NeuroRehabilitation - Volume 26, issue 2

Authors: Park, Ji-Won | Kim, Yun-Hee | Jang, Sung Ho | Chang, Won Hyuk | Park, Chang-hyun | Kim, Sung Tae

Article Type: Research Article

Abstract: Background: Failure of early motor learning due to damage in any brain area involved in this process may interfere with successful rehabilitation of such patients. Objective: We investigated the changes in activation of the motor network during sequential finger motor learning to delineate the characteristics of the cortico-subcortical network during motor skill learning. Methods: Twenty healthy, right-handed volunteers participated. Subjects were instructed to perform eight blocks of a sequential finger motor task while functional MRI (fMRI) was performed. Results: The participants had an improvement in performance over time from block 1 to block 4, …indicating that successful learning had occurred, followed by a plateau from block 5 to the last block. On fMRI, activities of the contralateral primary sensorimotor cortex, the premotor cortex, the supplementary motor area, and the posterior parietal cortex gradually increased from block 1 to block 4 and then decreased from block 5 to the last. In contrast, activity of the ipsilateral cerebellum showed a linear increase spanning the last block with peak activation. The thalamus and basal ganglia showed unilateral or bilateral activities at the unique stage of motor learning. Conclusions: These findings delineated the characteristic plastic changes and different roles of the cortico-subcortical network during the early phase of motor learning and automatization. Show more

Keywords: Cortico-subcortical network, functional MRI, motor learning

DOI: 10.3233/NRE-2010-0540

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 95-103, 2010

Authors: van't Hooft, Ingrid | Norberg, Annika Lindahl

Article Type: Research Article

Abstract: In a pilot study we examined the feasibility of a condensed version of the Swedish Memory and Attention Re-Training on children treated for medulloblastoma combined with a structured coaching programme for their parents. Parental coaching contained the translation of the child's new skills into daily life, and education regarding their own stress mechanisms. Before and after intervention we assessed the children's cognitive performance, social relations and self image as well as their parents stress. All three families continued the programme without interruption. Observations revealed that this condensed version of the programme was more stressful to participants. However, several …aspects of the children's attention and memory performance improved from pre to post-training assessment. In addition, all of the children reported enhancement of their social relations and self image. Initially, symptoms of parental stress were pronounced for the three mothers, but fairly low for the fathers. After training and coaching, the stress level of both mothers and fathers was low. Our findings encourage full scale studies examining whether this combination of condensed cognitive training and specific coaching programme for parents may influence not only the children's cognitive performance but also their social relations, self image and their parents stress. Show more

Keywords: Childhood brain tumour, acquired brain injury, cognitive training, parent coaching, self-image

DOI: 10.3233/NRE-2010-0541

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 105-113, 2010

Authors: AlAbdulwahab, Sami S. | Al-Gabbani, Maha

Article Type: Research Article

Abstract: Background: Reduction of spasticity in hip adductor muscles is one of the essential factors to improve standing, gait, and personal hygiene of children with spastic diplegic cerebral palsy (CP). Surgical and medical methods have been commonly used for such purposes. These methods are expensive, required special skill and have side effects. Objective: To study the effect of conventional TENS on spasticity in hip adductors and gait parameters of children with spastic diplegic CP. Subject: An experimental group of twenty seven ambulant children with spastic diplegic CP and control group of fifteen healthy children were voluntary participants …in the study. Methods: The experimental group received two different TENS management programs. The 1st TENS program was a one-time trial management program that included an ongoing application of conventional TENS on bilateral hip adductors during passive hip abduction, and during walking for a pre-determined distance. The 2nd TENS program was a one-week trial management program that included 15 minutes of ongoing application of conventional TENS on bilateral hip adductors during walking, three sessions a day for a week. The effects of the TENS program was assessed using the Modified Ashworth Scale, the balance master system and visual observations of knee positions. Results: A significant improvement was recorded in spasticity of hip adductors, gait parameters and knees position of the experimental group. Conclusion: Functional application of TENS to hip adductors of children with spastic diplegic CP can reduce spasticity and improve gait pattern. Show more

Keywords: TENS, CP, hip adductor, spasticity

DOI: 10.3233/NRE-2010-0542

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 115-122, 2010

Authors: Hassan-Zadeh, Roghiyeh | Mahmoudaliloo, M. | Bakhshipour, A. | Roofigari, A.R. | Zadeh, H. Shariat

Article Type: Research Article

Abstract: Introduction: The aim of this study is to test if deprivation of tactile sense can be compensated by the hearing sense, early after nerve repair in the hand. Method: This tool was used early after repair of the ulnar nerve with the intention of improving recovery of hand sensibility by maintaining an active sensory map of the hand in the somatosensory cortex during the deafferentation period. “Audiovisual tactile” was used early after repair of the ulnar nerve repair in a 25-years-old man. Sensory evaluation was done at regular intervals in 2, 5 and 7 months after introduction of …the intervention. Results: Results showed that sensory results are better in the patient who used the artificial sensibility regimen compared with the one who did not. Discussion: This result suggests that deprivation of one sense can be compensated by another sense. Show more

Keywords: Nerve repair, sensory re-education, audiovisual tactile, hand sensibility

DOI: 10.3233/NRE-2010-0543

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 123-126, 2010

Authors: Gorgey, Ashraf S. | Poarch, Hunter | Miller, Joshua | Castillo, Teodoro | Gater, David R.

Article Type: Research Article

Abstract: Objective: To determine the effects of 10 weeks of locomotor training (LT) using body weight supported (BWS) treadmill training and resistance training (RT) programs on over-ground walking recovery, walking speed and distance, functional independent measure (FIM), walking index for spinal cord injury (WISCI) and Berg Balance Score in an elderly person with an incomplete spinal cord injury (SCI). Design: A 66 year-old-male with a chronic incomplete SCI at C5/C6 ASIA Impairment Scale (AIS) D was admitted for rehabilitation following posterior laminectomy at L3âĂŞL5. The participant was a short distance ambulator relying primarily on his power wheelchair for mobility. He …completed 10 weeks of LT using manual BWS treadmill twice weekly and RT for knee extensor muscle groups twice a week. A weekly test of the over-ground distance and speed were recoded over the course of the 10 weeks. Additionally, the participant underwent a three month evaluation after discharge. Results: The 10-week program resulted in independent use of bilateral Canadian crutches to ambulate for 200 feet and increased over-ground walking speed. The FIM score increased from 3 to 6 and Berg balance score increased from 11 to 41. The WISCI score increased from 1 to 10. Three months post-discharge, the participant maintained his functional independency in sit to stand activity and over-ground walking. Conclusion: A combined program of LT and RT could enhance walking recovery in a person with a long-term SCI. The findings suggest that twice a week of LT can promote motor recovery if it is accompanied with an approach that effectively loads the paralyzed lower extremities. Show more

Keywords: Locomotor training, resistance training, spinal cord injury

DOI: 10.3233/NRE-2010-0544

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 127-133, 2010

Authors: Campos, Tania Fernandes | Barroso, Marina Tostes Miranda | de Lara Menezes, Alexandre Augusto

Article Type: Research Article

Abstract: This study intended to evaluate the influence of stroke on memory processes (encoding, storage and retrieval) of visual and verbal stimuli and its implications to the motor practice. Twelve patients (6 with right and 6 with left brain lesions; 6–36 months post-lesion) and 12 healthy subjects, 45–65 years old from both sexes were studied. The encoding and storage processes were evaluated during test sessions where each subject had three attempts to identify two lists with 10 stimuli each (10 figures and 10 words referring to animals and objects). The retrieval process was evaluated by immediate free retrieval and by recognition …tests. Data were analyzed by Mann-Whitney test. Performance was worse in patients (encoding – visual: p = 0.0001 and verbal: p = 0.0001; storage – verbal: p = 0.0001) and those with right lesions had worse performance in visual encoding (p = 0.0005) and those with left lesions had in verbal storage (p = 0.0246) and retrieval (p = 0.0001). According to results it is suggested that the patients were not able to adequately codify and store the information, however, they were adequately able to recover by recognition and this implicates the necessity to make a observational, distributed and varied practice in cerebrovascular disease patients therapy. Show more

Keywords: Stroke, encoding, storage, retrieval, memory

DOI: 10.3233/NRE-2010-0545

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 135-142, 2010

Authors: Shatil, Evelyn | Metzer, Avishag | Horvitz, Omer | Miller, Ariel

Article Type: Research Article

Abstract: Objectives: To explore unprompted adherence to a personalized, home-based, computerized cognitive training program in patients with multiple sclerosis (MS), and to examine the impact of training on cognitive performance. Methods: Participants were assigned to a training (n = 59) or a control group (n = 48). Those in the training group were instructed to train three times a week for 12 weeks. The control group received no training. All participants were evaluated with a Neuropsychological Examination (N-CPC) at baseline and at the end of the study. Results: In the training group, 42 (71.2%) participants …adhered to the training schedule and 22 (37.3%) completed the entire training regimen. In the control group, 24 (50.0%) participants agreed to be retested on the N-CPC. The training group showed a significant improvement over that shown by the control group in three memory-based cognitive abilities (general memory, visual working memory and verbal working memory). Post-hoc exploration of data from the N-CPC showed that cognitive training was also associated with increased naming speed, speed of information recall, focused attention and visuo-motor vigilance. Conclusions: The appreciable rates of adherence and cognitive improvements observed indicate that personalized cognitive training is a practical and valuable tool to improve cognitive skills and encourage neuronal plasticity in patients with MS. Show more

Keywords: Cognitive training, multiple sclerosis, memory, personalized medicine, plasticity

DOI: 10.3233/NRE-2010-0546

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 143-153, 2010

Authors: Broetz, D. | Burkard, S. | Weller, M.

Article Type: Research Article

Abstract: Objectives: To evaluate the long-term effect of a specific conservative treatment method for patients with lumbar disc prolapse. Background data: Low back pain and symptoms of disc herniation have a good prognosis. Yet the rates of disability and sick-leave because of recurrences are high and cost-intensive. Methods: Fifty consecutive patients with clinically and neuroradiologically confirmed lumbar disk prolapse, who responded to the first five daily physiotherapy sessions with pain centralization, were prospectively treated with mechanical physiotherapy with repeated end range spinal movements and leg movements. The results after one year of follow-up have been published previously …(J Neurology  250 (2003), 746–749). Results: From the initial cohort of 50 patients, 5 patients were operated within one year after discharge and one patient died. One patient had surgery for disc prolapse 13 months after discharge. Three patients were lost for follow-up. None of the 40 remaining patients has had surgery until the last follow-up. Conclusion: Pain centralization during the first 5 treatment sessions of mechanical physiotherapy is a useful diagnostic tool to predict a good longterm outcome. Mechanical physiotherapy with end range spinal movements and leg movements is an effective treatment strategy for many patients with lumbar disk disease. Show more

Keywords: Disc herniation, physical therapy, longterm outcome, centralization

DOI: 10.3233/NRE-2010-0547

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 155-158, 2010

Authors: Yang, Chung Yong | Park, Soon-Ah | Kim, Hun Soo | Shin, Yong Il

Article Type: Research Article

Abstract: The new antivirals clevudine, telbivudine and emtricitabine may be potent agents for the treatment of hepatitis B virus (HBV). However, there have been no reports on serious adverse events associated with the use of clevudine. A son and his mother both had HBV infection (ages: 27 and 47 years, respectively), and they had received antivirus treatment with clevudine (30 mg daily). They developed progressive weakness of the lower extremities and difficulty arising from the ground. Both the patients had symptoms for the previous 3∼4 months in process of 14∼17 months of clevudine therapy. The physical examinations showed positive Gower's sign, …a decreased gait velocity and symmetrical proximal weakness (MRC grade 4/5). Their blood tests at admission revealed elevated or positive HBs Ag, HBV DNA, AST, ALT, creatine kinase, LDH, myoglobin and CK-MB. For both patients, the electrodiagnostic studies indicated myopathy and the pathologic findings of biopsied muscles revealed myositis. Drug-induced polymyositis was suspected and the clevudine was finally withdrawn. The muscle weakness and laboratory findings were improved for both patients after conservative care. We report here on the first cases of polymyositis that may have been caused by administering the new nucleoside analog clevudine for treating HBV infection. Show more

Keywords: Polymyositis, clevudine, nucleoside analog, hepatitis B infection, myopathy

DOI: 10.3233/NRE-2010-0548

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 159-162, 2010

Authors: Jang, Sung Ho | Ahn, Sang Ho | Lee, Jun | Cho, Yoon Woo | Son, Su Min

Article Type: Research Article

Abstract: Purpose: We describe a patient with cortical infarct, whose sensori-motor function for the hand seemed to be reorganized into the lateral area, as demonstrated by functional MRI (fMRI). Methods: A 59-year-old male patient presented with severe sensori-motor dysfunction of the left hand, which first occurred at the onset of an infarct in the right primary sensori-motor cortex (SM1) centered on the precentral knob. The sensori-motor function of the affected hand recovered to a normal state at 6 months from onset. fMRI was performed using the blood oxygen level-dependent technique at 1.5T with a standard head coil (at 6 …months from onset). The active and passive movements were performed at the metacarpophalangeal joint using a specially equipped apparatus, and touch stimulation was applied on the dorsum of the hand using a rubber brush. Results: The contralateral SM1 centered on the precentral knob was found to be activated during the active movements, passive movements, and touch of the unaffected (right) hand movements. By contrast, the lateral area of the infarcted SM1 of the right hemisphere was activated during the three kinds of stimulation of the affected hand. Conclusions: We conclude that the sensori-motor function of the affected hand seemed to have been reorganized into the lateral area of the infarcted SM1. Show more

Keywords: Stroke, motor recovery, functional MRI

DOI: 10.3233/NRE-2010-0549

Citation: NeuroRehabilitation, vol. 26, no. 2, pp. 163-166, 2010