In cases of moderate-to-severe impairment after stroke, transcranial direct current stimulation at the start, rather than the end, of peripheral nerve stimulation prior to motor training may effect better functional outcomes. Future research with a larger sample size is needed to validate the findings of this proof-of-concept study. Show more

Keywords: Peripheral nerve stimulation, transcranial direct current stimulation, neuroplasticity, transcranial magnetic stimulation, robot-assisted upper extremity motor training

DOI: 10.3233/NRE-161375

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 439-449, 2016

Authors: Norup, Anne | Guldberg, Anne-Mette | Friis, Claus Radmer | Deurell, Eva Maria | Forchhammer, Hysse Birgitte

Article Type: Research Article

Abstract: OBJECTIVE: To describe the work of an interdisciplinary visual team in a stroke unit providing early identification and assessment of patients with visual symptoms, and secondly to investigate frequency, type of visual deficits after stroke and self-evaluated impact on everyday life after stroke. METHODS: For a period of three months, all stroke patients with visual or visuo-attentional deficits were registered, and data concerning etiology, severity and localization of the stroke and initial visual symptoms were registered. One month after discharge patients were contacted for follow-up. RESULTS: Of 349 acute stroke admissions, 84 (24.1%) had visual …or visuo-attentional deficits initially. Of these 84 patients, informed consent was obtained from 22 patients with a mean age of 67.7 years(SD 10.1), and the majority was female (59.1%). Based on the initial neurological examination, 45.4% had some kind of visual field defect, 27.2% had some kind of oculomotor nerve palsy, and about 31.8% had some kind of inattention or visual neglect. The patients were contacted for a phone-based follow-up one month after discharge, where 85.7% reported changes in their vision since their stroke. CONCLUSION: In this consecutive sample, a quarter of all stroke patients had visual or visuo-attentional deficits initially. This emphasizes how professionals should have increased awareness of the existence of such deficits after stroke in order to provide the necessary interdisciplinary assessment and rehabilitation. Show more

Keywords: Stroke, visual deficits, vision disorders, visual rehabilitation, and early rehabilitation

DOI: 10.3233/NRE-161376

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 451-461, 2016