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

Authors: Nejati, Vahid | Pouretemad, Hamid Reza | Bahrami, Hajar

Article Type: Research Article

Abstract: Background: Attention and executive function play an important role in fluent speaking. The aim of the present study is to evaluate effect of attention training in rehabilitation of stuttering. Method: In this random clinical trial 30 children with developmental stuttering participate in a random allocation sampling in case or control group. In case group, we trained patient with NEurocognitive Joyful Attentive Training Intervention (NEJATI) in 12 sessions. Riley Stuttering severity instrument-3 (SSI-3), Wisconsin Card Sorting Test (WCST), and Stroop Color Word Test (SCWT) are used for evaluation of executive function before and after intervention. Dependent T -Test was …used for analysis. Results: Comparing case group before and after intervention showed a significant enhancement in executive function and reduced stuttering severity. Conclusion: Attention training propose as a non lingual method of language and speech rehabilitation in developmental stuttering. Show more

Keywords: NEurocognitive Joyful Attentive Training Intervention (NEJATI), cognitive rehabilitation, developmental stuttering

DOI: 10.3233/NRE-130847

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 297-303, 2013

Authors: Yeo, Sang Seok | Jang, Sung Ho

Article Type: Research Article

Abstract: The main function of the corticospinal tract (CST) is control of the distal musculature used for fine movements, in contrast, the corticoreticular pathway (CRP) innervates the proximal and axial musculature. We report on a patient with an intracerebral hemorrhage (ICH) who showed recovery of an injured CST and an injured CRP by diffusion tensor tractography (DTT). The patient, a 38-year-old man, presented with severe paralysis of the right upper and lower extremities due to a spontaneous ICH in the left corona radiata and basal ganglia. When he started rehabilitation at 3 weeks after onset, he showed more severe weakness in …the proximal joints (shoulder and hip joints) than distal joints (hand and ankle joints). This proximal weakness improved rapidly in parallel with distal weakness over 3 weeks of rehabilitation. DTT performed at 3 and 6 weeks post-ICH revealed that a thin left CST observed at 3 weeks thickened at 6 weeks, and that a discontinuation of the left CRP at the midbrain level at 3 weeks was restored at 6 weeks. In addition, the track volumes of the left CST and CRP increased from 221 and 244 at 3 weeks to 725 and 625 at 6 weeks. In conclusion, we demonstrated the recovery of an injured CST and an injured CRP in a patient with ICH. Show more

Keywords: Diffusion tensor imaging, corticoreticulospinal tract, corticoreticular pathway, corticospinal tract, stroke

DOI: 10.3233/NRE-130848

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 305-309, 2013

Authors: Jang, Sung Ho

Article Type: Review Article

Abstract: Brain plasticity can be classified as adaptive and maladaptive. Maladaptive plasticity indicates hindered functional recovery or the development of an unwanted symptom. Although a considerable amount is known about adaptive plasticity in stroke, relatively little is known of maladaptive plasticity. In the current study, previous studies on motor function-related maladaptive plasticity in stroke are reviewed in terms of compensatory movement pattern (CMP), delayed-onset involuntary abnormal movements (IAMs), and the ipsilateral motor pathway as a motor recovery mechanism. For successful stroke rehabilitation, it is important that the characteristics of maladaptive plasticity are accurately recognized. However, there is a lack of definitive …evidence regarding the recognition of motor function-related maladaptive plasticity, although it seems that each of the three above-mentioned topics are involved. As for CMP, patients with a good neurological state as much as having a normal movement pattern, should be considered to have maladaptive plasticity, and in terms of the ipsilateral motor pathway, patients with bilateral innervations can be considered to have maladaptive plasticity. On the other hand, IAMs due to delayed neuronal degeneration should be ruled out in patients with delayed-onset IAMs. Therefore, for the accurate recognition of motor function-related maladaptive plasticity in stroke, a thorough evaluation of neurological state using brain mapping techniques is necessary, and subsequently, the prevention or intensive management of maladaptive plasticity is needed. Show more

Keywords: Plasticity, maladaption, adaption, stroke, compensation, motor recovery

DOI: 10.3233/NRE-130849

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 311-316, 2013

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

Article Type: Research Article

Abstract: This study investigated how stroke patients improve the walking patterns by using the Elastic Walking Band, which was included with a long elastic band and four pierced plastics as fixed points. Fifteen patients with stroke were recruited. Participants were nine males and six females. Gait parameters were measured with the GAITRite system to analyze the spatial and temporal parameters of walking by stroke patients. The Elastic Walking Band had no significance in cadence, swing time and stance on both limbs. However, the Elastic Walking Band significantly improved velocity in stroke patients. Furthermore, there was a significant difference in step length …of the less-affected limb between the two conditions, but no significant difference in the affected side. When the patients walked with the Elastic Walking Band, affected and less-affected stride length were also significantly increased as compared with barefoot walking. There were significant differences of velocity, less-affected step length, both stride length between walking with and without the Elastic Walking Band. Consequently, the Elastic Walking Band can be used as an assistive walking device that is lighter and less expensive for stroke patient gait training in the clinic. Show more

Keywords: AFO, orthosis, assistive device, Thera-band, gait training

DOI: 10.3233/NRE-130850

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 317-322, 2013

Authors: Jijimol, G. | Fayaz, R.K. | Vijesh, P.V.

Article Type: Research Article

Abstract: Objective: To evaluate the correlation between the trunk impairment and balance in patients with chronic stroke. Methods: Thirty subjects with chronic stroke participated in the study. The subjects were evaluated with the trunk impairment scale (TIS) and Tinetti balance scale (TBS). Result: Spearman’s correlation showed highly significant correlation between TIS and TBS scores (rho = 0.911). Conclusion: The study reveals that the trunk impairment and balance in subjects with stroke are positively correlated with each other.

Keywords: Trunk impairment, balance, chronic stroke

DOI: 10.3233/NRE-130851

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 323-325, 2013

Authors: Jin, Hong | Jiang, Yibo | Wei, Qin | Chen, Long | Ma, Genshan

Article Type: Research Article

Abstract: Objective: Using heart rate recovery (HRR) after exercise as an index of autonomic function, we evaluate the effects of aerobic cycling training on HRR and cardiovascular fitness (peak VO2 ) in chronic stroke patients and investigate the relationship between changes in HRR and those in peak VO2 . Methods: 128 participants with chronic stroke were randomized to a 12-week (5×/week) progressive aerobic cycling training group (n = 65) or a control group (n = 63). Peak VO2 , muscle strength, 6-minute walking distance (6MWD) and HRR were measured before and after the intervention. Results: …Cycling training leads to significant increase in peak VO2 , HRR, muscle strength and 6MWD. In the cycling group, percent changes in peak VO2 were positively associated with those in paretic and nonparetic muscle strength and HRR. Linear regression revealed that percent increases in peak VO2 were significantly correlated with percent changes in HRR when controlling for pre-peak VO2 , age, gender, duration since stroke and improved muscle strength. Conclusion: Aerobic cycling training can favorably modify HRR in stroke survivors. Rapid HRR, as an indicator of enhanced autonomic function, is useful for predicting gains in cardiovascular fitness. These findings indicate the underlying importance of autonomic modulation on cardiovascular adaptations to stroke exercise rehabilitation. Show more

Keywords: Exercise, physical fitness, heart rate recovery, autonomic dysfunction, stroke

DOI: 10.3233/NRE-130852

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 327-335, 2013

Authors: Cavalcanti, Paula Regina Aguiar | Campos, Tania Fernandes | Araüjo, John Fontenele

Article Type: Research Article

Abstract: The present study aimed to assess changes in the circadian and homeostatic control of the sleep-wake pattern in stroke patients and correlations with quality of life. Participants were 22 patients (55 ± 12 years) and 24 healthy subjects (57 ± 11 years). Instruments used were: the Pittsburgh Sleep Quality Index, SF-36 Questionnaire and Actigraphy. Data were analyzed by Mann-Whitney test and Spearman's correlation. Results identified a significant difference in sleep quality and quality of life between patients and healthy subjects, with patients on average exhibiting poor sleep quality (patients: 8.4 ± 3.4; healthy subjects: 6.2 ± 2.5; p = …0.0001) and low quality of life scores (p < 0.001). Correlation analysis detected an association between circadian variables (total activity, start and finish times of activity) and quality of life (p < 0.001). Associations between homeostatic variables (sleep duration, latency and efficiency) and quality of life were also significant (p < 0.001). In conclusion, results in this study showed compromised sleep quality and quality of life in the patients evaluated, associated with circadian and homeostatic alterations. This suggests that complaints regarding poor sleep quality be taken into consideration when planning the rehabilitation of stroke patients. Show more

Keywords: Quality of life, sleep-wake, circadian rhythm, stroke

DOI: 10.3233/NRE-130853

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 337-343, 2013

Authors: Kong, Keng-He | Lee, Jeanette

Article Type: Research Article

Abstract: Objective: To document temporal recovery of upper extremity dexterity and establish predictors of limb dexterity in a cohort of stroke patients in the first year after stroke. Design: Prospective cohort study. Subjects: One hundred patients with a first-ever ischemic stroke admitted to a rehabilitation centre. Methods: Assessment of upper extremity dexterity, motor power and selfcare function using the Motor Assessment Scale (MAS), Upper Extremity Motor Index (UEMI) and Modified Barthel Index (MBI) respectively. Results: Eighteen percent, 25.5% and 31.6% of patients recovered limb dexterity at 3, 6 and 12 months after stroke …respectively. Patients who recovered dexterity late (⩾6 months after stroke) were significantly younger with lower rehabilitation admission UEMI scores than those who recovered dexterity early. The UEMI score was the most significant correlate of limb dexterity at all follow up periods. Recovery of limb dexterity at 12 months was predicted by UEMI (OR1.54, 95% CI 1.13–2.10) and MBI (OR 1.03, 95% CI 1.00–1.07) scores on admission to rehabilitation. Conclusions: In this study, 31.6% of patients recovered upper extremity dexterity at 12 months after stroke. Although late recovery of dexterity occurs only in a small proportion of patients, this finding is still pertinent given the significant impact of dexterity on upper limb and selfcare function. Show more

Keywords: Stroke, upper extremity, prognosis

DOI: 10.3233/NRE-130854

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 345-350, 2013

Authors: Jones, Ciara | O'Keeffe, Kiadhnait | Kingston, Craig | Carroll, Aine

Article Type: Research Article

Abstract: Introduction: A high incidence of depression following a stroke has been reported. Many studies exclude those with communication impairments. However, there is an increased risk of psychosocial issues for individuals with communication difficulties. Psychosocial issues have a significant impact on the individual and their families. There is very limited research in this area. Methods: A retrospective case review of the assessment and intervention with three individuals with significant communication difficulties following stroke was completed. Key interdisciplinary intervention factors were identified. Results: Psychosocial issues were identified in all three cases. The assessment of cognitive difficulties, interdisciplinary intervention …targeting communication between family members, facilitation of emotional expression and liaison with appropriate community services were identified as key interventions. These interventions targeted at psychosocial issues resulted in a positive outcome for the individuals and their family. Discussion and Conclusion: Psychosocial issues are prevalent in individuals and their families with significant communication impairments following stroke. Clinically, these issues may be overlooked. The complexity of working with individuals with cognitive and communication impairments also contributes to poor identification of psychosocial issues. This case series clearly highlights that intervening at the psychosocial level through interdisciplinary working can facilitate meaningful outcomes for the individual and their family. Show more

Keywords: Communication disorders, stroke, psychosocial issues, interdisciplinary assessment and interventions, carer stress

DOI: 10.3233/NRE-130855

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 351-358, 2013

Authors: Cha, Yu-Jin | Kim, Hee

Article Type: Research Article

Abstract: This article has been retracted. You can find the retraction notice here: (http://content.iospress.com/articles/neurorehabilitation/nre1288 ).

DOI: 10.3233/NRE-130856

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 359-368, 2013

Authors: Jo, Hae Min | Song, Jun-chan | Jang, Sung Ho

Article Type: Research Article

Abstract: We investigated the effect of a static stretching device on spasticity and motor function for people with chronic hemiparesis following stroke. Ten participants with chronic hemiparesis following stroke who had severe spasticity and incomplete weakness of the affected wrist and hand were recruited. The stretching device consisted of a resting hand splint, a finger and thumb stretching system, and a frame. The stretched state was maintained for 10 minutes/session, and the static stretching program was performed for 2 sessions/day and 7 days/week for 4 weeks. Spasticity and motor function of the affected wrist and hand were assessed three times with …intervals of 4 weeks (twice [Pre-1, Pre-2] before and once [Post-1] after starting the static stretching program). The effect of the static stretching device was assessed using modified Ashworth scale (MAS) scores, by measuring active range of motion (AROM), and using the wrist and hand subsection of the Fugl-Meyer motor assessment (FMA). The main effects of the static stretching program on MAS scores for wrist and metacarpophalangeal (MCP) joints and FMA scores were significant. AROMs of MCPs and wrist showed an increase, however, no significant main effects of the static stretching program were observed. MAS in flexor muscles of MCP joints showed a significant decreased from Pre-2 (mean ± standard deviation (SD): 2.56 ± 0.55; median and interquartile range (IQR): 2.42, 2.12–3.08) to Post-1 (mean ± SD: 1.05 ± 0.49; median and IQR: 1.08, 0.87–1.50) (P < 0.001), and MAS in wrist flexor muscles also showed a significant decrease from Pre-2 (mean ± SD: 3.20 ± 0.78; median and IQR: 3.0, 2.75–4.0) to Post-1 (mean ± SD: 1.90 ± 0.73; median and IQR: 2.0, 1.0–2.5) (P < 0.001). FMA score also showed a significant increase from Pre-2 (11.3 ± 6.09) to Post-1 (14.5 ± 6.20) (P < 0.001). It was found that the static stretching device effectively relieved spasticity and improved motor function in subjects with severe spasticity and incomplete weakness following stroke. Show more

Keywords: Motor function, spasticity, stretch, hemiparesis, stroke

DOI: 10.3233/NRE-130857

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 369-375, 2013

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

Article Type: Research Article

Abstract: We investigated the effectiveness of an AFO-shaped band as an assistive walking device in patients with neurological lesions. The participants included 11 patients with a recent history of a CVA and one multiple sclerosis patient. In each patient, the order of conditions (AFO, AFO-shaped band, barefoot) was randomized. Participants were required to walk on the GAITRite mat twice during each condition. The average gait velocity among patients using the AFO-shaped elastic band was significantly higher than those under barefoot conditions (p = 0.015). Participants using the AFO-shaped elastic band also showed a significantly higher average number of steps per …minute (cadence) as compared with the barefoot and AFO conditions (p = 0.007). Significant differences in stride length on the unaffected side were found between the AFO-shaped band and barefoot conditions (p = 0.029). Our results indicated that the AFO-shaped elastic band could be useful for patients with central neurological lesions with respect to gait, especially walking velocity, cadence, and stride length on the affected side. Thus, the AFO-shaped elastic band could be a practical tool for clinicians to train patients with central neurological lesions to walk. Show more

Keywords: Ankle foot orthosis, gait, multiple sclerosis, orthotic devices, rehabilitation, stroke

DOI: 10.3233/NRE-130858

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 377-383, 2013

Authors: Lee, Na Kyung | Kwon, Jung Won | Son, Sung Min | Nam, Seok Hyun | Choi, Yong Won | Kim, Chung Sun

Article Type: Research Article

Abstract: Objective: The aim of this study is to investigate whether progressive resistive training with closed-kinetic chain (CKC) and open-kinetic chain (OKC) exercises could change plantar pressure distribution during walking in patients with stroke. Methods: Thirty-nine stroke patients were recruited and randomly divided into a CKC exercise group (n = 13), an OKC exercise group (n = 13), and a control group (n = 13). Both CKC and OKC exercise groups performed their own respective training programs 5 times per week for 6 weeks, whereas no training was done in the control group. Barefoot plantar pressure …distribution was measured during walking in terms of contact area (CA), peak contact force (PCF), and contact impulse (CI) on each of three foot regions (i.e. forefoot (FF), midfoot (MF), and hindfoot (HF)). Results: In the CKC exercise group, there were significant changes in only the CA and PCF of HF. In the OKC exercise and control groups, no significant differences were found for all variables of plantar pressure distributions. Conclusion: We found that resistive training with closed kinetic chain exercises could be an effective treatment method for improving normal gait patterns in stroke patients. These findings may be attributed to the fact that CKC exercise induced use of the ankle and knee muscles and provided repetitive sensory input from the affected foot. Show more

Keywords: Closed-kinetic chain exercise, open-kinetic chain exercises, plantar pressure distribution, gait pattern

DOI: 10.3233/NRE-130859

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 385-390, 2013

Authors: Zhang, Jianli | Yin, Changhao | Zhang, Yu | Zhao, Libo | Fu, HongJuan | Feng, Jiachun

Article Type: Research Article

Abstract: Aim: To explore the role of rs11053646 polymorphism of oxidized low-density lipoprotein receptor 1 (OLR-1) gene in the susceptibility and prognosis of ischemic stoke (IS). Methods: A total of 304 IS patients and 377 age and sex-matched healthy controls were recruited. Patients were followed up for 6 months for recovery evaluation of stroke. Genotyping analyses of the rs11053646 G > C polymorphisms of OLR1 gene were performed. Results: The genotype frequencies and alleles frequencies at rs11053646 were significantly differed between stroke subjects and control subjects (both P < 0.001). The presence of CC genotype was …significantly higher in IS subjects than in controls (38% vs. 25%, P = 0.001). Similarly, the C allele carriage in IS was significantly higher than controls (59% vs. 49%, P < 0.001). Regression analysis showed the CC homozygote had a significantly increased risk for stroke (adjusted OR = 2.080; P = 0.001). The genotype of rs11053646 were not associated with the IS subtype and severity at admission, but determine the clinical outcome at 6 months after discharge from hospital. Conclusion: The rs11053646 polymorphism of OLR1 gene be used as a molecular marker for the susceptibility and prognosis of IS in Chinese population. Show more

Keywords: Ischemic stroke, susceptibility, prognosis, oxidized LDL receptor gene 1

DOI: 10.3233/NRE-130860

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 391-396, 2013

Authors: Mendez, Mario F. | Owens, Emily M. | Reza Berenji, Gholam | Peppers, Dominique C. | Liang, Li-Jung | Licht, Eliot A.

Article Type: Research Article

Abstract: Introduction: Primary blast forces may cause dysfunction from mild traumatic brain injury (mTBI). Objective: To investigate the effects of primary blast forces, independent of associated blunt trauma and post-traumatic stress disorder, on sensitive post-concussive measures. Methods: This study investigated post-concussive symptoms, functional health and well-being, cognition, and positron emission tomography (PET) neuroimaging among 12 Iraq or Afghanistan war veterans who sustained pure blast-force mTBI, compared to 12 who sustained pure blunt-force mTBI. Results: Both groups had significantly lower scores than published norms on the Rivermead Post-Concussion Questionnaire (RPQ) and the SF36-V Health Survey. Compared …to the Blunt Group, the Blast Group had poorer scores on the Paced Auditory Serial Addition Test (PASAT) and greater PET hypometabolism in the right superior parietal region. Only the Blast Group had significant correlations of their RPQ, SF36-V Mental Composite Score, and PASAT scores with specific regional metabolic changes. Conclusion: This pilot study suggests that pure blast force mTBI may have greater post-concussive sequelae including deficits in attentional control and regional brain metabolism, compared to blunt mTBI. A disturbance of a right parietal-frontal attentional network is one potential explanation for these findings. Show more

Keywords: Mild traumatic brain injury, blast forces, post-concussion, positron emission tomography imaging

DOI: 10.3233/NRE-130861

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 397-407, 2013

Authors: McIntyre, Amanda | Mehta, Swati | Janzen, Shannon | Aubut, JoAnne | Teasell, Robert W.

Article Type: Review Article

Abstract: Objective: The objective of this study was to determine rates of functional outcomes, based on Glasgow Outcome Scale scores, among older adults (>60 years) after a traumatic brain injury. Methods: An extensive database search was conducted. To be included all articles were published in English, included individuals 60 years or older, explicitly stated in-hospital GCS scores and GOS scores within one year post-TBI. Data was pooled on patient characteristics, mortality rates, time to death, and study design. Results: A total of 11 studies were included in this review. Among individuals with severe TBI, favourable, unfavourable, and …fatal outcomes were observed in 7.9% (CI 5.3%–11.8%), 13.8% (CI 10.0%–18.8%) and 79.3% (CI 73.2%–84.4%), respectively. Among those with moderate TBI, favourable, unfavourable, and fatal outcomes were observed in 32.2% (CI 18.0%–50.7%), 29.5% (CI 16.5%–47.0%), and 42.5% (CI 26.1%–60.7%), respectively. Among those with mild TBI, favourable, unfavourable, and fatal outcomes were observed in 80.5% (CI 53.2%–93.7%), 7.0% (CI 1.9%–22.7%), and 10.7% (CI 3.1%–30.9%), respectively. Conclusion: This study has demonstrated the significant interaction between GCS and GOS among older adults. Although older adults may require aggressive and comprehensive treatment to achieve these favourable outcomes, high rates of unfavourable outcome should not justify the use of conservative treatment. Show more

Keywords: Aging, traumatic brain injury, Glasgow coma scale, Glasgow outcome scale

DOI: 10.3233/NRE-130862

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 409-414, 2013

Authors: Kiselka, Anita | Greisberger, Andrea | Heller, Mario

Article Type: Research Article

Abstract: Background: Resistance exercise is effective in improving muscle strength and preventing muscle weakness in multiple sclerosis (MS) patients. Control of resistance training intensity based on perceived muscular effort is applicable to healthy individuals, yet there is no evidence of its utility for MS patients. Objective: To compare perception of muscular effort in MS patients to healthy controls. Methods: Based on their perception of muscular effort, twenty-five MS patients and twenty-eight controls adjusted static elbow extension tasks according to five levels on the OMNI-Resistance Exercise Scale. Elbow extension strength and muscle activity were measured via load cell …dynamometer and surface electromyography (EMG) and related to each participant’s maximal voluntary contraction (MVC) strength and muscle activity. Two-way analysis of variance was used to evaluate statistical significance. Results: There were no statistically significant differences between MS patients and healthy controls, they produced similar relative torque values (F1 = 0.196; p > 0.05) and extensor muscle activities (F2,617 = 1.556; p > 0.05) across all effort levels. Conclusion: No differences were found in the perception of muscular effort in MS patients and the age-matched control group. Future studies should explore, whether rating of perceived exertion is an effective instrument to control resistance training intensity in MS patients. Show more

Keywords: Multiple sclerosis, perception, effort, exertion, rating scale, muscle strength, surface electromyography, upper extremity

DOI: 10.3233/NRE-130863

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 415-423, 2013

Authors: Oh, Duck-Won | Park, Hyun-Ju

Article Type: Research Article

Abstract: Purpose: This study aimed to describe a community-based ambulation training for ambulatory patients with incomplete spinal cord injury (SCI) and then to report the results of the training. Method: Four patients with incomplete SCI participated in this study. The indoor and outdoor walking function was assessed at four intervals: pre-training, post-training, and at 4-week and 1-year follow-ups after successful completion of the community-based ambulation training. Training consisted of the four-staged ambulation protocol with weekly-increased environmental demands, which consisted of 1-hour sessions six times a week for a 4-week period (i.e., a total of 24 sessions). Results: …The walking function of all patients was remarkably improved after the training, and these effects were favorably maintained at the 4-week and 1-year follow-ups. Conclusion: These findings suggest that the use of community-based ambulation training is a beneficial therapeutic option to improve the walking function of ambulatory patients with incomplete SCI and to offer better opportunities for reintegration into community life. Show more

Keywords: Spinal cord injury, community-based ambulation training, walking

DOI: 10.3233/NRE-130864

Citation: NeuroRehabilitation, vol. 32, no. 2, pp. 425-432, 2013