NeuroRehabilitation - Volume 23, issue 1

Authors: Sawaki, Lumy

Article Type: Editorial

DOI: 10.3233/NRE-2008-23101

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 1-2, 2008

Authors: Edwards, Dylan | Fregni, Felipe

Article Type: Research Article

DOI: 10.3233/NRE-2008-23102

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 3-14, 2008

Authors: Blanton, Sarah | Wilsey, Heather | Wolf, Steven L.

Article Type: Research Article

Abstract: Results from studies supporting the application of constraint-induced movement therapy (CI therapy) in patients with stroke have steadily increased over the past decade. The exploration of this intervention has provided a broad foundation from which to build further development of evidence-based practice in neurorehabilitation. This article first provides an update on CI therapy efficacy based on the relative chronicity of stroke and the functional levels of participants from whom data have been acquired. A review of current considerations is discussed, including guidelines for screening criteria, the role of the patient and family during the intervention, options for various delivery modes …and suggestions to monitor outcomes. Finally, future directions are explored through identification of integrated approaches with CI therapy including: robotics, virtual environments, mental imagery, pharmaceutical manipulations and cortical stimulation. Clinical application of a research based intervention should not occur in isolation. CI therapy researchers should be charged to define the critical aspects of this therapy and appropriate adjunctive interventions that augment its applicability and effectiveness. Show more

DOI: 10.3233/NRE-2008-23103

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 15-28, 2008

Authors: Waller, Sandy McCombe | Whitall, Jill

Article Type: Research Article

Abstract: Bilateral arm training has emerged as an approach that leads to positive outcomes in addressing upper extremity paresis after stroke. However, studies have not demonstrated improvements in all patients using current outcome measures. Furthermore, the rationale for using this type of training has been incompletely explained. The purpose of this article was to first review the theoretical justifications for the use of bilateral arm training by examining motor control and neural mechanisms underlying arm function and neural recovery, and second, to discuss examples of clinical studies using a variety of bilateral training strategies to identify who may benefit most …from this approach. We argue that bilateral arm training is a necessary adjunct to unilateral training because bilateral re-training is important and best served through bilateral not unilateral training, and also, that bilateral training may help unilateral skill recovery through alternative putative mechanisms. Our review of the empirical evidence suggests that individuals at all levels of severity can benefit in some manner from bilateral training, but that not all approaches are effective for all severity levels. In addition to requesting more randomized controlled trials and studies of neurophysiological mechanisms we conclude the following: 1) Bilateral training can improve unilateral paretic limb functions of the upper extremity after stroke, however, specific training approaches need to be matched to baseline characteristics of the patients; 2) Given the importance of bilateral activities in daily life, there is a need to recognize, train and assess the important contribution of supportive role functions of the paretic arm used on its own and as part of complementary bilateral functional skills; 3) An assessment of bilateral and unilateral functioning which includes bilateral task analysis, as well as, evaluations of interlimb coordination should be included in all studies that include bilateral training; 4) Studies with thoughtful sequencing or combining of bilateral approaches or sequencing of bilateral and unilateral approaches are needed to assess if there are improved outcomes in paretic and bilateral limb function. Show more

Keywords: Bilateral, coordination, motor control, upper extremity

DOI: 10.3233/NRE-2008-23104

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 29-41, 2008

Authors: Zeuner, K.E. | Molloy, F.M.

Article Type: Research Article

Abstract: Dystonia is a disabling movement disorder, which is characterized by an abnormal pattern of muscle activity with co-contraction of agonist and antagonist muscles. In the case of focal hand dystonia (FHD), these abnormal movements affect muscles of the forearm and hand while performing a specific task. Patients may initially present with dystonic symptoms occurring with a selective task (simple writer's cramp or musician's cramp), and may progress to develop symptoms with multiple tasks (dystonic writer's cramp). The underlying cause of this disabling condition remains unclear. This review examines recent studies designed to further elucidate the underlying pathophysiological processes …in focal dystonia. Animal research work, and neurophysiological and neuroimaging studies in humans, have identified several possible mechanisms that may contribute to the underlying pathophysiology, including impaired sensorimotor integration, motor cortex activation and surround inhibition. Pharmacological treatment for dystonia is currently suboptimal. Based on these recent pathophysiological findings, several promising and novel non-pharmacological treatment modalities have recently been developed. Attempts at modulating impaired sensorimotor integration and cortical inhibition using sensorimotor retraining, and the range of sensory training techniques recently described, are further discussed in this review. Show more

Keywords: Focal hand dystonia, sensory training, motor training, abnormal reorganization, maladaptive plasticity

DOI: 10.3233/NRE-2008-23105

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 43-53, 2008

Authors: Hesse, Stefan

Article Type: Research Article

Abstract: Restoration and improvement of gait after stroke are major aspects of neurorehabilitation. Mobilization out of the bed into the wheelchair and verticalisation with the help of a standing frame are first steps. With the patient cardiovascular stable, gait restoration is put on the agenda. Instead of tone-inhibiting and gait preparatory maneuvers, patients should practice complex gait cycles repetitively. Treadmill training with partial body weight support enables the harness-secured patients to practice numerous steps assisted by two or three therapists. In controlled studies, it proved equally effective as walking on the floor. Gait machines, as the Lokomat or the Gait …Trainer GTI, intend to relieve the strenuous effort for the therapists. For the GTI, several controlled trials showed a superior effect in acute stroke patients with respect to walking ability and velocity. For the ambulatory patient, aerobic treadmill training is effective to improve speed and endurance without worsening gait quality. Belt velocity and inclination are gradually increased so that the patients reach a predefined target heart rate. On the belt, patients walk more symmetrically, and higher velocities result in a facilitation of paretic muscles and render gait more efficient. In summary, gait rehabilitation has seen dramatic changes over the last years. More is to be expected. Show more

Keywords: Gait training, treadmill, stroke, partial body weight support, hemiparesis

DOI: 10.3233/NRE-2008-23106

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 55-65, 2008

Authors: Mazzocchio, Riccardo | Meunier, Sabine | Ferrante, Simona | Molteni, Franco | Cohen, Leonardo G.

Article Type: Research Article

DOI: 10.3233/NRE-2008-23107

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 67-80, 2008

Authors: Krebs, Hermano Igo | Mernoff, Stephen | Fasoli, Susan E. | Hughes, Richard | Stein, Joel | Hogan, Neville

Article Type: Research Article

Abstract: Objective: To compare the outcome of training the functional movement of transport of the arm and grasping an object with the alternative of training the transport of the arm in isolation. Design: Pretest-posttest comparison. Setting: Rehabilitation hospitals, outpatient care. Participants: Volunteer sample of forty-seven persons with persistent hemiparesis from a single, unilateral stroke within the past one to five years. Intervention: Robotic therapy 3x/week for 6 weeks for the paretic upper limb consisted of either a) sensorimotor, active-assistive impairment-based exercise during repetitive planar reaching tasks, or b) a “free-hand” approach, in which …the robot assisted subjects employing the sensorimotor active-assistive exercise to transport the hand to a series of targets, where it stopped to allow the person to interact with actual objects (functional approach 1), or c) transport and manipulation, in which the robot assisted subjects employing active-assistive exercise during repetitive planar reaching tasks while grasping a simulated object and releasing it at the target or followed by grasp and release of a simulated object (functional approach 2). Primary Outcome Measure: Fugl-Meyer Assessment. Results: All three groups improved from pre- to post-treatment with the sensorimotor impairment based approach demonstrating the best outcome of the three approaches. Conclusions: Short-term, goal-directed robotic therapy can significantly improve motor abilities of the exercised limb segments in persons with chronic stroke, but contrary to expectation, training both the transport of the arm and manipulation of an object (functionally-based approaches) did not confer any advantage over training solely transport of the arm (impairment-based approach). Show more

Keywords: Stroke, rehabilitation, robotics, task specific training

DOI: 10.3233/NRE-2008-23108

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 81-87, 2008

Authors: Kaelin-Lang, Alain

Article Type: Research Article

Abstract: A number of different neurorehabilitation strategies include manipulation of the somatosensory system, e.g. in the form of training by passive movement. Recently, peripheral electrical nerve stimulation has been proposed as a simple, painless method of enhancing rehabilitation of motor deficits. Several physiological studies both in animals and in humans indicate that a prolonged period of patterned peripheral electrical stimulation induces short-term plasticity at multiple levels of the motor system. Small-scale studies in humans indicate that these plastic changes are linked with improvement in motor function, particularly in patients with chronic motor deficits after stroke. Somatosensory-mediated disinhibition of motor pathways is …a possible underlying mechanism and might explain why peripheral electrical stimulation is more effective when combined with active training. Further large-scale studies are needed to identify the optimal stimulation protocol and the patient groups that stand to benefit the most from this technique. Show more

Keywords: Somatosensory stimulation, neurorehabilitation, stroke, motor deficits

DOI: 10.3233/NRE-2008-23109

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 89-93, 2008

Authors: Rösser, Nina | Flöel, Agnes

Article Type: Research Article

Abstract: Pharmacological agents, known to modulate practice-dependent plasticity in animal models of brain damage, have recently received increased interest for treatment of motor recovery after stroke. The present paper gives an overview of agents that are currently available. Amphetamines have been repeatedly shown to promote recovery of function in animals, but clinical data remain inconclusive. Other pharmacological agents evaluated for motor recovery include selective norepinephrine re-uptake inhibitors, dopamine, dopamine agonists, cholinergic substances, serotonin re-uptake inhibitors, and granulocyte – colony stimulating factor. Although preliminary data from animal and human experimental studies on these agents are promising, larger clinical trials are needed before …any of the available agents may be recommended for routine use. Show more

Keywords: Brain damage, motor rehabilitation, amphetamine, dopamine, acetylcholine, serotonin, G-CSF

DOI: 10.3233/NRE-2008-23110

Citation: NeuroRehabilitation, vol. 23, no. 1, pp. 95-103, 2008