NeuroRehabilitation - Volume 28, issue 1

Authors: Zasler, Nathan D. | Kreutzer, Jeffrey S.

Article Type: Introduction

DOI: 10.3233/NRE-2011-0624

Citation: NeuroRehabilitation, vol. 28, no. 1, pp. 1-2, 2011

Authors: Gosseries, Olivia | Bruno, Marie-Aurélie | Chatelle, Camille | Vanhaudenhuyse, Audrey | Schnakers, Caroline | Soddu, Andrea | Laureys, Steven

Article Type: Research Article

Abstract: Following a coma, some patients may “awaken” without voluntary interaction or communication with the environment. More than 40 years ago this condition was coined coma vigil or apallic syndrome and later became worldwide known as “persistent vegetative state”. About 10 years ago it became clear that some of these patients who failed to recover verbal or non-verbal communication did show some degree of consciousness – a condition called “minimally conscious state”. Some authors questioned the usefulness of differentiating unresponsive “vegetative” from minimally conscious patients but subsequent functional neuroimaging studies have since objectively demonstrated differences in residual cerebral processing and hence, …we think, conscious awareness. These neuroimaging studies have also demonstrated that a small subset of unresponsive “vegetative” patients may show unambiguous signs of consciousness and command following inaccessible to bedside clinical examination. These findings, together with negative associations intrinsic to the term “vegetative state” as well as the diagnostic errors and their potential effect on the treatment and care for these patients gave rise to the recent proposal for an alternative neutral and more descriptive name: unresponsive wakefulness syndrome. We here give an overview of PET and (functional) MRI studies performed in these challenging patients and stress the need for a separate ICD-9-CM diagnosis code and MEDLINE MeSH entry for "minimally conscious state" as the lack of clear distinction between vegetative state/unresponsive wakefulness syndrome and minimally conscious state may encumber scientific studies in the field of disorders of consciousness. Show more

Keywords: Consciousness, vegetative state/unresponsive wakefulness syndrome, minimally conscious state, functional MRI, positron emission tomography

DOI: 10.3233/NRE-2011-0625

Citation: NeuroRehabilitation, vol. 28, no. 1, pp. 3-14, 2011

Article Type: Editorial

DOI: 10.3233/NRE-2011-0626

Citation: NeuroRehabilitation, vol. 28, no. 1, pp. 15-16, 2011

Authors: Harvey, Lisa A. | Glinsky, Joanne A. | Katalinic, Owen M. | Ben, Marsha

Article Type: Research Article

Abstract: Contractures are a common and disabling problem for people with spinal cord injuries. To date, contractures have largely been managed with physical interventions such as stretch and passive movements. These are typically administered either manually or with the assistance of various orthoses, devices or aids. However, the results of recent clinical trials question the effectiveness of these interventions. They indicate that therapists should not expect to see a change in joint mobility or muscle extensibility from stretches applied for less than 30 minutes a day over less than 3 months. This suggests that contractures may be a far more complex …and multifactorial problem to manage than previously assumed. This paper challenges clinicians and researchers to reappraise the effectiveness of current contracture management. Show more

Keywords: Spinal cord injury, contracture, muscle stretching

DOI: 10.3233/NRE-2011-0627

Citation: NeuroRehabilitation, vol. 28, no. 1, pp. 17-20, 2011

Authors: Lannin, Natasha A. | Ada, Louise

Article Type: Research Article

Abstract: The use of splints in neurorehabilitation is common, with splints being used to meet varied clinical aims. This paper explores the use of splints after stroke and examines the rationale underpinning current use. It covers the use of splints to reduce spasticity, prevent contracture and improve activity. As well as presenting the theoretical rationale underpinning splinting as an intervention, it examines the current evidence from randomised trials testing the theories. In summary, there is strong evidence that wearing a splint all night has no additional effect in reducing spasticity over usual therapy or in preventing contracture, whether the wrist is …splinted in neutral or in maximum extension. It is not surprising that splinting has not shown an effect on activity, given that there was little effect on the impairments that it was directed towards. In conclusion, it is now time to re-focus on improving muscle performance in order to enable activity rather than preparing the patient for function by affecting abnormal reflex activity. Show more

DOI: 10.3233/NRE-2011-0628

Citation: NeuroRehabilitation, vol. 28, no. 1, pp. 21-28, 2011

Authors: Tyson, Sarah F. | Kent, Ruth M.

Article Type: Research Article

Abstract: Upper limb orthotics, or splints, are widely advocated for people with stroke however opinion about whether, and how, they should be used is varied. We therefore systematically reviewed the literature on upper limb orthotics for people with stroke and other non-progressive brain lesions to establish whether an orthosis can improve function or/and impairments. Search strategy: The Cochrane library, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO and RECAL were searched. We screened reference lists and contacted lead authors and other researchers in the field. Selection criteria: Randomised controlled trials of upper limb orthoses in stroke survivors and other non-progressive brain …lesions. Data collection and analysis: Two reviewers independently identified trials, extracted data and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model. Main results: We analysed 4 trials with 126 participants. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. Conclusions: Current evidence suggests that an upper limb orthosis does not effect upper limb function, range of movement at the wrist, fingers or thumb, nor pain. Show more

Keywords: Stroke, orthosis, splint, upper limb

DOI: 10.3233/NRE-2011-0629

Citation: NeuroRehabilitation, vol. 28, no. 1, pp. 29-36, 2011

Authors: Morris, Christopher | Bowers, Roy | Ross, Karyn | Stevens, Phil | Phillips, David

Article Type: Research Article

Abstract: An international multidisciplinary group of healthcare professionals and researchers participated in a consensus conference on the management of cerebral palsy, convened by the International Society for Prosthetics and Orthotics. Participants reviewed the evidence and considered contemporary thinking on a range of treatment options including physical and occupational therapy, and medical, surgical and orthotic interventions. The quality of many of the reviewed papers was compromised by inadequate reporting and lack of transparency, in particular regarding the types of patients and the design of the interventions being evaluated. Substantial evidence suggests that ankle-foot orthoses (AFOs) that control the foot and ankle in …stance and swing phases can improve gait efficiency in ambulant children (GMFCS levels I-III). By contrast, little high quality evidence exists to support the use of orthoses for the hip, spine or upper limb. Where the evidence for orthosis use was not compelling consensus was reached on recommendations for orthotic intervention. Subsequent group discussions identified recommendations for future research. The evidence to support using orthoses is generally limited by the brevity of follow-up periods in research studies; hence the extent to which orthoses may prevent deformities developing over time remains unclear. The full report of the conference can be accessed free of charge at www.ispoint.org. Show more

Keywords: Cerebral palsy, orthoses, orthotic, evidence-based, consensus

DOI: 10.3233/NRE-2011-0630

Citation: NeuroRehabilitation, vol. 28, no. 1, pp. 37-46, 2011

Authors: Elliott, Catherine M. | Reid, Siobhan L. | Alderson, Jacqueline A. | Elliott, Bruce C.

Article Type: Research Article

Abstract: Objectives: To investigate the effects of lycra® arm splint wear on goal attainment and three dimensional (3D) kinematics of the upper limb and trunk in children with cerebral palsy (CP). Design: Randomised clinical trial whereby participants were randomised to parallel groups with waiting list control. Participants: Sixteen children with CP (hypertonia) aged 9 to14 years. Intervention: Three months lycra arm splint wear combined with goal directed training. Main outcome measure: Goal attainment scale, and 3D upper limb and trunk kinematics across four upper limb movement tasks. Results: 17/18 children …achieved their movement goals following three months of splinting. Selected joint kinematics improved on immediate splint application. Further improvements in joint kinematics were demonstrated following 3 months of splint wear, particularly in elbow extension, shoulder flexion and abduction and in thorax flexion. Only improvements in movement compensations at the thorax remained following removal of the splint. Conclusions: The lycra® arm splint, made a quantifiable change to the attainment of movement goals of importance to the child. Furthermore, improvements were demonstrated in selected maximum range of movement and joint kinematics during functional tasks at the elbow and shoulder joints and thorax segment in children with CP. Show more

Keywords: Cerebral Palsy, upper limb kinematics, lycra splinting, 3D motion analysis, goal attainment scale

DOI: 10.3233/NRE-2011-0631

Citation: NeuroRehabilitation, vol. 28, no. 1, pp. 47-54, 2011

Authors: Hoffman, Henry B. | Blakey, Glyn L.

Article Type: Research Article

Abstract: Repetitive task-specific training appears to improve upper extremity function among individuals with neurological injuries. However, treatment options are limited for neurological patients who cannot effectively incorporate their hand consistently for functional grasp and release/prehension activities. Traditional therapy approaches are not considered to be effective in controlled clinical trials. However, constraint induced movement therapy (CIMT) has shown to be a successful treatment approach for patients who exhibit some wrist and finger extension. The vast majority of stroke survivors, head injury and incomplete spinal cord Injury patients do not exhibit sufficient wrist and/or finger extension to qualify for CIMT. Patients with moderate …to severe upper extremity hemiparesis are therefore unable to benefit from the latest advances in neuro-rehabilitation. The SaeboFlex and SaeboReach Functional Dynamic Orthoses have the biomechanical advantage in allowing prehension / grasp and release activities for individuals with moderate to severe hemiparesis. These orthoses are designed to position the neurological wrist and fingers into extension for proper functional training. This article describes Saebo's functional dynamic orthoses – the SaeboFlex, SaeboReach, and the SaeboStretch dynamic resting hand splint for contracture prevention – and summarizes developing evidence for the orthoses in the clinic/rehabilitation environment. This is a review article. Show more

Keywords: Stroke, brain injury, functional orthoses, rehabilitation, arm, hand

DOI: 10.3233/NRE-2011-0632

Citation: NeuroRehabilitation, vol. 28, no. 1, pp. 55-61, 2011