NeuroRehabilitation - Volume 9, issue 3

Authors: Kreutzer, Jeffrey S. | Zasler, Nathan D.

Article Type: Introduction

DOI: 10.3233/NRE-1997-9301

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 177-177, 1997

Authors: Katz, Noomi | Hartman-Maeir, Adina | Weiss, Pnina | Armon, Nira

Article Type: Research Article

Abstract: The purpose of this study was to examine and compare the cognitive profiles of three groups of Israeli individuals who exhibit cognitive deficits for diverse reasons, using the Neurobehavioural Cognitive Status Examination (Cognistat, former name NCSE). The test is a standardized cognitive screening instrument which includes general areas of alertness, attention, orientation, language (comprehension, repetition, naming), construction, memory, calculations and reasoning (similarities, judgement). Assessment results are provided as a profile of the different domains and graded on four performance levels (average, mild, moderate, severe). Subjects included 47 healthy independent elderly subjects, 47 neurosurgical patients and 42 persons suffering from dementia. …Supporting the hypothesized direction, statistically significant differences were found among the three groups on raw scores of all individual subtests and on the four performance levels with the healthy elderly subjects showing the highest performance and persons with dementia the lowest. Construction subtest scores were low for all groups and seemed to detect the aging process as well as disease-related dysfunction. The mean scores and standard deviations of all groups for most subtests were similar or a little lower to those reported in the American standardization data suggesting the test's cross-cultural applicability. In conclusion, the Cognistat was found to be a useful screening test for clinical and research purposes, however, further research is required. Show more

Keywords: Cognitive assessment, Cognistat (NCSE), Elderly, Dementia, Neurosurgical

DOI: 10.3233/NRE-1997-9302

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 179-186, 1997

Authors: Jones, D. Gareth

Article Type: Research Article

Abstract: Neural regeneration, once considered unlikely, is now a leading area of experimental research and its underpinning of future clinical approaches is a serious possibility. The background to current research into neural regeneration is reviewed and the major principles of neural grafting are explored. The tension between fundamental biological processes and therapeutic attempts to override these processes is assessed. Particular emphasis is placed on spinal cord transplantation studies. The roles of stem cells, foetal grafts, and gene therapy are investigated.

Keywords: Neural regeneration, CNS, Spinal cord, Neural grafting

DOI: 10.3233/NRE-1997-9303

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 187-194, 1997

Authors: Bartolome, Gudrun | Prosiegel, Mario | Yassouridis, Alexander

Article Type: Research Article

Abstract: Objective: The purpose of this prospective cohort study was: (1) to document and investigate long-term post-treatment outcome focusing on swallowing disability; and (2) to reveal variables predicting successful functional follow-up results in 63 patients with neurogenic dysphagia. All patients were admitted to an inpatient neurologic rehabilitation unit. Main outcome measurements: Information was gathered through chart review and questionnaires. Functional outcome was categorized according to the degree of feeding status: (1) total tube feeding; (2) oral and tube feeding combined; (3) oral feeding with compensation; and (4) total oral feeding. ‘Improvement’ was determined as a positive shift in the …type of feeding, ‘deterioration’ as a negative shift and ‘no change’ was defined as remaining at the same nutritional level. The safety of feeding was assessed by tracking the occurrence of pneumonia. Results: Seventy percent of the patients achieved an improved immediate outcome after therapy. During long-term follow-up examinations, 43% of all patients showed further improvement, 57% did not show any change in their feeding ability and no deterioration was reported for any patient. Comparisons of the relative frequencies of the feeding modalities before and after therapy revealed a significant reduction in tube feeders and a significant increase in oral feeders with compensation during inpatient-treatment. The outpatient-interval showed a significant shift in total oral feeders without compensations but no significant improvement within the tube feeders and within the partial oral feeders. The improvement in nutritional status was not associated with an increased risk of pneumonia. Additional comparisons of the relative frequencies of the compensatory strategies indicated a significant reduction in all treatment techniques at final follow-up. Using logistic regression, predictors of successful post-discharge outcome involved a decreasing pre-treatment interval and unexpectedly low Barthel–ADL mobility scores. Conclusions: As a result we advocate regular follow-up controls using videofluoroscopic and/or videoendoscopic examination. This facilitates comparisons of swallowing efficiency with and without compensation in order to reduce compensatory strategies as early as possible. The analysis of predictive variables suggests early use of therapy to enhance the chances of successful long-term outcome. Show more

Keywords: Dysphagia, Long-term follow-up, Swallowing disability, Swallowing therapy, Deglutition, Deglutition disorders

DOI: 10.3233/NRE-1997-9304

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 195-204, 1997

Authors: Martin White, Susan | Seckinger, Suzie | Doyle, Margaret | Strauss, David L.

Article Type: Research Article

Abstract: This article will describe the development and use of compensatory strategies for people with traumatic brain injury. Brain injury results in a wide variety of physical, cognitive, communication and behavioural deficits which impact on daily living skills, work and recreation. Because of these problems, strategy development may be required to address many aspects of a client's life. As this article shows, the compensatory strategies incorporated into one community-based, real-Life rehabilitation programme in Philadelphia, Pennsylvania, are as varied as the challenges they seek to address.

Keywords: Traumatic brain injury, Compensatory strategies

DOI: 10.3233/NRE-1997-9305

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 205-212, 1997

Authors: Smith, T.S. | Genoff, M.C.

Article Type: Research Article

Abstract: Reflex sympathetic dystrophy (RSD) is identified by the existence of pain, trophic changes, vasomotor instability, limited range of motion and swelling of an extremity. RSD is difficult to treat and prognosis is often poor. Although widely noted in the medical literature, the vocational rehabilitation literature has failed to address the potential role of vocational rehabilitation professionals in the social and economic employment outcome for people with RSD. Vocational rehabilitation professionals are defined as those performing vocational assessments, assessing transferable skills, determining adaptive skills, certifying residual work-related capacities, conducting vocational interest testing, coordinating efforts with pre-injury employers to assist in work …reentry efforts, or performing other activities to assist in the placement or retraining of individuals with RSD. The sources used for this article include a review of the literature and observations of the authors. A vocational rehabilitation primer is provided. The following topics are addressed: the anatomical and physiological basis of RSD, treatment protocols, difficulties in accurately diagnosing RSD, influence of litigation, job placement considerations and vocational planning. As the vocational rehabilitation counsellor faces a greater number of people either diagnosed with RSD, or exhibiting RSD symptoms, he/she will be challenged to: (1) increase one's knowledge base about the etiology and treatment of RSD; (2) coordinate personal efforts with other professionals; and (3) provide personal counselling to address lifestyle and motivational factors. Show more

Keywords: Reflex sympathetic dystrophy, Vocational rehabilitation, Return-to-work

DOI: 10.3233/NRE-1997-9306

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 213-219, 1997

Authors: Fluharty, George | Wallat, Chris

Article Type: Research Article

Abstract: Denial of deficits often accompanies brain injury. Unfortunately, confronting unrealistic beliefs directly is sometimes ineffective. Alternative approaches include embedding, substitution, distraction, time out on the spot, teaching natural facilitative techniques and exploiting implicit recognition of deficits. The authors describe how these techniques improved the rehabilitation outcomes for two clients.

Keywords: Anosognosia, Agitation, Environmental modifications, Outcome

DOI: 10.3233/NRE-1997-9307

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 221-225, 1997

Authors: Crews Jr., W. David | Rusek, Judith T. | Barth, Jeffrey T. | Goering, Aaron M. | Walraven, Julie | Johnson, Janis

Article Type: Research Article

Abstract: To date, there has been a relative absence of studies which have examined the utility and effectiveness of sensory stimulation procedures in comatose, spinal-cord-injured patients. This report describes the interdisciplinary utilization (within an acute care setting) of a comprehensive sensory stimulation programme with a 21-year-old, comatose, tetraplegic male patient. To promote behavioural arousal, multiple sensory stimulation sessions were conducted with the patient daily. Within each session (and across sensory modalities), the effectiveness of sensory stimulation procedures was evaluated via use of A-B-A within-subject designs. Results indicated that the patient exhibited significantly greater behavioural arousal during sensory stimulation (B1 ), as …compared to pre-(A1 ) and post-(A2 ) treatment baselines. There was also a non-significant trend of increased behavioural arousal during the post- as compared to the pre-treatment baselines (i.e. carry-over effect). By termination of this programme, the patient exhibited an overall increased level of arousal/behavioural responsiveness (i.e. decreased coma) as compared to his level at the initiation of this programme. These findings are discussed in light of factors that may affect the effectiveness and implementation of such sensory stimulation programmes with comatose, tetraplegic patients in acute care settings. Show more

Keywords: Sensory stimulation, Behavioral arousal, Comatose, Tetraplegic

DOI: 10.3233/NRE-1997-9308

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 227-236, 1997

Authors: Cifu, David X. | Craig, Earl J. | Pezzella, Nickolas | Calabrese, Vincent

Article Type: Research Article

Abstract: Demyelination involving both the peripheral and central nervous system, seen with Acute Severe Combined Demyelination, results in a combination of the deficits from Acute Inflammatory Demyelinating Polyneuropathy and Acute Disseminated Encephalomyelitis. The unique medical, physical, psychosocial and functional challenges this disorder presents to the rehabilitation team have not been described. A-70-year old individual with a 3-week course of ascending paralysis, dysesthesias, urinary retention, insomnia and cognitive deficits is presented. An individualized program of rehabilitation entailing principles of spinal cord injury, brain injury and geriatric rehabilitation was implemented. Significant improvements in upper extremity weakness, pain, bladder control, sleep disturbance and cognition …were achieved, however, lower extremity weakness and truncal control deficits remained after a 10-week rehabilitation program. This case report describes the rehabilitative management of an adult with Acute Severe Combined Demyelination, highlighting the unique aspects of intervention. Show more

Keywords: Acute inflammatory demyelinating polyneuropathy, Acute disseminated encephalomyelitis, Rehabilitation

DOI: 10.3233/NRE-1997-9309

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 237-243, 1997

Authors: Pohl, Patricia S. | Winstein, Carolee J. | Onla-or, Somporn

Article Type: Correction

DOI: 10.3233/NRE-1997-9310

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 245-249, 1997

Article Type: Other

DOI: 10.3233/NRE-1997-9311

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 251-252, 1997

Article Type: Other

DOI: 10.3233/NRE-1997-9312

Citation: NeuroRehabilitation, vol. 9, no. 3, pp. 253-255, 1997