NeuroRehabilitation - Volume 12, issue 3

Authors: Kreutzer, Jeffrey S.

Article Type: Introduction

DOI: 10.3233/NRE-1999-12301

Citation: NeuroRehabilitation, vol. 12, no. 3, pp. 155-155, 1999

Authors: Lindström, B. | Kristensen, B. | Gerdle, B.

Article Type: Research Article

Abstract: Objective: The aim was to assess the perceived motor impairment in patients with minimal or no overt motor symptoms after ischaemic stroke. Study design: Ten patients with stroke and 22 healthy subjects were investigated. The investigation included different tests, single maximal dynamic knee extensions and single dynamic knee flexions at different angular velocities, and an endurance test consisting of 100 maximal repeated dynamic knee extensions. The tests were performed using an isokinetic dynamometer with simultaneous surface electromyography registration. Peak torque of the mechanical performance, signal amplitude and mean frequency of the electromyography were determined for each contraction. …Results: The peak torque values indicated that the patients with no overt motor deficits exhibited clear motor impairment in former affected limb. The two electromyography parameters indicated to some extent that also the so-called unaffected limb was affected. Conclusions: The tests used in the present study revealed impairments not clinically observed on routine clinical examination. These findings might be of importance in optimising the rehabilitation for the patients returning to various activities in their daily lives. Show more

Keywords: electromyography, endurance, fatigue, stroke, velocity

DOI: 10.3233/NRE-1999-12302

Citation: NeuroRehabilitation, vol. 12, no. 3, pp. 157-167, 1999

Authors: Berg, Daniela | Naumann, Markus | Elferich, Barbara | Reiners, Karlheinz

Article Type: Research Article

Abstract: Objectives: To analyze the long term effect of botulinum toxin (BTX) injections and the efficacy of a structured occupational therapy program in patients with writer's cramp (WC). Study design: We retrospectively investigated 28 patients with WC; 26 received BTX, 15 took part in a structured occupational training program, containing modification of the way of writing and employment of different writing devices. Two of these 15 patients had occupational therapy only, the others had the training program in addition to the BTX injections. The efficacy was evaluated using a self-assessment rating scale. Results: The mean …follow-up was 20.2 months. Twenty-three percent of BTX-treated patients reported a marked, 35% a moderate and 42% only minimal or no response after BTX at the best time. Patients with relatively localized forms of WC, i.e., involvement of finger or wrist muscles had a better response to BTX than patients with more complex forms of dystonia affecting various muscle groups. Thirty-three percent of the patients taking part in the occupational therapy training program reported a marked or moderate improvement after occupational therapy, whereas 47% reported only limited benefit but still an important additional effect to BTX. No benefit was reported by 20%. In patients with combined treatment, the reported improvement after occupational therapy was additive to BTX indicating that occupational therapy potentiates the effect of BTX. Conclusion: BTX is a very useful and effective therapy in a substantial proportion of patients with WC. A short structured occupational therapy program further improves the effect of BTX and may be the only form of treatment in single cases of WC patients. Show more

Keywords: writer's cramp, botulinum toxin, occupational therapy

DOI: 10.3233/NRE-1999-12303

Citation: NeuroRehabilitation, vol. 12, no. 3, pp. 169-176, 1999

Authors: Cifu, David X. | Seel, Ronald X. | Kreutzer, Jeffrey S. | Marwitz, Jennifer | McKinley, William O. | Wisor, Douglas

Article Type: Research Article

Abstract: At 20 medical centers, 2,099 consecutive adult patients with tetraplegia SCI were assessed at acute care admission, in-patient rehabilitation admission, and in-patient rehabilitation discharge. Age differences were examined by separating the sample into 11 age categories and conducting one way ANOVA's on treatment, medical expense, and outcome measures that included the FIM and the ASIA Motor Index Score. Analyses revealed that persons aged 35–55 showed the greatest improvement, and persons aged 70 and older showed the least improvement. SCI patients aged 18–34 had longer inpatient rehabilitation stays than patients aged 35–64, and incurred greater rehabilitation medical expenses than patients aged …65 and older. Acute care outcome and charges, and functional independence were unrelated to age. Patients younger than 30 were most often discharged to non-institutional settings and institutionalization rates were similar for persons aged 30–69. Present findings suggest that tetraplegia patients can be categorized into three distinct age groupings: 18–34, 35–64, and 65 and older. Findings also suggest that the ASIA Motor Index is more sensitive than the FIM for measuring changes during hospitalization in the tetraplegic population. Show more

DOI: 10.3233/NRE-1999-12304

Citation: NeuroRehabilitation, vol. 12, no. 3, pp. 177-185, 1999

Authors: Kolakowsky-Hayner, Stephanie A. | Hoffman, Beth | Metz, Stacie M. | Parente, Rick

Article Type: Research Article

Abstract: In the past 30 years, literally hundreds of cognitive enhancing substances have been investigated. This large body of research has produced mixed results and there is no consensus as to whether these substances actually enhance cognition. Furthermore, little systematic evidence is available that documents whether or not these substances are efficacious treatments for Alzheimer's disease. This review summarizes findings of well-controlled clinical studies, provides a brief discussion of current therapeutic approaches for the treatment of Alzheimer's disease, discusses research regarding cognitive enhancing substances, and draws impartial conclusions concerning the efficacy of cognitive enhancing substances for the treatment of Alzheimer's disease.

Keywords: cognitive enhancing drugs, Alzheimer's disease

DOI: 10.3233/NRE-1999-12305

Citation: NeuroRehabilitation, vol. 12, no. 3, pp. 187-200, 1999

Authors: Braha, Richard E.D. | Joyce, Brenda M. | Smith, Lorraine S.

Article Type: Research Article

Abstract: Objective: To investigate the therapeutic effects of methyl-phenidate (Ritalin) in the treatment of prolonged low arousal state following a severe brain injury. To implement a behavioural program, designed to train communication skills to this patient. Study design: A single case withdrawal design was conducted in a hospital setting with a patient with a severe brain injury. Titrated doses of Ritalin were administered, and a modified arousal scale was designed to monitor the patient's status. Results: Results indicated improvements in arousal during the treatment phase. This improvement in arousal allowed implementation of a behavioural program, …designed to train communication skills to this patient. Following the neurobehavioural program reliability for yes and no responses increased to 58% and 73% respectively. Conclusions: Improvement in arousal was achieved which allowed implementation of a behavioural program, designed to train communication skills to this patient. Show more

Keywords: ritalin, neuro-behaviour therapy, low arousal, communication, traumatic brain injury

DOI: 10.3233/NRE-1999-12306

Citation: NeuroRehabilitation, vol. 12, no. 3, pp. 201-204, 1999

Authors: Muramatsu, Hikaru | Matsumoto, Masahiro | Shimura, Toshiro | Node, Yoji | Teramoto, Akira

Article Type: Research Article

Abstract: This report describes the effects of a programmable pressure-controlled valve shunt system (PVSS) for ventriculoperitoneal (V-P) shunt dysfunction, e.g. overdrainage, during rehabilitation therapy of two stroke (subarachnoid or intra-cerebral hemorrhage) patients with normal pressure hydrocephalus (NPH). The effects were superior to those in two other NPH patients who received a V-P shunt with a fixed valve-pressure system. The V-P shunt with PVSS was useful to treat non-invasively the functional overdrainage and slit ventricle syndrome that some patients experienced in the rehabilitation ward.

Keywords: ventriculoperitoneal shunt overdrainage, slit ventricle syndrome, rehabilitation, programmable valve shunt system

DOI: 10.3233/NRE-1999-12307

Citation: NeuroRehabilitation, vol. 12, no. 3, pp. 205-210, 1999

Authors: Kittur, Smita D. | Ruskin, Paul

Article Type: Research Article

Abstract: Agitation in patients with Alzheimer's disease is a common behavior problem in middle stages of the disease. The treatment of agitation at present mostly focuses on pharmacological intervention. The patients in the two case studies presented here showed agitated behavior due to mirror self-misperception. The agitation was measured by Cohen-Mansfield test one week before and after the intervention. The intervention consisted of covering mirrors accessible to the patients, which completely alleviated their agitation. This intervention illustrates the great benefits to be gained by awareness of practical solutions to overcome environmental stressors, since the simple non-pharmcological changes avoided unnecessary medication with …attendant problems of drug interactions and side effects. Show more

Keywords: Alzheimer's disease, mirror misidentification, agitated behavior

DOI: 10.3233/NRE-1999-12308

Citation: NeuroRehabilitation, vol. 12, no. 3, pp. 211-214, 1999