NeuroRehabilitation - Volume 10, issue 3

Authors: Dietz, V.

Article Type: Introduction

DOI: 10.3233/NRE-1998-10301

Citation: NeuroRehabilitation, vol. 10, no. 3, pp. 167-168, 1998

Authors: Schröter-Morasch, Heidrun | Bartolome, Gudrun

Article Type: Research Article

Abstract: Swallowing requires a complex, well coordinated interaction of structures of the mouth, pharynx, larynx and esophagus for moving liquids, food and secretions from the upper aerodigestive tract to the stomach. These structures are supplied by five cranial nerves and the upper three cervical nerves, governed by pattern generators in the brainstem with influences of higher cortical and subcortical structures. Numerous neurogenic diseases can affect the normal propulsive and contractile movements of the muscles, resulting in retention and misdirection of the bolus. This may lead to lifethreatening malnutrition and pulmonary complications as well as to considerable reduction in quality of life. …While it used to be the case that patients were exclusively fed via nasal tube or PEG and frequently had to permanently retain a canula, the last two decades have seen a fundamental change in diagnosis and therapy. This review describes the physiologic and pathophysiologic events during swallowing, the etiology of neurogenic swallowing disorders and the diagnostic procedures which are prerequisites for developing therapeutic measures. Treatment programs and techniques developed to restore, compensate or adapt for neurogenic swallowing disorders are summarized. Show more

Keywords: Swallowing disorders, Neurogenic dysphagia, Functional therapy, Neurorehabilitation

DOI: 10.3233/NRE-1998-10302

Citation: NeuroRehabilitation, vol. 10, no. 3, pp. 169-189, 1998

Authors: Curt, Armin

Article Type: Research Article

Abstract: The clinical assessment of the extent and severity of spinal cord injury (SCI) can be supplemented by electrophysiological data (somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electroneurography. Electrophysiological examinations are advantageous over clinical examinations, as they can reliably be applied also in uncooperative patients. They provide an early diagnosis of the functional deficit in patients with acute SCI and are predictive of recovery of specific functions. The results of tibial nerve SSEP and MEP of the anterior tibial muscle allow the prediction of the outcome of ambulatory capacity, and pudendal nerve SSEP that of bladder function. In tetraplegic …patients median and ulnar nerve SSEP and MEP of the abductor digiti min. muscle can indicate the development of hand function. Finally, neurographic recordings of upper and lower limbs allow differentiation between the proportion of peripheral and central nerve lesion underlying muscle paresis. This is of prognostic value in regard to the development of muscle tone and consequently for planning of an adequate therapy. Thus, electrophysiological examinations complement the assessment of spinal cord lesion, they arc predictive of functional outcome, and are able to monitor the course of neurological deficit. Therefore, the data are helpful for planning and selecting the appropriate therapeutical approaches (e.g. functional electrical stimulation, application of botulinum toxin, splinting procedures) within the rehabilitation programme. Show more

Keywords: Spinal cord injury, Clinical examination, Electrophysiological recordings, Functional outcome

DOI: 10.3233/NRE-1998-10303

Citation: NeuroRehabilitation, vol. 10, no. 3, pp. 191-203, 1998

Authors: Quintern, J.

Article Type: Research Article

Abstract: The restoration of lost motor functions after upper motor neuron lesions by functional electrical stimulation (FES) is not a new technique. Early feasibility demonstrations of FES assisted standing and stepping in paraplegics between 1960 and 1980 showed great promise that FES may soon become an effective method to regain upright mobility after spinal cord injury. However, the difficulties encountered have been underestimated. Today, there is a wide gap between FES related research and the clinical application of FES in paraplegic patients. In this paper the scientific literature about FES and its clinical applications is carefully reviewed. The possible reasons for …the low clinical relevance of FES and possible solutions for the development of enhanced FES systems are analyzed. Although the functional gain with present FES systems for mobility restoration in paraplegics is relatively low, FES may be beneficial to prevent secondary complications which occur after spinal cord injuries. The development of distributed systems and selective peripheral nerve stimulation techniques, the progress in microelectronics and sensor technology, and the development of nonlinear and closed-loop control strategies give promise for the development of practical and enhanced FES systems that will offer paraplegic patients some additional degrees of freedom. Show more

Keywords: Functional electrical stimulation, Neural prostheses, Spinal cord injuries, Standing, Locomotion

DOI: 10.3233/NRE-1998-10304

Citation: NeuroRehabilitation, vol. 10, no. 3, pp. 205-250, 1998

Authors: Keller, Thierry | Curt, Armin | Popovic, Milos R. | Signer, Annelies | Dietz, Volker

Article Type: Research Article

Abstract: A four channel functional electrical stimulation system with surface electrodes was developed and tested to give individuals with complete C4 and C5 tetraplegia a possibility to perform a grasping function. The proposed neuroprosthesis is EMG controlled, and it is voluntarily activated using the deltoid muscle of the contralateral arm. The duration of the processed above the threshold EMG signal was used to control the duration of the grasp, and the amplitude of the EMG signal was used to control the grasp strength. The following are the benefits of the proposed system: (1) restoration of the lost grasping function; (2) natural …and easy to train control of hand opening and closing; (3) smooth adjustment of the grasping force; (4) a subject can use natural control strategies to control the prosthesis; and (5) the control algorithm is easy to integrate into a micro-controller device. Functional tests with a subject with C4 to C5 complete tetraplegia showed that the system significantly increased the subject’s independence in performing everyday tasks. The limiting factor for using the proposed neuroprosthesis was the fatigue of the proximal arm muscles. Surprisingly, the fatigue of the finger flexors, finger extensors and the contralateral arm deltoid muscles were not the limiting factor. Note that the deltoid muscle of the contalateral arm was used to control the prosthesis. Show more

Keywords: Rehabilitation, Functional electrical stimulation (FES), EMG control, Grasping, Tetraplegia

DOI: 10.3233/NRE-1998-10305

Citation: NeuroRehabilitation, vol. 10, no. 3, pp. 251-255, 1998

Authors: Berger, Wiltrud

Article Type: Research Article

Abstract: The results from spastic gait disorder measurements are referred to a common concept of the knowledge about cerebral palsy. The maturation of the normal gait pattern is blocked at the stage of early development. Until now only a small amount of data existed about the theoretical and practical function of physiotherapy due to difficulties of research and documentation. In children with cerebral palsy (CP), in addition, the perinatal lesion, although not progressive, changes the clinical appearance according to development, thus complicating the problems. New techniques now available (MRI, PET, TMS) will help to unravel possible rearrangements on cortical, spinal, and, …perhaps, muscular levels. Only better knowledge about the mechanisms underlying the motor disability will be the foundation for rationally based effective therapies. Show more

Keywords: Development, Cerebral palsy, Spasticity, Co-activation, Locomotion, Plasticity, Physiotherapy

DOI: 10.3233/NRE-1998-10306

Citation: NeuroRehabilitation, vol. 10, no. 3, pp. 257-265, 1998

Authors: Schurch, Brigitte

Article Type: Research Article

Abstract: Unbalanced bladder function represents one of the main problems in spinal cord injured patients. Bladder outlet obstruction, especially detrusor-sphincter dyssynergia, is the principal cause of impaired voiding. Currently, intermittent self-catheterization with eventual additional anticholinergic drugs is the best conservative method to achieve low pressure voiding and continence. Electrical stimulation to empty the bladder is possible at various stimulation sites: the bladder wall, the pelvic nerves, the sacral roots and the spinal cord. With respect to electrode application, stimulation of the sacral roots is most attractive. Several selective procedures aiming to overcome the concomitant stimulation-induced external urethral sphincter contractions have been …described. Some of these are widely used and doing well in humans (post-stimulus voiding principle), whereas others are still undergoing experimentation (collision blocks, anodal blocks, quasitrapezoidal impulse). Whatever the choosen method, electrical stimulation of the bladder is to be reserved for selected cases. If the introduction of the self-catheterization failed, sphincterotomy remained, until recently, the only alternative to overcome detrusor- sphincter dyssynergia. However, post-operative complications and long-term failure are not infrequent. Botulinum-A injections into the external urethral sphincter to induce partial paralysis, represents an attractive alternative to surgical sphincterotomy. Easiness of the method and satisfactory long-term results have encouraged physicians to use it more often in neurogenic voiding disorders. Reversibility and innocuousness of the procedure enhanced patients acceptance. Show more

Keywords: Neurogenic bladder, Detrusor-sphincter dyssynergia, Self-catheterization, Electrical stimulation, Botulinum-A toxin

DOI: 10.3233/NRE-1998-10307

Citation: NeuroRehabilitation, vol. 10, no. 3, pp. 267-279, 1998

Article Type: Other

DOI: 10.3233/NRE-1998-10308

Citation: NeuroRehabilitation, vol. 10, no. 3, pp. 281-282, 1998

Article Type: Other

DOI: 10.3233/NRE-1998-10309

Citation: NeuroRehabilitation, vol. 10, no. 3, pp. 283-286, 1998