NeuroRehabilitation - Volume 32, issue 3

Authors: Greenwald, Brian D. | Gurley, James M.

Article Type: Editorial

DOI: 10.3233/NRE-130865

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 433-435, 2013

Authors: Khan, Sarah | Chang, Richard

Article Type: Review Article

Abstract: Introduction: A sense of proper sensory processing of head motion and the coordination of visual and postural movements to maintain equilibrium is critical to everyday function. The vestibular system is an intricate organization that involves multiple levels of sensory processing to achieve this goal. Purpose: This chapter provides an overview of the anatomical structures and pathways of the vestibular system. Summary: The five major vestibular structures are located in the inner ear and include: the utricle, the saccule, and the lateral, superior, and posterior semicircular canals. Hair cells on the neuroepithelium of the peripheral vestibular organs …carry sensory impulses to primary processing centers in the brainstem and the cerebellum. These areas send input via ascending and descending projections to coordinate vital reflexes, such as the vestibuloocular reflex and the vestibulospinal reflex, which allow for the proper orientation of the eyes and body in response to head motion. Specific connections regarding higher level cortical vestibular structures are poorly understood. Conclusion: Vestibular centers in the brainstem, cerebellum, and cerebral cortex function to integrate sensory information from the peripheral vestibular organs, visual system, and proprioceptive system to allow for proper balance and orientation of the body in its environment. Show more

Keywords: Vestibular apparatus, kinocilium, stereocilia, utricle, saccule, semicircular ducts, macula, cupula, striola, vestibular, nuclear complex, vestibuloocular reflex, vestibular spinal reflex

DOI: 10.3233/NRE-130866

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 437-443, 2013

Authors: Chandrasekhar, Sujana S.

Article Type: Research Article

Abstract: Objectives: All degrees of traumatic brain injury (TBI) are associated with balance dysfunction and/or dizziness. The clinician assessing and managing patients with TBI should become familiar with vestibular and non-vestibular causes of dizziness and imbalance, and be able to perform screening tests to determine when referral to a vestibular specialist is warranted. This chapter outlines the clinical pathways to be followed in history-taking, physical examination, and assessment. Introduction: Dizziness, vertigo, balance dysfunction and gait ataxia can have their origin in the vestibular system, elsewhere, or be multifactorial. The complex anatomy and physiology of the balance canals, otolithic organs, …and vestibular nerves peripherally, and the vestibular nuclei centrally, as well as the neural connections between vestibular, oculomotor, and proprioceptive systems will be covered in clinically pertinent detail. Methods: A majority of diagnosis of dizziness/vertigo can be made after a proper history has been obtained. This can be challenging in all dizzy patients, and more so in the TBI patient in whom memory and recall may be impaired. The reader will learn how to use tools such as dizziness questionnaires as well as targeted history taking to elicit the information. Similarly, the addition of a programmatic, targeted physical examination of the dizzy patient will allow the clinician to fine-tune the diagnosis between peripheral and central causes. Results: Once history and examination have narrowed the diagnostic possibilities, appropriate testing – in the vestibular laboratory and radiologic testing – is indicated. The reader will learn when these tests should be considered, and what the findings will show. Treatment can then be targeted for maximal outcome. Conclusion: Managing TBI is challenging; the addition of dizziness or balance complaints in these individuals makes it even more so. This paper seeks to provide a useful roadmap clinical pathway for assessment of these patients with appropriate and timely referral for treatment. Show more

Keywords: Dizziness, balance disorders, vertigo, gait ataxia, TBI, vestibular dysfunction

DOI: 10.3233/NRE-130867

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 445-454, 2013

Authors: Smouha, Eric

Article Type: Research Article

Abstract: Objectives: To present a framework for the diagnosis and treatment of inner ear disorders, with an emphasis on problems common to neuro-rehabilitation. Introduction: Disorders of the inner ear can cause hearing loss, tinnitus, vertigo and imbalance. Hearing loss can be conductive, sensorineural, or mixed; conductive hearing loss arises from the ear canal or middle ear, while sensorineural hearing loss arises from the inner ear or auditory nerve. Vertigo is a hallucination of motion, and is the cardinal symptom of vestibular system disease. It should be differentiated from other causes of dizziness: gait imbalance, disequilibrium, lightheadedness (pre-syncope). Vertigo can …be caused by problems in the inner ear or central nervous system. Methods: The diagnosis of inner ear disorders begins with a targeted physical examination. The initial work-up of hearing loss is made by audiometry, and vertigo by electronystagmography (ENG). Supplemental tests and MRI are obtained when clinically indicated. Results: The clinical pattern and duration of vertigo are the most important clinical features in the diagnosis. Common inner ear causes of vertigo include: vestibular neuritis (sudden, unilateral vestibular loss), Meniere’s disease (episodic vertigo), benign paroxysmal positional vertigo (BPPV), and bilateral vestibular loss. Common central nervous system causes of vertigo include: post concussion syndrome, cervical vertigo, vestibular migraine, cerebrovascular disease, and acoustic neuroma. Conclusion: A basic knowledge of vestibular physiology, coupled with a understanding of common vestibular syndromes, will lead to correct diagnosis and treatment in most cases. Show more

Keywords: Acoustic neuroma, benign paroxysmal positional vertigo, dizziness, imbalance, inner ear, labyrinthitis, Meniere's disease, migraine, nystagmus, superior canal dehiscence syndrome, vertigo, vestibular neuritis, vestibulo-ocular reflex

DOI: 10.3233/NRE-130868

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 455-462, 2013

Authors: Lei-Rivera, Laura | Sutera, John | Galatioto, Jessica A. | Hujsak, Bryan D. | Gurley, James M.

Article Type: Research Article

Abstract: Introduction: Although a majority of patients following minor traumatic brain injury recover to their pre-morbid functional level, persistent activity and participation limitations can occur in the refractory patient. These long-term consequences of brain injury may only become apparent months to years after the injury. In order to quantify these long-term sequella, laboratory, clinical and functional outcome measures may not only identify needed areas of treatment, but may also assist in determining the impact of the treatment on the individuals function. Purpose: The aim of this manuscript is to review the clinical utility of vestibular laboratory testing and the …bedside vestibular examination in patients following mild traumatic brain injury. In addition, the validity and inter-observer reliability of functional outcome measures commonly used in individuals with mTBI will also be reviewed. Summary: Because of the diffuse pathology seen with mTBI, multiple tests are needed to determine the resultant impairment and their impact on the patient’s activity level and participation level. Laboratory test and bedside tests of vestibular impairment are reviewed. Functional outcome measures including the Dynamic Gait Index, the Functional Gait Assessment, the Balance Error Scoring System, and Dual Task Performance are reviewed for their appropriateness in quantifying the effect of mTBI at activity level and participation level of the individual. Conclusion: TBI rehabilitation services are increasingly exemplified by the needs of patients, rather than by the underlying pathology or diagnosis. Basing treatment decisions and treatment timing on laboratory, clinical, and functional testing can optimize the rehabilitation outcome. Show more

Keywords: Vestibular rehabilitation, traumatic brain injury, concussion, outcomes measures

DOI: 10.3233/NRE-130869

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 463-472, 2013

Authors: Gay, Robin K.

Article Type: Research Article

Abstract: Introduction: Problems with balance and dizziness are one of the most common complaints of individuals who have experienced a brain injury and are reported in up to 90% of cases. Despite the ubiquity of vestibular disturbance in this population, there remains a dearth of research on the interaction between physiological and cognitive systems responsible for maintaining balance. Purpose: The purpose of this article is to review studies on the interaction of physiological and cognitive processes required to maintain balance that may aide assessment and recovery of balance disturbance in patients with brain injury. Summary: This article …provides a review of research on the role of higher order cognitive processes in maintaining balance and rational for further inclusion of neurocognitive measures in the assessment of vestibular disturbance. Conclusion: Greater inclusion of neurocognitive measures in assessment of vestibular disturbance provides a method of assessment containing increased ecological validity compared to traditional assessments, better prepares patients for discharge, and may reduce the incidence of future injury. Show more

Keywords: Balance, dizziness, mild traumatic brain injury, concussion, sports injury, neurocognitive assessment, falls prevention, brain injury rehabilitation

DOI: 10.3233/NRE-130870

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 473-482, 2013

Authors: Cohen, Allen H.

Article Type: Research Article

Abstract: Introduction: This article discusses, in a clinically relevant format, the importance of including a neuro-optometrist as a member of the management team for patients with balance disorders. Purpose: To review the importance of vision and visual processing for maintaining a sense of balance and equilibrium and the role of the neuro-optometrist in the overall rehabilitation of patients with balance disorders Summary: Dizziness, balance problems and the sensation that the space world is moving (vertigo) are one of the most commonly reported problems in general medical practice. Persons with a central nervous system injury or other idiopathic …causes of visual processing problems or who have functional vision problems that are not adequately managed, often experience extreme difficulty with balance and movement, as well as with their perception of space. Consequently, the patient often experiences difficulty functioning in an environment with excessive visual stimulation such as a grocery store or shopping mall. Symptoms of disequilibrium, vestibular and balance problems are commonly a result of VOR disturbance secondary to an inner ear problem and an unstable binocularity. Conclusion: The combination of neuro-optomertic rehabilitative therapy and balance therapy will result in a is an effective treatment for reducing or resolving these symptoms. Show more

Keywords: Neuro-optometric rehabilitation therapy, vestibular ocular reflex, VOR, disequilibrium, visual-vestibular disorder, dorsal stream and ventral stream

DOI: 10.3233/NRE-130871

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 483-492, 2013

Authors: Shaikh, Aasef G. | Ghasia, Fatema F.

Article Type: Research Article

Abstract: Introduction: Foveation is the fundamental requirement for clear vision. Saccades rapidly shift the gaze to the interesting target while gaze holding ensures foveation of the desired object. Purpose: We will review the pertinent physiology of saccades and gaze holding and their pathophysiology leading to saccadic oscillations, slow saccades, saccadic dysmetria, and nystagmus. Summary: Motor commands for saccades are generated at multiple levels of the neuraxis. The frontal and parietal eye field send saccadic commands to the superior colliculus. Latter then projects to the brain-stem saccadic burst generator. The brain-stem burst generators guarantee optimum signal to ensure …rapid saccadic velocity, while the neural integrator, by mathematically integrating the saccadic pulse, facilitates stable gaze holding. Reciprocal innervations that ensure rapid saccadic velocity are prone to inherent instability leading to saccadic oscillations. In contrast, suboptimal function of the burst generators causes slow saccades. Impaired error correction, either at the cerebellum or the inferior olive, leads to impaired saccade adaptation and ultimately saccadic dysmetria and oculopalatal tremor. Impairment in the function of neural integrator causes nystagmus. Conclusion: Neurophysiology of saccades, gaze holding, and their deficits are well recognized. These principles can be implemented to define novel therapeutic and rehabilitation approaches. Show more

Keywords: Balance, vision, cerebellum, brainstem, nystagmus, vertigo

DOI: 10.3233/NRE-130872

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 493-505, 2013

Authors: Rine, Rose Marie | Wiener-Vacher, Sylvette

Article Type: Research Article

Abstract: Introduction: The effect of vestibular dysfunction since birth is more debilitating than that attained later in life, and unlike adults, children with vestibular dysfunction since or shortly after birth do not recover function without intervention. Purpose: The purpose of this report is to provide an overview of the etiology of vestibular dysfunction in children as well as the related impairments, and to describe testing methods and evidence based interventions to ameliorate the vestibular related impairments in children. Summary: In recent years, investigations have revealed that vestibular dysfunction is more common in children than previously thought, with …consequent impairments in motor development, balance and reading abilities. The dysfunction may be due to central or peripheral lesions, each with distinct presentation of symptoms and test results. Common etiologies and clinical presentation of vestibular dysfunction in children are reviewed; appropriate screening and diagnostic techniques and efficacious medical and rehabilitation interventions are presented. Conclusion: Despite advances in clinical and diagnostic testing of vestibular function in children and infants, testing of vestibular function is not typically done. Comprehensive testing of signs and symptoms is critical for diagnosis and implementation of appropriate interventions. Show more

Keywords: Pediatric vestibular deficits, pediatric vestibular rehabilitation, pediatric vestibular testing

DOI: 10.3233/NRE-130873

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 507-518, 2013

Authors: Gurley, James M. | Hujsak, Bryan D. | Kelly, Jennifer L.

Article Type: Research Article

Abstract: Introduction: Vertigo, dizziness, and imbalance are a symptom complex that is commonly found following concussion. Early metabolic changes following concussion may lead to worsening of the injury and symptoms in individuals not properly managed from the outset. When symptoms do not recover spontaneously, skilled vestibular rehabilitation can be an effective modality in an attempt to normalize the individual’s vestibular responses. Purpose: The purpose of this review is to appraise the current and accepted methods available to the skilled clinician in quantifying and treating vestibular dysfunction following concussion. Incidence and prognostic indicators will be reviewed along with common barriers …to recovery. Summary: Vestibular Rehabilitation following concussion utilizes similar tools and techniques employed when treating those solely with peripheral pathology. The clinician must not only have a solid understanding of when and why certain exercises are required, but also be willing to accept that less exercise may be indicated in this population. As injury to the system following mild traumatic brain injury can include both peripheral and central structures, the duration of therapy and the time to recovery may be prolonged. Co-morbidities including cognitive and behavioral issues, visual-perceptual dysfunction, metabolic dysfunction, and autonomic dysfunction may hamper the effectiveness of the traditional Vestibular Rehabilitation approach. As successful treatment does not occur in a vacuum, working closely with other disciplines well versed in treating these co-morbid issues will help the individual to obtain optimal recovery. Conclusion: Vestibular Rehabilitation is an effective modality for managing dizziness, vertigo, and imbalance following concussion. Careful consideration of the acuity of the injury, along with effective management of co-morbid conditions will optimize the result. Show more

Keywords: Vestibular rehabilitation, traumatic brain injury, concussion

DOI: 10.3233/NRE-130874

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 519-528, 2013

Authors: Lin, Emerald | Aligene, Kathy

Article Type: Research Article

Abstract: Introduction: Dizziness and vertigo encompass a spectrum of balance-related symptoms caused by a variety of etiologies. Balance is affected by many systems: proprioceptive pathways, and visual, cerebellar, vestibulocochlear, and vascular/vasovagal systems. Treatment includes antihistamines, antiemetics, benzodiazepines, anti-inflammatory, anti-Meniere’s, anti-migraine, antidepressants, anticonvulsants, and aminopyridines. Many medications may cause these balance-related symptoms. Onset characteristics differ and may be reversible or irreversible. Ototoxic drugs may affect the cochlea, the vestibular system, or both. Medications, whether at “therapeutic” or toxic doses, have a spectrum of side effects, depending on the medication and individual. Purpose: The section on drugs that treat dizziness and …balance deficiencies was divided to elaborate on medications by classes and etiology specific treatment. Drugs with potential to cause balance-related symptoms were chosen to elaborate on specific medical issues encountered in rehabilitation. Background on advantages of certain drugs and methods to minimize adverse effects are reviewed. Summary: Effective treatment depends on generating an accurate diagnosis, using the appropriate drug, appropriate dosage, and for an appropriate duration. For every medication, there is a spectrum of side effects at “therapeutic” and toxic doses, depending on the medication and individual. Conclusion: Practitioners must ensure correct diagnoses and cater their treatments to the patients’ clinical scenario and medical units’ capacities. Show more

Keywords: Dizziness, vertigo, orthostatic hypotension, ototoxicity

DOI: 10.3233/NRE-130875

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 529-542, 2013

Authors: Aligene, Kathy | Lin, Emerald

Article Type: Research Article

Abstract: Objectives: The purpose of this chapter is to provide an update on the clinical management of vestibular and balance dysfunction in a concussed athlete with a focus on diagnosis, initial work-up, and initial and continuing management. Although much is still unknown about the etiology of vestibular and balance dysfunction in a concussed athlete, we briefly review current theories about neural pathophysiology to help link proposed treatment methodologies. Introduction: The treatment and management of vestibular and balance dysfunction in concussed athletes requires a multidisciplinary approach and is based on continuous reassessment of the presenting symptoms. The clinical challenge toward …managing persistent symptoms of the post-concussive athlete is discerning whether a set of symptoms match diagnostic testing and whether further neurological work up is necessary. Because there are no discrete time boundaries to make such judgment calls, we offer a guide to help with the difficult clinical decisions necessary to treat the post-concussive athlete. Methods: Literature search was performed using the following keywords: Vestibular and balance dysfunction, concussion, concussed athlete and treatment, vestibular rehabilitation therapy. Original research studies, literature reviews, and clinical guidelines were reviewed between 1997 and 2012, with the majority of articles dating beyond 2004. Although we acknowledge that post-concussive states lie within a continuum, we decided to divide treatment and management into three stages: time after initial impact, recovery, and prolonged recovery. Results: In post-concussive athletes, impairments in balance may exist as a result of transmitted force to peripheral and central neural substrates that integrate sensory information and coordinate motor function. Corroborative information, clinical examination, neuropsychological testing, and continual reassessment are means to determine severity of dysfunction and track clinical course and resolution of symptoms. Persistence of symptoms beyond initial impact may require medication trials or adjustments that are tailored to the patient’s medical history and/or neurocognitive rehabilitative techniques such as vestibular rehabilitation therapy to prevent progression of neurologic sequelae. Prolonged recovery of more than six months may require neurological consultation. Conclusion: Concussion management and treatment of vestibular and balance impairments in athletes should be assessed in a stepwise manner, from initial impact to resolution of symptoms. If symptoms are prolonged, impaired neuronal mechanisms or irreversible cerebral damage may underlie persistent symptoms and cognitive deficits seen in neurocognitive testing. Management protocols are currently focused on individualized assessment of neurocognitive assessment and comprehensive symptomatic evaluation (Reddy et al., 2008). It is widely accepted that neurocognitive and resolution of concussion-induced symptoms must be resolved prior to returning to sport or play and therefore, the athlete should be reassessed and treated until symptoms resolved. Show more

Keywords: Vestibular and balance dysfunction, concussion, concussed athlete and treatment, vestibular rehabilitation therapy

DOI: 10.3233/NRE-130876

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 543-553, 2013

Authors: Amonn, Frauke | Frölich, Jan | Breuer, Dieter | Banaschewski, Tobias | Doepfner, Manfred

Article Type: Research Article

Abstract: Background: We report the effects of a computer-based neuropsychological training in children with Attention-Deficit Hyperactivity Disorder (ADHD). We hypothesized that a specific training focusing on attentional dysfunction would result in an improvement of inattention, observable in test performance, behavior and performance during experimental school lessons and in parent and teacher ratings of the related core symptom. Method: We chose a within-subject-control-design with a 4 week baseline period and subsequent 12 to 15 weekly training-sessions. 30 children (6 to 13 years old) with a diagnosis of ADHD (ICD 10: F 90.0) and no other comorbidities participated in the study. …Results: The training revealed significant improvement in training parameters of the neuropsychological training and in the symptoms of inattention and deportment as rated during experimental school lessons. However, generalization of training effects as measured by parent and teacher ratings was not detected. Conclusions: We conclude that neuropsychological training could be helpful as one adjunct module in the complex treatment of ADHD but to prove clinical value, similar training programs must focus more strongly on individually existing neuropsychological deficits. Training programs should be more intensive and should eventually be combined with home based training access. Show more

Keywords: ADHD, neuropsychological training, neuropsychological deficits, attention control

DOI: 10.3233/NRE-130877

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 555-562, 2013

Authors: Ibrahim, Alaa I. | Alhusaini, Adel A. | Hegazy, Fatma A. | Hawamdeh, Ziad M.

Article Type: Research Article

Abstract: Aims: To investigate the effect of foot wedge and carrying weighted bag on loading the paretic lower limb in children with hemiparetic CP. Design: Cross-sectional study. Participants: A convenient sample of 18 ambulant children with spastic hemiparetic CP was evaluated. Fifteen matched normal children acted as a control group. Methods: Using two calibrated scales, measurements of weight supported on each lower limb were obtained under four different standing conditions. Results: During quiet standing, the percentage of weight supported on the paretic limb was 35.59% with symmetry index equals 0.57. Standing with the …non-paretic foot is placed on a lateral foot wedge, was the best condition that increased the percentage of weight supported on the paretic limb to 47.18% and improved the symmetry index to 0.90. Non-significant improvement of symmetry index 0.61 was recorded when carrying a weighted bag with the paretic hand, but carrying with the non-paretic hand unnecessarily loads the non-paretic limb and further decreases the symmetry index to 0.49. Conclusions: Using a lateral foot wedge beneath the non-paretic foot and carrying a weighted bag with the paretic hand improve the loading function of the paretic limb and relief the non-paretic limb from overloading. Show more

Keywords: Weight bearing, asymmetry, hemiparetic CP, foot wedge, carrying weight, paretic limb

DOI: 10.3233/NRE-130878

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 563-571, 2013

Authors: Mirowska-Guzel, Dagmara | Gromadzka, Grazyna | Seniow, Joanna | Lesniak, Marcin | Bilik, Marta | Waldowski, Konrad | Gruchala, Katarzyna | Czlonkowski, Andrzej | Czlonkowska, Anna

Article Type: Research Article

Abstract: Background: The efficacy of rehabilitation in ischemic stroke patients likely varies because of brain plasticity. One of the main neurotrophins in the central nervous system is brain-derived neurotrophic factor (BDNF). Objectives: This study aimed to determine allelic and genotypic distribution of BDNF -196 G>A and -270 C>T polymorphisms, and to assess the impact of repetitive transcranial magnetic stimulation (rTMS) on serum BDNF concentrations measured before rehabilitation, after the first 6 h of rehabilitation, and after 3 weeks of rehabilitation. Methods: Twenty-six patients with hand paresis and 20 with aphasia were randomly assigned to treatment with rTMS …or sham stimulation (placebo group). Results: In men with aphasia, after the first 6 h of rTMS-supported rehabilitation, BDNF concentration was lower among rTMS-treated patients than placebo-treated patients. A similar difference was observed in women with aphasia after 3 weeks of rTMS-supported rehabilitation. No significant differences in serum BDNF concentration were observed in patients with different BDNF -196 G>A or -270 C>T genotypes. During the observation period, BDNF concentration did not differ significantly between patients who improved and those who did not. Discussion: One possible explanation for the observed difference between rTMS-stimulated and sham-stimulated patients is the suppression of BDNF production by rTMS in the healthy brain hemisphere. Show more

Keywords: Aphasia, brain-derived neurotrophic factor (BDNF), hand paresis, ischemic stroke, rehabilitation, repetitive transcranial magnetic stimulation (rTMS)

DOI: 10.3233/NRE-130879

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 573-582, 2013

Authors: Kim, Eun Hyuk | Lee, Jun | Jang, Sung Ho

Article Type: Research Article

Abstract: Background: Middle cerebral artery (MCA) territory infarct is the most common type of cerebral vascular territory infarct. Accurate prediction of motor outcome is important for stroke rehabilitation. Objectives: We conducted an investigation of prognostic factors of motor outcome in patients with a large MCAterritory infarction, using diffusion tensor tractography (DTT) of the corticospinal tract (CST). Methods: A total of 37 consecutive hemiparetic patients with a large MCA territory infarct were recruited for this study; DTT was performed within 5âĂŞ30 days after onset. Patients were classified into three groups according to DTT findings: in group A – …CST integrity was preserved around infarct regions, in group B – CSTs were discontinuous, and, in group C – the upper ends of CSTs did not reach infarcted regions. Fractional anisotropy (FA) ratio of the affected CST (versus the unaffected ipsilateral CST) was calculated, and evaluation of motor function was performed using the Motricity Index (MI), modified Brunnstrom classification (MBC) score, and the functional ambulation category (FAC) score at onset and at six months after onset. Results: Significantly greater changes in motor function (MI, MBC, and FAC) were observed between onset and six months post-onset in group A, compared with groups B and C (p < 0.05). However, no significant difference was observed between groups B and C (p > 0.05). FA ratios showed positive correlation with six-month MIs, and scores for MBC and FAC (p < 0.05). Conclusions: Results of this study demonstrate the usefulness of early DTT findings of CSTs for prediction of motor outcome in patients with a large MCA territory infarct. Show more

Keywords: Cerebral infarct, middle cerebral artery, motor function, diffusion tensor imaging, corticospinal tract

DOI: 10.3233/NRE-130880

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 583-590, 2013

Authors: Tavernese, Emanuela | Paoloni, Marco | Mangone, Massimiliano | Mandic, Vesna | Sale, Patrizio | Franceschini, Marco | Santilli, Valter

Article Type: Research Article

Abstract: Background: Segmental muscle vibration (SMV) has been used to improve gait and to reduce spasticity in stroke patients. No data exist about the possibility to improve upper limb motor function by using SMV. Methods: Forty-four patients with hemiparesis following chronic stroke were randomized to an experimental (n = 24) and a control group (n = 20). Patients in the experimental group received two weeks of general physical therapy and SMV over the biceps brachii and flexor carpi ulnaris muscles of the paretic side, while those in the control group received two weeks of general physical therapy. …Kinematic analysis of reaching movement was performed at baseline and two weeks after treatment ended. Results: Normalized jerk, indicating the smoothness of movement, significantly improved in the experimental group, with significant difference emerging between groups at the post-treatment evaluation. Patients in the experimental group also displayed a significant improvement for mean linear velocity, mean angular velocity at shoulder, distance to target at the end of movement and movement duration. No differences emerged between baseline and post-treatment evaluations in the control group. Conclusions: when added to general physical therapy, SMV is effective in improving, in a short-term period, upper limb motor performances of reaching movement in chronic stroke patients. Show more

Keywords: Segmental muscle vibration, chronic stroke, reaching movement, rehabilitation, kinematic analysis

DOI: 10.3233/NRE-130881

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 591-599, 2013

Authors: Back, Claudio Gregório Nuernberg | Benedini-Elias, Priscila C.O. | Mattiello, Stela M. | Sobreira, Claudia | Martinez, Edson Z. | Mattiello-Sverzut, Ana Claudia

Article Type: Research Article

Abstract: The mechanical and metabolic characteristics of skeletal muscle fibers can interfere with muscle contractile performance in healthy subjects. Few studies have investigated the degree of association between muscle function and muscle fiber morphology in patients with myopathy. A biopsy was obtained from the left biceps brachii muscle of 12 subjects with myopathic disorders. The relative cross-sectional area of type 2 fibers and their subtypes was determined by the ATPase technique. Relative torque (RT) was calculated by dividing isokinetic elbow flexion peak torque (PT) values (90 and 180° s−1 ) by isometric PT values. Correlations were analyzed using Spearman's coefficient (r). …The relative cross-sectional area of type 2b fibers was positively correlated with RT90 (r = 0.71, P = 0.009) and RT180 (r = 0.73, P = 0.007). The relative cross-sectional area of type 2a fibers showed a moderate and negative correlation with RT180 (r = −0.62, P = 0.03) and a low correlation with RT90 (r = −0.57, P = 0.05). In contrast to healthy subjects, patients with myopathy presented changes in the contractile behavior of type 2a fibers and compensatory adaptations in type 2b fibers. The results suggest that RT in combination with morphometric parameters provides data regarding muscle function in patients with myopathic disorders and can contribute to the establishment of therapeutic exercises. Show more

Keywords: Myopathy, skeletal muscle, biopsy, isokinetic, peak torque

DOI: 10.3233/NRE-130882

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 601-608, 2013

Authors: Yoo, In-gyu | Jung, Min-ye | Yoo, Eun-young | Park, Soo-hyun | Park, Ji-hyuk | Lee, Jin | Kim, Han-sol

Article Type: Research Article

Abstract: Background: Therapeutic concept of interlimb transfer provides very important information relevant to patients with stroke because it can be applied to help these patients recover movement skills disrupted following unilateral damage to the brain. Objectives: The purpose of this study was to determine the transfer effects for both specialized training in each hemisphere and reversed training of a specialized task. Methods: Twenty patients (ten women and ten men) with stroke and hemiparesis participated. All participants were in Brunnstrom recovery stage five or higher for arm and hand function and had Mini-Mental State Examination scores ⩾25. We …used a training task involving a modified static cone, modified box and block, and modified pegboard tasks. The specified-training group performed the reaching movements (based on grip, reach, and release movements) in a modified training setting in which left-handed participants began from a single starting location and proceeded to one of three target locations (1S3T condition), and the right-handed participants started form one of three starting locations and proceeded to a single target location (3S1T condition). The unspecified training group performed these movements starting under reverse-start and target conditions. Results: As a result of the left-to-right limb transfer in the specified-training group differed significantly in duration from that in the pre-training group. Also, the biceps brachii and triceps (lateral head) muscles were significantly more active after performing the specified training than before. On the other hand, the activity of the upper trapezius muscle did not significantly differ after specified training compared with before training. Conclusion: Consequently, a symmetric transfer advantage was observed that depended on the characteristic resources of each hemisphere. The transfer of specified training from one arm to the other had a more positive influence on functional recovery than did unspecified training for patients with stroke and hemiparesis. Show more

Keywords: Electromyography, hemisphere, inter-limb transfer

DOI: 10.3233/NRE-130883

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 609-615, 2013

Authors: Hadoush, Hikmat | Mano, Hirofumi | Sunagawa, Toru | Nakanishi, Kazuyoshi | Ochi, Mitsu

Article Type: Research Article

Abstract: Background: Mirror illusion therapy (mirror therapy) is based on the experimental substrate of a visual illusion of active hand movement to excite ipsilateral primary motor cortex (iM1). Purpose: We tested whether iM1 excitability could be modulated by enabling or disabling vision of the active hand during mirror therapy. Method: Motor cortical activations of healthy right-handed participants were identified by magnetoencephalography. Participants performed voluntary index finger extension of their dominant and non-dominant hands, separately, while viewing mirror reflection images of their active hand superimposed upon their hidden inactive hand. This was performed either with vision of the …active hand (uncovered viewing condition) or without vision of the active hand (covered viewing condition). Results: In the covered viewing condition, the iM1could be excited in all participants (n = 10) and this excitation did not differ whether the active hand was the dominant or non-dominant hand. However, in the uncovered viewing condition, dominant and non-dominant hands were able to excite iM1 only in some participants (n = 4 and n = 7, respectively). Moreover, the participants’ responses to the illusion validation questionnaire revealed that the covered viewing condition could cause clearer visual illusion for the active hand than the uncovered viewing condition. Conclusion: Disabling vision of the active hand during mirror therapy was more effective to excite iM1 responses by creating more immersive visual illusion of the active hand. Show more

Keywords: Mirror illusion, ipisilateral motor cortex, magnetoencephalagraphy

DOI: 10.3233/NRE-130884

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 617-624, 2013

Authors: Waldman, Genna | Yang, Chung-Yong | Ren, Yupeng | Liu, Lin | Guo, Xin | Harvey, Richard L. | Roth, Elliot J. | Zhang, Li-Qun

Article Type: Research Article

Abstract: Objectives: To investigate the effects of controlled passive stretching and active movement training using a portable rehabilitation robot on stroke survivors with ankle and mobility impairment. Methods: Twenty-four patients at least 3 months post stroke were assigned to receive 6 week training using the portable robot in a research laboratory (robot group) or an instructed exercise program at home (control group). All patients underwent clinical and biomechanical evaluations in the laboratory at pre-evaluation, post-evaluation, and 6-week follow-up. Results: Subjects in the robot group improved significantly more than that in the control group in reduction in spasticity …measured by modified Ashworth scale, mobility by Stroke Rehabilitation Assessment of Movement (STREAM), the balance by Berg balance score, dorsiflexion passive range of motion, dorsiflexion strength, and load bearing on the affected limb during gait after 6-week training. Both groups improved in the STREAM, dorsiflexion active range of motion and dorsiflexor strength after the training, which were retained in the follow-up evaluation. Conclusion: Robot-assisted passive stretching and active movement training is effective in improving motor function and mobility post stroke. Show more

Keywords: Stretching, movement training, robotics, stroke, rehabilitation

DOI: 10.3233/NRE-130885

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 625-634, 2013

Authors: McGuinness, Siobhan | Hillan, Josephine | Caldwell, Sheena B.

Article Type: Research Article

Abstract: Objectives: Our purpose is to assess the effectiveness of Botulinum toxin (Btx) on gait dysfunction due to ankle clonus in neurological patients. Methods: We use a retrospective case note review of 11 patients attending the Regional Acquired Brain Injury Unit (RABIU), Musgrave Park Hospital, Belfast, Northern Ireland. All patients had received Btx for the treatment of ankle clonus. Demographic data including diagnosis and time since neurological insult was collected. Information regarding walking speed and assistance required to walk before and after Btx treatment was analysed. Results: In 10 of 11 patients, walking speed was significantly improved …at 4–6 weeks post Btx injections (P = 0.006) and at 14–16 weeks post Btx injections (P = 0.005). Eight patients reduced their level of dependency on assistance. Subjective improvements in levels of pain, gait pattern and ‘toe clawing’ were also reported. Conclusions: Our findings suggest that Botulinum toxin has a role in treating ankle clonus in neurological patients, where it interferes in gait. Walking speed and level of dependence on others improved in this group. Show more

Keywords: Botulinum toxin, ankle clonus, gait, ambulation, patients, rehabilitation

DOI: 10.3233/NRE-130886

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 635-647, 2013

Authors: Bang, Young-Im | Min, Kyunghoon | Sohn, Young H. | Cho, Sung-Rae

Article Type: Research Article

Abstract: The purpose of this study was to define the acoustic voice and speech characteristics of patients with Parkinson disease (PD). Seven female patients with PD and seven female healthy controls participated in this study. Each subject was instructed to vocalize extended corner vowels (/a/, /e/, /i/, /u/) three times for at least 5 seconds at a comfortable voice loudness and tone. The voice was analyzed using the Praat program. As a result, female patients with PD showed a significant increase in jitter and noise-to-harmonics ratio (NHR). In addition, F1 and F2 among the PD patients demonstrated asymmetric centralization of unrounded …vowels (/a/, /e/, /i/) in high/low/front/back positions of the tongue, consequently leading to a significant decrease in vowel space area, compared to healthy controls. This study showed the acoustic characteristics of vowel sounds not only by laryngeal variables such as abnormal jitter and NHR, but also by articulatory variables such as asymmetric centralization and reduced vowel space area in female patients with PD. Therefore, it is important to use these objective and sensitive variables to evaluate the status or severity of hypokinetic dysarthria in patients with PD. Show more

Keywords: Parkinson disease, acoustic analysis, vowel space area, centralization

DOI: 10.3233/NRE-130887

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 649-654, 2013

Authors: Hilgers, Christoph | Mündermann, Annegret | Riehle, Hartmut | Dettmers, Christian

Article Type: Research Article

Abstract: Objective: The aim of this randomized controlled trial was to test the hypothesis that a three-week whole body vibration (WBV) training in addition to a standard rehabilitation program improves walking ability in patients with Multiple Sclerosis (MS). Patients and Method: Sixty patients with definite MS were randomly allocated to the intervention or control group. Training sessions were performed three times per week for three weeks. Patients adopted a moderate squat position on a vibration platform. The training sessions comprised series of 3 × 60-sec exercise sets with increasing amplitude between sessions from 1 to 2 mm. During the …exercise series, the vibration platform was turned on for the intervention group and switched off for the control group. A mixed factor ANOVA was used to compare sit to stand test, timed up and go test, 10-meter walk test, and 6-min walk test data between patient groups and between baseline and follow-up. Results: All outcome measures improved from baseline to follow-up (P < 0.001). The 6-minute walk test showed significantly greater improvements from baseline to follow-up for the intervention than for the control group (P < 0.001). Conclusion: Determinants of walking ability in patients with MS that are specific to walking endurance tasks are most affected by vibration training designed to improve strength endurance. Show more

Keywords: Walking ability, endurance, fatigue, rehabilitation, multiple sclerosis, whole body vibration, vibration platform, WBV

DOI: 10.3233/NRE-130888

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 655-663, 2013

Authors: Yeo, Sang Seok | Kim, Seong Ho | Jang, Sung Ho

Article Type: Research Article

Abstract: Background: The corticoreticular pathway (CRP) innervates the proximal muscles of extremities and axial muscles; therefore, it is involved in postural control and gait. We report on a patient who exhibited proximal weakness due to a CRP injury, which was evaluated using diffusion tensor tractography (DTT). Methods: A 62-year-old male patient who had been injured in a traffic accident underwent conservative management for a contusional hemorrhage in the right frontotemporal lobes, and a subdural and epidural hematoma in the right temporoparietal lobes. The patient exhibited right proximal weakness (shoulder: 3+ , hip: 3+ ) at two weeks after onset. …Findings on brain MRI revealed encephalomalactic lesions in both frontal lobes. Results: Findings on DTT of the left CRP showed discontinuation at the midbrain level; in contrast, the integrities of the corticospinal tract in both hemispheres were maintained from the cerebral cortex to the medulla along the known pathway of the corticospinal tract. Conclusion: The proximal weakness of the right shoulder and hip observed in this patient appeared to be attributed to injury of the left CRP. Show more

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

DOI: 10.3233/NRE-130889

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 665-669, 2013

Authors: Foy, Catherine M.L. | Somers, Julian S.

Article Type: Research Article

Abstract: Objectives: To characterize and determine the pre-injury and injury-related variables that are linked to the extent of functional recovery following rehabilitation at a mixed therapy and educational residential programme and whether these variables differ for traumatic brain injury (TBI) and non traumatic brain injury (nonTBI). Methods: 106 young adults (age 16–36 years) with moderate-to-severe TBI who had attended and been discharged from the centre since 2002 were included. Clients received 5 hours of education and/or therapy each day. Functional level was assessed using the FIM + FAM. Regression analysis was used to determine possible predictors of functional independence …at discharge. Main Outcomes and Results: Clients with TBI and nonTBI made clinically and statistically significant improvements in their functional abilities during their neurorehabilitation. For the combined TBI and nonTBI group, FIM + FAM scores at discharge were predicted by FIM + FAM at admission and length of stay. These two predictors explained 80% of the variance in the FIM + FAM score at discharge. Conclusion: Both clients with TBI and nonTBI benefited from a mixed inpatient neurorehabilitation programme. This benefit was predicted by their functional abilities at admission and the length of stay. These findings are of importance as it becomes increasingly necessary to demonstrate who will benefit from residential intensive neurorehabilitation as opposed to community therapy. Show more

Keywords: Traumatic brain injury, functional independence measure, outcomes, education

DOI: 10.3233/NRE-130890

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 671-678, 2013

Authors: Perrin, Paul B. | Stevens, Lillian Flores | Villaseñor Cabrera, Teresita | Jimenez-Maldonado, Miriam | Martinez-Cortes, Maria Luisa | Arango-Lasprilla, Juan Carlos

Article Type: Research Article

Abstract: Objective: To compare the mental health of family caregivers of individuals with Traumatic brain injury (TBI) to an age-matched healthy control from Guadalajara, Mexico. Setting: Hospital Civil Fray Antonio Alcade, a public medical facility in Guadalajara, Mexico. Participants: Ninety family caregivers of individuals with TBI and 89 healthy controls (n = 179) did not differ with respect to age, sex, marital status, education, or household income. Main Outcome Measures: Outcome measures assessed satisfaction with life (Satisfaction with Life Scale), depression (Patient Health Questionnaire-9), social support (Interpersonal Support Evaluation List), self-esteem (Rosenberg Self-Esteem Scale), …and anxiety (State-Trait Anxiety Inventory). Results: A multivariate analysis of variance found that in comparison to controls, TBI caregivers reported substantially lower mental health scores across all indices, as well as lower social support in two out of three comparisons. The effect sizes of the social support differences were small; two out of five mental health differences reached medium-sized effects; and the other three reached large-sized effects. Conclusions: Because TBI caregivers’ mental health influences the quality of informal care they can provide, mental health interventions for family caregivers are an extremely important part of TBI rehabilitation in Latin America, especially considering familism as a core value in Latino culture. Show more

Keywords: TBI caregivers, Latin America, mental health

DOI: 10.3233/NRE-130891

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 679-686, 2013

Authors: Kim, Hyung-Sik | Choi, Mi-Hyun | Kim, Hyun-Joo | Yeon, Hong-Won | Yoon, Hee-Jeong | Lee, In-Hwa | Hong, Sang-Pyo | Yu, Na-Rae | Choi, Jin-Seung | Yi, Jeong-Han | Chung, Young-Sun | Lim, Dae-Woon | Chung, Soon-Cheol

Article Type: Research Article

Abstract: Background: This study attempted to identify the effect of administration of highly concentrated oxygen on simple visual matching task performance, blood oxygen saturation [SpO2 (%)], and heart rate [HR (bpm)] of intellectually and developmentally disabled people. Methods: Nineteen intellectually and developmentally disabled people (mean age 30.6 ± 5.7 years) participated in an experiment consisting of a simple visual matching task performed under 21% and 92% oxygen. SpO2 and HR were measured under both oxygen conditions. Results: When 92% oxygen was supplied, the response time decreased, SpO2 increased, and HR decreased compared to the …vales obtained using 21% oxygen. The response time decreased for subjects with a high SpO2 and HR during the simple visual matching task phase. Conclusion: This result supports the hypothesis that administration of highly concentrated oxygen can positively affect the cognitive performance of intellectually and developmentally disabled people. Show more

Keywords: Highly concentrated oxygen, cognitive performance, blood oxygen saturation, heart rate, intellectually and developmentally disabled people

DOI: 10.3233/NRE-130892

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 687-692, 2013

Authors: Eichstaedt, Katie E. | Kovatch, Keith | Maroof, David Aaron

Article Type: Research Article

Abstract: Background: The traditional Bonferroni method is a commonly used post hoc hypothesis test to adjust for familywise error rate inflation; however, a less well-known derivative of this test, the Holm’s sequential procedure, provides an alternative method for familywise error rate correction. This less conservative approach is particularly relevant to studies investigating neuropsychological functioning because of the extent to which neuropsychological datasets tend to include interrelated outcome measures, reducing the relevance of the universal null hypothesis assumption, on which the traditional Bonferroni method relies. Methods: Mathematical illustrations demonstrating how to compute the two adjustments are provided. The two …methods are compared using a simple hypothetical dataset. Results: By using the divisors (n − j + 1) in lieu of n , Holm’s sequential procedure is guaranteed to never reject fewer hypotheses than the traditional Bonferroni adjustment. Conclusions: The Holm’s sequential procedure corrects for Type I error as effectively as the traditional Bonferroni method while retaining more statistical power. Although the Holm’s sequential procedure is more complicated to compute than the traditional Bonferroni method, the Holm’s sequential procedure may be a more appropriate method for adjusting familywise error rate inflation in many types of neuropsychological research. Show more

Keywords: Holm's sequential, Bonferroni, Type I error, neuropsychology

DOI: 10.3233/NRE-130893

Citation: NeuroRehabilitation, vol. 32, no. 3, pp. 693-696, 2013