NeuroRehabilitation - Volume 53, issue 1

Authors: Sanders, John C. | MacWilliams, Bruce A. | Prasad, Sarada | Mahan, Mark A.

Article Type: Research Article

Abstract: BACKGROUND: Lower-extremity spasticity and impaired gait control after central nervous system injury are challenging to improve, because spasticity limits residual motor control while providing mechanical support. Highly selective partial neurectomies (HSPNs) can substantially reduce spasticity but may have greater risks in patients with complex lower-extremity spastic gait. OBJECTIVE: To examine the potential of ultrasound- and stimulation-guided highly selective motor nerve blocks (HSMNBs) to assess the potential impact of reduced spasticity on gait. METHODS: In this retrospective series, six patients underwent HSMNBs with movement assessment before and after the block. Range of motion, strength, position angles, surface …electromyography, lower limb kinematics, and patient satisfaction were assessed. RESULTS: Pre- and post-HSMNB movement analysis yielded dichotomous gait kinematics, which facilitated surgical decisions. Of the 59 metrics evaluated, 82% demonstrated a positive improvement post-block (62% improved more than one standard deviation (SD) of typically developing means, 49% improved > 2 SD) and 16% demonstrated a negative change (2% worsened > 1 SD). CONCLUSION: HSMNB provided clear efficacy in changing clinical, surface electromyography, and gait parameters. Movement analysis provided clear and robust objective and patient-centered evidence for surgical guidance. This protocol may provide utility in evaluation of patients being considered for HSPNs for complex spastic gait patterns. Show more

Keywords: Peripheral nerves, gait disorders, neurologic, spastic diplegia, denervation

DOI: 10.3233/NRE-230016

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 131-141, 2023

Authors: Bluvshtein, Vadim | Catz, Amiram | Mahamid, Ala | Elkayam, Keren | Michaeli, Dianne | Front, Lilach | Kfir, Adi | Gelernter, Ilana | Aidinoff, Elena

Article Type: Research Article

Abstract: BACKGROUND: Venous thromboembolism (VTE) is a concern following the onset of spinal cord lesions (SCL). OBJECTIVES: To assess the current efficacy and risks of anticoagulation after SCL and consider changes in thromboprophylaxis. METHODS: This retrospective cohort study included individuals admitted to inpatient rehabilitation within 3 months of SCL onset. Main outcome measures were the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, thrombocytopenia, or death, which occurred within 1 year of the SCL onset. RESULTS: VTE occurred in 37 of the 685 patients included in the study (5.4%, 95% CI 3.7–7.1%, 2.8% …PE), and in 16 of 526 patients who received prophylactic anticoagulation at rehabilitation (3%, 95% CI 1.6–4.5%, 1.1% PE, with at least 1 fatality). Of these 526, 1.3% developed clinically significant bleeding and 0.8% thrombocytopenia. Prophylactic anticoagulation, most commonly 40 mg/day, continued until a median period of 6.4 weeks after SCL onset (25% –75% percentiles 5.8–9.7), but in 29.7%, VTE occurred more than 3 months after SCL onset. CONCLUSION: The VTE prophylaxis used for the present cohort contributed to a considerable but limited reduction of VTE incidence. The authors recommend conducting a prospective study to assess the efficacy and safety of an updated preventive anticoagulation regimen. Show more

Keywords: Deep vein thrombosis, pulmonary embolism, spinal cord lesions, anticoagulation, prophylaxis

DOI: 10.3233/NRE-230063

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 143-153, 2023

Authors: Michalski, Andrzej | Dubas, Katarzyna | Nogaj, Sławomir | Stopa, Marcin

Article Type: Case Report

Abstract: BACKGROUND: The aim of this case report is to present the successful management of both diplopia and amblyopia in a specific clinical situation, demonstrating neuroplasticity of the visual system in an adult patient. Causes of diplopia include eye pathologies in monocular diplopia and ischemic ocular motor nerve palsies, sudden life-threatening and chronic conditions in central nervous system in binocular diplopia. Strabismic amblyopia and nonarteritic anterior ischemic optic neuropathy are quite often ophthalmic conditions, first one is caused by suppression during developmental period and the latter one by ischemia of the optic nerve in adults. Coexistence of aforementioned conditions may cause …unusual clinical situation in which ability of nervous system to functional reorganization could be demonstrated. CASE PRESENTATION: In our adult patient, diplopia was incited by the loss of suppression of the strabismic amblyopic eye, which was the consequence of a sudden decrease of the visual acuity in the previously better eye in the course of nonarteritic anterior ischemic optic neuropathy. This led to impairment in daily activities. RESULTS: Visual training rehabilitation improved distance and near visual acuity in the amblyopic eye over three months, and prescribing two pairs of glasses with prisms enabled the patient to return to daily activities. CONCLUSION: The discussed patient lost the suppression of the strabismic amblyopic eye. Management of amblyopia is usually undertaken in children, however considering neuroplasticity we successfully attempted to improve visual functioning of our patient, despite lower intensity of neuroplasticity functions in an adult brain. Show more

Keywords: Amblyopia, nonarteritic anterior ischemic optic neuropathy, suppression, visual training, neuroplasticity

DOI: 10.3233/NRE-220303

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 155-160, 2023

Authors: Piao, Honglan | Li, Han | Zhang, Jinming

Article Type: Case Report

Abstract: BACKGROUND: Backbend-induced pediatric thoracic spinal cord injury without radiologic abnormality (BBPT-SCIWORA) in children is rare in clinical practice and leads to lower limb motor dysfunction. There are few clinical studies on BBPT-SCIWORA and even fewer on treatments for BBPT-SCIWORA-induced lower limb motor dysfunction. OBJECTIVE: To explore the therapeutic effect of acupuncture at bilateral spine acupoints combined with lower limb acupoints in BBPT-SCIWORA. CASE PRESENTATION: This study reported four cases of BBPT-SCIWORA after dancing, two of which received a unique medium-frequency electroacupuncture treatment. They were all females aged between 5 and 12 years old. They were diagnosed …with BBPT-SCIWORA by magnetic resonance imaging (MRI), transferred to the rehabilitation department for lower limb dysfunction, and received rehabilitation treatments and acupuncture. Cases 1 and 2 received acupuncture treatment for lower limb acupoints, while Cases 3 and 4 received acupuncture treatment at the bilateral spine acupoints beside the lesion and lower limb acupoints. Cases 3 and 4 achieved better American spinal injury association (AIS) grades and lower extremity motor scores (LEMS) than Cases 1 and 2 after treatment. CONCLUSION: Acupuncture treatment of beside bilateral spine acupoints plus lower limb acupoints therapy might facilitate early lower limb motor function recovery in children with BBPT-SCIWORA. Show more

Keywords: BBPT-SCIWORA, beside bilateral spine acupoints, lower limb motor dysfunction, case report

DOI: 10.3233/NRE-230006

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 161-166, 2023

Authors: Cecchi, Francesca

Article Type: Other

Abstract: BACKGROUND: Cognitive Impairment (CI) after stroke is frequent and often persistent, and is associated with poor functional outcome. Occupational therapy (OT) is aimed at restoring functioning also by addressing CI. OBJECTIVE: Commentary on the review by Gibson et al. (2022) updating a previous Cochrane Review (Hoffmann et al., 2010 ) to investigate the effectiveness of OT on CI after stroke. METHODS: This review included randomised and quasi-randomised controlled trials evaluating OT for adults with clinically defined stroke and confirmed CI. Outcomes included basic activities of daily living (BADL) (primary), instrumental ADL (IADL), community integration and …participation, global cognitive function and specific cognitive abilities. RESULTS: Overall, 24 trials from 11 countries including 1142 participants. For BADL, a small effect below the minimal clinically important difference (MCID) was found immediately after intervention and at six months’ follow-up (low certainty evidence), but not at three months follow-up (insufficient evidence). For IADL, the evidence was very uncertain about an effect, while for community integration, there was insufficient evidence of an effect. For global cognitive performance, there was an improvement of clinical importance after the intervention (low-certainty). There was some effect for attention overall, and for executive functional performance overall (very low-certainty). Of the cognitive subdomains, there was evidence of effect of possible clinical importance, immediately after intervention, only for sustained visual attention (moderate certainty), for working memory (low certainty), and thinking flexibly (low certainty), while there was only low or very low certainty or insufficient evidence of an effect for other cognitive domains/subdomains; CONCLUSION: The authors concluded that the body of evidence for the effectiveness of OT interventions has improved since their first review. However, although their findings provide some support for the potential benefits of OT (mostly based on low certainty evidence), OT effectiveness for stroke patients remains unclear. Show more

Keywords: Occupational therapy, cognitive impairment, activities of daily living, stroke, rehabilitation, systematic review

DOI: 10.3233/NRE-236002

Citation: NeuroRehabilitation, vol. 53, no. 1, pp. 167-171, 2023