NeuroRehabilitation - Volume 36, issue 3

Authors: Riddick-Grisham, Susan

Article Type: Editorial

DOI: 10.3233/NRE-151211

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 233-234, 2015

Authors: Johnson, Cloie B. | Lacerte, Michel | Fountaine, John D.

Article Type: Research Article

Abstract: This article will discuss the history and evolution of what is now known as a life care plan. The objectives will be to understand that a life care plan is a tool of case management. A life care plan is based on a proper medical, psychological, case management, and/or rehabilitation foundation. The development of a life care plan requires following generally accepted and peer-reviewed methodology and standards of practice. Life care planning is a trans-disciplinary specialty practice. A life care plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research that provides an …organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health care needs. The reader will also learn there are Standards of Practice for life care planning that have been a long-standing guide for the practitioner and its core components will be discussed. There are qualifications of professionals who perform the specialty practice of life care planning which will be reviewed, and in conclusion there are special considerations for individuals coordinating life care plans with individuals who have sustained an acquired brain injury will also be discussed. Show more

DOI: 10.3233/NRE-151212

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 235-241, 2015

Authors: Lewis, Frank D. | Horn, Gordon J.

Article Type: Research Article

Abstract: BACKGROUND: There is increasing need for a well-organized continuum of post-hospital rehabilitative care to reduce long term disability resulting from acquired brain injury. OBJECTIVE: This study examined the effectiveness of four levels of post-hospital care (active neurorehabilitation, neurobehavioral intensive, day treatment, and supported living) and the functional variables most important to their success. METHODS: Participants were 1276 adults with acquired brain injury who were being treated in one of the four program levels. A Repeated Measures MANOVA was used to evaluate change from admission to discharge on the Mayo Portland Adaptability Inventory–4 T-scores. Regression analyses …were used to identify predictors of outcome. RESULTS: Statistical improvement on the MPAI-4 was observed at each program level. Self-care and Initiation were the strongest predictors of outcome. CONCLUSION: The results support the effectiveness of a continuum of care for acquired brain injury individuals beyond hospitalization and acute in-hospital rehabilitation. It is particularly noteworthy that reduction in disability was achieved for all levels of programming even with participants whose onset to admission exceeded 7 years post-injury. Show more

Keywords: Brain injury, continuum of care, neurologic outcomes, predictors, post-hospital rehabilitation

DOI: 10.3233/NRE-151213

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 243-251, 2015

Authors: Day, Steven M. | Reynolds, Robert J. | Kush, Scott J.

Article Type: Research Article

Abstract: BACKGROUND: A life care plan often analyzes needs up to a person’s life expectancy. Expected present value of necessary funding for such a plan is likewise based on the fixed survival time. If a client should live beyond or die before the life expectancy, a shortfall or excess of funding may seem inevitable. The life table, of which life expectancy is a summary measure, clarifies these issues. OBJECTIVES: We explain life expectancy and how it is used in tort litigation, economic calculations, and life care planning. We examine the life table, of which life expectancy is one …output. We illustrate how a life table provides age-specific probabilities of death and survival, life expectancies, and median survival times, and other information and that every life expectancy must be associated with a life table. We consider the implications for life care planners, forensic economists, and others. CONCLUSIONS: Life expectancy is a summary of more detailed information provided in a life table. The full life table provides better information for planning purposes. Whether life expectancy or a full life table should be used in developing and valuing a life care plan is not well understood. A multi-disciplinary approach may help clarify these issues. Show more

Keywords: Life expectancy, median survival time, survival probabilities, mortality rates, life table, expected present value, life care plan, life care planning

DOI: 10.3233/NRE-151214

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 253-266, 2015

Authors: Reid, Christine | Riddick-Grisham, Susan

Article Type: Research Article

Abstract: INTRODUCTION: The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. BACKGROUND: The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. PURPOSE: The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on …quality of life for people living with disabilities. CONCLUSION: Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities. Show more

Keywords: Rehabilitation, work, productive activity, life care planning, disability, case management, vocational, community integration, quality of life, disability

DOI: 10.3233/NRE-151215

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 267-274, 2015

Authors: Neulicht, Ann T. | Berens, Debra E.

Article Type: Research Article

Abstract: BACKGROUND: The needs of a child with an acquired brain injury (ABI) are not a scaled down version of those required by an adult with a brain injury who has impairments that impact their cognitive and physical or functional abilities, capacity for work, and/or independence in performing activities of daily living. PURPOSE: The purpose of this article is to provide a standardized methodology for analysis of pediatric ABI cases when evaluating vocational potential as part of the child’s future rehabilitation or life care planning. PEEDS-RAPEL © , a case conceptualization model for rehabilitation professionals, is defined in the …context of a tool or methodology for the evaluation of pediatric clients with ABI. Issues related to the analysis of a child’s needs and impact of a pediatric brain injury for the development of a rehabilitation or life care plan and future earning capacity opinion are reviewed. CONCLUSION: A case example is provided which illustrates each element of PEEDS-RAPEL © in providing a pediatric future care and earning capacity opinion. Show more

Keywords: Pediatric ABI, ABI and loss of earning capacity, ABI and employment potential, vocational development and brain injury, career guidance and development for ABI

DOI: 10.3233/NRE-151216

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 275-, 2015

Authors: Clark-Wilson, Jo | Holloway, Mark

Article Type: Research Article

Abstract: INTRODUCTION: This article explores Life Care Planning and the models of the provision of rehabilitation, case management and care for people with brain-injury in the context of the health and social care systems in the UK. BACKGROUND: Life Care Planning for individuals with brain injury is not generally a term recognised or understood in the UK. The authors have worked in the field of rehabilitation, case management and care with this client group for many years and integrated their knowledge of the systems associated with Life Care Planning in the UK. PURPOSE: The article explains …the process of assessment and Life Care Planning for individuals with brain injury in the UK. Case management, rehabilitation and care are described, highlighting the positive and negative influences that can affect the provision of these services. Research evidence is given of potential factors that can predict needs for brain-injured clients and their families in a Life Care Plan. CONCLUSION: In the UK, Life Care Planning is only undertaken by Care Experts in a one-off assessment for the litigation process for individuals claiming compensation; and, by those acting as Case Managers with a specialism in brain injury, who review or provide clinical work with clients on a long-term basis. Show more

Keywords: Brain injury, life care planning, case management, care expert, rehabilitation, care

DOI: 10.3233/NRE-151217

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 289-300, 2015

Authors: Baptiste, B. | Dawson, D.R. | Streiner, D.

Article Type: Research Article

Abstract: OBJECTIVE: To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. DESIGN: A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. STUDY SAMPLE: Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. METHODOLOGY: Eight predictor …variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. RESULTS: Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. CONCLUSIONS: This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions. Show more

Keywords: Service use, prediction, brain injury, database, case management

DOI: 10.3233/NRE-151218

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 301-312, 2015

Authors: Krause, James S. | Terza, Joseph V. | Cao, Yue | Clark, Jillian M.R.

Article Type: Research Article

Abstract: BACKGROUND: Literature examining emergency room visits (ERV) and emergency room related hospitalizations (ERH) after spinal cord injury (SCI) is limited. OBJECTIVE: Identify (1) the annual frequency of ERV and ERH and (2) their likelihood as a function of demographic, injury, and socioeconomic characteristics. METHODS: Participants (n  = 1,579) with SCI completed mailed self-report questionnaires. RESULTS: 37% reported at least one ERV, with an average of 85 ERV per 100 participants. 19% reported at least one ERH and an average of 33 ERH annually per 100 participants. A greater likelihood of …ERV was observed among non-whites, those with more severe SCI, less education, and lower income. Among those with at least one ERV, greater risk of ERH was observed among non-Hispanic whites, those with more severe SCI, lower education, and higher age. CONCLUSIONS: ERV are common after SCI and should be accounted for when predicting SCI related expenses. Those with the most severe SCI and those in the oldest age group were most likely to be hospitalized after an ERV. Show more

Keywords: Spinal cord injuries, health, emergency room, hospitalization, healthcare disparities, age factors

DOI: 10.3233/NRE-151219

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 313-321, 2015

Authors: Dimitriou, Julien | Montoute, Timothy | Levivier, Marc | Borruat, François-Xavier | Diserens, Karin

Article Type: Research Article

Abstract: BACKGROUND: Bilateral ptosis is a very interesting clinical challenge for doctors because of the multiple possible localizations of a lesion which can lead to this neurological sign. OBJECTIVES: Through this case report, we aim to determine the difference between an apraxia of lid opening (ALO) with difficulty in initiating the act of lid elevation, in spite of adequate understanding, motor control and cranial nerve pathways, and a bilateral ptosis with a lesion in the oculomotor nucleus or blepharospasm. METHODS: The case report of a 50-year-old patient presenting bilateral ptosis and multiple ischemic …lesions in the brainstem and bilateral frontal lobe lesions after the emergency removal of a large frontal tumor. RESULTS: Our patient had an ALO according to the neurological follow-up and showed the ability, after a few weeks, of initiating the act of opening her eyes with her hand. The ophthalmic evaluation confirmed that in her case the ALO was associated with a nuclear lesion of the oculomotor nerve secondary to a midbrain lesion. CONCLUSION: Our case report confirms multiple differential diagnoses in bilateral ptosis and the importance of clinical examination in spite of good neurological imaging. Show more

Keywords: Ptosis, apraxia, consciousness, coma

DOI: 10.3233/NRE-151220

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 323-327, 2015

Authors: Kraft, Eduard | Schaal, Matthias C. | Lule, Dorothee | König, Eberhard | Scheidtmann, Klaus

Article Type: Research Article

Abstract: BACKGROUND: The neural correlates of motor imagery (MI) are tightly coupled with the cortical motor control network. Therefore MI may have therapeutic potential for patients with motor deficits after an ischemic stroke. OBJECTIVE: The aim of our study was to assess the hemispheric balance of the cortical motor network during motor imagery (MI) in patients recovering from stroke in the sub-acute stage. METHODS: We studied 17 patients after cerebral ischemic stroke (sub-acute stage) and 12 healthy subjects using functional Magnetic Resonance Imaging (fMRI) during motor imagery and performance of isometric grip force …movements (5 Newton). Laterality indices (LI) were calculated from regional activation analysis to assess hemispheric distribution of activity in pre-specified motor areas. RESULTS: Laterality index (LI) revealed a more balanced cortical activity in MI for both controls (−0.03) and patients (−0.12) in the premotor cortex compared to movement execution (0.48 controls; 0.12 patients) and a trend towards a shift in contra-lesional activity in stroke patients. CONCLUSIONS: Our results indicate a preserved interhemispheric balance of patients in the sub-acute stage when activating the cortical motor areas during MI. This could provide a reasonable physiologic baseline for using MI as an additional rehabilitative therapy for improving functional recovery in the sub-acute stage after stroke. Show more

Keywords: Motor imagery, stroke, fMRI, motor recovery, motor cortex, premotor cortex

DOI: 10.3233/NRE-151221

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 329-337, 2015

Authors: Celik, Canan | Can, Asli Gencay | Yalbuzdag, Seniz Akcay | Ozer, Mustafa

Article Type: Research Article

Abstract: BACKGROUND: Sleep disorders and nocturnal hypoxia are common in patients with cerebrovascular disease. Sleep-disordered breathing is associated with a poor functional outcome in stroke patients. OBJECTIVE: We investigated the relationship between nocturnal hypoxia and functional outcome in the rehabilitation phase of stroke patients. METHODS: Thirty patients with stroke and 20 controls were included. Functional status was evaluated with the Functional Independence Measure (FIM). Pulse oximetry was performed overnight from 21.00 h to 07.00 h. Baseline awake oxygen saturation, nocturnal oxygen saturation, the lowest nocturnal oxygen saturation, and the >4% Oxygen Desaturation Index (ODI) were …calculated. RESULTS: The mean oxygen saturation measurements were not significantly different among the groups (p  >  0.05). There was no significant relationship between the FIM scores and the oxygen saturation measurements of the stroke patients (p  >  0.05). The baseline oxygen saturation in patients with disease duration of 3 months or less was 94.67, and it was 96.56 (p  = 0.016) in those with disease duration of more than 3 months. CONCLUSION: This study showed that nocturnal oxygen saturation was not associated with functional outcome in therehabilitation phase of stroke patients. Show more

Keywords: Nocturnal hypoxia, oxygen saturation, stroke, functional outcome

DOI: 10.3233/NRE-151222

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 339-343, 2015

Authors: Yazici, Gokhan | Guclu-Gunduz, Arzu | Bayraktar, Deniz | Aksoy, Songul | Nazliel, Bijen | Kilinc, Muhammed | Yildirim, Sibel Aksu | Irkec, Ceyla

Article Type: Research Article

Abstract: BACKGROUND: We thought that the application of Kinesio Tape (KT) on the foot and ankle in stroke patients may improve the quality of somatosensory information and may activate ankle muscles which have an important role in postural control and that ultimately balance could be improved in stroke patients. OBJECTIVE: The purpose of this study was to evaluate the effects of KT on balance in stroke patients. METHODS: Nineteen stroke patients and 16 healthy controls were included in the study. The study group was evaluated with and without KT. Balance of the all …subjects was evaluated Sensory Organization Tests (SOT) by using the Computerized Dynamic Posturography. Equilibrium, Strategy Analysis and Composite Equilibrium Scores were investigated in SOT. RESULTS: Statistically significant differences were observed in all of the SOT parameters between stroke patients and healthy controls (p  <  0.05). When the results with and without KT application were compared, the Equilibrium Scores in the conditions 3, 4, 6, Strategy Analysis Score in the conditions 2, 4, 6 and the Composite Equilibrium Score of the SOT were found to be improved in stroke patents (p  <  0.05). CONCLUSIONS: The results obtained from KT application are promising in improving balance in stroke patients. Show more

Keywords: Stroke, Kinesio Taping, balance

DOI: 10.3233/NRE-151223

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 345-353, 2015

Authors: Lancioni, Giulio E. | Simone, Isabella L. | De Caro, Maria F. | Singh, Nirbhay N. | O’Reilly, Mark F. | Sigafoos, Jeff | Ferlisi, Gabriele | Zullo, Valeria | Schirone, Simona | Denitto, Floriana | Zonno, Nadia

Article Type: Research Article

Abstract: BACKGROUND: Eye-tracking communication devices and brain-computer interfaces are the two resources available to help people with advanced amyotrophic lateral sclerosis (ALS) avoid isolation and passivity. OBJECTIVE: This study was aimed at assessing a technology-aided program (i.e., a third possible resource) for five patients with advanced ALS who needed support for communication and leisure activities. METHODS: The participants were exposed to baseline and intervention conditions. The technology-aided program, which was used during the intervention, (a) included the communication and leisure options that each participant considered important for him or her (e.g., music, videos, …statements/requests, and text messaging) and (b) allowed the participant to access those options with minimal responses (e.g., finger movement or eyelid closure) monitored via microswitches. RESULTS: The participants started leisure and communication engagement independently only during the intervention (i.e., when the program was used). The mean percentages of session time spent in those forms of engagement were between about 60 and 80. Preference checks and brief interviews indicated that participants and families liked the program. CONCLUSIONS: The program might be viewed as an additional approach/resource for patients with advanced ALS. Show more

Keywords: Amyotrophic lateral sclerosis, communication, leisure, technology-aided program, microswitches

DOI: 10.3233/NRE-151224

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 355-365, 2015

Authors: Virk, Sohaib | Williams, Tracey | Brunsdon, Ruth | Suh, Flora | Morrow, Angie

Article Type: Review Article

Abstract: BACKGROUND: Attention deficits are common after acquired brain injury (ABI) and adversely impact academic, vocational and social outcomes. The role of cognitive interventions in post-ABI attention rehabilitation remains unclear. OBJECTIVE: To evaluate effectiveness of cognitive interventions in treating attention deficits following ABI and to explore differences in treatment effect between ABI etiologies. METHODS: MEDLINE, EMBASE, PsycINFO and CENTRAL databases were searched for randomized controlled trials (RCTs). Studies were selected by three reviewers. Study quality was assessed using Cochrane Collaboration tool for RCTs. Effect sizes (Hedge’s g) for each attentional domain were …meta-analyzed with subgroup analysis by ABI etiology. RESULTS: Twelve RCTs with 584 participants were included, representing individuals with stroke, traumatic brain injury (TBI) and CNS-impacting malignancy. Cognitive rehabilitation improved divided attention in stroke survivors (g 0.67; 95% confidence interval, 0.35–0.98; p  <  0.0001) but not other ABI populations. Sustained, selective and alternating attention, and inhibition were not significantly improved in any ABI population. Follow-up data showed no evidence of long-term benefit. CONCLUSION: Cognitive rehabilitation resulted in short-term improvements in divided attention following stroke, but not after TBI or CNS-impacting malignancy. Cognitive interventions did not significantly improve other attentional domains in participants with stroke, TBI or CNS-impacting malignancy. Show more

Keywords: Acquired brain injury, cognitive rehabilitation, attention, meta-analysis, systematic review

DOI: 10.3233/NRE-151225

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 367-377, 2015

Authors: Shavelle, Robert M. | Brooks, Jordan C. | Strauss, David J. | Paculdo, David R.

Article Type: Research Article

Abstract: BACKGROUND: Much is known about survival after traumatic brain injury (TBI), yet relatively little about survival after anoxic brain injury (ABI). OBJECTIVE: To determine whether long-term survival after ABI is comparable to that after TBI. METHODS: We identified 237 patients with ABI and 1,620 with TBI in California who were aged 15 to 35, survived at least 1 year post injury, and were injured in 1986 or later. We analyzed the long-term follow-up data using the Cox Proportional Hazards Regression Model, controlling for age, sex, and severity of disability. RESULTS: …After adjustment for risk factors, no significant differences in long-term survival between ABI and TBI were found (hazard ratio = 0.97; 95% c.i. 0.57–1.65). CONCLUSIONS: In adolescents and young adults, long-term survival after ABI appears to be similar to that after TBI. Show more

Keywords: Survival, traumatic brain injury, life expectancy

DOI: 10.3233/NRE-151226

Citation: NeuroRehabilitation, vol. 36, no. 3, pp. 379-382, 2015