NeuroRehabilitation - Volume 31, issue 4

Authors: Machado, Calixto | Estévez, Mario | Carrick, Frederick R. | Rodríguez, Rafael | Pérez-Nellar, Jesús | Chinchilla, Mauricio | Machado, Yanín | Pérez-Hoz, Grisel | Carballo, Maylén | Fleitas, Marcia | Pando, Alejandro

Article Type: Research Article

Abstract: The term persistent vegetative state (PVS) refers to the only circumstance in which an apparent dissociation of both components of consciousness is found, characterized by preservation of wakefulness with an apparent loss of awareness. Several authors have recently demonstrated by functional neuroimaging studies that a small subset of unresponsive “vegetative” patients may show unambiguous signs of consciousness and command following that is inaccessible to clinical examination at the bedside. The term “estado vegetativo ” used in Spanish to describe the PVS syndrome by physicians came from the English-Spanish translation. The Spanish term “vegetativo ” is related to unconscious vital functions, …and “vegetal” is relative to plants. According to our experience, when a physician informs to patients' relatives that his/her family member's diagnosis is a “estado vegetativo ”, they understand the he/she is no more a human being, that there is no hope of recovery. The European Task Force on Disorders of Consciousness has recently proposed a new term, unresponsive wakefulness syndrome (UWS) , to assist society in avoiding the depreciatory term vegetative state . Our group has embraced the use of the new term UWS and might suggest that we change our concept and use of the term MCS to minimally responsive wakefulness state (MRWS) , or minimally aware wakefulness state (MAWS) . Medical terms must be current and avoid any pejorative description of patients, which will promote our abilities to serve humankind and challenge neuroscientists to offer society new and realistic hopes for neurorehabilitation. Show more

Keywords: Persistent vegetative state, minimally conscious state, disorders of consciousness, neuroimages

DOI: 10.3233/NRE-2012-00802

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 345-347, 2012

Authors: Shin, Yoon Kyum | Lee, Dong Ryul | Hwang, Han Jeong | You, Sung (Joshua) Hyun | Im, Chang Hwan

Article Type: Research Article

Abstract: Purpose: The purpose of this study was to compare EEG topographical maps in normal children and children with cerebral palsy (CP) during motor execution and motor imagery tasks. Method: Four normal children and four children with CP (mean age 11.6 years) were recruited from a community medical center. An EEG-based brain mapping system with 30 scalp sites (extended 10–20 system) was used to determine cortical reorganization in the regions of interest (ROIs) during four motor tasks: movement execution (ME), kinesthetic-motor imagery (KMI), observation of movement (OOM), and visual motor imagery (VMI). ROIs included the primary sensorimotor cortex (SMC), …premotor cortex (PMC), and supplementary motor area (SMA). Design: Descriptive analysis. Results: Normal children showed increased SMC activation during the ME and KMI as well as SMC and visual cortex (VC) activation during KMI. Children with CP showed similar activation in the SMC and other motor network areas (PMC, SMA, and VC). During the OOM and VMI tasks, the VC or occipital area were primarily activated in normal children, whereas the VC, SMC, and bilateral auditory areas were activated in children with CP. Discussion: This is the first study demonstrating different neural substrates for motor imagery tasks in normal and children with CP. Show more

Keywords: Motor imagery, EEG, cortical activation, topographical map

DOI: 10.3233/NRE-2012-00803

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 349-355, 2012

Authors: Rostami, Hamid Reza | Arastoo, Ali Asghar | Nejad, Seifollah Jahantabi | Mahany, Mohammad Khayatzadeh | Malamiri, Reza Azizi | Goharpey, Shahin

Article Type: Research Article

Abstract: Objective: To determine effects of implementing a practice period of modified constraint-induced movement therapy in a virtual environment on upper limb function in children with spastic hemiparetic cerebral palsy. Methods: In a single-blinded, randomised, controlled trial, 32 participants (18 female, 14 male) received 18 hours training in 3 different groups (virtual reality, modified constraint-induced movement therapy, and a combination group). The fourth group was a control group. Training sessions occurred every other day, 3 times per week for 4-week. Each session lasted for 1.5 hours. Assessment sessions were conducted before, after, and 3-month after treatment period using pediatric …motor activity log and the speed and dexterity subtest of the bruininks-oseretsky test of motor proficiency. Data analysis was conducted by ANOVA with repeated measures using SPSS 16.0 with alpha levels set at P < 0.05. Results: Significantly higher gains were observed in the combination therapy group for the amount of limb use (mean change, 2.72), quality of movement (mean change, 2.79), and speed and dexterity (mean change, 1.74) at post-test. These gains were maintained at the 3-month follow-up assessment. Conclusions: Modified constraint-induced movement therapy in a virtual environment could be a promising rehabilitation procedure to enhance the benefits of both virtual reality and constraint-induced therapy techniques. Show more

Keywords: Constraint-induced movement therapy, spastic hemiparetic cerebral palsy, upper limb function, virtual reality, virtual environment

DOI: 10.3233/NRE-2012-00804

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 357-365, 2012

Authors: Lewis, Jeffrey D. | Wassermann, Eric M. | Chao, Wendy | Ramage, Amy E. | Robin, Donald A. | Clauw, Daniel J.

Article Type: Research Article

Abstract: Many service members and veterans report chronic unexplained symptoms such as pain, fatigue and memory complaints, which have most recently been characterized as post-deployment syndrome (PDS). Chronic widespread pain is a component of this syndrome, producing significant disability and considerable health care costs. The similarity between the nature of these complaints and other medically unexplained illnesses such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome suggest that they may share a common mechanism. Here, we provide support for PDS as a consequence of pain and sensory amplification secondary to neuroplastic changes within the central nervous system, a phenomenon often …termed central sensitization. We also discuss how factors such as stress and genetics may promote chronic widespread pain in veterans and service members who develop PDS. Show more

Keywords: Chronic widespread pain, post-deployment, mild traumatic brain injury

DOI: 10.3233/NRE-2012-00805

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 367-372, 2012

Authors: Lee, Dong Gyu | Jang, Sung Ho

Article Type: Research Article

Abstract: Proper management of elbow spasticity is important in stroke rehabilitation. We investigated the effect and safety of ultrasound guided alcohol neurolysis of the MC nerve for controlling elbow flexor spasticity in hemiparetic stroke patients. Ten hemiparetic stroke patients with severe elbow spasticity were recruited for this study. We identified the MC nerve using ultrasound and performed neurolysis with 35% ethyl alcohol. The severity of spasticity was assessed using the modified Ashworth scale (MAS) score and associated reaction (AR) of elbow flexor. During the 2 months follow-up period, both MAS score and AR were reduced in all 10 patients. Before treatment, …the mean MAS score was 3.4 ± 0.5, and this improved to 0.1 ± 0.3 immediately post-neurolysis, 1.8 ± 1.0 at one month and 1.9 ± 0.8 at two months (p < 0.001). The mean change of AR of the affected elbow was significantly decreased, from 75.2 ± 30.0° before neurolysis to 24.8 ± 21.3° immediately post-neurolysis, 35.5 ± 24.7° at 1 month and 40.8 ± 25.1° at 2 months (p < 0.001). Ultrasound guided MC nerve block is an effective and safe procedure for relieving localized spasticity of the elbow flexor. Show more

Keywords: Ultrasound, musculocutaneous nerve, elbow, spasticity, ethyl alcohol

DOI: 10.3233/NRE-2012-00806

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 373-377, 2012

Authors: Kwon, Jae-Sung | Park, Mi-Jung | Yoon, In-Jin | Park, Soo-Hyun

Article Type: Research Article

Abstract: Aim: To examine the effects of conventional therapy (CT) combined with intensive virtual reality (VR) program on upper extremity function and activities of daily living (ADL) in individuals in the acute stage of stroke. Method: Twenty-six individuals were randomly assigned to the control or experimental group. The control group received CT, while the experimental group received VR training in addition to CT on same day. The Fugl-Meyer Assessment (FMA) and the Manual Function Test (MFT) were used to measure improvement of functioning in the affected limb and the Korean version of the Modified Barthel Index (K-MBI) was conducted …to evaluate ADL. Result: In tests of upper extremity functioning, VR group showed significant improvement on FMA and MFT (p < 0.05). In the CT group, only FMA score showed significant change (p < 0.05). ADL performance improved significantly in both groups (p < 0.05). However, there were no significant differences between the two groups in upper extremity function and ADL performance (p > 0.05). Conclusion: This study observed that VR training has the advantage of improving intended arm function during intensive training for individuals in the acute stage of stroke. Show more

Keywords: Stroke rehabilitation, virtual reality, upper extremity function

DOI: 10.3233/NRE-2012-00807

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 379-385, 2012

Authors: Hwang, Young-In | An, Duk-Hyun | Yoo, Won-Gyu

Article Type: Research Article

Abstract: This study investigated how to improve the walking patterns in stroke patients by using the Dual AFO, which was devised as an alternative AFO consisting of two thin pierced plastic pieces for the lower leg and foot. Fifteen individuals with hemiplegia were recruited. Participants were seven males and eight females. Gait parameters were measured with the GAITRite system to analyze the spatial and temporal parameters of walking by stroke patients.The Dual AFO significantly improved the step time of the non-affected foot compared with barefoot walking. There was no significance difference in the affected swing time between the two conditions, and …participants with the Dual AFO had a significantly shorter non-affected swing time. There was a significant difference in the affected single support time between walking with and without the Dual AFO. Additionally, the velocity was increased significantly in subjects with the Dual AFO compared with barefoot. Consequently, the Dual AFO might enhance stability during the stance phase on the affected side and mobility during the swing phase on the non-affected side to promote better walking in stroke patients. Show more

Keywords: Ankle-foot orthosis, modified AFO, assistive device, walking, foot drop

DOI: 10.3233/NRE-2012-00808

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 387-393, 2012

Authors: Yeo, Sang Seok | Jang, Sung Ho

Article Type: Research Article

Abstract: The corticospinal tract (CST) is the most important motor tract in the human brain. The authors compared CST fibers of the fingers and toes using diffusion tensor imaging. Eleven normal healthy subjects were recruited for this study. Functional MRI stimulation was performed using finger grasp-release movements and toe flexion-extension movements (1 Hz). CST fibers of the fingers and toes were determined by selecting fibers passing through seed (the CST portion in the pons) and target regions of interest (the activation areas of the cerebral cortex during active finger and toe movements, respectively). No significant differences were observed between CST fibers …of the fingers and toes in terms of fractional anisotropy, mean diffusivity, or tract volume (P > 0.05), and no differences were observed between the connectivities of CST fibers of the fingers and toes and the dorsal premotor cortex or the supplementary motor area (P > 0.05). However, the connectivities between CST fibers of legs and the contralateral primary motor cortex were greater than those of CST fibers of the fingers (P < 0.05). It was found that somatotopic CST fibers of the fingers and toes did not differ in terms of diffusion tensor imaging characteristics, but that transcallosal fibers to the contralateral motor cortex were more frequent for CST fibers of the toes than for CST fibers of the fingers. Show more

Keywords: Diffusion tensor imaging, corticospinal tract, somatotopy, gait, functional MRI, transcallosal fiber

DOI: 10.3233/NRE-2012-00809

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 395-399, 2012

Authors: Murillo, Narda | Kumru, Hatice | Opisso, Eloy | Padullés, Josep Maria | Medina, Josep | Vidal, Joan | Kofler, Markus

Article Type: Research Article

Abstract: Background: Clinical studies have shown that after incomplete spinal cord lesions at the thoracic level, patients can develop functional gait patterns through gait training. To date, however, training has been ineffective in producing gait in patients with clinically motor complete spinal cord lesions. Objective: Here we report a patient with chronic motor complete spinal cord injury who regained locomotor function with assistance after intensive gait rehabilitation treatment. Methods: A fifteen year old female patient had sustained motor complete spinal cord injury (T6, AIS B) 2 years earlier, with severe bilateral extensor spasticity, and ineffective previous gait …training with robotic systems. The therapy consisted of two months of gait training with a robotic system combined with bilateral functional electrical stimulation (FES) of the peroneal nerve, and one month of gait training with a special walker and FES of the left leg and occasionally on the right leg, due to flexor reflex could sometimes be initiated by the patient in the right leg without electrical stimulation. Neurophysiological studies and ten metres test were done. Results: At the end of training, the patient was able to cover a distance of 200 metres without FES with a walker and assistance from a physiotherapist, who pulled the walker with each step to help her to accomplish effective overground stepping. Motor and somatosensory evoked potentials were absent in the lower limbs. Conclusion: Even after a motor complete lesion with some preservation of sensory pathways, the spinal cord may be able to retain some of its locomotor function through intensive gait rehabilitation. Show more

Keywords: Motor complete lesion, central pattern generator, recovery of stepping

DOI: 10.3233/NRE-2012-00810

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 401-407, 2012

Authors: Kuipers, Kathy | Burger, Laura | Copley, Jodie

Article Type: Research Article

Abstract: Aim: To determine if a Clinical Reasoning Protocol assisted occupational therapists to consistently choose casting as an intervention in the context of moderate/severe upper limb hypertonia and possible contracture. Methods: Sixty-four intervention decisions (including strength/movement training, splinting and/or casting) were drawn retrospectively from initial reports at a community clinic. Associations between identified upper limb characteristics, stated clinical aims and intervention decisions were analysed using logistic regression. Results: Casting was statistically significantly likely to be chosen in the presence of moderate (CI95 1.88–39.80, p = 0.01) or severe hypertonicity (CI95 1.34–135.98, p = …0.03), and if the stated clinical aim was to reduce hypertonicity (CI95 2.01–18.10, p = 0.001) or contracture (CI95 1.31–12.73, p = 0.02). When reports included both these clinical aims, there was a highly significant association with the decision to cast (CI95 5.67–9.13, p = 0.001). Where casting was indicated as appropriate, but not chosen as an intervention, mitigating factors included older age (70–95 years), limited personal support and a clinical aim of comfort/hygiene maintenance. Conclusion: Occupational therapists using the Protocol consistently chose casting as an upper limb intervention for adults who demonstrated moderate/severe hypertonicity, contracture or limited functional ability. Prospective research is required to determine intervention outcomes following use of the Protocol. Show more

Keywords: Hypertonicity, spasticity, upper limb, casting, clinical decision

DOI: 10.3233/NRE-2012-00811

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 409-420, 2012

Authors: Nathan, Dominic E. | Prost, Robert W. | Guastello, Stephen J. | Jeutter, Dean C. | Reynolds, Norman C.

Article Type: Research Article

Abstract: Objective: To understand neural correlates of upper extremity task performance (functional vs. non-functional) and to understand their influence on neuromotor control strategies. Design: Cross-sectional descriptive study, with repeated measures. Setting: Medical center 1.5T MRI clinical imaging facility. Participants: Neurologically intact individuals, (M = 14 F = 5 mean age = 22.94 ± 3.1 years) all right hand dominant as determined by the Edinburgh handedness survey. Subjects performed upper extremity motor tasks of reaching and grasping in a block paradigm. Whole brain fMRI data was acquired using a 1.5T MRI scanner. Main outcome …measures: Differences in fMRI area of activation and maximum activation intensity for the whole brain were evaluated among the different upper extremity motor tasks. Results: Our results indicate (a) Activations in brain regions are task specific. (b) ANOVA results indicate functional goal oriented movements of reaching and grasping produce higher activation intensity (p < 0.0001) in more regions of the cortex (Somatosensory motor area, primary motor cortex, and parietal region) and cerebellum (p < 0.001) as compared to nonfunctional rhythmic movements of reaching only and grasping only. (c) There is some overlap in cerebellar activations, however areas of activation in the medial cerebellum were observed for reaching-and-grasping, while the grasping-only task produced activation more laterally in the cerebellum. Conclusions: Our findings suggest that (a) neuromotor strategy for functional goal-oriented movements is different from rhythmic movements such as finger tapping or non-functional movements, (b) This difference can be quantified and mapped using fMRI. (c) There are some overlap with activation of movement execution however the cognitive component that mediates the specific movement is not just the linear combination of simple movements rather it is task and context specific. (d) The results support the concept of using goal-oriented tasks in the applications of rehabilitation and therapy for restoration of function. Show more

Keywords: Functional goal-oriented movements, upper extremity neurorehabilitation, functional motor tasks, upper extremity neuromotor control

DOI: 10.3233/NRE-2012-00812

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 421-428, 2012

Authors: Čakrt, Ondřej | Vyhnálek, Martin | Slabý, Kryštof | Funda, Tomáš | Vuillerme, Nicolas | Kolář, Pavel | Jeřábek, Jaroslav

Article Type: Research Article

Abstract: Few clinical studies have evaluated physiotherapeutic interventions in patients with degenerative cerebellar ataxia. Investigations on the effectiveness of biofeedback-based interventions for training postural control in these patients have not been conducted yet. The aim of the present study was to assess the effectiveness of a 2-week intensive tongue-placed electrotactile biofeedback program for patients with progressive cerebellar ataxia. Subjects were seven adult patients suffering from cerebellar degeneration. Postural control was assessed with static posturography in two sensory conditions eyes open/closed on firm surface. For quantification of postural behavior, we used area, sway path and mean velocity of the centre of foot …pressure (CoP). Effects of treatment were determined by comparing Pre, Post and one month follow-up (Retention) experimental sessions. Analysis of measured CoP parameters for tests on firm surface showed a significant main effect of visual condition and no difference across test sessions under open eyes condition. Under eyes closed condition, there were significant differences between Pre versus Post and Pre versus Retention, while the difference Post versus Retention was not significant. Our results suggest that a balance rehabilitation program with postural exercise performed with a head position-based tongue-placed biofeedback system could significantly improve bipedal postural control in patients suffering from degenerative cerebellar ataxia. Show more

Keywords: Cerebellar ataxia, neurorehabilitation, biofeedback, postural control, physiotherapy, posturography

DOI: 10.3233/NRE-2012-00813

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 429-434, 2012

Authors: Maslovara, Sinisa | Soldo, Silva Butkovic | Puksec, Mirjana | Balaban, Branka | Penavic, Ivana Pajic

Article Type: Research Article

Abstract: This prospective clinical study includes 96 BPPV patients with the results of DHI testing ⩾ 40 points. They were segregated to be taken into this study and randomly divided into two therapy groups: 48 patients in Group I were treated pharmacotherapeutically with Betahistine Chloride (BC) and 48 patients in Group II underwent a rehabilitation treatment by performing an Epley maneuver. Total study duration was eight weeks, during which the patients were first examined upon arrival, checked after one, and rechecked after eight weeks. The tests included otoneurological examination and VNG, as well as completing three questionnaires: DHI, SF-36® , and …HADS® . During the first checkup after one week, 86.96% of patients in Group I and 93.33% in Group II had negative results at the Dix-Hallpike test. During the second checkup after an eight weeks' treatment, 95.65% in Group I and 97.78% patients in Group II had a negative result. At the beginning of the study, the values of patients' physical, emotional, and functional health (QoL) were equally distributed in both therapy groups, compared to standardized values of healthy population. During the first checkup, the values were significantly higher and by the second checkup, reached the statistic average, which corresponds with the healthy population. There was an obviously faster and more complete recovery of the patients in Group II, who underwent a rehabilitation treatment. Show more

Keywords: Benign Paroxysmal Positional Vertigo (BPPV), Quality of Life (QoL), Betahistine Chloride (BC), rehabilitation therapy

DOI: 10.3233/NRE-2012-00814

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 435-441, 2012

Authors: Stevens, Lillian Flores | Arango-Lasprilla, Juan Carlos | Deng, Xiaoyan | Schaaf, Kathryn Wilder | De los Reyes Aragón, Carlos José | Quijano, María Cristina | Kreutzer, Jeffrey

Article Type: Research Article

Abstract: Objective: To determine which factors are highly associated with burden and depression in a group of caregivers of persons with Traumatic Brain Injury (TBI) in Colombia, South America. Design: Prospective. Participants: Fifty-one pairs of individuals with TBI and their caregivers from two major cities in Colombia completed a comprehensive psychosocial evaluation that included information related to patient and caregiver sociodemographic factors, patient factors, and caregiver estimation of patient neurobehavioral functioning. Outcome measures: Caregiver burden (Zarit Burden Interview) and caregiver depression (PHQ-9). Results: Generalized linear models revealed that patient language problems and caregiver …perception of patient functioning on six neurobehavioral domains were related to caregiver burden. Caregiver socioeconomic status and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver depression. These variables were then selected as candidates for the multiple regression models, which were fit separately for caregiver depression and burden, and revealed that caregivers’ perception of patient depression was the only factor associated with both caregiver burden and depression. Conclusion: Caregivers’ perception of patient depression was the single best predictor of both caregiver burden and depression. Implications for treatment based on these preliminary findings are discussed. Show more

Keywords: Caregivers, depression, burden

DOI: 10.3233/NRE-2012-00815

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 443-452, 2012

Authors: Pergami, P. | Seemaladinne, N. | Billings, A.

Article Type: Research Article

Abstract: We recently developed a computer-based test that uses a pointing task with multiple levels of difficulty to evaluate upper extremity motor function. The purpose of this study is to report performance data in adults and children, to determine test reliability, and to validate this test against well established scales of motor function (Purdue Pegboard and 9-hole Pegboard tests). We examined 40 healthy right-handed subjects (18 children and 22 adults) to determine the correlation among computer-based test and validated measures. The test is quick to administer, engaging for adults and children, with a steep learning curve to stable performance, and can …be finely tuned to baseline ability. Test-retest reliability was confirmed for all levels of difficulty. The computer-based test demonstrated moderate correlation in healthy adults and children with the Purdue Pegboard test (Spearman, r = 0.52, p = 0.0005; Pearson, r = 0.55, p = 0.0002). Implications: The test is a valid measure of motor skills and could be use for periodic evaluation and monitoring in the clinic setting. Further development of a user-friendly version for self-administration would allow for home based monitoring of treatment/interventions. Show more

Keywords: Assessment of motor and process skills, computers, upper extremity

DOI: 10.3233/NRE-2012-00816

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 453-461, 2012

Authors: Miotto, Eliane Correa | Teixeira, Manoel Jacobsen

Article Type: Letter

DOI: 10.3233/NRE-2012-00801

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 463-464, 2012

Article Type: Other

DOI: 10.3233/NRE-2012-31417

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 465-468, 2012

Article Type: Other

DOI: 10.3233/NRE-2012-31418

Citation: NeuroRehabilitation, vol. 31, no. 4, pp. 469-470, 2012