NeuroRehabilitation - Volume 42, issue 2

Authors: Vickers, Kayci L. | Schultheis, Maria T. | Manning, Kevin J.

Article Type: Research Article

Abstract: BACKGROUND: Virtual reality technology allows neuropsychologists to examine complex, real-world behaviors with high ecological validity and can provide an understanding of the impact of demanding dual-tasks on driving performance. OBJECTIVE: We hypothesized that a task imposing high cognitive and physical demands (coin-sorting) would result in the greatest reduction in driving maintenance performance. METHODS: Twenty participants with acquired brain injury and 28 healthy controls were included in the current study. All participants were licensed and drove regularly. Participants completed two standardized VRDS drives: (1) a baseline drive with no distractions, and (2) the same route with three, …counterbalanced dual-tasks representing differing demands. RESULTS: A series of 3 (Task)×2 (Group) ANOVAs revealed that the ABI group tended to go slower than the HC group in the presence of a dual-task, F (1, 111) = 6.24, p  = 0.01. Importantly, the ABI group also showed greater variability in speed, F (1, 110) = 10.97, p  < 0.01, and lane position, F (1, 108) = 7.81, p  < 0.01, an effect driven by dual-tasks with both a cognitive and motor demand. CONCLUSIONS: These results indicate that long-term driving difficulties following ABI are subtle and likely due to reduced cognitive resources. Show more

Keywords: Brain injuries, chronic, TBI (traumatic brain injury), CVA (cerebrovascular accident), automobile driving,cognition

DOI: 10.3233/NRE-172301

Citation: NeuroRehabilitation, vol. 42, no. 2, pp. 213-222, 2018

Authors: Burgess, Gillian | Jewell, Vanessa D.

Article Type: Research Article

Abstract: BACKGROUND: Oculomotor dysfunction affects a significant number of adults with neurological conditions and binocular diplopia is a common symptom which impacts an individual’s ability to participate in meaningful daily activities. Occupational therapists use partial and complete occlusion to minimize binocular diplopia, however a review of the literature reflected a lack of standardized protocol for each intervention technique. The purpose of this study was to examine occupational therapists’ perspectives on the use of partial and complete occlusion and the clinical reasoning process used. METHODS: An electronic survey was distributed to occupational therapists working in a variety of practice settings. …The survey contained questions relating to demographics, the selected occlusion technique, and clinical reasoning for that selection. RESULTS: More than half of the 106 respondents used partial occlusion more frequently than complete occlusion. There was no correlation between respondent experience and self-report of competence in managing binocular diplopia. Respondents based their clinical reasoning on available evidence, client factors, and clinical expertise. CONCLUSION: Respondents offered conflicting perspectives on each occlusion technique. Future studies are required to examine which occlusion technique benefits clients. Show more

Keywords: Brain injury, clinical reasoning, complete occlusion, low vision, neurorehabilitation, partial occlusion

DOI: 10.3233/NRE-172263

Citation: NeuroRehabilitation, vol. 42, no. 2, pp. 223-233, 2018

Authors: Serrador, Jorge M. | Quigley, Karen S. | Zhao, Caixia | Findley, Thomas | Natelson, Benjamin H.

Article Type: Research Article

Abstract: OBJECTIVE: Chronic Fatigue Syndrome (CFS) is a disorder of unknown etiology associated with debilitating fatigue. One symptom commonly reported is disequilibrium. The goal of this study was to determine if CFS patients demonstrated verified balance deficits and if this was effected by comorbid fibromyalgia (FM). METHODS: Twenty-seven patients with CFS (12 with comorbid FM) and 22 age and gender matched controls performed posturography. RESULTS: Balance scores were significantly correlated with physical functional status in the CFS group (R2  = 0.43, P  < 0.001), which was not found for mental functional status (R2  = 0.06, P  > 0.5). CFS patients (regardless …of FM) had significantly higher anxiety subscale of the vertigo symptom scale scores. CFS patients, regardless of FM status, demonstrated significantly lower overall composite balance scores (Controls - 78.8±1.5; CFS – 69.0±1.4, P  < 0.005) even when controlling for anxiety and also had worse preference scores, indicating they relied on visual information preferentially even when visual information was incorrect. Interestingly, the CFS+FM group, not CFS only, demonstrated significantly worse vestibular scores (Controls – 70.2±2.4; CFS only - 67.9±3.8; CFS with FM - 55.4±4.6, P  = 0.013). INTERPRETATION: The major findings are that poor balance may be associated with poorer self-reported physical health. In addition, CFS patients seemed to rely preferentially on visual inputs, regardless of whether it was correct. The finding that vestibular function may be impaired in patients with CFS+FM but not in those with CFS alone suggests that the pathophysiology of CFS+FM may differ as has been suggested by some. Show more

Keywords: Chronic Fatigue Syndrome, fibromyalgia, posturography, vestibular function

DOI: 10.3233/NRE-172245

Citation: NeuroRehabilitation, vol. 42, no. 2, pp. 235-246, 2018

Authors: Park, Ji-Ho | You, Joshua (Sung) H.

Article Type: Case Report

Abstract: BACKGROUND: Postural instability is an important pathomarker in children with cerebral palsy (CP), and is often implicated in gait disturbance. OBJECTIVE: The purpose of this study was to investigate the therapeutic effects of long-term robotic hippotherapy (HPOT) on postural muscles size and static and dynamic postural stability in a child with CP. METHODS: Ultrasonography was used to measure postural muscles size. We also evaluated the magnitude of the separation between the center of pressure (COP) and center of mass (COM) during quiet stance and gait initiation (GI) using an eight-camera motion capture system and two force …plates. Robotic HPOT was provided as a 45-minute session once per week for 12 weeks. RESULTS: As transverse abdominal (12%) and lumbar multifidus (60%) muscles size improved, normalized sway area (16%) during the quiet stance decreased. Similarly, the maximal resultant COP-COM distance (12.84%) during the initial phase of GI increased. CONCLUSIONS: In a child with CP, robotic HPOT may be an important treatment for improving postural muscles size and postural stability in static and dynamic states. Show more

Keywords: Robotic hippotherapy, cerebral palsy, gait initiation, postural stability, center of pressure

DOI: 10.3233/NRE-172290

Citation: NeuroRehabilitation, vol. 42, no. 2, pp. 247-253, 2018