NeuroRehabilitation - Volume 34, issue 4

Authors: Jacobs, Harvey E.

Article Type: Editorial

DOI: 10.3233/NRE-141069

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 597-599, 2014

Authors: Buzan, Randall D. | Kupfer, Jeff | Eastridge, Dixie | Lema-Hincapie, Andres

Article Type: Research Article

Abstract: Introduction: Patients and their families struggle with accepting changes in personality after traumatic brain injury (TBI). A neuroanatomic understanding may assist with this process. Objectives: We briefly review the history of the Western conceptualization of the Self, and discuss how neuroscience and changes in personality wrought by brain injuries modify and enrich our understanding of our selves and our patients. Conclusion: The sense of self, while conflated with the concept of a “soul” in Western thinking, is more rationally considered a construct derived from neurophysiologic structures. The self or personality therefore often changes when the brain …changes. A neuroanatomic perspective can help patients, families, and clinicians accept and cope with the sequellae of TBI. Show more

Keywords: Traumatic brain injury, personality change, philosophy of mind

DOI: 10.3233/NRE-141071

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 601-611, 2014

Authors: Wortzel, Hal S. | Arciniegas, David B.

Article Type: Research Article

Abstract: Introduction: The advent of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is accompanied by substantial changes in the approach taken in this manual to traumatic brain injury (TBI) and its neuropsychiatric sequelae. Objective: This article reviews the issues pertaining to the treatment of TBI in the DSM-5, and changes relative to the outgoing DSM-IV-TR. The primary context for discussion of TBI in the DSM-5 is the section on Neurocognitive Disorders, where a basic framework is provided for the retrospective diagnosis of TBI and characterization of the clinical presentation as a Mild or Major Neurocognitive …Disorder. The distinctions between these conditions rest not on the initial severity of TBI but instead on the severity of posttraumatic cognitive impairments and their effects on everyday function. The text succinctly reviews the epidemiology, phenomenology, and natural history of TBI and highlights the need to consider the differential diagnosis for persistent postconcussive symptoms. Conclusion: The approach taken to the diagnosis of TBI and its neuropsychiatric consequences in the DSM-5 is improved substantially over that of the DSM-IV-TR, and it is likely to improve the evaluations of persons with TBI by mental health professionals. However, challenges borne of this approach are likely to be revealed as it is implemented in everyday practice and will guide the development of this section of DSM-5.1. Show more

Keywords: Traumatic brain injury, cognition disorders, DSM-5

DOI: 10.3233/NRE-141086

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 613-623, 2014

Authors: Webb, Nadia E. | Little, Brittany | Loupee-Wilson, Stephanie | Power, Elizabeth M.

Article Type: Research Article

Abstract: Introduction: Traumatic Brain Injury (TBI) initiates a cascade of neuromodulatory damage that blurs the distinctions between physical and psychological medicine. Monitoring endocrine function through labs is not part of the medical care algorithm for treatment of TBI, but the clinical symptoms are easily misidentified as they include: depression, fatigue, poor concentration, irritability and a decline in overall cognitive functioning. The reciprocal flow of change between neuroendocrine health and psychosocial health is well established within the field of neuroscience, social psychology, endocrinology and behavioral neurology, but has not translated into patient care. Objectives: This paper outlines common neuroendocrine disruptions …secondary to TBI and their clinical implications for treating mental health professionals. Conclusion: Wider adoption of the consensus guidelines on the detection and monitoring of endocrine abnormalities post-TBI may diminish the severity of functional impairment and improve quality of life. Show more

Keywords: HPA axis, psychoneuroimmunology, TBI, endocrine, social isolation, anterior pituitary, hypopituitarism, brain injury, PTSD, neuroendocrine injury, neurorehabilitation

DOI: 10.3233/NRE-141074

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 625-636, 2014

Authors: McQueen, Ryan | O'Shanick, Gregory J.

Article Type: Research Article

Abstract: Background: While acute rehabilitation following neurotrauma has evolved over the past 30 years to include the common use of pharmacologic agents to promote synaptogenesis and improve recovery potential, little guidance exists for a similar strategy in the post-acute or community re-entry phases of injury. Drawing upon the existing scientific literature, models of pharmacologic intervention in promoting stability in other disease states and the authors' collective clinical experience, this article provides a potential structure by which to implement methods to create a stable physiologic platform to facilitate behavioral intervention. Objectives: This article reviews basic foundations for physiologic optimization, pharmacologic …strategies for facilitation, and dyscompliance after neurotrauma. Methods: Literature review, case analysis, clinical experience. Results: Guidelines for facilitation of behavioral intervention with physiologic stabilization and with pharmacologic agents are presented with clinical rationale for their utilization. Conclusions: Improving physiologic readiness for behavioral intervention in the post-acute and community re-entry phases following neurotrauma has potential to improve both the efficiency and durability of these efforts. Show more

Keywords: Neurotrauma, pharmacology, interventions, behavioral facilitation, post-acute, community re-entry

DOI: 10.3233/NRE-141070

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 637-643, 2014

Authors: Lequerica, Anthony | Krch, Denise

Article Type: Research Article

Abstract: Introduction: With the general population in the United States becoming increasingly diverse, it is important for rehabilitation professionals to develop the capacity to provide culturally sensitive treatment. This is especially relevant when working with minority populations who have a higher risk for brain injury and poorer rehabilitation outcomes. Objectives: This article presents a number of clinical vignettes to illustrate how cultural factors can influence behavior in patients recovering from brain injury, as well as rehabilitation staff. The main objectives are to raise awareness among clinicians and stimulate research ideas by highlighting some real world examples of situations where …a specialized, patient-centered approach needs to consider factors of cultural diversity. Conclusion: Because one's own world view impacts the way we see the world and interpret behavior, it is important to understand one's own ethnocentrism when dealing with a diverse population of patients with brain injury where behavioral sequelae are often expected. Being able to see behavior after brain injury with an open mind and taking into account cultural and contextual factors is an important step in developing culturally competent rehabilitation practices. Show more

Keywords: Culture, diversity, rehabilitation, brain injury

DOI: 10.3233/NRE-141079

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 645-653, 2014

Authors: Karol, Robert L.

Article Type: Research Article

Abstract: Introduction: Neurorehabilitation requires a team effort. Over time the nature of teams has evolved from single discipline work through multi-disciplinary and inter-disciplinary teams to trans-disciplinary teams. However, there are inconsistencies in the literature and clinical practice as to the structure and function of these team models. Each model engenders advantages over its predecessor and unless the models are well understood clinicians may labor in a model that is less efficacious than the most transcendent model. Objectives: To define and examine the models of single discipline care, multi-disciplinary teams, inter-disciplinary teams, and trans-disciplinary teams and to review in depth …trans-disciplinary teams as the most advanced team model. This paper will also consider professional roles and integration across disciplines as well as the crucial topics of staff selection, attendance in rounds and the nature of rounds, staff physical plant assignments, and leadership responsibilities. Leadership responsibilities that will be addressed include scope of practice and role release, peer pressure, and culture change issues. Conclusions: The trans-disciplinary model is the gold standard for teams in neurorehabilitation because they entail more integrated service delivery than do other teams. Trans-disciplinary teams also represent a more persons-centered approach. To initiate a trans-disciplinary model, team members must have excellent communication and shared decision making including persons with brain injury. Leadership must address staff selection, scope of practice and role-release. Otherwise, the model will fail due to peer pressure and institutional or program cultural variables. Show more

Keywords: Team models, rehabilitation teams, multidisciplinary, interdisciplinary, transdisciplinary, role release, scope of practice, culture change

DOI: 10.3233/NRE-141080

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 655-669, 2014

Authors: Huckshorn, Kevin Ann | LeBel, Janice | Jacobs, Harvey E.

Article Type: Research Article

Abstract: Introduction: Seclusion, restraint (S/R) and coercive practices are used across human service populations, settings, with people of all ages. Their use has been increasingly scrutinized by the public, federal government and the media. Alternatives, interventions, and organizational approaches to these forms of containment are now emerging and advancing practice. Aim/purpose: This article provides an overview of the work conducted to reduce the use of coercion restraint, seclusion and other invasive practices in behavioral health settings that often include the defacto admission of persons with Acquired Brain Injury (ABI). The article also examines treatment culture factors that can exacerbate …behavior dysfunction and how to moderate such challenges to prevent the use of S/R procedures among people with ABI. Conclusion: Seclusion and restraint can be avoided and greatly reduced in settings serving people with ABI. When S/R use is recognized as an inadequate organizational response to harmful behavior that maintains patterns of aggression or harm, leadership-driven core strategies can be implemented to disrupt the behavioral sequence. The Six Core Strategies© provide a prevention based framework to anticipate challenge, intervene early, and analyze the factors that contribute to maintaining the cycle of violence if S/R is used. Show more

Keywords: Restraint, seclusion, coercion, acquired brain injury, mental health, treatment, trauma

DOI: 10.3233/NRE-141073

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 671-680, 2014

Authors: Jackson, Howard F. | Hague, Gemma | Daniels, Leanne | Aguilar Jr., Ralph | Carr, Darren | Kenyon, William

Article Type: Research Article

Abstract: Introduction: The importance of structure in post-acute brain injury rehabilitation is repeatedly mentioned in clinical practice. However, there has been little exploration of the key elements of structure that promote greater levels of functioning and emotional/behavioural stability and how these elements are optimally integrated within the infrastructure of a rehabilitation service. Objectives: The nature of structure and why it is helpful is explored initially. Thereafter, the processes involved in transition from externally supported structure to the client ‘self-structuring’ are described. The infrastructure for facilitating these transitional processes are considered in terms of the design of services for systemic …neurorehabilitation encompassing environmental factors (e.g. living environments, vocational and recreational options, step-up services and social milieus), therapeutic alliances (rehabilitation professionals, family, friends), organisational structures (service delivery, rehabilitation coaching, transdisciplinary teams) and rehabilitation philosophies and practice. Conclusion: It is concluded that the process of supporting individuals to transition from the ‘structure’ of the environment and other people towards self-structuring skills is a critical process in rehabilitation. This is reliant upon a comprehensive and robust organisational infrastructure that can successfully and flexibly integrate the core elements of structure across a transitional pathway towards increased independence and self-structuring. Show more

DOI: 10.3233/NRE-141082

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 681-694, 2014

Authors: Jackson, Howard F. | Tunstall, Victoria | Hague, Gemma | Daniels, Leanne | Crompton, Stacey | Taplin, Kimberly

Article Type: Research Article

Abstract: Background: Jackson et al. (this edition) argue that structure is an important component in reducing the handicaps caused by cognitive impairments following acquired brain injury and that post-acute neuropsychological brain injury rehabilitation programmes should not only endeavour to provide structure but also aim to develop self-structuring. However, at present there is no standardized device for assessing self-structuring. Objective: To provide preliminary analysis of the psychometric properties of the Behavioural Assessment of Self-Structuring (BASS) staff rating scale (a 26 item informant five point rating scale based on the degree of support client requires to achieve self-structuring item). …Methods: BASS data was utilised for clients attending residential rehabilitation. Reliability (inter-rarer and intra-rater), validity (construct, concurrent and discriminate) and sensitivity to change were investigated. Results: Initial results indicate that the BASS has reasonably good reliability, good construct validity (via principal components analysis), good discriminant validity, and good concurrent validity correlating well with a number of other outcome measures (HoNOS; NPDS, Supervision Rating Scale, MPAI, FIM and FAM). The BASS did not correlate well with the NPCNA. Finally, the BASS was shown to demonstrate sensitivity to change. Conclusions: Although some caution is required in drawing firm conclusions at the present time and further exploration of the psychometric properties of the BASS is required, initial results are encouraging for the use of the BASS in assessing rehabilitation progress. These findings are discussed in terms of the value of the concept of self-structuring to the rehabilitation process for individuals with neuropsychological impairments consequent on acquired brain injury. Show more

DOI: 10.3233/NRE-141087

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 695-708, 2014

Authors: Feeney, Timothy J. | Achilich, Jason

Article Type: Research Article

Abstract: Background: A significant number of individuals with brain injury demonstrate behavioral challenges that negatively affect their ability to live successfully in community settings. While there are a number of treatment approaches that have demonstrable effects in well controlled clinical settings, it is very difficult to implement these approaches in natural settings. Objectives: The goal of this study was to report the results of an investigation of the effects of a multicomponent behavioral intervention on the challenging behavior of an adolescent and young adult with growing behavioral concerns after acquired brain injury (TBI). Methods: The participants were …an 16 year old adolescent male and a 24 year old female, with escalating behavior problems after severe TBI. Multiple baseline designs were used to document the effects of an intervention package that integrated cognitive and executive function intervention to address severe challenging behaviors in natural settings. The following dependent variables were used to establish the effectiveness of the interventions: frequency and intensity of aggressive behaviors and participation in scheduled activities. The intervention included integrated components of positive behavior supports, cognitive supports and specific executive function scripts. Results: These single subject experiments demonstrated the effectiveness of a multicomponent intervention on the reduction of the frequency of problem behaviors and the increase of pro-social behaviors. Conclusion: These two successful interventions extended the findings of previously published data for the successful treatment of behavioral challenges using a flexible support-oriented intervention that combines behavioral, cognitive, and executive function components. Show more

Keywords: Behavior disorders, neurorehabilitation, traumatic brain injury, positive behavior support, cognitive-behavioral intervention, functional assessment, context sensitive treatment, multi-component intervention

DOI: 10.3233/NRE-141088

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 709-723, 2014

Authors: Suzuki, Toshiaki | Bunno, Yoshibumi | Onigata, Chieko | Tani, Makiko | Uragami, Sayuri

Article Type: Research Article

Abstract: Background: No scientific basis exists for the effect of motor imagery with eyes open. Objective: To investigate spinal neural function during motor imagery and at rest with eyes open or closed by analyzing F-waves generated by the left thenar muscles after left median nerve stimulation. Methods: Sixteen healthy volunteers performed motor imagery while achieving 50% maximal voluntary contraction by isometrically contracting the opponens pollicis muscle. For subjective comparisons after the test, patients were asked whether imaging was easier with eyes open or closed and were then asked to imagine the contraction while holding the sensor between …thumb and index finger with eyes open or closed. Results: Persistence during motor imagery under both visual conditions tended to increase compared with that at rest. F/M amplitude ratio was significantly higher during motor imagery under both visual parameters than at rest. Most subjects (14/16) found imaging easier with eyes open, but no relationship was found between F-wave data and subjective evaluations to determine the easier condition for motor imagery. Conclusion: Motor imagery with eyes open or closed increased the excitability of spinal neural output to the thenar muscles. However, subjective evaluation to determine the easier visual condition for motor imagery revealed insignificant results. Show more

Keywords: Motor imagery, eye condition, F-wave

DOI: 10.3233/NRE-141085

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 725-729, 2014

Authors: Swinnen, Eva | Baeyens, Jean-Pierre | Pintens, Seppe | Van Nieuwenhoven, Johan | Ilsbroukx, Stephan | Buyl, Ronald | Ron, Clijsen | Goossens, Maggie | Meeusen, Romain | Kerckhofs, Eric

Article Type: Research Article

Abstract: Background: Although body weight supported (BWS) treadmill training (TT) leads to some improvements in walking ability, it has not been proven that it is more effective than other walking therapies in persons with multiple sclerosis (PwMS). One possible explanation could be that BWSTT focuses on the cyclic movement of the lower extremities while the trunk is passively suspended in the harness. Objective: This study aimed to assess the 3 dimensional trunk and pelvis movements during BWS treadmill walking. Methods: 14 PwMS and 14 healthy persons (8 male/20 female; age 23 to 59 years) walked with 0%, …10%, 20%, 30%, 50% and 70% BWS. After a familiarization period, kinematic electromagnetic tracking (Polhemus Liberty™ 240/16) of the trunk and pelvis movements was applied. Statistical analysis consisted of a repeated measures ANOVA with simple contrasts (SPSS 20). Results: This study shows that BWS walking leads in general to smaller maximum trunk and pelvis movement amplitudes compared with walking without BWS, this with exception of the pelvis anterior-posterior movement in healthy subjects. conclusion: These data help to identify and isolate the effect of different BWS levels in PwMS and in healthy persons and suggest to use BWS lower than 30% for treadmill training. Show more

Keywords: Body weight support, gait, gait analysis, kinematics, multiple sclerosis, pelvis, rehabilitation, treadmill, trunk, walking

DOI: 10.3233/NRE-141089

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 731-740, 2014

Authors: King, Nigel

Article Type: Research Article

Abstract: Background: Older age and female gender are known factors in the development of persisting post concussion symptoms (PCS) following mild head injury (MHI). Very few studies however have examined these variables in permanent PCS. Objective: This systematic review empirically examines the extent to which such factors pertain to this group. Methods: Systematic electronic data base searches identified all long-term studies of two types: first, those with correlations between age or gender and outcome; second, those providing the mean ages or gender mixes of samples selected for poor outcome and samples not selected for such. …Results: Twenty studies from 1341 abstracts were ultimately analysed. Correlation studies showed poorer outcome to be associated with both older age (3/4 studies) and female gender (2/4 studies). Those with poor long-term outcome had a significantly higher mean age (40.6) than non-selected patients (32.5). The proportion of men in selected samples (54.8%) was significantly lower than those in non-selected ones (66.5%). Conclusions: Older age is a strong vulnerability factor in the development of permanent PCS and female gender is a significant one. Show more

Keywords: Mild head injury, permanent post concussion symptoms

DOI: 10.3233/NRE-141072

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 741-748, 2014

Authors: Lancioni, Giulio E. | Singh, Nirbhay N. | O'Reilly, Mark F. | Sigafoos, Jeff | Oliva, Doretta | Buonocunto, Francesca | Sacco, Valentina | D'Amico, Fiora | Navarro, Jorge | Lanzilotti, Crocifissa | De Tommaso, Marina | Megna, Marisa

Article Type: Research Article

Abstract: Background: Interventions for post-coma persons, who have emerged from a minimally conscious state but present with extensive neuro-motor impairment and lack of or minimal verbal skills, need to promote occupation and communication through the use of assistive technology. Objective: These two studies were aimed at assessing two technology-aided programs to promote leisure engagement and communication for three post-coma participants with multiple disabilities. Methods: Study I assessed a program to allow a woman and a man with extensive neuro-motor impairment and lack of speech to switch on music and videos, make requests to caregivers, and send messages …to (communicate with) relevant partners and receive messages from those partners. Study II assessed a program to allow a post-coma woman with extensive motor impairment and reduced verbal behavior to activate music, videos and requests, send and receive messages, and make telephone calls. Results: Data showed that both programs were successful. The participants of Study I managed leisure engagement, requests, as well as text messaging. The participant of Study II showed consistent leisure engagement, text messaging, and telephone calls. Conclusions: Assistive technology can be profitably used to provide post-coma persons with multiple disabilities relevant leisure and communication opportunities. Show more

Keywords: Leisure engagement, communication, post-coma persons with consciousness, multiple disabilities, assistive technology

DOI: 10.3233/NRE-141075

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 749-758, 2014

Authors: Larson, Eric B. | Feigon, Maia | Gagliardo, Pablo | Dvorkin, Assaf Y.

Article Type: Research Article

Abstract: Background: Recent advancement in the technology of virtual reality (VR) has allowed improved applications for cognitive rehabilitation. Objectives: The aim of this review is to facilitate comparisons of therapeutic efficacy of different VR interventions. Methods: A systematic approach for the review of VR cognitive rehabilitation outcome research addressed the nature of each sample, treatment apparatus, experimental treatment protocol, control treatment protocol, statistical analysis and results. Using this approach, studies that provide valid evidence of efficacy of VR applications are summarized. Applications that have not yet undergone controlled outcome study but which have promise are introduced. …Results: Seventeen studies conducted over the past eight years are reviewed. The few randomized controlled trials that have been completed show that some applications are effective in treating cognitive deficits in people with neurological diagnoses although further study is needed. Conclusion: Innovations requiring further study include the use of enriched virtual environments that provide haptic sensory input in addition to visual and auditory inputs and the use of commercially available gaming systems to provide tele-rehabilitation services. Recommendations are offered to improve efficacy of rehabilitation, to improve scientific rigor of rehabilitation research and to broaden access to the evidence-based treatments that this research has identified. Show more

Keywords: Brain injury, rehabilitation, virtual reality, outcome

DOI: 10.3233/NRE-141078

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 759-772, 2014

Authors: Hayward, Kathryn S. | Kuys, Suzanne S. | Barker, Ruth N. | Brauer, Sandra G.

Article Type: Research Article

Abstract: Background: A good motor outcome after stroke is often equated with independence in functional performance. However, for patients with severe motor disability a good outcome is unlikely, but an important change may be achievable. Objective: Determine if patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function. Methods: A prospective observational study of 239 patients with stroke admitted to inpatient rehabilitation in Brisbane, Australia was conducted. On admission and discharge, participants were assessed using the motor items of the Functional Independence Measure (m-FIM). The importance of change achieved on …the m-FIM was evaluated according to: 1) a statistical significant outcome; 2) achievement of a MCID based on a physician-anchored rating of change; and 3) shift in disability status e.g., severe to moderate disability. Results: Patients with severe motor disability achieved a significant improvement in motor function (p < 0.001), which saw up to 83% achieve a MCID and 85% shift out of ‘severe’ to either moderate or mild motor disability on discharge from inpatient rehabilitation. Conclusion: This study demonstrates that patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function on discharge from inpatient rehabilitation. Show more

Keywords: Stroke, inpatient rehabilitation, functional recovery, severe, motor

DOI: 10.3233/NRE-141076

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 773-779, 2014

Authors: Forslund, Marit V. | Arango-Lasprilla, Juan C. | Roe, Cecilie | Perrin, Paul B. | Andelic, Nada

Article Type: Research Article

Abstract: Objectives: The aims of this study were to examine (a) predictors of partnered relationship probability trajectories and relationship stability across 1, 2, and 5 years after traumatic brain injury, and (b) influences on the slopes of these trajectories. Materials & methods: Individuals (n = 105) from Norway with acute TBI were assessed during admission to an urban trauma center and again at 1, 2 and 5 years after injury. The outcome measures were partnered relationship status (partnered vs. single) at 1, 2 and 5 years post-injury investigated through multilevel modelling, and relationship stability (stable, unstable, and single) investigated …through multinomial logistic regression. Independent variables were sex, age at injury, partnered relationship at injury, having dependent children, education, employment and occupation status at time of injury, acute Glasgow Coma Scale score, posttraumatic amnesia, and length of stay in hospital. Results: Partnered relationship status at injury and the interaction of relationship status at injury by time, employment at injury and the interaction of TBI severity by time were significant predictors of participants' relationship trajectories. Having dependent children at the time of injury, higher education, and being in a blue collar occupation at time of injury were significant predictors of relationship stability. Conclusions: The identification of these influences on partnered relationship probability trajectories and stability could help clinicians and researchers develop and refine early interventions to reduce relationship dissolution in the first several years after brain injury. Show more

DOI: 10.3233/NRE-141084

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 781-788, 2014

Authors: Dutta, Arindam | Chugh, Sanjay | Banerjee, Alakananda | Dutta, Anirban

Article Type: Research Article

Abstract: Background: Non-invasive brain stimulation (NIBS) is a promising tool for facilitating motor function. NIBS therapy in conjunction with training using postural feedback may facilitate physical rehabilitation following posture disorders (e.g., Pusher Syndrome). Objectives: The objectives of this study were, 1) to develop a low-cost point-of-care-testing (POCT) system for standing posture, 2) to investigate the effects of anodal tDCS on functional reach tasks using the POCT system. Methods: Ten community-dwelling elderly (age >50 years) subjects evaluated the POCT system for standing posture during functional reach tasks where their balance score on Berg Balance Scale was compared with …that from Center-of-Mass (CoM) – Center-of-Pressure (CoP) posturography. Then, in a single-blind, sham-controlled study, five healthy right-leg dominant subjects (age: 26.4 ± 5.3 yrs) were evaluated using the POCT system under two conditions – with anodal tDCS of primary motor representations of right tibialis anterior muscle and with sham tDCS. Results: The maximum CoP-CoM lean-angle was found to be well correlated with the BBS score in the elderly subjects. The anodal tDCS strongly (p = 0.0000) affected the maximum CoP excursions but not the return reaction time in healthy. Conclusion: It was concluded that the CoM-CoP lean-line could be used for posture feedback and monitoring during tDCS therapy in conjunction with balance training exercises. Show more

Keywords: Wii balance board, microsoft kinect, balance disorders, non-invasive brain stimulation

DOI: 10.3233/NRE-141077

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 789-798, 2014

Authors: Swanenburg, Jaap | Hegemann, Stefan C.A. | Zurbrugg, Aron | Palla, Antonella | de Bruin, Eling D.

Article Type: Research Article

Abstract: Background: The aim of his study was to evaluate the reliability and validity of the Expanded Timed Get-up-and-Go (ETGUG) test in patients with bilateral vestibular loss (BVL). Methods: 21 BVL patients (58 ± 14 years) were recruited and measured twice by two raters. After a one hour break ETGUG was repeated by the first rater. 21 age matched controls (CON; 58 ± 14 years) were measured once by the first rater. All time scores of the ETGUG for the separate tasks and gait speed calculated from tasks 3 and 5 were analysed to determine relative and absolute reliability, …smallest detectable change (SDC) and discriminatory capabilities. Results: The ETGUG scores showed good to excellent inter-rater (ICC2,1 = 0.85–0.97) and test-retest reliability (ICC3,1 = 0.86–0.98) following log-transformation for tasks 2–6. Task1 scored fair r = 0.46–0.68. The SDCs were small (SDC = 0.05–0.21 seconds). Bland-Altman plots demonstrated good agreement between the measurements. There were significant differences between BVL and CON in ETGUG scores for tasks 1, 3, 4, 5, 6 & overall time. Task 2 showed no difference between the groups. BVL patients walked slower compared to the age-matched controls. Discussion: Good reliability of the ETGUG in BVL and an indication for the discriminatory capabilities for the separate tasks suggest that the ETGUG could facilitate the study of functional deficits in BVL patients. Good reliability, small measurement error and values of SDC warrant the further utilisation of the ETGUG for the evaluation of physical functioning in BVL patients. Show more

Keywords: Reliability, validity, gait speed, bilateral vestibular loss

DOI: 10.3233/NRE-141083

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 799-807, 2014

Authors: Berney, Loric | Wasserfallen, Jean-Blaise | Grant, Kathleen | Levivier, Marc | Simon, Christian | Faouzi, Mohamed | Paillex, Roland | Schweizer, Valérie | Diserens, Karin

Article Type: Research Article

Abstract: Background/purpose: A new coordinated interdisciplinary unit was created in the acute section of the department of clinical neurosciences, the Acute NeuroRehabilitation (NRA) unit. The objective was to evaluate the impact of the unit and its neurosensory programme on the management of tracheostomy patients in terms of reduction in the average time taken for weaning, weaning success rate and therapeutic efficiency. Methods: This 49-month retrospective study compares 2 groups of tracheostomy patients before (n = 34) and after (n = 46) NRA intervention. The outcome measures evaluate the benefits of the NRA unit intervention (time to decannulation, weaning and …complication rates) and the benefits of the coordination (time to registration in a rehabilitation centre and rate of non-compliance with standards of care). Results: Weaning failure rate was reduced from 27.3% to 9.1%, no complications or recannulations were observed in the post-intervention group after weaning and time to decannulation following admission to our unit decreased from 19.13 to 12.75 days. The rate of non-compliance with patient standards of care was significantly reduced from 45% to 30% (Mann-Whitney p = 0.003). Discussion/conclusions: This interdisciplinary weaning programme helped to reduce weaning time and weaning failure, without increased complications, in the sample studied. Coordination improved the efficiency of the interdisciplinary team in the multiplicity and complexity of the different treatments. Show more

Keywords: Neurorehabilitation, tracheostomy, neurosensory, multidisciplinary approach

DOI: 10.3233/NRE-141081

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 809-817, 2014

Article Type: Correction

DOI: 10.3233/NRE-141068

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 819-819, 2014

Authors: Kreutzer, Jeffrey S. | Zasler, Nathan

Article Type: Other

DOI: 10.3233/NRE-141067

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 821-821, 2014

Article Type: Other

DOI: 10.3233/NRE-2014-34424

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 823-830, 2014

Article Type: Other

DOI: 10.3233/NRE-2014-34425

Citation: NeuroRehabilitation, vol. 34, no. 4, pp. 831-833, 2014