NeuroRehabilitation - Volume 14, issue 1

Authors: Martelli, Michael F. | Zasler, Nathan D.

Article Type: Introduction

DOI: 10.3233/NRE-2000-14101

Citation: NeuroRehabilitation, vol. 14, no. 1, pp. 1-1, 2000

Authors: Nicholson, Keith

Article Type: Research Article

Abstract: This paper will present an overview of pain problems associated with lesions, disorder or dysfunction of the central nervous system (CNS). The incidence, qualities of the pain experience, associated sensory abnormalities, and other characteristics will be discussed. Particular attention will be paid to central pain (CP) associated with stroke as the most prominent and best studied of the many CP problems. In general, there is poor understanding of the pathophysiology of CP, problems are often severe and intractable, and treatment is typically difficult. The concept of CP is increasingly being invoked to account for various presentations not traditionally considered, e.g. …fibromyalgia. It is suggested that processes associated with CP might also contribute to the presentation in psychiatric Pain Disorders or other atypical pain problems. Finally, although perhaps not as problematic, a number of CNS disorders or lesions may be associated with reduced sensitivity to pain. Show more

DOI: 10.3233/NRE-2000-14102

Citation: NeuroRehabilitation, vol. 14, no. 1, pp. 3-13, 2000

Authors: Orza, Florin | Boswell, Mark V. | Rosenberg, Samuel K.

Article Type: Research Article

Abstract: Neuropathic pain is a challenge for clinicians because it is resistant to commonly prescribed analgesics, such as opioids and nonsteroidal antiinflammatory drugs. Fortunately, adjuvant analgesics, drugs not typically thought of as pain relievers, may be effective. It is helpful to classify adjuvant analgesics used to treat neuropathic pain into two broad categories: (1) membrane stabilizing agents, which inhibit ectopic discharges on damaged neural membranes, and (2) drugs that enhance dorsal horn inhibition, which may augment biogenic amine or GABAergic mechanisms in the dorsal horn of the spinal cord. Current evidence regarding efficacy generally does not support the use of one …drug over another, and selection of a particular drug may depend on experience or expected side effects. The overall efficacy of tricyclic antidepressants for neuropathic pain is modest, and they may produce intolerable side effects. Based on current studies, gabapentin is a reasonable alternative to antidepressants, as initial monotherapy or add-on treatment, particularly for painful diabetic peripheral neuropathy and postherpetic neuralgia. From a practical standpoint, to optimize analgesia more than one drug may be necessary. Although polypharmacy is the result, this approach may improve therapy and minimize side effects. From a safety standpoint, medications generally should be started at low doses and titrated to effect. Although labor-intensive, this strategy can improve compliance and optimize patient care. Show more

Keywords: neuropathic pain, anticonvulsants, antidepressants, antiarrhythmics, corticosteroids, gabapentin

DOI: 10.3233/NRE-2000-14103

Citation: NeuroRehabilitation, vol. 14, no. 1, pp. 15-23, 2000

Authors: Miller, Laurence

Article Type: Research Article

Abstract: A neurosensitization syndrome (NSS) is defined as: a syndrome of subjective discomfort and objective functional disability; that often appears excessive in duration and severity with respect to the identified initiating injury or event; that may be resistant to conventional medical and psychological treatment modalities; and that is hypothesized to develop as the result of progressively enhanced sensitivity or reactivity of central nervous system (CNS) mechanisms at the neurophysiological, biochemical, and intracellular levels. This paper applies the neurosensitization model to the three syndromes which are frequently comorbid and treatment-refractory in clinical practice: (1) chronic pain; (2) depression; and (3) posttraumatic …stress disorder. The understanding of how pathological behavioral syndromes spiral out of control may lead to productive, integrative medical, behavioral, and psychotherapeutic treatment strategies. Show more

Keywords: Neurosensitization Syndromes (NSS), Traumatic Disability Syndromes (TDS), chronic pain, Posttraumatic Stress Disorder (PTSD), depression

DOI: 10.3233/NRE-2000-14104

Citation: NeuroRehabilitation, vol. 14, no. 1, pp. 25-32, 2000

Authors: León-Carrión, José | Dominguez-Roldán, José María | Murillo-Cabezas, Francisco | del Rosario Dominguez-Morales, María | Muñoz-Sanchez, María Angeles

Article Type: Research Article

Abstract: Objective: To report new strategies in the treatment of persistent memory deficits following traumatic brain injury (TBI) using a combination of pharmacology and neuropsychological training. Study design: Two studies were carried out. The first study measured the regional cerebral blood flow (rCBF) of seven Patients with TBI with very severe memory deficits, once while resting and once one hour after the administration of citicholine (CDPc). In the second study, two groups of five patients of the same characteristics underwent an ecological neuropsychological memory rehabilitation program; during which time, one group was administered a placebo (Group A), and …the other received CDPc (1 g/d v.o.) (Group B). Results: The results of Experiment 1 showed a hypoperfusion of the inferior left temporal cerebral blood flow during rest state while an induced normalization was observed after administration of the drug. Results of Experiment 2 showed no improvements in Group A's neuropsychological functions, while memory, learning processes and verbal fluency of Group B improved significantly after treatment. Conclusions: CDP-choline seems to be a drug with special affinity for cerebral areas associated with memory acting just where needed, normalizing blood flow in the hypoperfused left temporo-basal region, and making neuropsychological training effective. In general, data suggests that cognitive rehabilitation would follow the principle of first restoring and maintaining cerebral blood flow in the lesional site and then exercising function. In this study on memory rehabilitation, memory recuperation was made possible by first normalizing blood flow at the lesional site and at the same time applying neuropsychological training. Show more

Keywords: citicholine, memory, neuropsychological rehabilitation, rCBF, traumatic brain injury

DOI: 10.3233/NRE-2000-14105

Citation: NeuroRehabilitation, vol. 14, no. 1, pp. 33-40, 2000

Authors: Kreutzer, Jeffrey S. | Kolakowsky-Hayner, Stephanie A.

Article Type: Research Article

Abstract: Interdisciplinary rehabilitation can be a complex, challenging, and sometimes confusing process. The varying experiences and perspectives of patients and professionals contribute to the diversity of challenging dilemmas. This manuscript is intended to help rehabilitation professionals improve their effectiveness and the quality of their relationships with patients, family members, and colleagues. The manuscript complements a prior publication, Laws of the House of Rehab: A Guide to Managing Psychological Distress and Promoting Benefit from Rehabilitation [2]. The authors have included additional information relating to principles of rehabilitation practice. The principles, labeled as “laws”, provide guidance for developing values and practice methods.

Keywords: rehabilitation, neurological disorders, therapeutic relationships, practice fundamentals, treatment outcomes

DOI: 10.3233/NRE-2000-14106

Citation: NeuroRehabilitation, vol. 14, no. 1, pp. 41-51, 2000

Article Type: Announcement

DOI: 10.3233/NRE-2000-14107

Citation: NeuroRehabilitation, vol. 14, no. 1, pp. 53-53, 2000