NeuroRehabilitation - Volume 24, issue 4

Authors: Bandholm, Thomas | Magnusson, Peter | Jensen, Bente R. | Sonne-Holm, Stig

Article Type: Research Article

Abstract: If the thickness and cross-sectional area of the dorsiflexor muscle group are related in children with cerebral palsy, measurements of muscle thickness may be used to monitor changes in muscle size due to training or immobilisation in these patients. We assessed the validity and reliability of measurements of dorsiflexor muscle-thickness using the cross-sectional area of the muscle group as the criterion-related muscle-size variable. Muscle thickness was measured using ultrasound, and cross-sectional area using MRI in nine children with spastic cerebral palsy (eight with hemiplegia). Test-retest reliability of the muscle-thickness measurements was assessed in six healthy subjects. All measurements were made …on both legs at 35% lower leg length. In the children with cerebral palsy, dorsiflexor muscle-thickness and cross-sectional area were well correlated (r 2 = 0.778, P < 0.001), and the reliability of the muscle-thickness measurements was high in the healthy subjects (ICC2.1 = 0.94, standard error of measurement = 0.04 cm). The dorsiflexor muscle-thickness was 22% less in the affected compared to the non-affected leg in children with hemiplegic cerebral palsy (P < 0.001). Accordingly, the dorsiflexor cross-sectional area was 32% less in the affected compared to the non-affected leg (P = 0.002). Measurements of dorsiflexor muscle-thickness can be reliably obtained, and they reflect dorsiflexor cross-sectional area in children with cerebral palsy. Show more

Keywords: Leg, magnetic resonance imaging, muscles, skeletal, reproducibility of results, ultrasonography

DOI: 10.3233/NRE-2009-0482

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 299-306, 2009

Authors: Salem, Yasser | Godwin, Ellen M.

Article Type: Research Article

Abstract: Background/Purpose: Improvement in mobility function has been the primary goal in the rehabilitation of children with cerebral palsy. Few studies have examined the effectiveness of task-oriented strength training for children with cerebral palsy. The purpose of this study was to examine the effects of task-oriented strength training on mobility function in children with cerebral palsy. Study design: A single-blind, randomized controlled trial with pre-training and post-training evaluations. Materials and methods: Ten children with cerebral palsy (GMFCS levels I-III) were randomly assigned to an experimental group (N = 5) or control group (N = 5). Mobility function …was assessed using the Gross Motor Function Measure (GMFM) and the Timed “Up and Go” (TUG) test. Participants in the control group received conventional physical therapy focused on improving walking and balance through facilitation and normalization of movement patterns. Participants in the experiment group received task-oriented strength training focused on strengthening the lower extremities and practicing functional tasks similar to those the child performs during daily activities. Results: After the 5-week training period there were significant improvements in the experimental group for dimension D (p = 0.009), and dimension E (p = 0.009) of the GMFM. The experimental group significantly reduced the time taken to complete the TUG (p = 0.017). Conclusion/Significance: This study supports the efficacy of task-oriented strength training for improving mobility function in children with cerebral palsy. The findings demonstrate that the application of a task-oriented strength training program is linked to positive functional outcomes. The results suggest that children with cerebral palsy may benefit from a task-oriented strength training program. Further studies with a larger randomized sample and longer post-intervention follow-up are necessary to document the long-term effects of participation in task-oriented strength training programs in the cerebral palsy population. Show more

Keywords: Cerebral palsy, strength training, task-oriented training, mobility function

DOI: 10.3233/NRE-2009-0483

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 307-313, 2009

Authors: Jang, Sung Ho

Article Type: Research Article

Abstract: The ipsilateral motor pathway is a normal motor control pathway and is accepted as one of the recovery mechanisms after stroke. Among the motor recovery mechanisms following stroke, the ipsilateral motor pathway from the unaffected motor cortex to the affected extremities has been the most actively researched. This mechanism is important clinically because it contributes to motor recovery in the early stages after the onset of stroke, and is related to poor motor outcome. In addition, the ipsilateral motor pathway can be manipulated by various rehabilitative interventions. We have reviewed the literature on the ipsilateral motor pathway in stroke patients …in relation to the methods of evaluation, previous studies, the underlying pathophysiologic mechanism, clinical characteristics, and rehabilitative aspects. Show more

Keywords: Stroke, motor recovery, brain plasticity, hemiplegia, brain

DOI: 10.3233/NRE-2009-0484

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 315-320, 2009

Authors: Turhan, Nur | Atalay, Ayce | Muderrisoglu, Haldun

Article Type: Research Article

Abstract: Objectives: Most cardiovascular abnormalities are associated not only with increased risk of certain ischemic stroke subtypes but also with markedly greater disability in stroke patients. We aimed to investigate the associations between age, comorbidity, cardiovascular problems, site and size of ischemic lesions and functional outcome in inpatient first-ever ischemic stroke patients. Subjects: A total of 129 first-ever ischemic stroke admissions to a university affiliated rehabilitation centre were involved. Methods: Demographic data, brain computerized tomography or magnetic resonance imaging reports of the patients were recorded. Cardiovascular parameters consisted of electrocardiographic, echocardiographic and carotid Doppler ultrasonographic findings. Location …and size of ischemic lesions was determined by using the Oxfordshire Community Stroke Project classification. Charlson Comorbidity index adjusted for ischemic stroke was used to assess associated health problems. Functional recovery was defined as the improvements made on Functional Independence Measure. Results: Our data indicated that the presence of chronic atrial fibrillation and carotid stenosis had significant associations with total anterior circulation infarcts. Multivariate analyses revealed that age, Charlson Comorbidity index adjusted for ischemic stroke, total anterior circulation infarcts, Functional Independence Measure on admission were associated with rehabilitation outcomes. Conclusions: Advanced age, high comorbidity, large anterior circulation infarcts and poor functional level on admission were independent indicators of unfavorable functional outcome. Hemodynamic comorbidities had significant impact on localization and extend of ischemic lesions. Show more

Keywords: Comorbidity, echocardiography, first-ever ischemic stroke, Oxfordshire Community Stroke Project

DOI: 10.3233/NRE-2009-0485

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 321-326, 2009

Authors: Sosnoff, Jacob | Motl, Robert W. | Snook, Erin M. | Wynn, Daniel

Article Type: Research Article

Abstract: We conducted a small pilot study that examined the effect of a 4-week period of unloaded leg cycling on spasticity in individuals with multiple sclerosis (MS). The sample included 22 individuals with MS who were assigned using a quasi-experimental method into either exercise (n = 12) or control (n = 10) conditions. The exercise condition consisted of unloaded leg cycling for 30 minutes per session, 3 times per week, across a 4-week period. The control condition served as a control for passage of time and instrumentation effects. The H-reflex, modified Ashworth scale (MAS), and Multiple Sclerosis Spasticity Scale …(MSSS-88) were collected before, 1-day after, and 1 and 4 weeks after the 4-week period. The 4-week period of unloaded leg cycling exercise was not associated with reductions in the H-reflex or MAS, whereas the exercise condition was associated with a reduction in MSSS-88 scores. This pattern of results suggests that chronic, unloaded leg cycling exercise is associated with improvements in spasticity from the participant's perspective, but neither improves nor worsens spasticity from electrophysiological and clinical perspectives. Show more

DOI: 10.3233/NRE-2009-0486

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 327-331, 2009

Authors: Anwar, Khalid | Barnes, M.P.

Article Type: Research Article

Abstract: Objective: To assess the validity and reliability of a Numeric Rating Scale (NRS) for the measurement of spasticity in multiple sclerosis. Design: Longitudinal study with multiple comparators over two clinic visits. Setting: Rehabilitation Centre in the North East of England, UK. Subjects: A total of thirty-five patients, with a diagnosis of multiple sclerosis (MS) that were attending a rehabilitation clinic. Results: The test/re-test reliability of the NRS showed there was a high correlation between the two visits (r = 0.672). Construct validity was assessed by examining the relationship between the mean …spasticity NRS and each of the other spasticity assessment tools. There was a statistically significant correlation between subject’s mean NRS diary scores and the Modified Ashworth Scale scores at both visits (Visit 1, r = 0.459, p = 0.0056; Visit 2, r = 0.446, p = 0.0106). There was a moderate, statistically significant correlation between the mean NRS diary scores and the Tardieu Scale (Visit 1, r = 0.429, p = 0.0113; Visit 2, r = 0.407, p = 0.0209). Conclusions: The spasticity NRS has been shown to be a valid and reliable tool in the assessment of spasticity with a moderate to high level of correlation with other clinician rated instruments used to assess spasticity. Show more

Keywords: Spasticity, measures of spasticity, multiple sclerosis

DOI: 10.3233/NRE-2009-0487

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 333-340, 2009

Authors: Yildirim, Yücel | Kara, Bilge | Arda, M. Nuri

Article Type: Research Article

Abstract: Objective: The aim of our study is to determine the effect of age, BMI (Body Mass Index: kg/m2 ), gender, level of lumbar disc operation and standardized physiotherapy of the patients during hospitalization on the Physiotherapy Functional Mobility Profile (PFMP). Design: A retrospective study. Patients: Eighty three patients who had undergone surgery with lumbar disc hernia were included in the study. Data were separately interpreted considering such parameters as age, BMI, gender, and level of operation which we believe might have affected the associated consequences. Methods: PFMP was used in the assessment of the …patients. Evaluations were made on the days when they were referred and discharged. Results and Conclusion: Increases were observed in totals and subheadings of PFMP scores during the early period of the inpatients exposed to lumbar disc operations to whom we applied standardized physiotherapy programs, with increases in subheadings involving ambulation being found significant. It follows from the conclusions of grouping our patients that functionality was positively influenced by 4th decade muscularity and by one-level operation in the early period. Show more

Keywords: Functional status, lumbar disc hernia, physiotherapy functional mobility profile

DOI: 10.3233/NRE-2009-0488

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 341-347, 2009

Authors: Jang, Sung Ho

Article Type: Research Article

Abstract: Detailed information about motor recovery is essential for brain rehabilitation because it enables us to establish scientific rehabilitative strategies and predict motor outcome. For this review, we summarized the literature on motor recovery of patients with traumatic brain injury (TBI) in relation to the following: epidemiology of motor weakness, mechanisms of injury that cause motor weakness, course of motor recovery, and mechanisms underlying motor recovery. The motor weakness in patients with TBI is characterized by a low incidence, decreased severity, long recovery time, and good motor outcome when comparing with cognitive or behavior problems following TBI or the motor weakness …affecting stroke patients. However, there are few studies describing the course of motor recovery and the underlying mechanisms of motor recovery. Knowledge in the course of recovery and the mechanisms of recovery can alert clinicians to obtain the salient information about the critical period for rehabilitation and the rehabilitative strategies respectively. Therefore, we suggest that further research should focus on these topics. Show more

Keywords: Brain injury, motor recovery, rehabilitation, hemiparesis

DOI: 10.3233/NRE-2009-0489

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 349-353, 2009

Authors: Youse, Kathleen M. | Coelho, Carl A.

Article Type: Research Article

Abstract: Background: It is documented that individuals with closed head injury (CHI) demonstrate difficulty with narrative and conversational discourse. Effective conversational discourse requires a complex interaction of linguistic, cognitive, and social abilities [6]. Reduced attention and concentration are among the most common cognitive sequela following CHI [39]. Aims: The present study investigated whether treatment of attention would facilitate conversational discourse for individuals with CHI. Two treatment protocols were investigated, the first social skills-based, and the second attention-based. It was hypothesized that attention training would improve not only attentional skills but also conversation, however social skills training, would only facilitate …conversational skills. Methods and Procedures: A single subject multiple treatments comparison design was employed with two individuals who were post-onset of CHI. Treatment effects on conversational performance were calculated using the f statistic [18] for measures of response appropriateness during conversations. Outcomes and Results: Effect sizes suggested that both treatments were active; however, the participants’ performances were variable reducing the magnitude of change observed. Results indicated minimal change from baselines, only partially supporting the research hypotheses. Conclusions: Although the two treatment regimens had some effect on the participants’ conversational performances it was not to the extent anticipated. The issues of candidacy for such treatments as well as the importance of incorporating natural contingencies into interventions for conversation training are discussed. Show more

DOI: 10.3233/NRE-2009-0490

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 355-364, 2009

Authors: Kuipers, Kathy | Rassafiani, Mehdi | Ashburner, J. | Griffin, J. | Worley, L. | Moes, L. | Fleming, Jennifer | Copley, Jodie

Article Type: Research Article

Abstract: Clients with acquired brain injury often demonstrate hypertonicity and decreased function in their upper limbs, requiring appropriate intervention. Splinting is one of the intervention methods that is widely used to address these issues. Literature shows that some clients are not using splints following fabrication. However, there is a paucity of research about the factors that influence clients to use or not use splints. This study aims to investigate these influential factors for clients with upper limb hypertonicity. Two survey tools including therapist and client questionnaires were developed and completed by both therapists and clients. Six therapists and 14 clients participated …in this study and completed the relevant questionnaires. The results illustrate that most clients (13 out of 14) were continuing to use their splints four weeks following discharge from hospital. The main goals of choosing splints for both therapists and clients were prevention of contracture and deformity. The most indicated client reasons for adhering to the splint wearing program were therapist-related factors including clients' trust and reliance on their therapists. Further reasons for clients implementing the recommended splint-wearing program and clinical implications are discussed. Show more

Keywords: Clinical (adult physical), acquired brain injury, splint

DOI: 10.3233/NRE-2009-0491

Citation: NeuroRehabilitation, vol. 24, no. 4, pp. 365-375, 2009