NeuroRehabilitation - Volume 32, issue 4

Authors: Wood, Rodger Ll.

Article Type: Editorial

DOI: 10.3233/NRE-130894

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 697-698, 2013

Authors: Wood, Rodger Ll.

Article Type: Research Article

Abstract: Background: Neurobehavioural disability often leads to serious social handicap. Many individuals never recover full social independence and will remain largely dependent upon family support, imposing a significant and potentially life-long psychological burden on those who care for injured relatives. Close relationships are at risk and many partnerships break down, increasing the risk of social isolation and subsequent psychological distress to the survivor. Objectives: The aim of this paper is to examine the nature of some cardinal features of neurobehavioural disability that contribute to poor psychosocial outcome; consider their organic origins, and problems associated with standardised methods of assessment. …Methods: A review of clinical literature addressing neurobehavioural disability after TBI. Results: Many forms of neurobehavioural disability are subtle but have a pervasive impact on psychosocial outcome in general and relationships in particular. Conclusions: Caution is recommended when employing standardised tests to identify the complex and often subtle nature of neurobehavioural disorders. More work is needed to define the nature and impact of different forms of neurobehavioural disorders that comprise this complex form of disability. Show more

Keywords: Neurobehavioural, disability, traumatic brain injury, assessment

DOI: 10.3233/NRE-130895

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 699-706, 2013

Authors: Bigler, Erin D. | Yeates, Keith Owen | Dennis, Maureen | Gerhardt, Cynthia A. | Rubin, Kenneth H. | Stancin, Terry | Taylor, H. Gerry | Vannatta, Kathryn

Article Type: Research Article

Abstract: Background: Neuroimaging studies identified either focal and/or non-specific frontotemporolimbic damage resulting from mild-complicated to severe traumatic brain injury (TBI) in a subset of 12 children 8–12 years of age who were part of the Social Outcomes of Brain Injury in Kids (SOBIK) study. The influence of identifiable damage on social behavior was examined. Methods: Magnetic resonance imaging was obtained on average 2.5 years post injury wherein cases with distinct abnormalities were selected. Various direct, performance-based measures of cognitive-social-emotional functioning were obtained along with data regarding peer relations and friendships in the classroom. Results: Overall, children …with TBI were impaired on tasks of social-emotional processing compared to children with orthopedic injury (OI). Ten of the 12 children with TBI had multiple areas of impaired social-emotional functioning in comparison to OI controls. With regards to friendships, four of the nine children with TBI who had classroom data had no mutual friends, four also received low peer acceptance ratings, and two were perceived by peers as having high levels of rejection/victimization in the classroom. Conclusions: Children with frontotemporolimbic or diffuse damage demonstrated variable social outcomes from their TBI. Results are discussed in terms of the heterogeneity of TBI-related abnormalities and their relationship to social behavior. Show more

Keywords: Traumatic brain injury, social brain, neuroimaging, theory of mind, frontotemporolimbic damage

DOI: 10.3233/NRE-130896

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 707-720, 2013

Authors: Krpan, Katherine M. | Anderson, Nicole D. | Stuss, Donald T.

Article Type: Research Article

Abstract: Background: Coping has been suggested as the final common pathway related to outcome after traumatic brain injury (TBI). Different types of coping have been related to either positive or negative psychosocial outcomes. As a result, a small set of studies have attempted to remediate coping through intervention, but the effectiveness of these studies has been modest. Conclusion: We propose that three primary factors are limiting our ability to effectively remediate coping following TBI through intervention TBI: 1) limited understanding of inter-patient variability following TBI; 2) limited understanding of the mechanisms underlying coping following TBI; and 3) reliance …on self-report measures of coping. We discuss these obstacles in the context of a model of frontal lobe function, and in light of recent behavioural work on coping. Show more

Keywords: Traumatic brain injury, coping, rehabilitation, inter-patient variability, mechanisms

DOI: 10.3233/NRE-130897

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 721-728, 2013

Authors: Tate, Robyn L. | Godbee, Kali | Sigmundsdottir, Linda

Article Type: Review Article

Abstract: Background and aims: Good assessment is an essential component of effective patient management. Yet the sheer volume of available assessment instruments presents a barrier for the clinician or researcher to (a) be knowledgeable about suitable measures and (b) keep up-to-date with new measures that are published. In order to create a resource of currently-used measures, we conducted a systematic review of assessment tools used in the research literature on traumatic brain injury (TBI). Methods: We used two electronic databases (Medline and PsycINFO) to identify full-length, English-language articles published between 2000 and 2012 in which outcome in adults with …TBI was assessed with behavioural tests or questionnaires. Results: The searches yielded 5,735 articles and after deletion of duplicates (n = 1,383) and articles not meeting selection criteria (n = 1,759), 2,593 articles were further examined. The articles contained 910 behavioural instruments, with a final set of 728 unique instruments. Each instrument was classified against the International Classification of Functioning, Disability and Health (ICF). Half of the instruments (n = 370, 50.8%) evaluated the mental functions domain of the ICF body functions component, with a substantially smaller proportion (n = 64, 8.8%) examining specific motor-sensory and other body functions. Instruments also covered domains of activities/participation (n = 109, 15.0%), environmental factors (n = 22, 3.0%) and personal factors (n = 36, 4.9%). A substantial number of scales (n = 93, 12.8%) were multidimensional across the body function domains (n = 32), as well as the functioning and disability part of the ICF (n = 60). The remaining 5% of instruments addressed concepts not covered by the ICF, including quality of life (n = 19, 2.6%) and rehabilitation process tools (such as therapeutic alliance). The 728 instruments were listed and more than 70 of the most common, spread across 20 domains, were highlighted. Conclusion: These data provide a comprehensive and up-to-date resource that gives the researcher or clinician a very large selection of assessment instruments covering the major areas of function pertinent to TBI. Show more

Keywords: Traumatic brain injury, cognition disorders, ICF, International Classification of Functioning, Disability and Health, neurobehavioral functioning, measurement, questionnaires, tests

DOI: 10.3233/NRE-130898

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 729-750, 2013

Authors: Prigatano, George P.

Article Type: Review Article

Abstract: Background: Holistic approaches to neuropsychological rehabilitation have progressively been recognized as an important form of rehabilitative care for persons who have a history of moderate to severe traumatic brain injury. OBJECTIVE: After providing historical and contemporary perspectives, identify challenges and opportunities facing the field of neuropsychological rehabilitation. Methods: Selective literature review from neuropsychological rehabilitation, neurosciences, learning theory, cognitive neuropsychology, and psychotherapy that highlight challenges to the development of holistic neuropsychological rehabilitation. Results: Ten challenges and associated opportunities that face the field of holistic neuropsychological rehabilitation are identified. Illustrations of these challenges and opportunities are provided. …Conclusions: Effectively addressing the challenges that face holistic neuropsychological rehabilitation will result in greater advances for this field of care for both children and adults. Show more

Keywords: Neuropsychological rehabilitation, holistic approaches, traumatic brain injury, adults, children, challenges and opportunities

DOI: 10.3233/NRE-130899

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 751-759, 2013

Authors: Alderman, Nick | Wood, Rodger Ll.

Article Type: Review Article

Abstract: Background: Neurobehavioural disability (NBD) following acquired brain injury undermines capacity for independent social behaviour and results in serious long-term social handicap. The presence of challenging behaviour as a feature of NBD has obvious implications for rehabilitation and community reintegration. Objectives: Behavioural approaches are seen by many as fundamental to the successful rehabilitation of challenging behaviour. This paper will a) define the nature of neurobehavioural rehabilitation; b) explore the characteristics of cases referred, and c) the outcomes achieved. Strengths, limitations and future developments of neurobehavioural approaches for challenging behaviour will be considered along with potential factors that limit generalisation …and longevity of treatment gains. Methods: Literature review. Results: Neurobehavioural services are distinguishable from other forms of neurorehabilitation. There is considerable evidence supporting the central role of both positive behaviour supports and contingency management approaches in creating conditions that minimise neurocognitive impairment, facilitate new learning, and ensure a positive social climate in both specialised inpatient units and community settings. Possible limitations include over-reliance on evidence from successful accounts of single cases and lack of knowledge regarding generalisation. Conclusions: Neurobehavioural rehabilitation is effective and can save care costs in the long term. More evidence regarding maintenance of gains is required. Show more

Keywords: Challenging behaviour, aggression, operant learning theory, rehabilitation

DOI: 10.3233/NRE-130900

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 761-770, 2013

Authors: Ruff, Ronald

Article Type: Research Article

Abstract: Background: When traditional psychotherapy is provided to patients with traumatic brain injuries (TBIs), the primary focus is on treating mood changes such as depression, anxiety or anger. However, traditional psychotherapeutic methods developed specifically for mood changes fall short when treating most TBI patients. In large part, this is because the psychological adjustment difficulties that most TBI patients face are linked to life-altering changes that are interwoven with permanent physical, cognitive, and social sequelae. In addition, mood changes in TBI patients are also caused by vocational and financial losses. Objective: The sudden onset of these unfamiliar and interdependent problems …necessitates a psychotherapeutic approach that acknowledges the inherent challenges of coping with multiple life-altering changes. For patients who experience a shattered sense of self, interventions need to be explored to make life meaningful following a TBI. Methods: An existentially-oriented approach is introduced in the following steps: (1) identifying pre-injury future expectations, (2) examining how the TBI has altered these expectations, (3) grieving the loss of the expected future, and (4) developing a realistic future that is existentially meaningful. Results: Pivotal gains are achieved when patients rebuild their lives according to their own core values. Conclusion: TBI patients can benefit from existential psychotherapy. Show more

Keywords: Psychotherapy, emotional problems, traumatic brain injury, acquired brain damage, existential approach

DOI: 10.3233/NRE-130901

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 771-779, 2013

Authors: Oddy, Michael | da Silva Ramos, Sara

Article Type: Research Article

Abstract: Background: The long term support of people with neurobehavioural disorders following a severe traumatic brain injury (TBI) can amount to a lifetime cost of several million dollars. Such costs are often obtained from personal injury compensation. However, those not eligible for such awards often depend on their families to provide support and care at no direct financial cost, but with indirect financial and human costs in terms of loss of productivity, and increased stress and health problems. Objectives: The aim of this paper is to examine the role of support workers in the long-term care of those with …neurobehavioural deficits following severe TBI and to discuss the feasibility of meeting some aspects of their role with technological solutions. Methods: This critical review uses observational and cost-analysis methodologies to establish the roles and costs associated with staff supporting people with neurobehavioural disorders resulting from severe TBI. Results: The role of support workers is varied and includes prompting to initiate and guide simple or complex activities, promoting social behaviour and managing emotional reactions. Some of these roles can be fulfilled by existing technology. Conclusions: Cost effective care of those with long-term neurobehavioural disorders can be provided by a combination of human support and existing technology. Show more

Keywords: Traumatic brain injury, neurobehavioural disorder, community based rehabilitation, cost-effectiveness, technology, review

DOI: 10.3233/NRE-130902

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 781-790, 2013

Authors: McMillan, T.M.

Article Type: Research Article

Abstract: Background: The evidence base on neurobehavioural disorders and their rehabilitation has been growing for four decades. Over that time understanding of the need for effective interventions for a range of handicaps in personal, interpersonal and employment spheres has developed. There is a continuing need to demonstrate whether interventions, are effective and cost-sensitive. Moreover, in pursuing effectiveness, clinicians need to be able to predict which individuals are likely to benefit from a programme and here, clinical experience needs to be informed by research evidence. Objective: To review the outcome of rehabilitation for neurobehavioural disorders. Methods: This review …initially considers the background to neurobehavioural rehabilitation and discusses methodological issues. It reviews the evidence for neurobehavioural interventions for severe head injury with emphasis on holistic models of care, behavioural treatments, interventions in non-specialist settings and for emotion perception and self-awareness. Results: In general, there is a need for further high quality studies with longer follow-ups and evidence for generalisation in the community. However, there is a growing consensus that intensive holistic rehabilitation programmes can improve community reintegration and self-efficacy. For behaviour disturbance the evidence base largely comprises studies with weaker (single group or single case) designs. Overall studies here provide limited evidence in support of behavioural approaches for externalised behaviour such as aggression. Further RCT or group comparison studies are needed. In terms of negative behaviours such as apathy, there are few studies on head injury and conclusions cannot be made with confidence. Self awareness is a key issue associated with good outcome in general and research to date supports use of interventions that focus in on-task behaviour and education. The correct perception of emotions in others is a precursor to successful social interaction, and here there is very little evidence although early studies are encouraging. Conclusion: There is mounting evidence to support the effectiveness of non-pharmacological interventions for neurobehavioural disorders. Successful outcomes are often associated with intensive and prolonged interventions involving multidisciplinary working. Show more

Keywords: Neurorehabilitation, neurobehavioural, holistic rehabilitation, traumatic brain injury

DOI: 10.3233/NRE-130903

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 791-801, 2013

Authors: Ponsford, Jennie

Article Type: Research Article

Abstract: Background: Traumatic brain injury results in some distinctive patterns of cognitive, behavioural and physical impairment which impact significantly on independent living skills and participation in work or study, social and leisure activities and interpersonal relationships. There is, however, still considerable variability in outcome across individuals in each of the reported domains. This has led to a significant body of research examining factors associated with outcome. A range of injury-related, personal and social factors have been shown to influence survival, as well as cognitive, functional and employment outcome. Methods: This paper reviews the factors associated with each of these …aspects of outcome specifically injury-related factors, including neuroimaging findings, GCS and PTA, other injuries, and cognitive and behavioural impairments; demographic factors, including age, gender, genetic status, education, pre-injury IQ and employment status; and social factors including family and other social support, cultural factors, pre-injury psychiatric history and coping style. Conclusion: The paper identifies contributions and complex interrelationships of all of these factors to outcome following TBI. It concludes with a brief discussion of the implications of these factors for the rehabilitation process. Show more

Keywords: Traumatic brain injury, outcome, prediction

DOI: 10.3233/NRE-130904

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 803-815, 2013

Authors: Agarwal, Nitin | Sarris, Christina | Hansberry, David R. | Lin, Matthew J. | Barrese, James C. | Prestigiacomo, Charles J.

Article Type: Research Article

Abstract: Objective: To evaluate the quality of online patient education materials for rehabilitation following neurological surgery. Methods: Materials were obtained from the National Institute of Neurological Disorders and Stroke (NINDS), U.S. National Library of Medicine (NLM), American Occupational Therapy Association (AOTA), and the American Academy of Orthopaedic Surgeons (AAOS). After removing unnecessary formatting, the readability of each site was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level evaluations with Microsoft Office Word software. Results: The average values of the Flesch Reading Ease and Flesch-Kincaid Grade Level were 41.5 and 11.8, respectively, which are well outside …the recommended reading levels for the average American. Moreover, no online section was written below a ninth grade reading level. Conclusion: Evaluations of several websites from the NINDS, NLM, AOTA, and AAOS demonstrated that their reading levels were higher than that of the average American. Improved readability might be beneficial for patient education. Ultimately, increased patient comprehension may correlate to positive clinical outcomes. Show more

Keywords: Readability, online, patient education, rehabilitation, neurological surgery

DOI: 10.3233/NRE-130905

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 817-821, 2013

Authors: Balconi, Michela

Article Type: Research Article

Abstract: External feedback from contextual cues allows humans to behave appropriately in their environments. In the present study, the explicit process of feedback monitoring (an explicit response to veridical vs false feedback) was explored. In addition, the contribution of the prefrontal cortex in this monitoring process was tested by administering an rTMS inhibitory paradigm. Seventeen subjects participated in the study and were required to detect correct vs. incorrect feedback. The experimental task included three main phases: the subject's performance (spatial decisional task); the system's response to the performance (external feedback); and the subject's judgment and response to this external feedback (feedback …monitoring). rTMS was performed on the DLPFC. As shown by the behavioural measures (error rate and response times), DLPFC deactivation induced worse performance (higher ER and RT) for both correct and incorrect feedback. Indeed, this prefrontal region seems to contribute to conscious monitoring functions when an explicit response is required. Possible applications to executive function analysis and rehabilitation are suggested. Show more

Keywords: Feedback monitoring, rTMS, dorsolateral prefrontal cortex, dysexecutive syndrome, consciousness

DOI: 10.3233/NRE-130906

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 823-831, 2013

Authors: Kim, Do Hyeon | Shin, Yong-Il | Joa, Kyung-Lim | Shin, Yoon Kyum | Lee, Jae Jin | You, Sung (Joshua) Hyun

Article Type: Case Report

Abstract: Purpose: The purpose of this study was to investigate the immediate effect of Walkbot gait training on knee joint stiffness in an individual with spastic hemiplegia. Method: A woman with hemiparetic stroke underwent a 30-minute Walkbot robotic-assisted gait training session. Knee flexion stiffness associated with hamstring spasticity and knee extension torques during the terminal swing phase was determined before and after the intervention using the Walkbot-STIFF measurement system. Design: Descriptive case analysis. Results: Knee joint extension kinematic at the terminal swing phase increased from 2.44° to −0.28°. Knee joint torque increased from 0.26 Nm …to 0.32 Nm. The knee flexion stiffness decreased from 0.0083 Nm/degree to 0.0022 Nm/degree following the training. Conclusions: The Walkbot robotic-assisted locomotor training was effective for reducing knee joint stiffness and improving extensor torque during functional gait. Moreover, the Walkbot-STIFF system was useful for assessing and monitoring spasticity during locomotor training. Show more

Keywords: Assistive device, cortical disinhibition, muscle stiffness, robotic-assisted gait training, stroke

DOI: 10.3233/NRE-130907

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 833-838, 2013

Authors: Facchin, Alessio | Beschin, Nicoletta | Toraldo, Alessio | Cisari, Carlo | Daini, Roberta

Article Type: Case Report

Abstract: Objectives: Prism Adaptation (PA) is a technique used in the rehabilitation of unilateral spatial neglect. Several researchers have reported positive results on a number of tasks, but negative outcomes have also been reported. These conflicting results could be due to the use of prisms of different power. The aim of this study was to investigate the amplitude and duration of the aftereffect induced by prisms of different power by different measures in a series of single cases of neglect. Methods: Five neglect patients and ten control subjects participated in the study. Prism adaptation was evaluated with Subjective Straight …Ahead (SSA), Open-Loop Pointing (OLP) and Line Bisection (LB) tasks, immediately before prism adaptation, immediately after, and 10/60 minutes after prism adaptation. The procedure was repeated with prisms of 5, 10 and 20 prismatic diopters (Δ ). Results: The OLP task provided the most sensitive measures for the size of the aftereffect. The 20Δ prism proved to be most effective in inducing an immediate aftereffect, while the aftereffect of the 5Δ prism seemed to last longer. Conclusion: We showed that the prism power and the task used for assessing PA effect are relevant variables to be consider in clinical practice of neglect rehabilitation. Show more

Keywords: Prism adaptation, neglect, neuropsychological rehabilitation, open loop pointing, straight ahead, line bisection

DOI: 10.3233/NRE-130908

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 839-853, 2013

Authors: Di Pancrazio, L. | Bellomo, R.G. | Franciotti, R. | Iodice, P. | Galati, V. | D'Andreagiovanni, A. | Bifolchetti, S. | Thomas, A. | Onofrj, M. | Bonanni, L. | Saggini, R.

Article Type: Research Article

Abstract: Background: Progressive supranuclear palsy (PSP) is an atypical parkinsonism clinically characterized by prominent axial extrapyramidal motor symptoms with frequent falls. The clinical response to L-dopa is poor and there is strong need for alternative treatment strategies. Methods: We tested the efficacy of a rehabilitative program combining a dynamic antigravity postural system (SPAD) and a vibration sound system (ViSS) on postural instability of 10 patients affected by PSP. The patients underwent SPAD and VISS treatments with a 3 sessions/week schedule for 2 months. Patients were clinically examined at baseline, every week during the 2-months treatment, and at 1 …month after the end of treatment for the following parameters: baropodometry static, baropodometry dynamic and stabilometry. PSP rating scale and PD36 quality of life scale were also administered. Results: The combined rehabilitative program produced improvement of all the parameters explored (p = 0.01–0.05) at the end of treatment as compared to baseline. Baropodometric dynamics improvement lasted until the end of follow-up. Conclusion: Our results suggest that a specific rehabilitation program could improve postural instability in PSP patients. A more continuous treatment protocol would allow stabilizations of results. Show more

Keywords: Progressive supranuclear palsy, rehabilitation, SPAD, VISS

DOI: 10.3233/NRE-130909

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 855-860, 2013

Authors: Yeo, Sang Seok | Chang, Pyung-Hun | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: Motor control of musculature of proximal and distal joints has been suggested to differ. However, no study comparing patterns of activation between movements of proximal and distal joints has been conducted. In this study, using functional near infrared spectroscopy (fNIRS), we attempted to compare patterns of cortical activation generated during movements of shoulder and hand. Methods: Nine normal subjects were recruited. fNIRS was performed using a fNIRS system with 49 channels. Flexion-extension movements of the right shoulder or hand were performed. We measured values of oxy-hemoglobin (HbO) and total-hemoglobin (HbT) in three regions of interest: the …primary sensory-motor cortex (SM1), the premotor cortex (PMC), and the prefrontal cortex (PFC). The relative activation ratio of HbO and HbT was estimated for comparison of the relative activity of the left PMC or PFC to the left SM1. Results: Mean values of HbO and HbT of the left SM1, PMC, and PFC were higher during movements of the right shoulder, compared with movements of the left hand. Relative activation ratios for movements of the right shoulder (HbO: PMC-104.5%, PFC-110.9%; HbT: PMC-136.3%, PFC-200.1%) were greater than 100%, and, by contrast, less than 100% (HbO: PMC-57.5%, PFC-84.8%; HbT: PMC-88.9%, PFC-70.3%) for movements of the right hand. Conclusions: Our results appear to indicate that movements of the shoulder require greater neural recruitment than movements of the hand. In addition, the PMC and PFC appeared to have greater involvement than the SM1 in movements of the shoulder; by contrast, the SM1 appears to have greater involvement than the PMC and PFC in movements of the hand. Show more

Keywords: Functional NIRS, motor control, corticospinal tract, corticoreticulospinal tract

DOI: 10.3233/NRE-130910

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 861-866, 2013

Authors: Radziszewski, Krzysztof

Article Type: Research Article

Abstract: Introduction: The complications of neurogenic dysfunction of the urinary bladder still constitute an important cause of death among spinal cord injury patients. Aim of study: The aim of this study was to assess transcutaneous electrical stimulation of the urinary bladder as a treatment for micturition disorders in patients after spinal cord injury (SCI) over 2 years of follow-up. Material and methods: The study involved 28 patients (22 men and 6 women) with neurogenic bladder dysfunction following a spinal cord injury. The patients were 16 to 68 years old and 2 to 26 months since their spinal …cord injury. The therapeutic programme involved 30 sessions of electrical stimulation of the urinary bladder, five sessions per week. The outcomes of electrical stimulation were assessed by comparing the results of urodynamic examinations performed before treatment, immediately on completion of the treatment and at 24 months post-treatment. Results: Transcutaneous electrical stimulation of the urinary bladder produced a significant increase in bladder capacity (p = 0.001), which was higher by a mean of 117.7 ml immediately on completion of the treatment and a mean of 101.6 ml (p = 0.018) two years after the treatment. The amount of post-void residual urine in the bladder decreased by a mean of 81.9 ml (p = 0.007) immediately after completion of the treatment and a mean of 76.9 ml (p = 0.011) two years after the treatment. Opening pressure was lower by a mean of 3.1 cm H2 O (p > 0.05) immediately on completion of the electrical stimulation treatment. Intravesical pressure at maximum flow decreased in 19 patients (68%) by a mean of 11.6 cm H2 O (p > 0.05). At the late follow-up assessment, opening pressure was lower in 17 patients (68%) by a mean of 6.7 cm H2 O. Two patients demonstrated the micturition phase, which had been absent at baseline and immediately after completion of the treatment. Opening pressure in the entire group was lower compared to baseline by 2.9 cm H2 O (p > 0.05). Also in the late follow-up assessment, intravesical pressure at maximum flow was reduced in 21 patients (79%) by a mean of 9.6 cm H2 O (p > 0.05). The maximum voiding velocity increased by a mean of 3.8 ml/s (p = 0.008) immediately after treatment completion and by a mean of 3.6 ml/s (p < 0.001) at two years post-treatment. Conclusions: Transcutaneous electrical stimulation of the neurogenic bladder in patients following spinal cord injury improves lower urinary tract function. Improved urinary tract function is seen two years following completion of the electrical stimulation treatment. Show more

Keywords: Neurogenic urinary bladder dysfunction, spinal injuries, urodynamic examination, electrical stimulation of the urinary bladder

DOI: 10.3233/NRE-130911

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 867-873, 2013

Authors: Cantor, Joshua B. | Gordon, Wayne | Gumber, Shinakee

Article Type: Research Article

Abstract: Background: Fatigue is among the most common sequelae of traumatic brain injury (TBI). Objectives: To summarize the empirical and theoretical literature on Post TBI fatigue (PTBIF) and identify some of the challenges that continue to confront clinicians, researchers and individuals with TBI. Methods: Qualitative literature review. The epidemiology, characteristics, and correlates of PTBIF are described. Challenges in the operational definition and measurement of fatigue are discussed and the empirical literature on measurement of PTBIF and theoretical models of the potential etiology of PTBIF is summarized. Existing treatments of PTBIF and the research supporting them are reviewed. …Future directions for clinical research are presented. Results: Although PTBIF is a high incidence condition after TBI that is related to significant suffering and reduced quality of life, it remains inadequately measured and treated. Its etiology and precipitants are poorly understood and intervention research is inadequate. Conclusion: Further research is necessary to develop psychometrically-sound objective and subjective measures of PTBIF and examine the efficacy of treatments for fatigue. Interventions shown to improve fatigue in other populations should be considered in treating PTBIF. Show more

Keywords: Traumatic Brain Injury, fatigue, epidemiology, assessment, treatment

DOI: 10.3233/NRE-130912

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 875-883, 2013

Authors: Copley, Jodie | Kuipers, Kathy | Fleming, Jenny | Rassafiani, Mehdi

Article Type: Research Article

Abstract: AIM: To evaluate the effect of individualized resting mitt splints on hypertonicity (spasticity and tissue stiffness) and passive range of motion (PROM). METHODS: A randomized, single blinded, single case design. Ten adults with acquired brain injury were randomized to control (no-splint) and experimental (splint) groups. The experimental group received an individualized (wrist position, wearing schedule) thermoplastic resting mitt splint. Measures included wrist and finger PROM, muscle stiffness (Modified Ashworth Scale), and spasticity (Modified Tardieu Scale) which were taken at five time points. RESULTS: Between-group analyses indicated a statistically significant effect on PROM at the wrist (d = 2.14, CI95 …= 0.57, 3.72, p < 0.05) and clinically important effects on finger PROM, and wrist and finger spasticity and stiffness. Within-group analyses indicated that splint-wear resulted in positive clinical effects ranging from zero effect (maintenance of pre-splinting status) to a large positive treatment effect. Non splint-wear resulted in negative clinical effects ranging from zero effect to a large negative treatment effect. CONCLUSION: Individualized resting splints for adults with moderate hypertonicity and no soft tissue contracture resulted in positive clinical effects to PROM, muscle stiffness and spasticity. Long-term splint-wear may be more beneficial than short-term wear, and may prevent the negative changes evident with no splint-wear. Resting hand splints should be considered for a select group where reduction in muscle stiffness and spasticity, or maintenance of PROM, is desired. Show more

Keywords: Hypertonicity, spasticity, upper limb, splinting

DOI: 10.3233/NRE-130913

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 885-898, 2013

Authors: Wallace, Sarah E. | Kimelman, Mikael D.Z.

Article Type: Research Article

Abstract: Objectives: The effectiveness of a Semantic Feature Treatment (SFT) at increasing word retrieval accuracy of untreated words was examined in relation to the influence of the number of shared features with treated words. Generalization of these improvements to discourse was also examined. Methods: Three adults with chronic aphasia completed 12 SFT sessions. Generalization to untreated words with many shared features (SFs) and with no shared features (NSFs), as well as generalization to discourse tasks, was analyzed. Results: All participants improved in word retrieval accuracy for treated words. Accuracy of retrieving untreated words improved for two participants. …Retrieval accuracy for untreated words with SF improved more than for words with NSF. Generalization of improvements to discourse tasks occurred for two participants. Conclusions: SFT improves word retrieval accuracy for some people with aphasia during confrontation naming and discourse tasks. Generalization may be slightly higher for untreated words with SFs than untreated words with NSFs. Future research is needed to further investigate the effect shared features have on generalization of improvements, and to determine candidacy for SFT. Show more

Keywords: Aphasia, semantic feature treatment, generalization, word retrieval

DOI: 10.3233/NRE-130914

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 899-913, 2013

Authors: Barwood, Caroline H.S. | Murdoch, Bruce E. | Riek, Stephan | O'Sullivan, John D. | Wong, Andrew | Lloyd, David | Coulthard, Alan

Article Type: Research Article

Abstract: Background: Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential therapeutic tool for the rehabilitation of language in chronic non-fluent aphasia post-stroke. Previous studies report that low frequency (1 Hz) rTMS applied to homologous language sites can facilitate behavioural language changes. Improvements in picture naming performance and speech output are frequently reported. Objectives: This study aims to assess the efficacy of inhibitory rTMS to modulate language performance in non-fluent aphasia. Methods: Low-frequency (1 Hz) rTMS was applied to six active stimulation and six placebo patients for 20 min per day over 10 days, as outlined …in a previous published investigation. Behavioural language outcome measures were taken at baseline (pre-stimulation) and 1 week, 2 months, 8 months and 12 months post-stimulation. Results: The findings demonstrate treatment-related changes observed in the stimulation group, up to 12 months post-stimulation, when compared to the placebo control group over time for naming performance, expressive language and auditory comprehension. Conclusion: These outcomes provide considerable evidence to support the theory of rTMS modulating mechanisms of transcallosal disinhibition in the aphasic brain, and highlight the potential clinical application of rTMS for language rehabilitation in chronic aphasia. Show more

Keywords: Non-fluent aphasia, aphasia, transcranial magnetic stimulation, TMS, rehabilitation, stroke, language

DOI: 10.3233/NRE-130915

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 915-928, 2013

Authors: Tamplin, Jeanette | Baker, Felicity A. | Jones, Bronwen | Way, Anneliis | Lee, Stuart

Article Type: Research Article

Abstract: Background: Communication deficits resulting from aphasia can negatively impact stroke survivors' relationships and social participation. Despite their difficulties, singing is accessible and enjoyable for many people with aphasia. Objectives: To explore the effects of group singing for people with aphasia. Methods: A community choir was established and facilitated by a neurologic music therapist. Mood (General Health Questionnaire-12; Visual Analogue Mood Scale), communication, cognition and global functioning (Stroke Impact Scale-3) and social functioning (Sense of Belonging Instrument) were measured before, and at 12-weeks and 20-weeks after joining the choir. Three choir members and five caregivers also completed …semi-structured interviews about their experience of the choir. Results: Baselines measures were collected for 13 participants with aphasia. Prior to joining the choir, participants had higher levels of negative mood symptoms and poorer subjective sense of belonging compared to Australian general population samples. Results from the GHQ-12 suggested a trend towards reduction of psychological distress after participating in the choir. Thematic analysis of the interviews revealed five common themes: increased confidence, peer support, enhanced mood, increased motivation, and changes to communication. Conclusion: The strength of findings was limited by the number of participants and lack of a control group, however clear benefits of choir participation were demonstrated. Preliminary findings were encouraging and warrant further rigorous investigation. Show more

Keywords: Singing, music therapy, choir, aphasia, stroke, communication, well-being, mood

DOI: 10.3233/NRE-130916

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 929-941, 2013

Authors: Kalron, Alon | Greenberg-Abrahami, Michal | Gelav, Simona | Achiron, Anat

Article Type: Research Article

Abstract: Objective: To describe and evaluate the effects of a new home-based sensory re-education training tool on hand sensibility and manual dexterity in people with MS experiencing upper limb sensory deficits. Methods: Twenty-five people with relapsing-remitting MS (18 women), mean age 50.6 years (SD = 11.4), volunteered to participate. Participants were initially assigned to a 7-week control phase followed by a 3-week home-based sensory re-education phase. Measurements used were the nine-hole peg test, the two point discrimination test, the monofilaments test and the functional dexterity test. Measurements were collected at baseline, following the control phase and at the end …of the trial. Results: Participants demonstrated an improvement in the nine-hole peg (26.8 (SD = 3.5) vs. 22.6 (SD = 3.2); mean difference (95% CI) 4.9 (0.9, 7.1), P = 0.03) and functional dexterity tests (38.6 (SD = 4.4) vs. 33.8 (SD = 4.9); mean difference (95% CI) 4.8 (1.8, 7.0); P = 0.02) at the end of the sensory re-education phase compared to the end of the control phase. No differences were observed as to the monofilaments and two-point discrimination tests. Conclusions: Sensory re-education training does not affect the level of sensory impairment in the hand but may lead to improvement in select measures of manual dexterity. Show more

Keywords: Multiple sclerosis, sensory deficits, sensory retraining, manual dexterity

DOI: 10.3233/NRE-130917

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 943-948, 2013

Authors: Argolo, Natalie | Sampaio, Marília | Pinho, Patrícia | Melo, Ailton | Nóbrega, Ana Caline

Article Type: Research Article

Abstract: Objective: To investigate the effect of motor swallowing exercises on swallowing dynamic, quality of life and swallowing complaints in Parkinson's disease (PD). Design: A before-after trial. Setting: University Medical Center. Participants: Parkinson's disease patients with dysphagia complaints. Interventions: Motor swallowing exercises designed to increase the strength and range of motion of the mouth, larynx and pharyngeal structures, coordination between breathing and swallowing, and airway protection. Patients should perform the exercises twice a day, five days a week, for five weeks. Main outcome measure(s): The primary outcome was the difference before …and after the intervention in number of swallowing videofluoroscopic events (Swallowing Score). The secondary outcomes were quality of life (QOL) and swallowing complaints. Results: Fifteen patients concluded the study (10 man/5 woman; mean age 59.2 ± 9.17). The videofluoroscopic events with greater improvement were loss of bolus control (P < 0.03), piecemeal swallow (P = 0.05) and residue on the tongue (P < 0.01), valleculae (P = 0.01) and pyriform sinuses (P = 0.05). Lingual pumping and dental absence were interfering factors associated with treatment failure (beta standardized coefficient = −16.6, 26.2; P = 0.02, 0.002, respectively). The domains with greater improvements in QOL were fear (P = 0.02) and symptom frequency (P = 0.05). Regarding swallowing complaints, patients reported to have reduced mainly their difficulty in moving food in the mouth when chewing (P = 0.02). Reduction in swallowing disorders was not related with QOL improvement (cor = 0.13, [95% CI, 0.6–0.4], P = 0.63). Conclusions: Motor swallowing exercises may reduce swallowing disorders in PD patients without lingual pumping and dental absence and impact positively QOL and swallowing complaints in individuals with PD. Show more

Keywords: Parkinson's disease, rehabilitation, deglutition disorders

DOI: 10.3233/NRE-130918

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 949-955, 2013

Authors: Johnston, Maureen | de Morton, Natalie | Harding, Katherine | Taylor, Nick

Article Type: Research Article

Abstract: Question: Is the de Morton Mobility Index (DEMMI) valid for measuring the mobility of patients living in the community with Parkinson disease (PD)? Design: A prospective cohort study comparing the DEMMI with existing mobility-related activity measures. Participants: 102 consecutive patients with PD (mean age 72.4 years, SD 8.3) who received multidisciplinary outpatient care in a community rehabilitation facility over 6 to 8 weeks. Outcome measures and analysis: The DEMMI and other measures of mobility-related activity at admission and discharge (10 metre walk test, Berg balance scale, timed up and go test, functional reach test …and pull test) were used to assess convergent validity. Discriminant validity of the DEMMI was assessed by comparison to measures of other constructs, and. unidimensionality was examined using Rasch analysis. Results: Evidence of convergent (rho ranged from 0.47 to 0.84), discriminant (rho ranged 0.12 to 0.22), and known groups validity were obtained for the DEMMI (Mean difference 20.3 units, 95% CI 14.5 to 26.0). Rasch analysis confirmed that the DEMMI was unidimensional. Conclusion: The DEMMI has a broader scale width than existing mobility-related activity measures, provides interval level measurement and is a unidimensional measure of mobility in patients with PD living in the community. Show more

Keywords: Parkinson disease, mobility measurement, DEMMI scale, mobility outcome, balance

DOI: 10.3233/NRE-130919

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 957-966, 2013

Authors: Cheng, S.P. | Yang, C.Y. | Tang, F.I. | Chen, I. Ju

Article Type: Research Article

Abstract: Background: Introducing evidence-based exercise guidelines of Parkinson's disease (PD) into clinical practice and community settings has been highlighted. Aim: This study tested the feasibility and compared the weekly effects of a 12-week walking training program on PD patients and community-dwelling seniors. Design: A prospective quasi-experimental design was used. PD patients in Hoehn and Yahr Stage I through III (PG) and community-dwelling adults older than 65 were recruited (CG). Methods: In the outpatient department of a hospital, the information of personal data, coordination test, and walking ability of participants were collected first. They then participated …in a 36-session, 12-week treadmill walking training program. Results: Weekly data of step length and velocity in PG and CG were collected. The walking training program achieved significant velocity (χ2 = 126.38, p < 0.001) and step length (χ2 = 27.27, p = 0.001) improvements in PG. Differences in improvement between PG and CG in terms of velocity (χ2 = 7.089, df = 1, p = 0.008) and step length (χ2 = 7.718, df = 1, p = 0.005) were also identified. Conclusion: The applicability of this 12-week walking program both for PD patients and community-dwelling older adults was identified. Conducting the economic evaluation and neurology studies of the 12-week walking program and test the effects of five-week walking program are suggested. Show more

Keywords: Parkinson disease, aged, rehabilitation, walking

DOI: 10.3233/NRE-130920

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 967-976, 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: Correction

DOI: 10.3233/NRE-130983

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 977-977, 2013

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

Article Type: Correction

DOI: 10.3233/NRE-130984

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 979-979, 2013

Article Type: Other

DOI: 10.3233/NRE-2013-32430

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 981-988, 2013

Article Type: Other

DOI: 10.3233/NRE-2013-32431

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 989-992, 2013