NeuroRehabilitation - Volume 9, issue 1

Authors: Light, Kathye E.

Article Type: Introduction

DOI: 10.3233/NRE-1997-9101

Citation: NeuroRehabilitation, vol. 9, no. 1, pp. 1-2, 1997

Authors: Bourbonnais, Daniel | Bilodeau, Suzie | Cross, Pauline | Lemay, Jean-François | Caron, Stéphanie | Goyette, Michel

Article Type: Research Article

Abstract: The objective of the study is to describe a new reeducation program based on a multi-directional and multi-articular dynamometer and to evaluate its applicability in one chronic right hemiparetic subject. The treatment sessions lasted 1 h and were conducted three times per week for a period of 8 weeks. During these sessions, the subject was asked to exert 10 repetitions of 16 torque combinations exerted at the shoulder, elbow and forearm or combined with handgrip exertion. The sequence of torques and force progressed from proximal to distal joints, and were realized in and out of the typical ‘synergy patterns’ described …in this population. In addition, the levels of torque and force requested were increased progressively throughout the treatment period. The coordination of both upper extremities, tested using the finger to nose test, and the dexterity of the affected side, evaluated using the Box and Blocks assessment, tended to improve as treatments progressed. These results indicate the feasibility of this approach and suggest that it may be worthwhile examining the effectiveness of this approach on improving the functional performance of the upper extremity in a larger population of hemiparetic subjects. Show more

Keywords: Motor performance, Muscle activation, Cerebrovascular accident, Weakness

DOI: 10.3233/NRE-1997-9102

Citation: NeuroRehabilitation, vol. 9, no. 1, pp. 3-15, 1997

Authors: Miller, Gloria J.T. | Light, Kathye E.

Article Type: Research Article

Abstract: Controversy exists between accepted principles of strength training and one of our popular neurological therapeutic exercise approaches. Graded resistive exercise is a common method of strength training in the general population. Bobath avoided resistive exercise with post-stroke individuals with spasticity suggesting that the use of effort would only increase cocontraction and reduce coordination. Bobath's theories remain unsupported. The purpose of this study was to test the clinical assumption that graded resistive exercise leads to loss of force production and force modulation in spastic subjects in such a way that spasticity and cocontraction increases and force control is reduced. Nine subjects …with a diagnosis of stroke with left hemiplegia and evidence of spasticity in the left biceps performed graded resistive exercise with simultaneous measurements of cocontraction, spasticity levels, and fractionated reaction time. The results of this study indicated that there was little difference between the effects of graded exercise on the performance of paretic and non-paretic muscle. When differences were found, resistive exercise appeared to have a beneficial effect on the performance of paretic muscle. The results of this study suggest that graded resistive exercise is not detrimental to post-stroke spastic muscle, and should be considered as a possible remediation for the deficits of muscle weakness and reduced function in post-stroke individuals. Show more

Keywords: Stroke, Spasticity, Resistive exercise

DOI: 10.3233/NRE-1997-9103

Citation: NeuroRehabilitation, vol. 9, no. 1, pp. 17-28, 1997

Authors: Morris, David M. | Crago, Jean E. | DeLuca, Stephanie C. | Pidikiti, Rama D. | Taub, Edward

Article Type: Research Article

Abstract: A new therapeutic approach to rehabilitation of movement after stroke, termed Constraint-Induced (CI) Movement Therapy, has been derived from basic research with monkeys given somatosensory deafferentation. CI consists of a family of therapies; their common element is that they induce stroke patients to greatly increase the use of a more affected upper extremity for many hours a day over a 10–14 consecutive-day period. These therapies have significantly improved quality of movement and substantially increased amount of use of a more affected extremity in the activities of daily living in the life situation. The purpose of this paper is to describe …the protocol used by the investigative team that developed the family of CI therapies and examined them as an effective rehabilitation approach. Show more

Keywords: Stroke, Rehabilitation, Therapy, Upper extremity, Motor control, Behavior

DOI: 10.3233/NRE-1997-9104

Citation: NeuroRehabilitation, vol. 9, no. 1, pp. 29-43, 1997

Authors: Maher, Lynn M. | Rothi, Leslie J.G. | Heilman, Kenneth M.

Article Type: Research Article

Abstract: Praxis is defined as skilled, purposive limb movement. While it has been a consistent finding that lesions of the left cerebral hemisphere result in significantly worse performance on praxis testing than lesions of the right cerebral hemisphere, recently some investigators have proposed that the right hemisphere may also play an important role in mediating praxis. To learn if the right hemisphere does have a role in praxis we studied right-handed patients with right or left hemisphere lesions, as well as right-handed normal controls who were matched for age and education. Two trained raters scored the transitive gesture performance of the …forelimb ipsilateral to the injured hemisphere. For the normal controls, left and right hand performances were scored separately and used for statistical comparison. Independent comparisons were made on six dimensions that are important for accurate gesture performance and on an overall apraxia score. When compared to normal control subjects the patients with left hemisphere lesions (LHD) did demonstrate deficient praxis; that is, ideomotor apraxia. However, those with right hemisphere lesions (RHD) did not. Based on this study it would appear that the right hemisphere does not play a crucial role in praxis. Show more

Keywords: Apraxia, Praxis, Right hemisphere, Skilled movements

DOI: 10.3233/NRE-1997-9105

Citation: NeuroRehabilitation, vol. 9, no. 1, pp. 45-55, 1997

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

Article Type: Research Article

Abstract: There is substantial evidence to indicate that sensory-motor control of the ipsilesional upper extremity (UE) in adults after unilateral stroke is abnormal. Some of the sensory-motor deficits differ as a function of the side of the cerebral lesion. Rapid movements of the ipsilesional UE that require precise timing and sequencing are more affected in individuals with lesions in the left hemisphere. In contrast, ipsilesional movements that have constrained spatial requirements are more affected in those with lesions in the right hemisphere. Ipsilesional UE coordination of discrete tasks may be normal, but the coordination of continuous tasks is affected in adults …with left stroke. Sensation in the ipsilesional UE appears to be unaffected, or minimally affected after stroke. Strength deficits have been demonstrated in the ipsilesional UE, but primarily in those with right sided lesions. Ipsilesional performance deficits are revealed in clinical tests of function that use time to completion as the measure of success. Ipsilesional performance deficits may reflect motor control deficits that are masked on the contralateral side by hemiplegia and hemisensory loss. Interventions that focus on specific motor control deficits, such as speed of sensory-motor processing, through practice with the ipsilesional UE, may result in functional improvements in both limbs. Show more

Keywords: Stroke, Motor control, Rehabilitation

DOI: 10.3233/NRE-1997-9106

Citation: NeuroRehabilitation, vol. 9, no. 1, pp. 57-69, 1997

Authors: Giuliani, Carol A. | Purser, Jama L. | Light, Kathye E. | Genova, Perry A.

Article Type: Research Article

Abstract: Objectives: Our purpose was to identify impairments in movement control for subjects with left and right brain lesions using a kinematic analysis of the trajectory of a stylus during an upper limb tapping task. We hypothesized that subjects with left cerebrovascular accident (LCVA) would have bilateral deficits in programming while subjects with right cerebrovascular accident (RCVA) would only have deficits in the limb contralateral to the lesion. Study design: Data were collected from 11 subjects with LCVA, 11 with RCVA, and 22 non-disabled subjects who were age and gender-matched to subjects with left or RCVA. Subjects were videotaped …performing a Fitts tapping task on a single 3-inch target with each hand. The stylus movement was digitized at 60 Hz and data were calculated for each tap cycle and averaged across each 10-s trial. We examined differences in the kinematic variables of cycle frequency, amplitude, symmetry in up and down velocity, symmetry in timing of up and down velocity, and temporal phases of acceleration and deceleration for up and down directions of the tap cycle. Multivariate analyses were performed on four dependent kinematic variables, and univariate ANOVAs were conducted for the differences in phases between stroke and non-disabled limbs. Results: Subject with LCVA showed lower frequencies, and asymmetrical velocity and timing ratio in both ‘uninvolved’ and ‘involved’ limbs compared to non-disabled subjects. Subjects with RCVA showed similar impairments for the ‘involved’ limb only. Conclusions: Left hemisphere lesions create bilateral impairments in programming movement reversals. Right hemisphere lesions produced deficits only for the limb contralateral to the lesion. Strategies used by the subjects with LCVA may be-related to the need for subjects to use feedback to perform this rapid continuous sequencing task. Suggestions for rehabilitation are presented. Show more

Keywords: Kinematic analysis, Bilateral deficits, Fitts tapping task

DOI: 10.3233/NRE-1997-9107

Citation: NeuroRehabilitation, vol. 9, no. 1, pp. 71-87, 1997

Authors: Schulz, Geralyn M.

Article Type: Research Article

Abstract: A speech production impairment can occur following damage to either the left or right hemisphere. The nature of the impairment, however, differs depending on which hemisphere is damaged and within the left hemisphere, whether the damage is to the anterior or posterior language areas. This paper reviews the recent literature on the types of speech production impairments that follow damage to the left and right cerebral hemispheres. Damage to the left hemisphere anterior language area causes primarily a phonetic impairment, i.e. a deficit in executing the articulatory maneuvers of sound production with a preserved ability to select the correct sound. …Damage to the left hemisphere posterior language area causes primarily a phonological impairment, i.e. a deficit in the correct selection of a sound with an intact ability to implement the articulatory maneuvers for that incorrect sound. Damage to the right hemisphere can cause a speech production problem to the prosodic aspects of language. These differences have direct implications for the theraputic remediation of these speech production impairments. Show more

Keywords: Speech production, Left vs. right hemisphere, Aphasia

DOI: 10.3233/NRE-1997-9108

Citation: NeuroRehabilitation, vol. 9, no. 1, pp. 89-102, 1997