NeuroRehabilitation - Volume 23, issue 2

Authors: Martelli, Michael F. | Nicholson, Keith | Zasler, Nathan D.

Article Type: Research Article

Abstract: Persistent cognitive, emotional and behavioral dysfunction following brain injury present formidable challenges in the area of neurorehabilitation. This paper reviews a model and practical methodology for community based neurorehabilitation based upon: 1. Evidence from the “automatic learning” and “errorless learning” literature for skills relearning after brain injury; 2. A widely applicable task analytic approach to designing relevant skills retraining protocols; 3. Analysis of organic, reactive, developmental, and characterological obstacles to strategy utilization and relearning, and generation of effective therapeutic interventions; and 4. Procedures for (a) promoting rehabilitative strategy use adapted to acute and chronic neurologic losses, …(b) an individual’s inherent reinforcement preferences and coping style, (c) reliant on naturalistic reinforcers which highlight relationships to functional goals, utilize social networks, and (d) employ a simple and appealing cognitive attitudinal system and set of procedures. This Holistic Habit Retraining Model and methodology integrates core psychotherapeutic and learning principles as rehabilitation process ingredients necessary for optimal facilitation of skills retraining. It presents a model that generates practical, utilitarian strategies for retraining adaptive cognitive, emotional, behavioral and social skills, as well as strategies for overcoming common obstacles to utilizing methods that promote effective skills acquisition. Evidence from the “automatic learning” and “errorless learning” literature for skills relearning after brain injury; A widely applicable task analytic approach to designing relevant skills retraining protocols; Analysis of organic, reactive, developmental, and characterological obstacles to strategy utilization and relearning, and generation of effective therapeutic interventions; and Procedures for (a) promoting rehabilitative strategy use adapted to acute and chronic neurologic losses, (b) an individual’s inherent reinforcement preferences and coping style, (c) reliant on naturalistic reinforcers which highlight relationships to functional goals, utilize social networks, and (d) employ a simple and appealing cognitive attitudinal system and set of procedures. Show more

Keywords: Neurorehabilitation, holistic rehabilitation, cognitive rehabilitation, traumatic brain injury, habit retraining

DOI: 10.3233/NRE-2008-23201

Citation: NeuroRehabilitation, vol. 23, no. 2, pp. 115-126, 2008

Authors: Sullivan, Karen | Madden, Isabelle

Article Type: Research Article

Abstract: Previous research on the effectiveness of memory-improvement programs has typically included older adults or those with cognitive impairments. Results from these studies have been difficult to generalise to other populations and yielded inconsistent results, partly depending on the type of memory measured. Given that the effectiveness of memory-improvement programs on young healthy adults is not well understood, the aim of this study was to evaluate a commercially available memory training program, Memory Power , marketed as effective for all age groups, and all types of memory. Twenty, first-year psychology students were randomly allocated to one of two groups: Memory Power …or Control. It was hypothesised that Memory Power participants would have significantly increased objective memory performance (RAVLT, RMBT), subjective memory functioning (EMQ, SMQ), and reported use of prospective memory aids (MAQ) at Follow-Up, than Controls. Multiple 2 × 2 mixed repeated-measures ANOVAs were used to assess training effects between Memory Power and Control groups, across Baseline and Follow-Up sessions. No significant group differences were found in subjective memory functioning, or reported use of prospective memory aids. Findings on objective memory function were mixed; no significant effects were found with the (RAVLT), but significant effects (a group main effect and a group by session interaction) were found using RMBT, suggesting improved performance on this measure of memory function for trained participants. The implications of these results for memory-improvement programs more broadly are discussed. Show more

Keywords: Neuropsychology, memory improvement, subjective memory, memory rehabilitation, memory training, memory aids

DOI: 10.3233/NRE-2008-23202

Citation: NeuroRehabilitation, vol. 23, no. 2, pp. 127-135, 2008

Authors: Shiraishi, Hideki | Yamakawa, Yuriko | Itou, Ayaka | Muraki, Toshiaki | Asada, Takashi

Article Type: Research Article

Abstract: Previous studies have discussed the effectiveness or ineffectiveness of prism adaptation for neglect patients. Purpose: The aim of present study was to determine the long-term effect of prism adaptation with activity performance instead of pointing performance on chronic neglect patients. Subjects: Seven patients with chronic unilateral spatial neglect were recruited. Methods: We performed an 8-week intervention using prismatic glasses. Changes in eye movement before and after intervention were measured using an eye mark recorder system. We also assessed intentional spatial bias in terms of center of gravity in the standing position using a tactile sensor scan system. Additionally, regional cerebral …blood flow was measured using SPECT (IMP) before and after intervention. Results: Eye movements significantly improved on the neglected side (p < 0.01), and the effects were sustained for up to 6 weeks after the removal of the prism. The center of gravity significantly moved to the left and forward. Furthermore, rCBF showed a significant increase at the parietal cortex, pericalleosal area of the left hemisphere (P < 0.05). Conclusion: These results suggest that intervention using prismatic glasses could improve eye movement on the neglected side and correct intentional spatial bias. Prism intervention might be one valuable method for the activation of the important areas of the brain in neglect patients. Show more

Keywords: Prism intervention, long-term intervention, unilateral spatial neglect, chronic patient, eye movement, center of gravity, regional cerebral blood flow

DOI: 10.3233/NRE-2008-23203

Citation: NeuroRehabilitation, vol. 23, no. 2, pp. 137-151, 2008

Authors: Fragoso, Yara Dadalti | Santana, Diego Luiz Ballio | Pinto, Rodrigo Cruz

Article Type: Research Article

Abstract: Fatigue is a common and disabling symptom of multiple sclerosis (MS). There is no effective pharmacological treatment for fatigue, although a few reports point towards beneficial effects from physical activity for MS patients suffering from fatigue. We devised a physical activity program for MS patients with fatigue and present the results from our first use of this program, on nine patients from our region. The program consisted of a 20-week series of gradual stretching, resistance and aerobic exercises, adapted to the individual clinical condition of each patient. The results showed significant improvement in cardio-circulatory parameters, as well as a significant …decrease in scores on the fatigue scale. The success of this program led patients to ask to continue with it after the trial was finished, and more patients are enrolling in the program, motivated by the good results reported by fellow patients. Show more

Keywords: Multiple sclerosis, fatigue, physical activity, conditioning

DOI: 10.3233/NRE-2008-23204

Citation: NeuroRehabilitation, vol. 23, no. 2, pp. 153-157, 2008

Authors: Hayashi, Akiko | Kayama, Mami | Ando, Kiyoshi | Ono, Masafumi | Suzukamo, Yoshimi | Michimata, Akira | Akiyama, Miki Onishi | Fukuhara, Shunichi | Izumi, Shin-Ichi

Article Type: Research Article

Abstract: Few studies have revealed the impact of tele-coaching on patients with intractable diseases, including intractable neurological diseases. This study aimed to analyze and describe subjective evaluations of coaches and intervention subjects on the functions of tele-coaching intervention for patients with spinocerebellar degeneration. This qualitative descriptive study was conducted between December 2005 to July 2006. Immediately prior to data collection three experienced coaches had delivered individual 10 session semi-structured tele-coaching interventions to 24 subjects. Data from the 24 logs kept by coaches and individual interviews with the three coaches and nine patients were analyzed using a content analysis technique. Although patients' …subjective evaluations varied, the themes that emerged from the data analysis were generally positive: that the tele-coaching enabled patients to tell their own stories in a daily-life setting, encouraged them to experience and adopt fresh points of view, and helped them to start working towards attainable goals without giving up. Our results indicate that it is especially important to encourage patients with intractable diseases to become aware of their latent desires and goals. For patients such as those with spinocerebellar degeneration the time frame for coaching interventions might be extended when required to accommodate treatment of their changing medical and mental condition. Show more

Keywords: coaching, tele-coaching, rehabilitation, spinocerebellar degeneration, qualitative research, content analysis

DOI: 10.3233/NRE-2008-23205

Citation: NeuroRehabilitation, vol. 23, no. 2, pp. 159-169, 2008

Authors: Han, Bong Soo | Ahn, Sang Ho | Jang, Sung Ho

Article Type: Research Article

Abstract: The diffusion tensor tractography (DTT) allows the corticospinal tract(CST) to be visualized at the subcortical level and functional MRI (fMRI) is capable of precisely identifying activation sites at the cortex. Therefore, it seems that combined DTT/fMRI would allow more accurate evaluation of the state of the CST. We have attempted to demonstrate cortical reorganization in a patient with cortical hemorrhage using DTT analyzed by fMRI activations. Six normal subjects and a 12-year-old female patient with a hemorrhage in the left fronto-parietal cortex were recruited. fMRI was performed at 1.5-T with timed hand grasp-release movements, and DTT was performed using 1.5-T …with a Synergy-L Sensitivity Encoding head coil. Three-dimensional reconstructions of the fiber tracts were obtained using the fMRI activation as the seed region of interest and the CST area of the anterior pons as the target region of interest. The tract of the affected hemisphere originated from the lateral area of the injured precentral knob and descended along the known corticospinal tract pathway. It seems that the motor function of the affected hand was reorganized into the lateral area of the injured precentral knob. Therefore, these combined modalities would be helpful in elucidating the state of the CST. Show more

Keywords: Diffusion tensor imaging, functional MRI, corticospinal tract, cerebral infarct

DOI: 10.3233/NRE-2008-23206

Citation: NeuroRehabilitation, vol. 23, no. 2, pp. 171-174, 2008

Authors: Blicher, Jakob Udby | Nielsen, Jørgen Feldbæk

Article Type: Research Article

Abstract: Purpose: To identify predictors of outcome, epilepsy, spasticity and depression one year after severe acquired brain injury. Method: Retrospective cohort study. A consecutive sample of 165 patients with severe acquired brain injury admitted for inpatient rehabilitation during a 18-month time period, was contacted and offered home visits one-year after brain injury. Of the 165 patients 12 did not participate. The cohort included patients with different etiologies primarily traumatic brain injury (65), stroke (25) and subarachnoid hemorrhage (34). Functional independent measure (FIM) was measured at admission at rehabilitation unit and at follow-up. At follow-up the presence of epilepsy, spasticity, …and depression was evaluated. Results: Using multiple logistic regression a short length of stay at acute hospital (LOS1) (P = 0.004), a high FIM score at admission (P < 0.001), and low age (P = 0.003), were all predictors of good outcome. No difference was found between etiologies (P = 0.077). The presence of spasticity was predicted by low FIM score (P < 0.001), longer LOS1 (P < 0.036), etiology (P < 0.001), and lower age (P = 0.001). Depression was predicted by higher age (P = 0.035). Conclusions: Age, functional status, and length of acute hospital stay are associated with outcome one year after brain injury. The functional outcome was not correlated to etiology. Show more

Keywords: Brain injuries, rehabilitation, age factors, stroke, muscle spasticity

DOI: 10.3233/NRE-2008-23207

Citation: NeuroRehabilitation, vol. 23, no. 2, pp. 175-183, 2008

Authors: Struchen, Margaret A. | Clark, Allison N. | Sander, Angelle M. | Mills, Monique R. | Evans, Gina | Kurtz, Diana

Article Type: Research Article

Abstract: Neuropsychologists are increasingly asked to provide recommendations regarding functional abilities based on test results, particularly within the rehabilitation setting. Yet, the empirical basis for making such recommendations is limited. The current study examines relationships between executive functioning and social communication measures and concurrently measured occupational and social integration outcomes. Participants were 121 individuals with traumatic brain injury (TBI) recruited from participants in a longitudinal study of outcome following TBI who had all received comprehensive brain injury rehabilitation. As part of a larger study designed to evaluate social communication abilities following TBI, participants completed measures of executive functioning, affect perception, perceived …communication ability, and functional outcome. After adjusting for age, education, and performance on executive functioning measures, social communication performance accounted for a unique 5.6% of the variance in occupational outcomes and 7.9% of variance in social integration outcomes. Executive functioning performance accounted for a unique 13.3% of the variance in occupational functioning and 16.0% of explained variance in social integration. These results provide evidence of the value of executive functioning and social communication measures in the prediction of functional outcomes. Additionally, such results provide preliminary support for the addition of social communication measures to assessment of TBI in neuropsychological practice. Show more

Keywords: Traumatic brain injury, social communication, functional outcome

DOI: 10.3233/NRE-2008-23208

Citation: NeuroRehabilitation, vol. 23, no. 2, pp. 185-198, 2008