NeuroRehabilitation - Volume 21, issue 1

Authors: West, Deborah

Article Type: Introduction

DOI: 10.3233/NRE-2006-21101

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 1-1, 2006

Authors: Sugden, Steven G. | Kile, Shawn J. | Farrimond, Derald D. | Hilty, Donald M. | Bourgeois, James A.

Article Type: Research Article

Abstract: We present a case that promotes early intervention and pharmacological treatment for the neuropsychiatric sequelae (frontal lobe syndrome, including cognitive impairment and aggressive behavior) associated with traumatic brain injury (TBI) and delirium. The patient, who sustained significant systemic complications related to his trauma, was previously diagnosed with alcohol and drug dependence and antisocial personality disorder. These antecedent conditions and prolonged systemic complications likely played a complicating role in his course of recovery.

Keywords: Amantadine, donepezil, valproate, aggression, frontal lobe syndrome, traumatic brain injury

DOI: 10.3233/NRE-2006-21102

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 3-7, 2006

Authors: Ciuffreda, Kenneth J. | Han, Ying | Kapoor, Neera | Ficarra, Anthony P.

Article Type: Research Article

Abstract: The purpose of this study was to assess reading-related oculomotor rehabilitation in individuals with acquired brain injury. Adults with either stroke (n = 5) or traumatic brain injury (n = 9) participated. Training paradigms included single-line and multiple-line simulated reading, as well as basic versional tracking (fixation, saccade, and pursuit), twice per week over an 8 week period. Training modes included normal internal oculomotor visual feedback either in isolation (4 weeks) or concurrent with external oculomotor auditory feedback (4 weeks). Training effects were assessed objectively using infrared eye movement recording technology for simulated and actual reading, with the …assessments occurring before, midway, and after training. In addition, the individuals were assessed subjectively using a reading rating-scale questionnaire. All reported considerably improved reading ability, and this was confirmed by several of the objective oculomotor measures. There was a trend for improvement to be better with the combined visual and auditory oculomotor feedback. Reading-related oculomotor rehabilitation produced significant gains in both the subjective and objective domains. It is believed that rapid saccadic oculomotor adaptation, as well as the training of rhythmicity and automaticity, were involved in modifying eye movement behavior to produce a more systematic approach and resultant improved reading profile. Show more

Keywords: Acquired brain injury, oculomotor feedback, oculomotor rehabilitation, reading, saccadic adaptation, visual attention

DOI: 10.3233/NRE-2006-21103

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 9-21, 2006

Authors: Clauss, Ralf | Nel, Wally

Article Type: Research Article

Abstract: Background: Zolpidem is an omega 1 specific indirect GABA agonist that is used for insomnia, but may have efficacy in brain damage. The long term efficacy of zolpidem in the permanent vegetative state is described in three patients. Method: Two motor vehicle accident patients and one near drowning patient, all of them in the permanent vegetative state for at least three years, were rated according to the Glasgow Coma and Rancho Los Amigos scale before and after zolpidem application. Long term response to daily application of this drug was monitored for 3–6 years. Results: All patients …were aroused transiently every morning after zolpidem. Glasgow Coma Scale scores ranged from 6–9/15 before to 10–15/15 after zolpidem. Rancho Los Amigos Cognitive scores ranged from I–II before to V–VII afterward. Drug efficacy did not decrease and there were no long term side effects after 3–6 years daily use. Conclusion: Zolpidem appears an effective drug to restore brain function to some patients in the permanent vegetative state. Show more

Keywords: Diaschisis, GABA, dormancy, brain injury, permanent vegetative state

DOI: 10.3233/NRE-2006-21104

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 23-28, 2006

Authors: Haas, Christian T. | Turbanski, Stephan | Kessler, Kirn | Schmidtbleicher, Dietmar

Article Type: Research Article

Abstract: It is well known that applying vibrations to men influences multiple physiological functions. The authors analysed post effects of whole-body-vibration (WBV) on motor symptoms in Parkinson's disease (PD). Sixty-eight persons with PD were randomly subdivided into one experimental and one control group. Motor symptoms were assessed by the UPDRS (Unified Parkinson's Disease Rating Scale) motor score. A cross-over design was used to control treatment effects. The treatment consisted of 5 series of whole-body-vibration taking 60 seconds each. On average a highly significant (p < 0.01) improvement of 16.8% in the UPDRS motor score was found in the treatment …group. Only marginal changes (p > 0.05) were found in the control group. The cross-over procedure showed comparable treatment effects (14.7% improvement after treatment). With respect to different symptom clusters only small changes were found in limb akinesia and cranial symptoms. By contrast, tremor and rigidity scores were improved by 25% and 24%, respectively. According to the structure of symptom changes it is unlikely that these effects are explainable on peripheral sensory level, exclusively. With respect to the findings of other studies one can speculate about changes in activation of the supplementary motor area and in neurotransmitter functions. Show more

Keywords: Random whole-body-vibration, Parkinson, UPDRS, motor-control

DOI: 10.3233/NRE-2006-21105

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 29-36, 2006

Authors: Navipour, Hassan | Madani, Hossein | Mohebbi, Mohammad R. | Navipour, Reza | Roozbayani, Parviz | Paydar, Afshin

Article Type: Research Article

Abstract: Background: Fatigue is among the most common, yet least understood symptoms of Multiple Sclerosis (MS). The debilitating symptoms of MS can have adverse effects on the sufferer's self-esteem. We report the effect of a short-term self-managed graded exercise programme on fatigue and self-esteem of patients with MS. Methods: Thirty-four (age range: 20–50, mean: 29.7 years; M:F 0.7:1.0) patients with MS who lived in Tehran and were not physically disabled entered the study. Self-esteem score was measured with the Persian translation of the Coopersmith Self-Esteem Inventory. Fatigue was evaluated with a visual analogue scale. The patients performed the …self-managed techniques for 6 weeks. Self-esteem and fatigue were evaluated once more after the self-managed graded exercise programme. Results: On paired sample test, the self-esteem score of the patients was significantly different before (53.9) and after (68.1) the self-managed graded exercise programme (P<0.0001). The score of fatigue was also significantly different before (4.59) and after (5.76) the intervention (P<0.0001). Conclusions: This study can provide us with important insights into our understanding of the potential for developing self-care training as an alternative in rehabilitation of the patients with MS. Self-managed graded exercise programme may be considered as an alternative to direct nursing services for patients with MS. Show more

Keywords: Multiple sclerosis, coopersmith self-esteem inventory, self-esteem, self-managed, graded exercise, visual analogue scale, fatigue

DOI: 10.3233/NRE-2006-21106

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 37-41, 2006

Authors: Mount, Julie | Dacko, Stan

Article Type: Research Article

Abstract: Purpose: This is a pilot study to determine if endurance exercises for dorsiflexors will improve walking for people with foot drop secondary to MS, and if improvement in muscle endurance for persons with MS can be predicted based on the amount of central fatigue (CF) in the muscle. Subjects: Five individuals with foot drop secondary to MS and five age-matched controls. Methods: The intervention was 4 sets of 10 isometric contractions, at 60% of MVC, 3X/week, 8 weeks. Pretests-posttests included a dorsiflexor endurance test with superimposed electrical stimulation to measure CF, and a gait …assessment including measurement of dorsiflexion at initial contact. Results: Two of 5 subjects with MS had significant improvement in muscle endurance in both legs and in dorsiflexor control during walking. Correlation between CF and improved endurance was not significant (r = −0.07). One of the subjects with significant improvement in endurance had a significant decrease in central activation failure. Conclusions and discussion: For individuals with foot drop secondary to MS, endurance exercises for the dorsiflexors can result in improved walking. CF may not be useful in predicting whether a muscle will improve in endurance with exercise. Improvement may result from either a peripheral training effect, a central learning effect, or both. Show more

Keywords: Multiple sclerosis, exercise, foot drop

DOI: 10.3233/NRE-2006-21107

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 43-50, 2006

Authors: Reid-Arndt, Stephanie A.

Article Type: Research Article

Abstract: Cancer survivorship research has yielded important insights into the impact of breast cancer and associated treatments on such issues as vocational functioning, social role and community functioning, and quality of life. Efforts to understand factors that may impact these functional outcomes have specifically focused on medical, individual, and environmental variables. A relatively recent line of study suggests that neuropsychological functioning is an important individual variable to consider when assessing outcomes among breast cancer survivors, as there is evidence that at least a portion of women undergoing chemotherapy treatment for breast cancer will evidence an apparent decline in neuropsychological functioning. Two …critically important issues are less well understood at this time, however. First, what is the underlying etiology of observed changes in cognitive functioning? Second, what is the functional significance of changes in neuropsychological functioning on work, social role and quality of life outcomes? To highlight potential directions for future research, this paper provides a review of existing literature documenting theories and research addressing these issues, and it discusses the potential impacts that changes in neuropsychological abilities may have on vocational, social role, and quality of life outcomes among breast cancer survivors. Show more

Keywords: Neuropsychology, breast cancer, quality of life, vocational outcomes

DOI: 10.3233/NRE-2006-21108

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 51-64, 2006

Authors: Reitz, A. | Haferkamp, A. | Wagener, N. | Gerner, H.J. | Hohenfellner, M.

Article Type: Research Article

Abstract: Objectives: To study the outcome of different bladder management strategies in patients with neoplastic spinal cord compression. Methods: 22 patients with neoplastic spinal cord compression underwent urodynamic examination. According to the urodynamic data and the underlying disease different bladder management strategies were recommended. In patients with curatively treated disease a full bladder rehabilitation program was arranged. In patients with metastatic malignant disease, voluntary voiding was continued if possible or a suprapubic catheter was placed. Results: Eight patients were treated with curative intention. Of those, 2 patients were able to void during urodynamics continued normal …voluntary voiding. Six patients were taught intermittent catheterisation, with three additionally received oral anticholinergic treatment because of UMN lesion. At follow-up, all patients had successfully finished bladder rehabilitation program and at follow up, all patients were continuing their previously recommended bladder rehabilitation program. Fourteen patients had malignant disease and were treated palliatively. In 2 patients with UMN lesion, voluntary control of micturition was maintained and both continued voluntary voiding. In 12 patients a suprapubic catheter was inserted. At follow-up, 9 out of 14 had died (mean 8 month after primary visit), the remaining 5 continued treatment with suprapubic catheters. Conclusion: Underlying disease and life expectancy should be considered for the selection of bladder management in patients with neoplastic spinal cord compression. In patients with curatively treated disease, a full bladder rehabilitation program is recommended while in patients with malignant disease and palliative care, a suprapubic catheter might be the treatment of choice. Show more

Keywords: Spinal cord neoplasms, bladder, neurogenic rehabilitation, treatment outcome

DOI: 10.3233/NRE-2006-21109

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 65-69, 2006

Authors: Silverman, Erin P. | Sapienza, Christine M. | Saleem, Ahmad | Carmichael, Chris | Davenport, Paul W. | Hoffman-Ruddy, Bari | Okun, Michael S.

Article Type: Research Article

Abstract: Respiratory symptoms are recognized as sequelae of motor dysfunction in idiopathic Parkinson's disease (IPD) and these symptoms have the potential to cause problems with swallow, cough, voice and speech. Specifically, maneuvers that require rapid activation and coordination of upper airway and chest wall musculature become progressively impaired as motor dysfunction progresses during the natural course of the disease. This study reports on the maximum inspiratory and expiratory pressures produced by 28 participants (average age 64) diagnosed with moderate to severe IPD (average stage 2.5 with a range of 2.0–3.0). All measures were collected during the “medication on” state. Outcomes of …a specific respiratory muscle strength training technique for improving maximum expiratory pressure are reported for three of the patients in this study. Techniques that focus on strengthening the respiratory muscles in patients with IPD (other than with low load breathing exercises), have not been previously reported. The results of this pilot study demonstrate that respiratory muscle weakness may be an important factor in the respiratory complications in IPD and that respiratory muscle strength training has the potential to improve expiratory muscle strength for this population. This improvement has the potential to positively impact high forced respiratory activities, such as forced breathing maneuvers, swallow, cough and speech functions that require greater magnitude and duration of expiration. Show more

Keywords: Respiratory pressure, Parkinson's disease, training, maximum expiratory, maximum inspiratory

DOI: 10.3233/NRE-2006-21110

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 71-79, 2006

Authors: Tamietto, Marco | Torrini, Gaia | Adenzato, Mauro | Pietrapiana, Paolo | Rago, Roberto | Perino, Claudio

Article Type: Research Article

Abstract: Development of reliable procedures to assess fitness to safe driving after traumatic brain injury (TBI) is a crucial step in rehabilitation. However, prior studies are highly inconsistent in the choice of measures recommended for predicting driving fitness from different pre-driving measures. In the present paper the relevant literature is reviewed with the aim of shedding light on the reasons for these inconsistencies. The discrepant results reflect investigative choices which differ in five aspects: (1) the type of predictors used as pre-driving screening; (2) the type of measures considered as the criterion for the determination of fitness to drive after TBI; …(3) the severity of the TBI in the sample of patients studied; (4) the extent of the neural structures damaged by TBI and the overlap of these areas with those involved in driving tasks; (5) the length of the follow-up considered. The strengths and weaknesses of the different methods and measures are discussed with their implications for future research and clinical rehabilitation. Encouraging findings come from recent studies that combined together medical, psychosocial, and personality measures, thereby improving the explanatory power of the predictors used. The use of post-injury driving fitness measures with great ecological and external validity seems equally promising in assessing actual driving in the real world. Show more

Keywords: TBI, brain injury, driving safety, rehabilitation

DOI: 10.3233/NRE-2006-21111

Citation: NeuroRehabilitation, vol. 21, no. 1, pp. 81-92, 2006