NeuroRehabilitation - Volume 22, issue 4

Authors: Jang, Sung Ho

Article Type: Research Article

Abstract: Elucidation of the motor recovery mechanisms in stroke patients is important because such information could provide the scientific basis for stroke rehabilitation. The motor recovery mechanism after stroke, however, has not yet been clearly elucidated, but several suggested mechanisms have been proposed. These include the ipsilateral motor pathway from the unaffected motor cortex to the affected hand, peri-lesional reorganization, the recovery of a damaged lateral corticospinal tract, and contribution of the secondary motor area. Additionally, little is known about the motor recovery mechanism for patients with intracerebral hemorrhage, for locomotor recovery, and for damage at the subcortical level. Therefore, we …suggest that further research should be focused on the elucidation of motor recovery mechanisms in relation to the above topics. In the current study, we tried to review the literatures about the motor recovery mechanisms of the patients with stroke. Show more

Keywords: Stroke, motor recovery, functional MRI, magnetic stimulation, diffusion tensor image

DOI: 10.3233/NRE-2007-22401

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 253-259, 2007

Authors: Qutubuddin, Abu A. | Cifu, David X. | Armistead-Jehle, Patrick | Carne, William | McGuirk, Theresa E. | Baron, Mark S.

Article Type: Research Article

Abstract: Postural instability is a common impairment in idiopathic Parkinson's disease (PD). People with PD are prone to balance and walking difficulties. This study analyzed the feasibility of a prospective investigation of Computerized Dynamic Posturography (CDP) and standard Physical Therapy (PT) treatments in individuals with mild-moderate PD. Treatment took place at two sites: 1) CDP therapy at the Southeast Parkinson's Disease Research Education and Clinical Center (PADRECC) within a Veterans Affairs Medical Center and 2) standard physical therapy at a community outpatient rehabilitation center. Final analysis compared 15 patients randomly assigned for therapy to either the CDP or PT treatments. Therapy …time was eight weeks (four weeks of CPD or PT followed by home therapy for four weeks). The CDP therapy included gradually intensified closed chain and mobility training. Standard PT consisted of upright, mat, and theraball exercises and gait training. The home exercise phase was identical for both groups. The pilot data demonstrated treatment was tolerated by 68 percent of the sample despite the occurrence of a progressive neurological condition and medical comorbidities. While results failed to reveal any differences between treatment groups, both groups demonstrated improvement on selected outcome measures. An expanded prospective study with methodological improvements appears warranted. Show more

Keywords: Balance, computerized dynamic posturography, Parkinson disease, postural instability, long forceplate, Berg Balance Scale, physical therapy

DOI: 10.3233/NRE-2007-22402

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 261-265, 2007

Authors: Katz-Leurer, Michal | Shochina, Mara

Article Type: Research Article

Abstract: Purpose: To investigate whether autonomic impairment post stroke modifies the influence of early aerobic training in relation to resting heart rate, peak workload and walking performance at the subacute stage post event. Methods: Sixty-four patients after a first ischemic stroke were included and randomly assigned either to an aerobic training or to a control group. The training period lasted 8 weeks. Heart rate variability (HRV) parameters, aerobic and functional abilities were measured. Results: Early aerobic exercise significantly improved endurance and walking performance in stroke patients (p < 0.05). A significant association was found between the HRV …parameters two weeks post event and heart rate at rest and peak workload at the beginning of the program. No significant interaction effects between autonomic impairment and training on outcome measures were found. Conclusion: Early aerobic training resulted in positive effects on peak workload and walking parameters in stroke patients. No modification effect was found between HRV parameters and exercise on those parameters. Show more

Keywords: Heart rate variability, aerobic exercise, stroke

DOI: 10.3233/NRE-2007-22403

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 267-272, 2007

Authors: Kim, Dong Gyu | Ahn, Young Hwan | Byun, Woo Mok | Kim, Tae Gun | Yang, Dong Suk | Ahn, Sang Ho | Cho, Yoon Woo | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: Diffusion tensor image tractography (DTT) could be useful for exploring the state of the corticospinal tract (CST) at the level of the subcortical white matter. The purpose of this study was to demonstrate the speed of degeneration of the CST in patients with cerebral infarct, using DTT. Design: Two patients with middle cerebral artery territory infarct were recruited for this study. DTT was performed 5 times with an interval of 7 days, starting at 2 days after onset, using a 1.5-T system with a synergy-L Sensitivity Encoding head coil. The termination criteria used were fractional anisotrophy < …0.3, 0.2, 0.1, respectively, and an angle change > 45°. Results: Detection of CST degeneration began at the 9 day DTT in both patients. The most rapid CST degeneration was noted for 7 days at 16 days from onset. We did not detect any tract in the affected hemisphere of both patients at the 23-day DTT. Conclusions: We demonstrated that CST degeneration begins before 9 days from onset and progresses rapidly in patients with middle cerebral artery territory infarct. It seems that the CST degeneration began earlier than expected. Show more

Keywords: Diffusion tensor imaging, corticospinal tract, degeneration, stroke

DOI: 10.3233/NRE-2007-22404

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 273-277, 2007

Authors: Kwon, Yong-Hyun | Kim, Chung Sun | Jang, Sung Ho

Article Type: Research Article

Abstract: Previous studies have proven that motor deficits are expressed in the ipsi-lesional limbs of the injured hemisphere in a variety of motor tasks. However, it still remained controversial for the distinct characteristics of the motor deficits according to the dysfunction of each hemisphere related to motor control. We evaluated the performance of the ipsi-lesional limb in stroke patients and age-sex matched normal controls. Kinematic components such as the temporal variation and accuracy index were analyzed. Our findings revealed that both groups with right or left hemisphere damage showed poor accuracy in terms of complex visuomotor function. Overall, patients with left …hemisphere damage exhibited temporal inconstancies in simple repetitive movement. Accordingly, the non-dominant hemisphere plays a primary role in the function of complex visuospatial accuracy, whereas the dominant hemisphere is mainly involved in the motor control of bilateral upper limbs as well as the performance of complex tasks. Therefore, we assumed that such deficits may be caused by damage of the lateralized hemispheric function, depending on the property of the performed task and hemispheric asymmetry. The manifest understanding of the ipsi-lesional motor abnormalities provides clinicians with useful neurophysiologic information, and with the necessity of careful evaluation and therapeutic intervention on the ipsi-lesional upper limb, often clinically assumed as “the non-affected side”. Show more

Keywords: Ipsi-lesional motor deficits, lateralized motor control, hemispheric function, task complexity

DOI: 10.3233/NRE-2007-22405

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 279-286, 2007

Authors: Koyama, Tetsuo | Sano, Kyoko | Tanaka, Shotaro | Hatanaka, Teruaki | Domen, Kazuhisa

Article Type: Research Article

Abstract: Objective: Examination of effectiveness of different sites of constraint-induced movement therapy (CI therapy) for upper-extremity impairment of patients after stroke. Subjects: Patients exhibiting moderate to slight upper-extremity impairment after stroke. Methods: The patients received a modified version of CI therapy for a cumulative total of 5 h daily for 10 days. Using Fugl-Meyer scores, shoulder/elbow/forearm, wrist and hand functions were separately assessed before and after treatment. To assess the site-specific effects of CI therapy, before and after scores were statistically compared at each site using Wilcoxon signed-rank tests. Relative effects were evaluated by paired comparison of …the results at each site with, in turn, the results at every other site. Instances of single-score increments were, using standard chi-square tests, statistically isolated and compared. Results: Nineteen patients, 12–169 (median 31) months after stroke, were enrolled in this study and completed the protocol. Age range was 40–81 (median 65) years old and pretreatment Fugl-Meyer total scores spanned 31–64 (median 48). Analyses detected statistically significant improvements for wrist, hand and coordination but not for shoulder/elbow/forearm subcomponents. For the hand, at least single-point increments were observed in 74% of the population, while only 47% showed similar increments for the shoulder/elbow/forearm, and 53% for the wrist. Statistical analysis revealed that a higher proportion had increments in hand scores. Conclusions: Statistical analysis shows that CI therapy is most beneficial for treating hand function, suggesting an efficient application of this treatment. Show more

DOI: 10.3233/NRE-2007-22406

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 287-293, 2007

Authors: Hartman-Maeir, Adina | Eliad, Yafit | Kizoni, Rachel | Nahaloni, Irit | Kelberman, Hagit | Katz, Noomi

Article Type: Research Article

Abstract: Objectives: To evaluate the functional status, leisure activity and satisfaction in adult stroke survivors participating in a community rehabilitation program, and to compare these outcomes with stroke survivors not attending any program. Method: Subjects included in the study were survivors of a first stroke that received inpatient rehabilitation and were living at home at least one year post onset. Twenty seven were participants in a community rehabilitation program and 56 were non-participants. The outcome measures were the Stroke impact Scale (SIS), Functional Independence Measure (FIM), Instrumental Activities of Daily Living Questionnaire (IADLq), Activity Card Sort (ACS), and the …Life-Satisfaction questionnaire (Li-Sat-9). Results: The results revealed severe stroke impact and low functioning in activities of daily living in the participant group, yet the level of participation in leisure activities improved significantly after attending the program (t = −8.1, p = 0.000). The comparison with the non participant group revealed that participants were even more disabled in basic activities of daily living (as measured by the FIM) than non-participants (t = −3.1, p = 0.004). However, the satisfaction rates of the participants were significantly higher than non participants from "life as a whole" and from their leisure situation (p < 0.05). Conclusions: Stroke survivors participating in a community based rehabilitation program did not show an advantage in terms of disability levels over non-participants. However, their activity level increased due to the program and their satisfaction scores were higher than non-participants. Show more

Keywords: Stroke rehabilitation outcome, participation, life-satisfaction

DOI: 10.3233/NRE-2007-22407

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 295-301, 2007

Authors: Sinotte, Michèle Page | Coelho, Carl A.

Article Type: Research Article

Abstract: Non-linguistic cognitive skills have recently become an area of focus in aphasia research. One skill that has received in-depth investigation is the role of attention in language tasks. In applying the resource allocation theory to aphasic language deficits, researchers have described performance variablity in language tasks that may result from insufficient capacity, inefficient allocation, or inappropriate allocation of attentional resources [16]. The present study was designed as a follow-up to a recent study examining direct attention training as a treatment for reading impairment in mild aphasia [3]. A treatment program was implemented to target complex attention skills for an individual …with mild reading difficulties secondary to aphasia. Results revealed modest gains in reading rate and comprehension. A decrease in the variability of comprehension of longer complex reading passages was noted, suggesting a more efficient allocation of the participant's attentional resources. The positive gains noted for this individual's reading skills were felt to be the result of improvement in allocation of attentional resources rather than improvement in linguistic skills. The findings of this study add to the growing body of literature pertaining to the value of expanding assessment and treatment protocols for individuals with aphasia to include both linguistic and cognitive measures. Show more

Keywords: Attention, aphasia, reading, treatment

DOI: 10.3233/NRE-2007-22408

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 303-310, 2007

Authors: Meinzer, Marcus | Elbert, Thomas | Djundja, Daniela | Taub, Edward | Rockstroh, Brigitte

Article Type: Research Article

Abstract: Constraint-Induced Movement Therapy (CIMT) is a powerful and well evaluated therapeutic tool for the treatment of post-stroke paresis. CIMT is based on an intensive training (massed practice) principle and a gradual rebuilding of movement functions (shaping principle). In this article we will review how CIMT principles can be adapted to treat post-stroke aphasia, thereby establishing a Constraint-Induced Aphasia Therapy (CIAT). First results of this new approach suggest success and feasibility for the treatment of chronic aphasia. The observation of reorganizational changes in brain activity following intensive language training add to previous evidence that CIMT-based therapy may lead to macroscopic remodelling …of cortical network architecture. Show more

Keywords: Chronic aphasia, Constraint-Induced Aphasia Therapy, neurorehabilitation, magnetoencephalography, brain plasticity

DOI: 10.3233/NRE-2007-22409

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 311-318, 2007

Authors: Magee, Wendy L.

Article Type: Research Article

Abstract: People in low awareness states following profound brain injury typically demonstrate subtle changes in functional behaviors which challenge the sensitivity of measurement tools. Failure to identify and measure changes in functioning can lead to misdiagnosis and withdrawal of treatment with this population. Thus, the development of tools which are sensitive to responsiveness is of central concern. As the auditory modality has been found to be particularly sensitive in identifying responses indicating awareness, a convincing case can be made for music therapy as a treatment medium. However, little has been recommended about protocols for intervention or tools for measuring patient responses …within the music therapy setting. This paper presents the rationale for an assessment tool specifically designed to measure responses in the music therapy setting with patients who are diagnosed as minimally conscious or in a vegetative state. Developed over fourteen years as part of interdisciplinary assessment and treatment, the music therapy assessment tool for low awareness states (MATLAS) contains fourteen items which rate behavioral responses across a number of domains. The tool can provide important information for interdisciplinary assessment and treatment particularly in the auditory and communication domains. Recommendations are made for testing its reliability and validity through research. Show more

Keywords: Music therapy, minimally conscious, vegetative, assessment

DOI: 10.3233/NRE-2007-22410

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 319-324, 2007

Authors: Campbell, Loretta | Wilson, F. Colin | McCann, John | Kernahan, George | Gray Rogers, Rosalind

Article Type: Research Article

Abstract: Objectives: To investigate if errorless learning applied by carer(s) in an everyday setting can reduce the frequency of everyday memory problems following severe traumatic brain injury (TBI). Research design: Multiple baseline single case experimental design. Methods and procedures: A patient with severe memory impairment, six years post TBI was recruited via an outpatient neurorehabilitation clinic. ABA analysis was conducted using daily frequency counts of everyday memory problems as an index of change. Experimental intervention: Errorless learning delivered by the patient’s carer, aimed at reducing the occurrence of identified everyday memory problems. The carer was …guided in treatment implementation by an Occupational Therapist. Main outcomes and results: Incidence of frequently occurring memory lapses was significantly reduced (p < 0.001) and this was maintained at 3 months post intervention. Conclusion: This study highlights the potential clinical value of errorless learning with self-generated cues applied by carers within an everyday setting. Show more

Keywords: Memory rehabilitation, errorless learning, family and carers, brain injury

DOI: 10.3233/NRE-2007-22411

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 325-333, 2007

Authors: Krause, Phillip | Szecsi, Johann | Straube, Andreas

Article Type: Case Report

Abstract: We report on a multiple sclerosis patient who received functional electrical stimulation to reduce spastic muscle tone of the lower limbs. Stimulation by means of surface electrodes applied to the thigh muscles induced cycling leg movements. Spastic muscle tone was measured clinically using the modified Ashworth scale and semiautomatically by pendulum testing of spasticity. This was done before and directly after stimulation. The patient was able to endure the stimulation for ca. 30 minutes; there was a significant reduction of spasticity after each stimulation session. We conclude, that this type of stimulation could be another potential treatment modality for multiple …sclerosis patients, especially those with a high score in the expanded disability Status scale. Show more

Keywords: Multiple sclerosis, functional electrical stimulation, spasticity, case report

DOI: 10.3233/NRE-2007-22412

Citation: NeuroRehabilitation, vol. 22, no. 4, pp. 335-337 , 2007