NeuroRehabilitation - Volume 49, issue 4

Authors: Luan, Shuo | Wu, Shao-Ling | Xiao, Ling-Jun | Yang, Hai-Yun | Liao, Mei-Xin | Wang, Shao-Ling | Fan, Sheng-Nuo | Ma, Chao

Article Type: Research Article

Abstract: BACKGROUND: Cricopharyngeal muscle dysfunction (CPD) management has been challenging in clinical practice. OBJECTIVE: To compare the efficacy and safety of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in treating CPD. METHODS: Forty patients with CPD were randomly divided into two groups, namely the botulinum toxin injection group (BTX group) and balloon dilatation group (BD group). Patients in the BTX group received a single ultrasound-guided injection of 50 units of botulinum toxin type A, while the BD group received dilatation therapy five times per week, consecutively for two weeks. Relative opening percentage of the upper esophageal …sphincter (UES), the penetration-aspiration scale (PAS), and the Dysphagia Outcome Severity Scale (DOSS) were evaluated by a videofluoroscopic swallowing study (VFSS) at baseline, 1-month, and 3-months posttreatment. The Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA) were also used to evaluate participants’ swallowing function at baseline and the 1-week, 2-week, 1-month, and 3-month follow-ups. RESULTS: A generalized estimating equation (GEE) model revealed the significant main effect for time in UES, PAS, DOSS, FOIS, and SSA compared to baseline (P <0.05), while no group-by-time interactions (except for the PAS assessment) or main effect for treatment was detected among the above multiple variances. No systematic complications or severe adverse effects were noted. CONCLUSION: Both ultrasound-guided botulinum toxin type A injections and balloon dilatation therapy have been proven as safe and effective treatments for CPD patients. Future clinical trials with longer follow-up periods and more participants are warranted. Show more

Keywords: Neurogenic cricopharyngeal muscle dysfunction, ultrasound-guided botulinum toxin injection, balloon catheter dilatation therapy, dysphagia

DOI: 10.3233/NRE-210113

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 629-639, 2021

Authors: Gu, Pengpeng | Tu, Wenzhan | Deng, Fen | Ye, Limei | Li, Sisi | Bai, Guanghui | Jin, Xiaofeng | Li, Shasha | Jiang, Songhe

Article Type: Research Article

Abstract: BACKGROUND: Graded motor imagery (GMI) therapy is a neural rehabilitative physiotherapy that has been shown to alleviate the severity of complex regional pain syndrome, phantom limb pain and disability. OBJECTIVE: To identify neural networks associated with the use of graded mirror therapy (MT) while imagining hand movements. METHODS: We made a block-design functional magnetic resonance imaging study of MT included three experiments: (1) immobile unimanual MT (IU-MT), in which the right hand flexed and made a fist, which then remained immobile; (2) mobilization unimanual MT (MU-MT), in which the right hand performed a flexion-extension movement; and …(3) mobilization bimanual MT (MB-MT), in which both hands performed a flexion-extension movement. When subjects started their hand movements, they gazed at the mirror and imagined the same movement behind the mirror. RESULTS: We discovered that the sensorimotor area of the left brain, superior temporal gyrus/middle temporal gyrus (STG/MTG) of the right brain and visual areas were activated by IU-MT. In MU-MT, only the STG/MTG was activated. Furthermore, MB-UT mostly activated the sensorimotor area and STG of the right brain. However, there were no brain areas activated by MU-MT compared with IU-MT or MB-MT; but, MB-MT activated more motor areas than IU-MT. Importantly, we determined that the level of mirror imagery was negatively correlated with signals in the mirror neuron system (MNS) and positively related with the signals in the sensorimotor areas. CONCLUSIONS: We suggest that graded MT might be a sequential therapeutic program that can enhance the sensorimotor cortex. The MNS might have an initiating role in graded MT. Thus, there is the possibility that graded MT is a helpful treatment strategy for the rehabilitation of dysfunctional patients. Show more

Keywords: Graded motor imagery, cerebral activation, visual illusion, functional magnetic resonance imaging (fMRI), rehabilitation

DOI: 10.3233/NRE-210185

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 641-654, 2021

Authors: Philipson, Erik B. | Gause, Emma | Conrick, Kelsey M. | Erickson, Scott | Muma, Amy | Liu, Zhinan | Ayyagari, Rajiv C. | Vavilala, Monica S.

Article Type: Research Article

Abstract: BACKGROUND: Many students return to school after concussion with symptoms but without formal support. OBJECTIVE: To examine concussion symptoms and temporary academic accommodations during school use of a four-week student-centered return to learn (RTL) care plan. METHODS: Five public high schools used the RTL care plan and contributed student-level data after student report of concussion. Data on concussion symptoms, temporary academic accommodations corresponding to reported symptoms, and accommodations provided during RTL care plan use were examined. RESULTS: Of 115 students, 55%used the RTL care plan for three (34%) or four (21%) weeks. Compared to …students whose symptoms resolve within the first two weeks, students who used the RTL care plan for three or four weeks reported more unique symptoms (P  = 0.038), higher total severity score (P  = 0.005), and higher average severity per symptom (P  = 0.007) at week one. Overall, 1,127 weekly accommodations were provided. While least reported, emotional symptoms received corresponding accommodations most often (127/155 reports: 82%of occurrences). CONCLUSIONS: Use of an RTL care plan can facilitate the RTL of students with a concussion and may aid in the identification of students who are in need of longer-term support. Show more

Keywords: Concussion, return to learn, traumatic brain injury

DOI: 10.3233/NRE-210182

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 655-662, 2021

Authors: Bateman, Emma A. | VanderEnde, Jordan | Sequeira, Keith | MacKenzie, Heather M.

Article Type: Case Report

Abstract: BACKGROUND: Hemicraniectomy to manage raised intracranial pressure following traumatic brain injury (TBI) has improved survival but may increase the incidence of Sinking Skin Flap Syndrome (SSFS). SSFS is a clinical syndrome in which patients with craniectomy develop objective neurologic abnormalities due to the pressure of the atmosphere on the unprotected brain, often presenting with postural headaches and neurologic deficits that localize to the craniectomy site. Previously thought to be a rare complication of craniectomy after TBI, evidence suggests SSFS is under-recognized. OBJECTIVE: To describe the clinical and radiographic features leading to diagnosis and the impact of temporizing and …definitive management of SSFS on outcomes in inpatients with moderate/severe TBI. METHODS: Two patients’ symptoms, qualitative behaviour observation, physical and cognitive outcome measures, and neuroimaging pre- and post-temporizing measures and cranioplasty are presented. RESULTS: Both patients demonstrated partial improvements with temporizing measures and substantial improvements in functional, cognitive, physical, and rehabilitation outcomes from the cranioplasty and resolution of SSFS. CONCLUSIONS: Rehabilitation care providers are critical to the timely diagnosis and management of SSFS, including the use of temporizing measures and advocacy for definitive treatment with cranioplasty. These cases highlight the diverse clinical presentations and importance of SSFS diagnosis to improve patient outcomes. Show more

Keywords: Decompressive craniectomy, case series, elevated intracranial pressure, traumatic brain injury, complications, neurorehabilitation, herniation, neurologic dysfunction

DOI: 10.3233/NRE-210160

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 663-672, 2021

Authors: Buckley, Trevor R.

Article Type: Case Report

Abstract: BACKGROUND: There is much research examining trajectories of cognitive recovery in those who sustain mild traumatic brain injury (mTBI). OBJECTIVE: Although the majority of research indicates a full recovery within months of a single, uncomplicated mTBI there remain few who report cognitive symptoms long after injury. Ample evidence indicates incentives to underperform on cognitive testing can negatively affect cognitive recovery, but there is little to no research on how incentives to perform well may affect recovery. This gap in research should be considered to obtain a full picture of cognitive recovery following mTBI. METHOD: Aeromedical Evaluations …present a unique opportunity to study cognitive and functional recovery after mTBI. Three case studies are presented from the Aviation Community of recovery from mTBI. Each case presented is one who was monetarily incentivized to perform well on testing. RESULTS: All three cases passed established guidelines for performance validity testing. Each case recovered to estimated baseline performance, though one case needed additional time. There was some evidence of lowered processing speed on two of the three cases. CONCLUSIONS: Consistent with current literature on mTBI, recovery from injury is considered the rule as opposed to the exception. Though there are many studies examining how incentives to underperform hinder recovery, there is little research on how incentives to perform well may affect cognitive performance after mTBI. Such may be considered a gap in research and should be a focus of future work. Show more

Keywords: Mild traumatic brain injury (mTBI), aeromedical psychology, mTBI recovery, pilot evaluation

DOI: 10.3233/NRE-210201

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 673-684, 2021

Authors: Ferrario, Irene | Negrini, Stefano

Article Type: Other

Abstract: BACKGROUND: Depression is very common in patients after a stroke and it can impact recovery. OBJECTIVE: The Cochrane Review aimed to determine whether psychological therapy, pharmacological interventions, non-invasive brain stimulation, or their combination can prevent depression after stroke. METHODS: The population addressed were patients who suffered from a stroke and had no previous diagnosis of depressive disorders. Studies comparing pharmacological intervention to placebo, psychological therapy to usual care, and non-invasive brain stimulation to sham stimulation or usual care were included. RESULTS: Outcome information was available for nine pharmacological and two psychological trials, showing favorable …treatment effects. CONCLUSIONS: The available evidence suggests that pharmacological interventions and psychological therapy may prevent depression and improve mood after stroke. Although, the current evidence is of very low quality resulting in serious uncertainties about the estimates of effect observed. Show more

Keywords: Depression, stroke, psychological therapy, antidepressant, non-invasive brain stimulation

DOI: 10.3233/NRE-218006

Citation: NeuroRehabilitation, vol. 49, no. 4, pp. 685-687, 2021