NeuroRehabilitation - Volume 24, issue 3

Authors: Coker, Patty | Lebkicher, Carisa | Harris, Lauren | Snape, Jamie

Article Type: Research Article

Abstract: The aim of this single case study was to determine the effectiveness of a modified version of constraint-induced movement therapy (mCIMT) on a child less than one year of age with a diagnosis of hemiplegic cerebral palsy. A single-subject ABAB design with a 6-month follow-up evaluation used repeated measures of gross and fine motor skills to determine changes at each phase of the study. Measures included the Peabody Developmental Motor Scale-2 (PDMS-2), the Gross Motor Fine Motor Measure-88 (GMFM-88) and videotape analysis of specific motor skills typically seen in children less than one year of age. The child in this …study participated in a conventional occupational and physical therapy for 2 hours a week during the 2 baseline phases, A1 and A2, and mCIMT during the 2 intervention phases, B1 and B2. The mCIMT involved constraint of the non-affected limb for 1-hour a day for 30 consecutive days as the child was engaged in developmentally appropriate, task specific activities implemented by therapists and parents. Following participation in this mCIMT, the child demonstrated clinical improvements in both gross and fine motor skills as measured by standardized assessments and videotape analysis of motor behaviors. He was completing developmental motor tasks at his chronological age despite motor deficits resulting from a right-sided hemiparesis. The results of this study supports the use of mCIMT for children less than one year of age and could shift the focus of future research studies to determining the age in which to implement mCIMT before patterns of learned non-use begin to affect the normal development of skilled motor movements in children with hemiplegic CP. Show more

Keywords: Cerebral palsy, hemiplegia, rehabilitation, constraint therapy, motor skills

DOI: 10.3233/NRE-2009-0469

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 199-208, 2009

Authors: Al-Abdulwahab, Sami S. | Al-Khatrawi, Wafa M.

Article Type: Research Article

Abstract: Neuromuscular electrical stimulation (NMES) of the gluteus medius muscles using a surface electrode during functional walking training has never been reported as a management option to improve gait in spastic diplegic children. Purpose: This study was investigates the short and longer term effects of simultaneous continuous NMES of both hip abductors during walking on the temporal-spatial gait characteristics and hip adductor muscle tone in children with spastic diplegia caused by cerebral palsy (CP). Subjects: Three groups of subjects participated: an experimental group of twenty-one ambulant spastic diplegic children; a CP control group containing ten ambulant spastic diplegic …children; and a healthy control group with twenty normal children. Method: The experimental group received three different NMES management programs. The first NMES program was designed to evaluate the immediate short-term effects of simultaneous continuous NMES of both gluteus medius muscles during walking. The second NMES program aimed to evaluate the effect of 15 minutes of simultaneous and continuous NMES of both gluteus medius muscles during walking, three sessions a day for a week. The third program was similar to the first and was designed to detect any additional changes in gait after full adaptation to NMES and completion of the second program. A dual channel stimulator with self-adhesive electrodes at the tolerable motor threshold level was used with a frequency of 20 Hz and pulse width of 50 μ s. The effect of NMES programs was assessed using a three-dimensional gait analysis system and the Modified Ashworth Scale. Results: Significant improvement in the temporal-spatial parameters and hip adductor muscle tone of the experimental group (p < 0.001–0.05) was observed. Conclusion: The NMES management programs used in this study improved the gait of spastic diplegic CP children. Show more

Keywords: Cerebral palsy, FES, NMES, gait

DOI: 10.3233/NRE-2009-0470

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 209-217, 2009

Authors: Yasuda, Yuzuru

Article Type: Research Article

Abstract: Objective: To investigate whether the application of glycerin poultice to the flexor digitorum profundus in the middle phalanx of the little finger (GFML) improves motor disturbance in Parkinson Disease (PD). Methods: Dorsiflexion of the little finger and diameter of the pupil in 22 patients with PD and 23 control subjects was evaluated before and after application of GFML. Motor disturbance in patients with PD was evaluated before and after application of GFML. Results: The application of GFML increased dorsiflexion of the little finger and constricted the pupil in all subjects, which suggests that application of GFML …caused the decreased tension of the flexor digitorum profundus and lowered sympathetic nerve activity. With application of GFML, motor disturbance in patients with PD was improved. Conclusions: The application of GFML improves motor disturbance in PD which might be caused by reversing the mechanism of the muscle mechanosensitive reflex. Show more

Keywords: Parkinson disease, glycerin poultice, flexor digitorum profundus in the middle phalanx of the little finger, sympathetic nerve activity, muscle mechanosensitive reflex

DOI: 10.3233/NRE-2009-0471

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 219-223, 2009

Authors: Ansari, Noureddin Nakhostin | Naghdi, Soofia | Hasson, Scott | Mousakhani, Atefeh | Nouriyan, Azam | Omidvar, Zeinab

Article Type: Research Article

Abstract: Patients with neurological conditions may be affected by spasticity. The Modified Modified Ashworth Scale (MMAS) is a clinical tool used to measure spasticity. The purpose of the present study was to investigate the inter-rater reliability of the MMAS during the assessment of elbow flexor spasticity in adult patients with post-stroke hemiplegia. Twenty-one adult patients with stroke (5 women, 16 men) with a median age of 60 years (interquartile range, 47–68) were tested. Elbow flexors on the affected side were examined. Inter-rater reliability for two inexperienced raters was very good. The weighted Kappa value was 0.81 (Standard Error = 0.097, 95% …CI: 0.62–1.00, p = 0.0002). The weighted percentage agreement was 97.4%. The agreement between raters occurred mostly on score 1 (38.1%) followed by score 0 (23.8%). The MMAS yielded reliable measurements between raters when used on patients post-stroke with elbow flexor spasticity. Show more

Keywords: Stroke, spasticity, modified modified ashworth scale, inter-rater reliability

DOI: 10.3233/NRE-2009-0472

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 225-229, 2009

Authors: Man, David W.K. | Chung, Jenny C.C. | Mak, Margaret K.Y.

Article Type: Research Article

Abstract: The purpose of this paper was to examine the reliability and validity (concurrent and construct) of a newly developed online Chinese version of the Rivermead Behavioral Memory Test (OL-RBMT) and its equivalence with the face-to-face version (FTF-RBMT). The OL-RBMT and FTF-RBMT were administered to 30 subjects with stroke in a two-week interval to establish their test-retest reliability, as well as to compare the two tests' equivalence. The OL-RBMT was further compared with another 30 age- and gender-matched, non-stroke patients to establish its construct validity. Its concurrent validity was established by computing scores with that of the Chinese version of Neurobehavioral …Cognitive Status Examination (NCSE or Cognistat). The intra-class correlation for test-retest reliability of the OL-RBMT was 0.94 (P < 0.01). Pearson's correlation coefficients between the subscores of OL-RBMT and FTF-RBMT ranged from 0.84 to 0.93 (P < 0.01). Statistically significant correlation was found between OL-RBMT and NCSE scores (R = 0.797, P < 0.001), as well as in the differences in OL-RBMT scores between the stroke and non-stroke groups (Z = −4.041, P < 0.001). We consider that the reliability and validity of this newly developed online version of RBMT was established. Usability of the OL-RBMT was also discussed. Show more

Keywords: Stroke, tele-assessment, memory, validity, neuropsychological assessment

DOI: 10.3233/NRE-2009-0473

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 231-236, 2009

Authors: Chelvarajah, Ramesh

Article Type: Research Article

Abstract: Introduction: Upright posture confers numerous medical and social benefits to a spinal cord injured (SCI) patient. Doing so is limited by symptoms of orthostatic hypotension. This is a common secondary impairment among tetraplegic sufferers. Objective: Establish the proportion of SCI patients who are restricted from using standing apparatus, such as standing frames and standing wheelchairs, because of inducing symptomatic orthostatic hypotension or the fear of developing these disabling symptoms. Study Design: Survey conducted by Internet-accessible electronic questionnaire. Questionnaire validated for reliability and accuracy. Results: 293 respondents. Mean age 44.6; 76% male. Median time from …injury: 7 years. 38% suffered with orthostatic hypotension; majority were complete injuries and all (except one – T12) were T5 or above level. 52% replied that they were using standing wheelchairs or frames. Of these, 59 (20% of total) stated that orthostatic hypotension symptoms were limiting the use of their upright apparatus. Of those who did not use standing wheelchairs or frames, 16 (5.5% of total) reported that this was because of the fear of worsening their orthostatic hypotension. Conclusion: Orthostatic hypotension restricts standing apparatus use in a large proportion (a total of 25.5% of respondents in this survey) of SCI patients. Show more

Keywords: Orthostatic hypotension, postural hypotension, spinal cord injury, standing apparatus, standing device, standing wheelchair, standing frame, passive standing

DOI: 10.3233/NRE-2009-0474

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 237-242, 2009

Authors: Szecsi, J. | Schiller, M.

Article Type: Research Article

Abstract: Background: The presence of spasms precludes the use of artificial electrical activation of the muscles to restore mobility. The prospect of using an electrical stimulus that produces motor activation without causing unwanted reflex activation in patients with high levels of spasticity is an appealing one. Objective: The purpose of the study was to determine the efficacy of modulated middle frequency alternating current (MFAC) muscle stimulation compared to the conventional method of standard low frequency rectangular pulse (LFRP) stimulation used in cycling of persons with spinal cord injury (SCI) and pronounced spasticity. Methods: To evaluate cycling-relevant differences …between stimulation modes, 13 subjects with SCI (ASIA-A), 11 of them with strong spasticity, underwent isometric and cycling measurements using both 20 Hz LFRP and 4 KHz modulated with 50 Hz MFAC. The isometric long-lasting reflex torque response in the quadriceps and hamstrings muscles, and the dynamic work during 1000 sec of ergometric cycling as well as the number of involuntary stops caused by hyperreflexia were recorded. Results: The long-lasting reflex torque response was significantly lower when using MFAC than with LFRP stimulation. During MFAC stimulation work generated was on average 374% higher (p = 0.002) and the number of involuntary stops was on average 32% lower (p < 0.001) than during standard LFRP stimulation-propelled cycling. Conclusion: These findings suggest that MFAC-stimulated cycling of strongly spastic SCI subjects is more effective in terms of generated isometric torque and power than stimulation with LFRP. Thus, more health benefits, e.g., cardiovascular and muscular training and spasticity-decreasing effects, can be expected faster using MFAC instead of LFRP in stimulation-propelled cycling. Show more

Keywords: Cycling, spinal cord injury, spasticity, work, functional electrical stimulation

DOI: 10.3233/NRE-2009-0475

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 243-253, 2009

Authors: Ellis, Charles | Peach, Richard K.

Article Type: Research Article

Abstract: Background: Current descriptions of the language problems following traumatic brain injury (TBI) generally emphasize evaluating discourse production and explaining the observed outcomes in terms of disruptions to executive processes. The notion of sentence production impairments at the sentence level has generally been ignored. To respond to this issue, we examined patterns of intrasentential pausing and sentence planning during sentences produced by normal and TBI speakers. Methods: Seven individuals with TBI functioning at Rancho Level V-VI and seven age-matched controls participated in this pilot experiment. Group performances were compared for pause time and verbal initiation time during the production …of sentences varying in syntactic complexity under two conditions (reading and repetition). Results: Significant group differences were observed in pausing during both conditions. Pausing patterns of the participants with TBI were strongly correlated with the syntactic complexity of sentences. No significant group differences were observed on verbal initiation time of repeated sentences, although increased initiation times were present among the TBI participants. Conclusions: These findings of this pilot project suggest that the deficits in language production following TBI may include specific impairments to sentence planning. This evidence suggests that the language profile of TBI may be one of both microlinguistic and macrolinguistic impairments. Show more

Keywords: Language, cognition, confusion, pauses, Rancho Levels, verbal initiation

DOI: 10.3233/NRE-2009-0476

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 255-266, 2009

Authors: Trnovec, Svorad | Halatsch, Marc-Eric | Behnke-Mursch, Julianne | Mursch, Kay

Article Type: Research Article

Abstract: So far, little attention has been paid to the biomechanical aspects of decompressive craniectomy. The brain tissue deformation occurring in these patients is difficult to quantify. Twenty-six patients suffering from a large bone defect after craniectomy were examined in supine position. The third ventricle's axial diameter was measured by transcranial ultrasound. Subsequently, the patient was brought into a sitting position. After 5 minutes, another measurement was taken. This procedure was repeated about 7 days after cranioplasty. The patients were grouped according to “early cranioplasty” (cranioplasty within 40 days after craniectomy, median 30 days) and “late cranioplasty”, (cranioplasty more than 40 …days, median 80 days). Data of 13 healthy volunteers were used as a reference standard. In the healthy volunteers, the third ventricle was enlarging after reaching the sitting position. The median diameter was 2.35 mm in the lying and 2.9 mm in the sitting position (p > 0.05). In the patients before early cranioplasty, a decrease of the diameter after reaching the sitting position was observed. The mean diameter was 7.0 mm in the lying and 5.9 mm in the sitting position (p > 0.01). This difference was not significant in patients before late cranioplasty (9.7 vs. 9.4 mm). After cranioplasty, the mean diameter was 6.6 and 6.2 mm in the early cranioplasty group and 9.2 mm and 9.4 mm in the late cranioplasty group (lying and sitting position, respectively). This data demonstrate for the first time that unphysiological orthostatic brain tissue deformation occurs in patients after craniectomy. Show more

Keywords: Cerebral infarction, decompressive craniectomy, head trauma, transcranial ultrasound

DOI: 10.3233/NRE-2009-0477

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 267-271, 2009

Authors: Jang, Sung Ho | Kim, Dae-Shik | Son, Su Min | Cho, Yun Woo | Kim, Seong Ho | Kim, Oh Lyong | Ahn, Sang Ho

Article Type: Research Article

Abstract: Diffusion tensor tractography (DTT) is useful for elucidating the status of the corticospinal tract (CST). The purpose of this study was to investigate the usefulness of DTT for determining the causes of motor weakness in patients with traumatic brain injury (TBI). Five patients with TBI were recruited for this study. DTT was performed using 1.5-T with a Synergy-L Sensitivity Encoding (SENSE) head coil. DTT was obtained with termination criteria of FA < 0.2 and an angle change > 45°. On the DTT of patient 1, who had diffuse axonal injury, the focal lesion was detected in the left pons, and …was not detected on routine brain images. In patients with deep cerebral hemorrhage, the integrity of the CST of patient 3 was preserved, although the lesion was more extensive than that of patient 2, who showed severe degeneration with the disruption of the CST at the lesion site. In patient 4, the integrity of the left CST was disrupted by a left transtentorial herniation. Although the CST of the affected hemisphere was connected at the cortex level in patient 5, who had a cortical contusional hemorrhage, the motor function of the lower extremity was worse than that of the upper extremity according to the involvement of the somatotopic area of the primary motor cortex. DTT would be useful in elucidating the causes of motor weakness in patients with TBI at the subcortical level, including conditions such as diffuse axonal injury, deep intracerebral hemorrhage, and transtentorial herniation. Show more

Keywords: Brain injury, diffusion tensor tractography, corticospinal tract, motor function

DOI: 10.3233/NRE-2009-0478

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 273-278, 2009

Authors: Jang, Sung Ho

Article Type: Research Article

Abstract: The corticospinal tract (CST) is the most important motor pathway in the human brain, therefore, the accurate estimation of the CST state following brain injury would enable us to predict the motor outcome or enable accurate surgical planning. The corona radiata (CR) and the posterior limb of the internal capsule (PL) are important locations because they are related to poor motor outcome. In this study, we reviewed the available literature regarding the location of the CST at the CR and PL in the human brain. The results of this review indicate that the CST is located in the posterior portion …of the CR and PL. However, a direct comparison of the results of previous studies would be impossible because many of the previous studies did not define the exact boundary or analytic standards used to locate the CR or PL. Therefore, further complementary studies that define these in detail are warranted. Show more

Keywords: Corticospinal tract, motor function, diffusion tensor imaging

DOI: 10.3233/NRE-2009-0479

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 279-283, 2009

Authors: Jang, Sung Ho

Article Type: Research Article

Abstract: The corticospinal tract (CST) is the major neuronal pathway that mediates voluntary movements. The preservation or recovery of the CST is mandatory for good recovery of impaired motor function in patients with a stroke. However, the role of the CST in motor recovery in stroke patients is not well-elucidated. In the current study, we reviewed the literature related to the role of the CST in motor recovery in stroke patients with respect to the following: recovery of a damaged CST, peri-lesional reorganization at the subcortical level, peri-lesional reorganization at the level of the cortex, the ipsilateral motor pathway from the …affected hemisphere to the affected extremities, and locomotor recovery. Show more

Keywords: Corticospinal tract, stroke, motor recovery, hemiplegia

DOI: 10.3233/NRE-2009-0480

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 285-290, 2009

Authors: Yoon, Bum Chul | Kim, Mee Young | Byun, Yong Gwon | Ha, So Young | Han, Bong Suk | You, Joshua (Sung) H. | Kim, Chung-Ju

Article Type: Research Article

Abstract: We investigated a long-term exercise-induced neuroplasticity and spatial memory recovery in 15 rats in a treadmill as follows: normal control rats (NC), streptozotocin (STZ)-induced diabetic control rats (DC), and STZ-induced diabetic rats exercising in a treadmill (DE). As per the DE group, the running exercise in a treadmill was administered for 30 minutes a day for 6 weeks. Neuronal immediate-early gene (IEG) expression (c-Fos) in the hippocampus and radial arm maze (RAM) tests were measured and revealed that the c-Fos levels in DE were significantly higher than those in NC and DC (p < 0.05). Behavioral data analysis indicated …that spatial memory performance scores, obtained from the RAM test, were significantly different among the three groups (p < 0.05). The memory scores of NC and DE were higher than those of DC (p < 0.05). These findings suggest that exercising in the treadmill increased neuronal immediate-early gene expression associated with neuroplasticity, thereby improving spatial memory. This is the first experimental evidence in literature that supports the efficacy of exercise-induced neuroplasticity and spatial motor memory in diabetes care. Show more

Keywords: Diabetes mellitus, Treadmill exercise, c-Fos, Neuroplasticity, Hippocampus, Spatial memory, Rats

DOI: 10.3233/NRE-2009-0481

Citation: NeuroRehabilitation, vol. 24, no. 3, pp. 291-297, 2009