NeuroRehabilitation - Volume 17, issue 3

Article Type: Introduction

DOI: 10.3233/NRE-2002-17301

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 175-175, 2002

Authors: Yasuda, Satoko | Wehman, Paul | Targett, Pamela | Cifu, David X. | West, Michael

Article Type: Research Article

Abstract: This manuscript reviews recent research on return to work (RTW) for individuals who sustain spinal cord injury (SCI), including the effects of demographics variables, occupational characteristics, workplace accommodations, quality of life, physical functional limitations, and other variable. Demographic variables that influence RTW for persons with SCI include age at injury onset, chronological age, gender, education, ethnicity, marital status, and per-injury work intensity. Others include satisfaction, and adjustment to sustaining SCI. In an effort to enhance employment opportunities for individuals with disabilities including SCI, Ticket to Work Incentive Improvement Act of 1999 (TWILA) has been passed by Congress and some …states have begun implementing targeted initiatives through the State Partnership Systems Change Initiatives (SPI). Future research directions are recommended in light of recent legislative initiatives. Show more

Keywords: spinal cord injury, employment, return to work, quality of life

DOI: 10.3233/NRE-2002-17302

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 177-186, 2002

Authors: Burnett, Derek M. | Kolakowsky-Hayner, Stephanie A. | White, Joy M. | Cifu, David X.

Article Type: Research Article

Abstract: Objective: To interpret the data from the Spinal Cord Injury-Model Systems as it applies to demographics, incidence and functional outcomes of minority patients with spinal cord injury. Design: Retrospective analysis of patients admitted to acute inpatient rehabilitation Spinal Cord Injury Model Systems Centers. Results: Descriptive statistics including means, standard deviations, and proportions were computed for all relevant variables. Participants were grouped into two categories for purposes of analysis, non-minorities (white) and minorities, who were >90% African American. Differential statistics were used for comparisons with regard to demographics, etiology, sponsor of care, length of stay, charges, ASIA …Motor Index scores, and FIM scores. Categorical data was analyzed using chi-square analyses while continuous data were analyzed using ANOVA procedures. Analyses revealed significant differences between minorities and non-minorities in terms of age at injury, gender, marital status, employment status, education level, health insurance provider, injury severity, etiology, and discharge disposition. Conclusion: Analysis of the data indicates that violence is the leading single cause of spinal cord injury in minority patients admitted to the model systems centers. The majority of patients who sustained spinal cord injury secondary to violence were minorities with the following demographics: young, single, unemployed males, with less than a high school education, residing in an urban area. Show more

Keywords: paraplegia, tetraplegia, demographics, minority, non-minority, violence

DOI: 10.3233/NRE-2002-17303

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 187-194, 2002

Authors: Gontkovsky, Samuel T. | McDonald, Nicholas B. | Clark, Pamela G. | Ruwe, William D.

Article Type: Research Article

Abstract: Technological advances over the past decade have given rise to the development of multiple computer-assisted cognitive rehabilitation programs. While results of investigations examining the efficacy of such techniques have been mixed, a positive trend for utilization of these procedures has been demonstrated. This review provides a discussion of the progression of research in this area, from anecdotal studies to controlled empirical investigations. Methodological shortcomings are examined and directions for future research in computer-assisted cognitive rehabilitation suggested.

Keywords: brain injury, cognitive rehabilitation, computers, neuropsychology, neurorehabilitation

DOI: 10.3233/NRE-2002-17304

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 195-199, 2002

Authors: Jepsen, Ruthanne H. | VonThaden, Karen

Article Type: Research Article

Abstract: A cognitive education program was developed to facilitate acquisition of cognitive skills and address the learning deficits of adolescent students with neurological, developmental disabilities, and autism. This study examined the outcomes of incorporating mediated cognitive education into special education classrooms. Cognitive education provided cognitive training utilizing REHABIT materials through mediated teaching. Following a matched pair model, forty-six students were assigned to either a treatment or a control group. All students received weekly instruction in Individual Educational Program (IEP) goals. Curriculum areas included IEP objectives in reading, math, social skills, health, science and social studies. Students in the control group received …regular classroom instruction. Students in the treatment group participated in cognitive educated one hour per week replacing thirty minutes of reading and thirty minutes of math. Pre and posttest comparisons on measures of intelligence, achievement and adaptive behavior showed those students in the treatment group attained higher scores across measures. Show more

DOI: 10.3233/NRE-2002-17305

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 201-209, 2002

Authors: Badics, E. | Wittmann, A. | Rupp, M. | Stabauer, B. | Zifko, U.A.

Article Type: Research Article

Abstract: The effects of targeted strength training in patients with muscle weakness of central origin following cerebrovascular accidents has hardly been investigated to date. This prospective non-randomized study of 56 patients was designed to shed light on the effects of strength building exercises on muscle tone and on the gain in muscle strength achieved with them. All patients underwent a full residential neurologic rehabilitation program for 4 weeks, which included an exercise program for restoring the extensor strength of the legs and the supporting strength of the arms by leg and arm presses. Throughout the rehabilitation program muscle spasticity was evaluated …clinically and maximal muscle strength on completion of the exercise program was compared to baseline. The extensor strength of the legs increased by 31.0 (± 26.7)% by 40.2 (± 15)%. significant for both variables . The extent of strength gain was positively correlated with the intensity and the number of exercising units. Muscle tone, which was abnormally high at baseline, did not further increase in any one case. The results of this study showed that targeted strength training significantly increased muscle power in patients with muscle weakness of central origin without any negative effects on spasticity. Show more

Keywords: cerebrovascular accident, rehabilitation, strength training, muscle strength, muscle tone

DOI: 10.3233/NRE-2002-17306

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 211-214, 2002

Authors: Turton, Ailie | Pomeroy, Valerie

Article Type: Research Article

Abstract: Very little time is available for arm and hand training while patients are in hospital after stroke. Therapeutic strategies that use intensive practice in the early days and weeks after stroke may improve the recovery of upper limb function. This paper considers the physiology of the brain in acute stroke and evaluates the evidence for and against early intensive activity of the upper limb as an essential precursor to any decision to invest in increased activity.

DOI: 10.3233/NRE-2002-17307

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 215-224, 2002

Authors: Zhang, Ling | Abreu, Beatriz C. | Gonzales, Vera | Huddleston, Neil | Ottenbacher, Kenneth J.

Article Type: Research Article

Abstract: This study examined the effects of environmental predictability on postural control during functional reaching while seated in healthy individuals and patients with traumatic brain injury (TBI). The postural perturbation used required reaching to the left versus reaching to the right, while seated, under predictable versus unpredictable conditions. Indexes of postural control – trajectory stability and response reach times – were measured using an electromechanical system in ten patients with TBI and ten healthy subjects. In the TBI group, greater trajectory stability and shorter response reach time were recorded under unpredictable conditions when reaching to both the right and left (d-index …0.57–2.3). In the control group, greater trajectory stability and shorter response time were recorded under predictable and unpredictable environments compared with the TBI group (d-index 0.46–0.95). This study refutes the hierarchical, predictable-to-unpredictable-environment model of postural control evaluation and treatment. The relationship between information processing demands and postural skill appears more complex than a simple linear association. Predictable and unpredictable conditions may be used concurrently, not sequentially, in TBI rehabilitation. Show more

Keywords: postural control, trajectory stability, predictable and unpredictable environments, traumatic brain injury

DOI: 10.3233/NRE-2002-17308

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 225-230, 2002

Authors: Wilson, F.C. | Harpur, J. | Watson, T. | Morrow, J.I.

Article Type: Research Article

Abstract: A regional survey of Consultant level Neurology, Neurosurgical and Rehabilitation staff identified a retrospective estimate of patients in vegetative or minimally responsive states from their own clinical caseloads (October 1995–97). 35 patients were identified; the majority of whom were not currently placed in specialist brain injury facilities following acute hospital intervention. In addition, a retrospective review of referrals to this unit (1995–2001) was also undertaken. Of twelve patients referred as being in a vegetative or minimally responsive state, 4 were considered as having been misdiagnosed (emerged) at follow-up; 2 had been presumed to be vegetative for at least one …year. All patients remained severely physically disabled (i.e., totally dependent for care) but four were nevertheless able to communicate their preference in quality of life issues, care decisions etc. either by verbal or non-verbal means. Vegetative-minimally responsive patients or those who are very severely and multiply disabled need skilled and frequently prolonged assessment. Appropriate management requires an experienced inter-disciplinary as opposed to multidisciplinary team working style, whose skill repertoire equips them to recognise often-subtle improvements in cognitive function and act to maximise individual patient's quality of life. The current paucity of service provision for this vulnerable group of patients is highlighted. Show more

Keywords: vegetative state, minimally responsive state, long term outcomes, service delivery

DOI: 10.3233/NRE-2002-17309

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 231-236, 2002

Authors: Goberman, Alexander M. | Coelho, Carl

Article Type: Research Article

Abstract: This paper reviews the literature pertaining to Parkinson's disease (PD) and the speech dysfunction typically associated with PD, including the effects on respiration, phonation, articulation, resonance, and prosody. The effect of treatment with the drug L-Dopa is also examined, along with the effect of L-Dopa treatment on Parkinsonian speech. This paper is the first of a two-part series. Part two examines the literature pertaining to the fluctuations that can occur during treatment with L-Dopa, the speech changes associated with these fluctuations, and methodological issues affecting the examination of fluctuations and PD speech.

DOI: 10.3233/NRE-2002-17310

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 237-246, 2002

Authors: Goberman, Alexander M. | Coelho, Carl

Article Type: Research Article

Abstract: The drug L-Dopa is used in the treatment of Parkinson's disease (PD), and patients often experience fluctuations in performance after a period of time taking L-Dopa. This paper reviews the literature pertaining to these fluctuations. While a number of researchers have examined L-Dopa related fluctuations in general, these fluctuations have rarely been addressed in speech research. To examine the effect of L-Dopa related fluctuations a number of methodological issues need to be addressed including time of day, anxiety level, disease stage, and drug regimen differences. Strategies are proposed for addressing these methodological issues in studying the effects of L-Dopa fluctuations …on PD speech. This paper is part two of a two part series; Part one examined PD and PD speech in general, along with L-Dopa treatment, and the effects of L-Dopa treatment on speech. Show more

DOI: 10.3233/NRE-2002-17311

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 247-254, 2002

Authors: Nelson, Arthur J. | Zwick, Dalia | Brody, Susan | Doran, Christine | Pulver, Lori | Rooz, Gitty | Sadownick, Marla | Nelson, Roger | Rothman, Jeffrey

Article Type: Research Article

Abstract: Background and purpose: The purpose of this study was (1) to determine the validity of the GaitRite System in detecting footfall patterns and selected gait characteristics of person with early stage Parkinson’s disease (PD) and (2) to investigate whether the Functional Ambulation Performance (FAP) scoring system is a valid tool to distinguish between selected gait characteristics of patients with early stage Parkinson’s disease and similar age of non-impaired individuals. The FAP score is a quantitative means of assessing gait based on specific spatial and temporal gait parameters. Participants: 11 volunteers with idiopathic Parkinson’s disease, (mean age = 74.3), …and 11 age matched volunteers, (mean age = 70.3), with no history of neurological disorder participated in the study. The non-impaired control group were not matched in age and sex but of similar age and males and females were represented in the control group. Methods: Temporal and spatial parameters of gait were analyzed for both preferred-speed and fast-speed walking using the computerized GaitRite system. The system integrates specific components of locomotion to provide a single, numerical representation of gait, the Functional Ambulation Performance Score (FAP) score. Results: The most powerful and discriminating variable between Parkinson’s and non-impaired groups for both walking speeds was the mean normalized velocity (MNV). Which is velocity divided by leg length. The MNV was 0.83 for PD at preferred walking speed and 1.14 at fast speed, the non-impaired group preferred-speed group walking was 1.33, while fast-speed walking MNV was 1.70. Note the fast walking of PD was slower than the preferred velocity of the non-impaired group. For preferred-speed walking, all gait variables analyzed in the study were different between the two groups beyond the p < 0.05 level of confidence with the single exception of right stance percentage. For fast-speed walking, three of the entered variables did not discriminate between the two groups: the fast walking FAP score, left fast-walking cadence, and right fast-walking single support percentage. Conclusion and discussion: Our results indicate that persons with Parkinson’s disease (PD) attain a significantly lower FAP score when ambulating at their preferred rate and demonstrate shorter step length and a longer step time than the age matched non-impaired group during both preferred and fast velocities of walking. Stance duration and double support duration were increased for the Parkinson’s population, whereas single support duration, mean cadence, and heel-to-heel base of support were markedly reduced for both walking speeds. The FAP score was significantly different from the non-impaired control group for preferred-speed walking. These results indicate that the GaitRite system can be useful in detecting footfall patterns and selected time and distance measurements of persons with early stage Parkinson’s disease and the FAP score discriminates between the PD population and the non-impaired controls when walking at preferred rate but not at fast walking. Show more

Keywords: Parkinson, ambulation, GaitRite system, validity

DOI: 10.3233/NRE-2002-17312

Citation: NeuroRehabilitation, vol. 17, no. 3, pp. 255-262, 2002