NeuroRehabilitation - Volume 32, issue 2

Authors: Gordon, Wayne A.

Article Type: Editorial

DOI: 10.3233/NRE-130837

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 197-198, 2013

Authors: Dams-O'Connor, K. | Spielman, L. | Hammond, F.M. | Sayed, N. | Culver, C. | Diaz-Arrastia, R.

Article Type: Research Article

Abstract: Objective: To characterize the clinical profiles of individuals with dementia who do and do not report a history of TBI. Introduction: Some evidence suggests that a history of traumatic brain injury (TBI) is associated with an increased risk of dementia later in life. The clinical features of dementia associated with TBI have not been well investigated. While there is some evidence that TBI is associated with increased risk of Alzheimer’s disease (AD), there are also indications that dementia associated with TBI has prominent behavioral, affective, and motor symptoms, making it distinct from AD. Methods: The current …study involves secondary analysis of baseline data from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS). Results: Individuals with dementia who reported a history of TBI had higher fluency and verbal memory scores and later onset of decline, but they are on more medications, had worse cardiovascular and cerebrovascular health, were more likely to have received medical attention for depression, and were more likely to have a gait disorder, falls, and motor slowness. Conclusion: These findings suggest that dementia among individuals with a history of TBI may represent a unique clinical phenotype that is distinct from known dementia subtypes. Show more

Keywords: Dementia, traumatic brain injury (TBI), National Alzheimer's Coordinating Center (NACC)

DOI: 10.3233/NRE-130838

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 199-209, 2013

Authors: Victoroff, Jeff

Article Type: Review Article

Abstract: Objectives: To determine the frequency of neurobehavioral signs and symptoms reported in every published case of traumatic encephalopathy with a view toward the development of clinical diagnostic criteria with predictive validity. Introduction: Cases of persistent or progressive neurological or neurobehavioral change following exposure to one or more head injuries have been reported since 1928. This condition is often referred to as traumatic encephalopathy (TE). To date, however, no diagnostic criteria have been advanced or accepted for the clinical diagnosis of TE. Provisional research diagnostic criteria are required not only for meaningful diagnosis but also to facilitate research to …determine the epidemiology, etiology, course, prognosis, imaging and biomarkers, neuropathological features and potentially effective treatments of TE. Methods: All 436 published cases of TE in all languages were reviewed. All symptoms and signs reported in these cases were classified and enumerated. Results: Ninety-seven cases met inclusion criteria based on sufficient documentation of the history and neurobehavioral examination. Provisional research diagnostic criteria for clinically probable and clinically possible TE were developed based on the most frequently reported clinical features. Conclusion: The provisional diagnostic criteria for TE presented here are the first published criteria for this condition based upon a systematic analysis of its clinical characteristics. This is the first a step toward scientifically derived consensus criteria, which are essential to accelerate progress in the investigation of this important condition. Show more

Keywords: Concussion, chronic traumatic encephalopathy, traumatic brain injury, boxing, football

DOI: 10.3233/NRE-130839

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 211-224, 2013

Authors: Hirshson, Chari I. | Gordon, Wayne A. | Singh, Ayushi | Ambrose, Anne | Spielman, Lisa | Dams-O'Connor, Kristen | Cantor, Joshua | Dijkers, Marcel

Article Type: Research Article

Abstract: Introduction: Although there has been a decline in the incidence of TBI in the general population, the rate of TBI in older adults has increased. Increased age has been long recognized as a predictor of worse outcomes after TBI. Despite the growing number of TBI in the elderly, our understanding of the long-term consequences of TBI is quite limited. Methods: Chart review; individuals 55 years and older, who completed inpatient acute rehabilitation during the period 2003âĂŞ2009 and who died one to four years after injury, were compared to matched patients who did not die. Results: There …were a significantly higher proportion of deceased subjects with a diagnosis of Abnormality of Gait (53%), respiratory medications at admission (32%) and discharge (17%). Deceased participants were more likely to be prescribed diabetes medication at discharge (35%) while controls were more likely to be prescribed cholesterol-lowering medications (27%) at admission. Deceased patients were discharged with significantly more medications, Conclusions: The results suggest the need for medical and lifestyle interventions for selected elderly TBI patients. The factors related to death following TBI in the elderly are in need of more research. Show more

Keywords: Traumatic brain injury, aging, mortality, long-term outcomes

DOI: 10.3233/NRE-130840

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 225-232, 2013

Authors: Dijkers, Marcel | Brandstater, Murray | Horn, Susan | Ryser, David | Barrett, Ryan

Article Type: Research Article

Abstract: Background: Elderly persons with traumatic brain injury (TBI) are increasingly admitted to inpatient rehabilitation, but we have limited knowledge of their characteristics, the treatments they receive, and their short-term and medium-term outcomes. This study explored these issues by means of comparisons between age groups. Methods: Data on 1419 patients admitted to 9 inpatient rehabilitation facilities for initial rehabilitation after TBI were collected by means of (1) abstraction from medical records; (2) point-of care forms completed by therapists after each treatment session; and (3) interviews at 3 months and 9 months after discharge, conducted with the patient or a …proxy. Results: Elderly persons (65 or older) had a lower brain injury severity, and a shorter length of stay (LOS) in acute care. During rehabilitation, they received fewer hours of therapy, due to a shorter LOS and fewer hours of treatment per day, especially from psychology and therapeutic recreation. They regained less functional ability during and after inpatient rehabilitation, and had a very high mortality rate. Conclusions: Elderly people can be rehabilitated successfully, and discharged back to the community. The treatment therapists deliver, and issues surrounding high mortality need further research. Show more

Keywords: Traumatic brain injuries, severity, rehabilitation, aging, hospitalization, mortality, activities of daily living, therapies

DOI: 10.3233/NRE-130841

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 233-252, 2013

Authors: Gavett, Brandon E. | Crane, Paul K. | Dams-O'Connor, Kristen

Article Type: Research Article

Abstract: Background: Telephone cognitive batteries are useful for large-scale screening and epidemiological studies, but their brevity and lack of content depth may cause psychometric limitations that hinder their utility. Objective: The current study addressed some of these limitations by rescaling the Brief Test of Adult Cognition by Telephone (BTACT; Tun & Lachman, 2006) using modern psychometric methods. Methods: Archival data were obtained from a national sample of 4,212 28 to 84-year-old volunteers in the National Survey of Midlife Development in the United States (Ryff et al., 2007) Cognitive Project (Ryff & Lachman, 2007). We fit a bi-factor …model to a combination of item-level, subscale-level, and scale-level data. Results: The best fitting model contained a general factor and secondary factors capturing test-specific method effects or residual correlations for Number Series, Red/Green Test, and the Rey Auditory Verbal Learning Test. Factor scores generated from this model were compared with conventional BTACT scores. Important score differences (i.e., >0.3 standard deviation units) were found in 28% of the sample. The bi-factor scores demonstrated slightly superior validity than conventional BTACT scores when judged against a number of clinical and demographic criterion variables. Conclusions: Modern psychometric approaches to scoring the BTACT have the benefit of linear scaling and a modest criterion validity advantage. Show more

Keywords: Telephone, cognitive assessment, modern psychometrics, bi-factor model, neuropsychology

DOI: 10.3233/NRE-130842

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 253-265, 2013

Authors: Yi, Angela | Dams-O'Connor, Kristen

Article Type: Review Article

Abstract: Objective: The purpose of this paper is to review the literature on psychosocial outcomes in older adults with TBI and identify factors associated with positive outcomes in this population. Introduction: Rates of TBI in older adults have increased in recent years. Little is known regarding the factors and cohort specific characteristics that contribute to long-term healthy psychosocial functioning in this population. Methods Review of literature. Results: A multitude of factors that impact psychosocial outcomes are discussed, including injury characteristics, individual characteristics, aging and cohort issues, and external environmental factors. Conclusions: There is …limited research examining psychosocial functioning in older adults who have sustained a TBI. Recommendations to guide clinical care and future research are provided. Show more

Keywords: Traumatic brain injury, older adults, psychosocial functioning

DOI: 10.3233/NRE-130843

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 267-273, 2013

Authors: Maroof, David Aaron

Article Type: Research Article

Abstract: The ethical responsibilities within clinical practice are ubiquitous. Yet, several aspects comprising the clinical neuropsychologist's role, although carrying equal ethical ‘weight,’ may be relegated to a lesser value and are considered irregularly. This paper is of the position that statistical assumptions are arbitrarily and unpredictably reported in research. However, violating statistical assumptions can often yield untenable results, rendering the inferences based on the primary analysis equally precarious. Just as clinicians are enjoined by their respective professional organizations to abide scrupulously by ethical principles in clinical practice, neuropsychologists should be equally careful over such important matters in research. Consistent examination (and …rectification when needed) and reporting of the status of statistical assumptions will help to not only broaden and maintain the ambitions of sound ethical practice but, ultimately ensure optimal patient care. Show more

Keywords: Ethics, neuropsychological examinations

DOI: 10.3233/NRE-130844

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 275-278, 2013

Authors: Lee, Jae Jin | Lee, Dong Ryul | Shin, Yoon Kyum | Lee, Nam Gi | Han, Bong S. | You, Sung (Joshua) Hyun

Article Type: Research Article

Abstract: Purpose: The purpose of this study was to compare topographical maps using a novel EEG-based brain mapping system with fMRI in normal and children with cerebral palsy (CP) during a grasping motor task. Method: A normal child (mean ± SD = 13 ± 0 yrs) and four children with CP (mean ± SD = 10.25 ± 2.86 yrs) were recruited from a local community school and medical center. A novel EEG-based brain mapping system with 30 scalp sites (an extension of the 10–20 system) and a 3T MR scanner were used to observe cortical activation patterns during a …grasping motor task. Design: Descriptive analysis. Results: In the EEG brain mapping data, the sensorimotor cortex (SMC) and inferior parietal cortex (IPC) were activated in all of the children. The children with CP showed additional activation areas in the premotor cortex (PMC), superior parietal cortex (SPC), and prefrontal cortex (PFC). In the fMRI brain mapping data, SMC activation was observed in all of the children, and the children with CP showed additional activation areas in the PMC and primary somatosensory cortex (PSC). Discussion: The EEG-based topographical maps were equivalent to the maps obtained from fMRI during the grasping motor task. The results indicate that our novel EEG-based brain mapping system is useful for probing cortical activation patterns in normal children and children with CP. Show more

Keywords: EEG, fMRI, cortical activation, topographical map

DOI: 10.3233/NRE-130845

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 279-285, 2013

Authors: Lee, Jung Ah | You, Joshua H. | Kim, Dong A. | Lee, Min Jin | Hwang, Pil Woo | Lee, Nam Gi | Park, Jeong Joon | Lee, Dong Ryul | Kim, Hyun-Kyung

Article Type: Research Article

Abstract: We investigated the long-term effects of comprehensive hand repetitive intensive strengthening training (CHRIST) on strength, morphological muscle size, kinematics, and associated motor functional changes in children with cerebral palsy (CP). Ten children (5 boys, 5 girls; age range, 6–11 years, mean age, 8.6 years) participated in the study. The children were classified according to the Manual Ability Classification System: 5 were Level II, 2 were Level III, and 3 were Level IV. Quantitative biomechanical measurements were performed to determine muscle strength, muscle size, kinematics (normalized jerk score), and motor function using a dynamometer, ultrasound, Vicon motion analysis, and standardized clinical …tests (Quality of Upper Extremity Skills Test, Jebsen-Taylor Hand Function Test, Functional Independence Measure, and Pediatric Motor Activity Log), respectively. Muscle strength, muscle size, kinematics, and motor function significantly improved after a 10-week intervention (3 times a week), and the long-term effects remained even at the 3-month follow-up. In conclusion, this is the first study highlighting the long-term efficacy of upper extremity strength training using the novel CHRIST system in children with CP, which will potentially open up new horizons for effective management in pediatric neurorehabilitation. Show more

Keywords: Cerebral palsy, CHRIST, muscle strength, upper extremity

DOI: 10.3233/NRE-130846

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 287-295, 2013