NeuroRehabilitation - Volume 25, issue 4

Authors: Jang, Sung Ho | Kim, Seong Ho | Kim, Oh Lyong | Byun, Woo Mok | Ahn, Sang Ho

Article Type: Research Article

Abstract: Diffusion tensor imaging (DTI) can be useful in detecting corticospinal tract (CST) injury at the subcortical white matter level. In the current study, we attempted to investigate the incidence and distribution of CST injury in patients with diffuse axonal injury (DAI), using DTI. Fourteen patients who showed motor weakness without any specific lesion along the CST pathway on conventional brain MRI, and twelve age-matched, normal healthy control subjects were recruited. DTI was performed using 1.5 T with a synergy-L Sensitivity Encoding (SENSE) head coil. Fractional anisotropy was measured using the region of interest method. A CST injury was defined as …the FA value of a certain area being decreased two standard deviations below that of normal controls. All 14 patients had more than one lesion at the CST injury, and the mean number of CST injuries was 3.6 (range: 2–7). The CSTs were involved at the following locations: the pons (61%), the cerebral peduncle (39%), the corona radiata (21%), the medulla (14%), and the posterior limb (11%). The pons was the most prevalent area of CST injury in patients with weakness caused by DAI at the subcortical level. We found that DTI is a useful technique for detecting a DAI of the CST at the subcortical level. Show more

Keywords: Diffusion tensor imaging, corticospinal tract, diffuse axonal injury

DOI: 10.3233/NRE-2009-0519

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 229-233, 2009

Authors: Ansari, Noureddin Nakhostin | Naghdi, Soofia | Hasson, Scott | Fakhari, Zahra | Mashayekhi, Masoud | Herasi, Mona

Article Type: Research Article

Abstract: The Modified Modified Ashworth Scale (MMAS) is a simple clinical outcome measure to assess muscle spasticity in people with brain injury. The objective of this cross-sectional study was to assess the interrater reliability of the MMAS in the upper limb of adult patients with hemiplegia. Participants were fifteen patients with a mean age of 57.3 ± 14.4 years. They had brain injury on average 33.3 ± 26.2 months earlier. Two common spastic muscle groups (elbow flexor and wrist flexor) on the hemiparetic side of the patients were rated by two physiotherapists according to a standardized protocol. The order of raters' …assessment and the sequence of muscle testing was randomized. The weighted Kappa (κw) values were calculated for reliability. The κw was 0.61 for elbow flexor and 0.78 for wrist flexor. Results support the good interrater reliability of the MMAS for persons with upper limb spasticity. Show more

Keywords: Spasticity, Modified Modified Ashworth Scale, hemiplegia, reliability

DOI: 10.3233/NRE-2009-0520

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 235-240, 2009

Authors: Öneş, Kadriye | Yalçinkaya, Ebru Yilmaz | Toklu, Banu Çetinkaya | Çağlar, Nil

Article Type: Research Article

Abstract: Our objective was to evaluate the relation between age, gender, initial functional, cognitive and motor condition, spasticity, diabetes mellitus, and functional outcome after rehabilitation of stroke patients. Eighty-eight patients who had suffered stroke were administered in this study. Participants were stroke patients undergoing rehabilitation in Istanbul Physical Treatment and Rehabilitation Training and Research Hospital. Functional condition (Functional Independence Measurement (FIM)), spasticity (Ashworth Scale), cognitive condition (Mini Mental State Evaluation (MMSE)), post-treatment FIM were measured. A significant positive association between MMSE at admission and the functional discharge measures was observed. A significant positive association Brunnstrom (upper lower extremity assessment) …scores and the functional discharge measures was observed. A significant positive association between spasticity at admission and the functional discharge measures was observed. In conclusions, the admission functional, motor, cognition condition, age, spasticity were a significant predictors of total and motor FIM score at discharge, but not gender and diabetes mellitus. Show more

Keywords: Stroke, rehabilitation, functional outcomes, cognitive condition, age, gender, spasticity, diabetes mellitus

DOI: 10.3233/NRE-2009-0521

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 241-249, 2009

Authors: Chitambira, Benjamin

Article Type: Case Report

Abstract: Background and Purpose: The objective of this case report is to report on the use of novel optokinetic chart stimulation to achieve recovery of affected upper limb and affected lower limb voluntary movements and full recovery of mobility in a patient with an acute hemorrhagic stroke. Method: An optokinetic chart was moved in front of the patient: from side to side, up and down and finally forwards and backwards. Specific active-assisted exercises of affected shoulder anti-gravity muscles were also carried out. These were external rotation, abduction, flexion and a combination of these through the D2F proprioceptive neuromuscular facilitation …(PNF) pattern. Results: Oxford score improved from 0/5 on admission to 3/5 on discharge, after 8 weeks, while Barthel Index improved from 0/20 to 20/20. STREAM scores improved from 1/70 on admission to 18/70 a month after admission and 70 /70 at follow-up 3 months after discharge. Discussion: Optokinetic chart stimulation led to restoration of voluntary movement on the affected side as well as restoration of independent mobility. Further research on the use of the optokinetic chart to enhance neural plasticity for restoration of voluntary movement and mobility is recommended. Show more

Keywords: Intracerebral hemorrhage, rehabilitation, optokinetic stimulation, vestibular rehabilitation

DOI: 10.3233/NRE-2009-0522

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 251-254, 2009

Authors: Lee, Mi Young | Park, Ji Won | Park, Rae Joon | Hong, Ji Heon | Son, Su Min | Ahn, Sang Ho | Cho, Yoon Woo | Jang, Sung Ho

Article Type: Research Article

Abstract: Objective: Little is known about the cortical activation pattern of compensatory movement (CM) in stroke patients. We attempted to investigate the cortical activation pattern of compensatory movement in stroke patients, using functional MRI (fMRI). Methods: Eight hemiparetic stroke patients were recruited for this study. We measured the shoulder abduction angle when each subject was simulating eating in a sitting position, which was considered as the degree of CM. The fMRI was performed at 1.5T using an elbow motor task at a frequency of 0.5 Hz. Results: There was an inverse correlation between the shoulder abduction angle …of the affected side and the LI (Laterality Index) (r = −0.745; p < 0.05). The shoulder abduction angle of the affected side was significantly related to the sum of activated voxels in all regions of interest (r = 0.776; p < 0.05) and the activated voxels of the supplementary motor area (r = 951; p < 0.05). However, we did not find any correlation between the shoulder abduction angle and the activated voxels of other brain areas. Conclusions: We demonstrated that a greater shoulder abduction angle on the affected side requires more cortical activation. Therefore, CM appears to be related to the change of the cortical motor control toward greater recruitment of cortical neurons. Show more

Keywords: Compensation, hemiplegia, functional MRI, motor function, stroke

DOI: 10.3233/NRE-2009-0523

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 255-260, 2009

Authors: Young, Daniel L. | Wallmann, Harvey W. | Poole, Iris | Threlkeld, A. Joseph

Article Type: Research Article

Abstract: Introduction: Body weight supported treadmill training (BWSTT) using high treatment frequency has been shown to improve gait after spinal cord injury (SCI). This case report describes the use of BWSTT at a very low treatment frequency. Subject: The subject was a 19 y.o. female with an incomplete C6 SCI, one year post-injury, with multiple gait deficits. Intervention: BWSTT was combined with conventional rehabilitation. Mean treatment frequency was 1.16 days/wk over 28.5 wks. A BWSTT progression algorithm based on observational gait analysis guided progressive changes in support levels, treadmill speed, and session length. Outcomes: During …the first 3 sessions, the subject tolerated an average of 15.7 minutes of BWSTT with 26% BWS at 0.8 m/s, improving to an average of 28 minutes of BWSTT with 10% BWS at 1.6 m/s in the last 3 sessions. Following 28.5 wks of very low frequency BWSTT, the subject displayed improved kinematics, walking speed, endurance, and distance during overground gait. Conclusion: Very low frequency BWSTT combined with conventional treatment improved quality and endurance of walking for a person with incomplete cervical SCI. Further work is needed to evaluate the long-term outcome of very low frequency BWSTT and the interaction of BWSTT with other interventions. Show more

Keywords: Spinal cord injury, body weight support, gait, treadmill training

DOI: 10.3233/NRE-2009-0524

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 261-270, 2009

Authors: Buchanan, Robert J. | Chakravorty, Bonnie J. | Tyry, Tuula | Hatcher, William | Vollmer, Timothy

Article Type: Research Article

Abstract: Objective: To determine if the demographic characteristics and health care needs of younger people with MS differ from older people with MS. Participants: The study analyzed enrollment data from the NARCOMS Registry to compare 1,987 younger adults with MS (30 years and younger) to 29,245 other adults with MS (over 30 years). Methods: Analyses of the NARCOMS data focused on descriptive characteristics of these adults with MS, using a t-test to identify any statistically significant age-related differences in means and a chi-squared test to identify any statistically significant age-related differences in proportions. Results: A …significantly larger proportion of younger adults with MS were female and African American compared to other adults with MS. We found significant age-related differences in the expression of physical disability domains but few significant age-related differences in symptoms of depression. We also observed significant age-related differences in the utilization of health providers, with larger proportions of other adults with MS treated by internists, urologists, rehabilitation specialists, and physical and occupational therapists. Conclusions: The comprehensive care of younger adults with MS should include monitoring for mental health conditions and the availability of mental health services. Show more

Keywords: Multiple sclerosis, younger adults, demographics, symptoms, treatments

DOI: 10.3233/NRE-2009-0525

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 271-278, 2009

Authors: Vitorino, Jussara

Article Type: Research Article

Abstract: Objective: The primary aim of the present investigation was to obtain the nasalance score in Portuguese speakers with multiple sclerosis (MS) in order to identify velopharyngeal impairments and to enhance clinicians’ ability to employ appropriate therapy strategies for speech disorders in MS. Design: Perceptual assessments (speech sample analysis) and instrumental technique (Nasometer) were performed. Two passages were constructed in the Portuguese Language: one similar to the Grandfather Passage for perceptual assessments and the other similar to the Zoo Passage for the nasalance score. Participants: Seventy (70) adult Portuguese speakers with MS and seventy five (75) nonneurologically disordered Portuguese …speakers were involved in this study. Results/Conclusion: The mean nasalance score of the MS participants was found to be significantly higher than of the control group, confirming velopharyngeal dysfunction in the Portuguese speakers group with MS. The results in this study contrast with a low incidence of velopharyngeal impairment present in English speakers with MS. These findings are discussed with respect to the degree of hypernasality and the potential influence of these impairments on the verbal output of the speakers of Portuguese. Show more

Keywords: Velopharyngeal dysfunction, physiological assessment, perceptual assessment, dysarthria, multiple sclerosis, nasalance

DOI: 10.3233/NRE-2009-0526

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 279-287, 2009

Authors: Yonetsu, Ryo | Nitta, Osamu | Surya, John

Article Type: Research Article

Abstract: Objective: By utilizing “patternizing” standards, this study attempted to obtain objective evaluation index of sit-to-stand (STS) movements of children with cerebral palsy (CP). In hopes that this understanding can lead to a standardized and effective physical therapy treatment of CP STS movements. Design: The subjects were 50 children with CP, aged from three years and two months to twelve years and four months, mean age nine years and eleven months. The control group consisted of ten healthy children, aged from four years and five months to eleven years and ten months, mean age seven years and two months. …In the analysis, firstly, pictures of the subjects’ (CP and control group) STS movements were taken from the side with one digital video camera. Next, these STS movements were classified into two phases (first phase, sitting position to hip off the seat; second phase, hip off the seat to standing position), and the state of the subjects’ extremities was evaluated by 15 items. Based on these 15 items, characteristics of STS movements were identified and recorded as YES or NO . Finally, using SPSS (version13), cluster analysis was conducted. Results: The subjects’ STS movements were classified into five aggregate groups. Conclusion: From these findings, it was possible to distinguish the characteristics and differences of STS movements in healthy children and CP subjects. Moreover, the CP subjects were also able to be classified into four groups based on their shared characteristics of STS movements. Show more

Keywords: Cerebral palsy, sit-to-stand movements, “patternizing”

DOI: 10.3233/NRE-2009-0527

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 289-296, 2009

Authors: King, Lauren K. | Almeida, Quincy J. | Ahonen, Heidi

Article Type: Research Article

Abstract: Recent studies have suggested that vibration therapy may have a positive influence on motor symptoms in individuals with Parkinson's disease (PD). However, quantitative evidence of these benefits is scarce, and the concept of “whole-body” vibration in these studies is vague. The objectives of the current study were to evaluate the influence of vibration on motor symptoms and functional measures in PD by delivering sound waves to the entire body. We delivered whole body sound wave vibration to 40 individuals with PD using a Physioacoustic Chair, a piece of equipment with speakers spaced throughout the chair permitting a series of programmed …low frequency sound waves through the body. Using a parallel cross-over design we utilized the Unified Parkinson's Disease Rating Scale (UPDRS), quantitative gait assessments, and a grooved pegboard for upper limb control. Improvements were seen in all symptom, motor control and functional outcome measures at the time of assessment. Specifically, a significant decrease in rigidity, and tremor were shown, as well as a significant increase in step length and improved speed on the grooved pegboard task. Results of this initial investigation provide support for vibration therapy as a non-pharmacological treatment alternative. Long-term benefits of vibration therapy will require further research. Show more

Keywords: Vibration therapy, Parkinson's disease, rehabilitation, gait, motor control

DOI: 10.3233/NRE-2009-0528

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 297-306, 2009

Authors: Kessels, Roy P.C. | Olde Hensken, Linda M.G.

Article Type: Research Article

Abstract: This pilot study examines whether learning without errors is advantageous compared to trial-and-error learning in people with dementia using a procedural task and a randomized case-control design. A sample of 60 people was recruited, consisting of 20 patients with severe dementia, 20 patients with mild-to-moderate dementia and 20 participants without dementia. The participants had to acquire a novel procedural problem-solving task with the help of cues (errorless learning) or with cues only given in case an error was made (trial-and-error learning). The number of steps completed without assistance immediately after errorless or trial-and-error learning and after a delay of 1–3 …days was recorded. Overall performance was better after errorless learning compared to trial-and-error learning (p = 0.012), with effect sizes being largest in the mild-to-moderate dementia group after delayed testing (d = 1.61). The effects of errorless learning were larger after delayed testing. We conclude that errorless learning of a procedural task results in a better performance than learning with errors. This study is the first to use a controlled group design to show such a benefit in patients with dementia. These findings can be extended to the acquisition of tasks that are relevant for everyday-life functioning, having important implications for dementia care. Show more

Keywords: Dementia, cognitive rehabilitation, errorless learning, skill learning

DOI: 10.3233/NRE-2009-0529

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 307-312, 2009

Authors: Joines, Sharon

Article Type: Research Article

Abstract: Objectives: To inform clinicians, caregivers and researchers involved with assessing and treating individuals with neurological disabilities of the benefits of universal design in enhancing quality of life. The improvement of quality of life has the potential to benefit the individuals with neurological disabilities and those whose lives overlap and intersect with those individuals. Methods: Literature and design reviews are used as a foundation for a model for incorporating and leveraging universal design to the benefit of the patient’s social sphere, which includes caregivers, family members and medical staff. By matching patients varied abilities with universal design solutions, the …model of universal design benefitting the patients’ social sphere will be demonstrated. Recommendations: Recommendations are made for clinicians and researchers that they may use in their practices and investigations in three areas: 1) educating patients about the benefits of universal design, 2) helping inform patients how to leverage universally designed products and approaches in their lives and living spaces and 3) understanding how to incorporate universal design principles into research and clinical spaces as demonstration pieces for patients. Show more

Keywords: Universal Design, neurological disabilities, inclusive design, design for all, stroke, spinal cord injury

DOI: 10.3233/NRE-2009-0539

Citation: NeuroRehabilitation, vol. 25, no. 4, pp. 313-326, 2009