NeuroRehabilitation - Volume 24, issue 2

Authors: Stearns, Ginny E. | Burtner, Patricia | Keenan, Kristina M. | Qualls, Clifford | Phillips, John

Article Type: Research Article

Abstract: Background: Constraint-Induced Movement Therapy (CIMT) is a therapeutic intervention using constraint of the less-affected limb and intensive use of the hemiplegic extremity in individuals with hemiplegia. The purpose of this study was to determine whether children with cerebral palsy (CP) who have undergone a 2-week function-based CIMT show improved hand function and underlying muscle activation changes associated with functional gains. Methods: Six children with hemiplegic CP participated in the study, receiving 4 hours of therapy 5 days a week coupled with bi-valve casts worn 8–12 hours for 14 days. Outcome measures of grip strength, pinch strength, dexterity tests …and electromyography (EMG) were compared before, immediately post- and 3 months post-intervention. Results: Repeated measures ANOVA and post hoc paired t -tests showed significant group improvements in all strength and dexterity measures (p < 0.05). EMG analysis showed significant increases in muscle activation on pinch measures (p = 0.05). Visual inspection of the EMG data suggested increased muscle activation during grip and a decrease in the muscle activation required during dexterity tasks. Conclusions: Our preliminary results support CIMT for improving strength and dexterity in children with hemiplegic CP. Further studies with greater sample sizes and longer study periods are recommended to determine muscle activation changes post CIMT. Show more

Keywords: Cerebral palsy, hand therapy, Constraint-Induced Movement Therapy

DOI: 10.3233/NRE-2009-0459

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 95-108, 2009

Authors: Lee, Dong Ryul | You, Joshua H. | Lee, Nam Gi | Oh, Jin Hwan | Cha, You Jin

Article Type: Research Article

Abstract: Purpose: This case study was conducted to determine Comprehensive Hand Repetitive Intensive Strengthening Training (CHRIST)-induced morphological changes in the commonly affected extensor carpi radialis (ECR) and triceps brachii (TRI) muscle and associated muscle strength and motor performance in a child with hemiparetic cerebral palsy (CP) using standardized clinical tests and ultrasound imaging. Design: A single case study with pre-/post-test. Subject: A 4.9-year-old female, diagnosed with hemiparetic CP. Method: The child received a 5-week course of CHRIST course, comprising of 60-minute periods a day, five times a week. A real-time ultrasound imaging was performed to …determine the CHRIST-induced changes in cross-sectional area (CSA) of the ECR and TRI. Clinical tests including the modified Wolf Motor function test (WMFT), the modified Jebsen-taylor hand function test (Jebsen hand) and the modified Pediatric Motor Activity Log (PMAL) questionnaire were used to compare the intervention-related changes in motor performance in upper extremity. Results: Ultrasound imaging data showed that the CSAs of both ECR and TRI muscles of the affected upper limb at relaxation and contraction states were enhanced and these therapy-induced morphological changes were associated with enhanced muscle strength and gross motor performance in reaching and grasping skills. Conclusions: Our results suggest that the CHRIST is effective in treating muscle weakness and motor function in a child with hemiparetic CP. This is the first evidence in literature that might shed light on the therapeutic efficacy of our novel intervention on muscle size, associated muscle strength and motor improvement. Show more

DOI: 10.3233/NRE-2009-0460

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 109-117, 2009

Authors: Stuifbergen, Alexa | Brown, Adama | Phillips, Lorraine

Article Type: Research Article

Abstract: The purpose of this study is to explore how selected behavioral and psychological factors may influence the disablement process in persons with multiple sclerosis. Specifically, we explored what contextual factors (age, length of diagnosis, comorbidities), resources (social support, adequacy of assistive devices), barriers, and health behaviors predict functional limitations, disability, and quality of life and what factors might moderate the relationship between functional limitation and disability and disability and quality of life. A sample of 442 persons with multiple sclerosis (371 females, 71 males; mean age 56, mean time since diagnosis 19 years) completed measures of demographic and disease-related variables, …barriers, social support, health behaviors, functional limitations, disability and perceived quality of life. Using regression analyses, the predictors explained significant amounts of variance in functional limitations (R2 = 0.37), disability (R2 = 0.36) and quality of life (R2 = 0.68), but there were no significant moderators of the relationship between functional limitations and disability and disability and quality of life. A model testing the indirect effects of functional limitations and direct effects of disability and the proposed moderators explained 66% of the variance in quality of life (CFI = 0.95, TLI = 0.89, RMSEA = 0.10). Barriers, social support and health behaviors were consistent predictors of the outcome variables. Show more

Keywords: Multiple sclerosis, disability, disablement process, functional limitations, quality of life

DOI: 10.3233/NRE-2009-0461

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 119-129, 2009

Authors: Plowman-Prine, E.K | Okun, M.S. | Sapienza, C.M. | Shrivastav, R. | Fernandez, H.H. | Foote, K.D. | Ellis, C. | Rodriguez, A.D. | Burkhead, L.M. | Rosenbek, J.C.

Article Type: Research Article

Abstract: The purpose of this study was to: (1) define perceptual speech characteristics of idiopathic Parkinson disease (IPD) across 35 speech dimensions adapted from Darley et al. [19] and grouped under six speech-sign clusters (respiration, phonation, resonance, articulation, prosody and rate); (2) examine the effects of levodopa on the 35 perceptual speech dimensions and speech-sign clusters; and (3) to compare the relative effectiveness of levodopa on global motor functioning vs. speech production. Sixteen patients with IPD read the ‘Grandfather Passage’ both ‘on’ and ‘off’ levodopa. Three blinded speech-language pathologists performed perceptual speech analyses using a seven-point scale. The diagnosis …of IPD was made by a movement disorders fellowship trained neurologist who applied UK Brain bank criteria and administered the Unified Parkinson Disease Rating Scale. Concordant with previous studies, the results of this experiment indicated that IPD disrupted multiple speech production subsystems, with prosody being the most severely affected domain. The perceptual dimensions that were most severely affected included: (1) sound imprecision; (2) mono-loudness; (3) mono-pitch; (4) reduced stress and (5) harsh voice. No significant differences were obtained between medicated states (‘on’/‘off’) for any of the 35 individual speech dimensions and speech-sign clusters. Global motor function significantly improved following dopaminergic medications. Show more

Keywords: Hypokinetic dysarthria, Parkinson's disease, levodopa, intelligibility, perceptual assessment of speech

DOI: 10.3233/NRE-2009-0462

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 131-144, 2009

Authors: Proto, Daniel | Pella, Russell D. | Hill, B.D. | Gouvier, Wm. Drew

Article Type: Research Article

Abstract: Visuoperceptual disruptions are among the most common, and most debilitating, of the aftereffects following stroke or head injury. Visuospatial neglect in particular, which frequently occurs as a result of insult to the right cerebral hemisphere, has a variety of implications for patient welfare and outcome. And while there exists a great deal of useful information in the area of visual neglect, it is spread out amongst near-countless journal articles, book chapters, and workshop summaries. Thus, it is the purpose of this paper to provide an overview of various topics relating to visuospatial disturbances. Areas covered include theories on sequelae and …neuropathology, common direct and indirect complications, rates and types of recovery, past and current trends in assessment and rehabilitation techniques, and thoughts on directions for future research. Show more

Keywords: Visuospatial neglect, rehabilitation, remediation, neuropathology, neglect assessment

DOI: 10.3233/NRE-2009-0463

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 145-157, 2009

Authors: Jang, Sung Ho | Park, Kyung-A | Ahn, Sang Ho | Cho, Yoon Woo | Byun, Woo Mok | Son, Su Min | Choi, Jin Ho | Kwon, Young Hyun

Article Type: Research Article

Abstract: Diffusion tensor image tractography (DTT) can visualize white matter tracts and provide a powerful vehicle with which to investigate the neural pathway at the subcortical level. We attempted to demonstrate the clinical significance of transcallosal fibers (TCF) originating from the corticospinal tract in patients with corona radiata infarct located below the corpus callosum, using diffusion tensor image tractography (DTT). Forty patients with corona radiata infarct located below the corpus callosum and 26 control subjects were enrolled in this study. We classified the DTT findings as follows: no transcallosal fiber from the CST (type A), transcallosal fiber ended in the corpus …callosum or connected to the cortex of the opposite hemisphere (type B), and transcallosal fiber that descended toward the lesion after passing through the corpus callosum (type C). Type C indicated that the presence of transcallosal fibers starting from the CST of the unaffected hemisphere was significantly more prevalent in the patients, and these patients showed the poorest motor function. It seems that transcallosal fibers originated from the CST of the unaffected hemisphere, and fibers descending toward the lesion in patients with corona radiata infarct may act to compensate for motor deficits. Show more

Keywords: Diffusion tensor image, brain injury, interhemispheric inhibition, corpus callosum, transcallosal fiber

DOI: 10.3233/NRE-2009-0464

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 159-164, 2009

Authors: Fong, Kenneth N.K. | Chan, Marko K.L. | Ng, Peggie P.K. | Ng, Serena S.W.

Article Type: Research Article

Abstract: Objectives: To evaluate processing speed performance in outpatients with moderate-to-severe traumatic brain injury (TBI). Design: Prospective cross-sectional observational study. Participants: Twenty outpatients with traumatic brain injury (TBI) were compared with 20 matched healthy subjects. Measure: Measurement by six instruments in the domains of simple reaction time (SRT), movement time (MT), and mental processing speed at a single time occasion. Results: Significant differences were found in speed but not accuracy of work between outpatients with TBI and healthy subjects. Simple reaction time was sensitive to predicting patients with moderate-to-severe TBI as opposed to …healthy counterparts. Conclusion: Outpatient clinics should consider measuring SRT. Show more

Keywords: Traumatic brain injury, simple reaction time, movement time, mental processing speed

DOI: 10.3233/NRE-2009-0465

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 165-173, 2009

Authors: Brown, D. | Rose, D. | Lyons, E.

Article Type: Research Article

Abstract: Following brain injury there is often a prolonged period of deteriorating psychological condition, despite neurological stability or improvement. This is presumably consequent to the remission of anosognosia and the realisation of permanently worsened status. This change is hypothesised to be directed partially by the socially mediated processes which play a role in generating self-awareness and which here direct the reconstruction of the self as a permanently injured person. However, before we can understand this process of redevelopment, we need an unbiassed technique to monitor self-awareness. Semi-structured interviews were conducted with 30 individuals with long-standing brain injuries to capture their …spontaneous complaints and their level of insight into the implications of their difficulties. The focus was on what the participants said in their own words, and the extent to which self-knowledge of difficulties was spontaneously salient to the participants. Their responses were subjected to content analysis. Most participants were able to say that they had brain injuries and physical difficulties, many mentioned memory and attentional problems and a few made references to a variety of emotional disturbances. Content analysis of data from unbiassed interviews can reveal the extent to which people with brain injuries know about their difficulties. Social constructionist accounts of self-awareness and recovery are supported. Show more

Keywords: Complaints, brain injury, social constructionist, self-awareness, difficulties

DOI: 10.3233/NRE-2009-0466

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 175-183, 2009

Authors: Gontkovsky, Samuel T. | Russum, Paula | Stokic, Dobrivoje S.

Article Type: Research Article

Abstract: Objective: To examine the validity of the Community Integration Questionnaire (CIQ) in measuring community integration in persons with chronic spinal cord injury (SCI) through its comparison with the Craig Handicap Assessment and Reporting Technique Short Form (CHART-SF). Design: Correlational analysis. Setting: Tertiary care rehabilitation hospital. Participants: Twenty-eight individuals with chronic SCI who completed the CIQ and CHART-SF during annual follow-up evaluation. Main outcome measures: The CIQ quantifies community integration based on subscales of Home Integration, Social Integration, and Productive Activity. The CHART-SF provides scores of community integration according to subscales of Physical …Independence, Cognitive Independence, Mobility, Occupation, Social Integration, and Economic Self-Sufficiency. Results: CIQ Home Integration was significantly correlated with CHART-SF Physical Independence, Cognitive Independence, Mobility, Occupation, and Social Integration (r’s = 0.47–0.57). CIQ Social Integration was significantly correlated with CHART-SF Cognitive Independence, Mobility, Occupation, and Social Integration (r’s = 0.43–0.77). CIQ Productive Activity was significantly correlated only with CHART-SF Mobility and Occupation (r’s = 0.39–0.41). Conclusions: The CIQ may serve as a valid measure for examining community integration in persons with chronic SCI and may be particularly appealing given its relative brevity/simplicity in administration and scoring. Show more

Keywords: Community integration, Community Integration Questionnaire, Craig Handicap Assessment and Reporting Technique Short Form, spinal cord injuries

DOI: 10.3233/NRE-2009-0467

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 185-192, 2009

Authors: You, Joshua H. | Shetty, Anand | Jones, Tawaih | Shields, Kimberli | Belay, Yordanos | Brown, Deborah

Article Type: Research Article

Abstract: The present study highlights the effects of the dual-task cognitive-gait intervention (CGI) on working memory and gait functions in older adults with a history of falls. Thirteen older adults with a history of falls were recruited from local community centers and randomly stratified into either the control (n = 5) or experimental (n = 8) group. The experimental group received the dual-task cognitive-motor intervention involving simultaneous motor (walking) and cognitive (memory recall) task whereas the control group received a placebo treatment (walking with simple music). The intervention was provided 30 minutes per session, over a 6-week period. Memory …measures included a combination of word recall and arithmetic task. Gait function measures included velocity and center of pressure (COP) stability. Non-parametric tests were used at p < 0.05. The experimental group showed a greater memory performance than the control (p < 0.05). However, no significant intervention-related changes in gait velocity and stability were observed. Our findings provide the first evidence in literature to demonstrate that the long-term dual-task cognitive-motor intervention improved memory of older adults with a history of falls under the dual cognitive motor task condition. Show more

Keywords: Cognition, gait, elderly falls, rehabilitation

DOI: 10.3233/NRE-2009-0468

Citation: NeuroRehabilitation, vol. 24, no. 2, pp. 193-198, 2009