NeuroRehabilitation - Volume 21, issue 3

Authors: Buchanan, Robert J. | Wang, Suojin | Stuifbergen, Alexa | Chakravorty, Bonnie J. | Zhu, Li | Kim, MyungSuk

Article Type: Research Article

Abstract: Objective: to identify any urban/rural differences among people with multiple sclerosis (MS) in the utilization of physician services and MS-focused care, as well as differences in patient perceptions of access and quality. Method: data were collected by surveying 1,518 people with MS throughout the United States, equally divided among urban, urban-adjacent rural areas, and more remote rural areas. Standard SAS procedures were used to analyze the results. Results: significantly larger proportions of people with MS in rural areas had a family or general practitioner as their primary physician while a significantly larger proportion of …people with MS in urban areas had a neurologist as their primary physician. Rural residents traveled significantly greater distances to receive MS-focused care than their urban counterparts. People with MS living in more remote rural areas averaged less satisfaction with their access to a neurologist and to MS-focused care, and less satisfaction with the quality of care received, than people with MS in urban areas. Conclusion: limited availability of MS specialists in rural areas, and greater travel time and distance required to receive care from these providers, present future challenges to providing appropriate and high quality MS-focused care to people living with MS in rural areas. Show more

Keywords: Multiple sclerosis, physician services, specialty care, urban/rural

DOI: 10.3233/NRE-2006-21301

Citation: NeuroRehabilitation, vol. 21, no. 3, pp. 177-187, 2006

Authors: McAuliffe, Megan J. | Ward, Elizabeth C.

Article Type: Research Article

Abstract: Electropalatography (EPG) has been employed to measure speech articulation since the mid-1970s. This technique has predominately been used in experimental phonetic research and in the diagnosis and treatment of articulation disorders in children. However, there is a growing body of research employing EPG to diagnose and treat articulatory impairment associated with acquired motor speech disorder (MSD) in adults. The purpose of this paper was to (1) review the findings of studies pertaining to the assessment and treatment of MSDs in adults using EPG, (2) highlight current methodologies employed, and (3) discuss the potential limitations of EPG in the assessment and …treatment of MSDs and examine directions for future applied research and treatment studies. Show more

DOI: 10.3233/NRE-2006-21302

Citation: NeuroRehabilitation, vol. 21, no. 3, pp. 189-203, 2006

Authors: Man, David W.K. | Soong, W.Y.L. | Tam, S.F. | Hui-Chan, Christina W.Y.

Article Type: Research Article

Abstract: Primary objective: The present study reports the results of 103 persons with acquired brain injury who were randomly assigned to one of three 20-session analogy problem-solving skill training groups, namely: online training (through computer video conferencing with interactive software); computer-assisted training (through interactive patient-directed software); therapist administered training (face-to-face therapist guided training activities); and a “no-treatment” control group. Research design: Pre- and post-test quasi-experimental design. Main outcome and results: Individuals' problem-solving skills and self-efficacy in all four groups were assessed over a four-week period. Overall, the training methods were found to be effective in improving …problem solving skills regardless of the modes of delivery (except in the case of the control group). The continuous “human touch” characteristics of the therapist-administered group showed significant better improvements in self-efficacy in problem-solving. Conclusion: The statistically significantly improvement in problem solving skills in the online-group suggests that this approach could effectively improve cognitive functions of person with ABI and yield training outcomes comparable to other modes of delivery such as the face-to-face training. The conceptualization and applicability of tele-cognitive rehabilitation, its implications for persons with ABI, and future studies in this research area are also discussed. Show more

Keywords: Acquired brain injury, problem solving, rehabilitation, tele-rehabilitation

DOI: 10.3233/NRE-2006-21303

Citation: NeuroRehabilitation, vol. 21, no. 3, pp. 205-217, 2006

Authors: Rousseff, Rossen T. | Tzvetanov, Plamen

Article Type: Research Article

Abstract: Objective: To describe three cases with false localising levels illustrating the difficulty in clinical diagnosis of spinal cord compression. Patients and methods: Three patients (aged 53, 55 and 57 years) developed acute (in one) and subacute (in two) spinal cord syndrome with paraparesis, bladder symptoms and sensory levels suggesting lower thoracic or higher lumbar involvement. Imaging at suspected levels was normal. Follow-up investigations after a significant delay showed compression at higher levels (up to 11 segments). Diagnoses were surgically verified. In one patient who died, post mortem investigation discloseed a caudally situated artery of Adamkiewicz and absent vicarious …vessels at T7–T8 that are usually present in such cases. Conclusions: The well known but rare phenomenon of false localizing sensory levels in spinal cord syndromes should be kept in mind. Its causes can lie in remote higher levels of compressive lesion or in vascular compromise due to variants of the blood supply. Show more

Keywords: Spinal cord, neuroimaging, somatosensory evoked potentials, false localizing levels

DOI: 10.3233/NRE-2006-21304

Citation: NeuroRehabilitation, vol. 21, no. 3, pp. 219-222, 2006

Authors: Buchanan, Robert J. | Wang, Suojin | Martin, Raymond A. | Ju, Hyunsu

Article Type: Research Article

Abstract: Objective: To identify factors associated with the utilization of physical and occupational therapies by nursing home residents with multiple sclerosis (MS) at admission to the facility. Design: The study analyzed 27,264 admission assessments for residents with MS recorded in the national Minimum Data Set (MDS) between June, 1998 and June, 2003. A multiple linear regression model was employed to analyze the MDS data. The total number of minutes of physical and occupational therapies provided are the dependent variables. Independent variables are demographic characteristics, payment source, behavioral symptoms, and a range of health-related characteristics. Results: The …use of physical and occupational therapies by residents with MS at admission to the nursing facility was significantly associated with payment source, controlling for other independent variables. Conclusions: When reimbursement is available these therapies are more likely to be prescribed or requested. Since provision of these rehabilitative services diminishes disability and handicap, expanded Medicaid coverage may reduce long term health care costs and also improve the quality of life. Show more

DOI: 10.3233/NRE-2006-21305

Citation: NeuroRehabilitation, vol. 21, no. 3, pp. 223-232, 2006

Authors: Ahn, Young Hwan | You, Sung H. | Randolph, Marilys | Kim, Seong Ho | Ahn, Sang Ho | Byun, Woo Mok | Yang, Dong Suk | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: Combined functional MRI (fMRI) and diffusion tensor tractography (DTT) imaging provides a powerful vehicle for the investigation of motor recovery mechanisms. Using this combined method, we investigated the motor recovery mechanism in patients with pontine infarct. Design: We evaluated six healthy control subjects and two patients with pontine infarct at 6 months from onset. fMRI was performed at 1.5 T with timed hand grasp-release movements. For DTT, we used each of the 32 noncollinear diffusion-sensitizing gradients. Three-dimensional reconstructions of the fiber tracts were obtained with FA <0.3, angle >45° as termination criteria. Results: …fMRI data revealed activation only in the contralateral primary sensorimotor cortex during movement of either hand. DTI findings from controls and the unaffected hemisphere of the patients showed that the corticospinal tract descended through the known corticospinal tract pathway. However, the tracts of the affected hemisphere in the patients were observed to pass along peri-infarct areas (patient 1: lateral, patient 2: posterior) in the pons. Conclusions: It seems that the peri-infarct areas compensate for corticospinal tract damage at the pons; this may be one mechanism of motor recovery for patients with pontine infarct. Show more

Keywords: Functional MRI, diffusion tensor image, stroke, motor recovery, hemiplegia

DOI: 10.3233/NRE-2006-21306

Citation: NeuroRehabilitation, vol. 21, no. 3, pp. 233-237, 2006

Authors: Ahn, Young Hwan | Kim, Seong Ho | Han, Bong Soo | Kim, Oh Lyong | Ahn, Sang Ho | Cho, Yoon Woo | Kwon, Yong-Hyun | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: Diffusion tensor imaging (DTI) with fiber tractography (FT) could be useful for exploration of the state of the corticospinal tract (CST) at the subcortical white matter level. The purpose of this study was to demonstrate focal lesions of the CST in patients with diffuse axonal injury (DAI), using DTI with FT. Design: Two patients with DAI and six normal control subjects were recruited to this study. DTI was performed using 1.5-T with a synergy-L Sensitivity Encoding (SENSE) head coil. Fractional anisotropy (FA) and apparent diffusion coefficients (ADC) were measured using a region of interest (ROI) method. …FTs were obtained with FA <0.3 and an angle change >45° as termination criteria. Results: On the DTI with FT, the focal lesions, which could not observed using routine brain MRI, were detected in the left brainstem of patient 1 and in the right pons and the left and right medulla of patient 2. The patients showed significantly decreased FA values in the focal lesions compared to normal controls. Conclusions: DTI with FT demonstrated focal lesions at the brainstem that had not been revealed by conventional brain MRI; these focal lesions explained the weaknesses of the patients. We conclude that DTI with FT may be a useful modality for use in investigating the status of CST in patients with DAI. Show more

Keywords: Motor recovery, diffusion tensor imaging, corticospinal tract, diffuse axonal injury

DOI: 10.3233/NRE-2006-21307

Citation: NeuroRehabilitation, vol. 21, no. 3, pp. 239-243, 2006

Authors: Lam, Yat San | Man, David W.K. | Tam, Sing Fai | Weiss, Patrice L.

Article Type: Research Article

Abstract: Objective: To evaluate the effectiveness of a 2-D virtual reality (2DVR) programme in the training of people with stroke on how to access and use the station facilities of the Mass Transit Railway (MTR). Method: A flat-screen 2DVR based training programme and a corresponding, typical psycho-educational programme with video modelling were developed for comparison through a research design that involved a randomised control group pre-test and post-test. Results: Twenty and sixteen subjects respectively received 10 training sessions using the 2DVR strategy and a video-based psycho-educational programme. An additional 22 subjects formed the control group. …They were assessed by using a behavioural checklist of MTR skills and a newly validated MTR self-efficacy scale. The subjects of both training groups showed a significant improvement in their knowledge, skills and self-efficacy in using the MTR (p < 0.01), whereas, the MTR skills and self-efficacy of the control group remained stable over a four-week interval. Conclusion: Though both training programmes were effective in training the patients with stroke, they demonstrated differential improvements in MTR skills and related self-efficacy. Additional studies are recommended to identify the most effective training procedures for maintaining these skills and the best transfer ratio in the training of VR-based community living skills of people with stroke. Show more

Keywords: Stroke, rehabilitation, virtual reality, independence, community, orientation

DOI: 10.3233/NRE-2006-21308

Citation: NeuroRehabilitation, vol. 21, no. 3, pp. 245-253, 2006

Authors: Galvin, Kerry A. | Jones, D. Gareth

Article Type: Research Article

Abstract: Neural stem cells residing in the adult human brain have the potential to provide a source of tissue for self-to-self cell replacement strategies for the treatment of neurodegenerative diseases. Adult human neural stem cells (NSCs) are self renewable in culture and can generate mature neural progeny which display the characteristics of functional neurons and glia. Despite this, a number of concerns remain regarding their current suitability for treating neurodegenerative disorders. It must be demonstrated that desired neuronal types can be generated in clinically significant quantities, and can induce long-lasting functional improvements in well-characterised animal models of neurodegenerative disorders. Furthermore, the …risks to patients in terms of tumour formation and side effects must be adequately assessed. Due to the paucity of data on adult human NSCs, a move from preclinical studies to clinical trials in human patients in the foreseeable future is unlikely. If clinical trials with autologous NSCs are pursued as a treatment option for neurodegenerative diseases, then lessons and insights from many years of clinical trials with fetal neural transplantation for Parkinson's and Huntington's diseases will be invaluable, and should be heeded. Issues include experimental versus therapeutic research, standardisation of methodologies, and minimisation of risks and maximisation of benefits. Show more

Keywords: Alzheimer's disease, clinical trials, neural grafting, Huntington's disease, Parkinson's disease

DOI: 10.3233/NRE-2006-21309

Citation: NeuroRehabilitation, vol. 21, no. 3, pp. 255-265, 2006