NeuroRehabilitation - Volume 29, issue 2

Authors: Parente, Rick | DeMott, Ellen | Johnson, Craig | Jennings, Peter | Silver, Rebecca

Article Type: Research Article

Abstract: This study presents a method for assessing subjective organization (SO) after brain injury and techniques for planning cognitive rehabilitation therapy based on the survivor's SO ability. Eighty-seven college students, 50 persons with traumatic brain injury (TBI), and 30 participants with specific learning disability (SLD) learned two overlapping lists of unrelated nouns in which half of the second list were words that the person had learned on the first list. The study assessed whether different patterns of recall for the overlapping words versus the new words on the second list would discriminate persons with brain injury relative to college students and …persons with SLD. The results indicated that college students and the SLD participants showed significantly diminished recall of overlapping words on the second list. However, the TBI participants showed significantly improved recall of the overlapping words. The results indicated that this task provides a simple diagnostic assessment of a participant's SO ability. The results also suggested that a TBI survivor's level of SO may moderate the success of prevocational cognitive rehabilitation therapies. Show more

Keywords: Subjective organization, memory, transfer of learning, traumatic brain injury, part-whole learning

DOI: 10.3233/NRE-2011-0685

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 117-124, 2011

Authors: Hoffer, Michael E. | Balaban, Carey D.

Article Type: Editorial

DOI: 10.3233/NRE-2011-0686

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 125-125, 2011

Authors: Hain, Timothy C.

Article Type: Research Article

Abstract: The vestibular system is a sophisticated human control system. Accurate processing of sensory input about rapid head and postural motion is critical. Not surprisingly, the body uses multiple, partially redundant sensory inputs and motor outputs, combined with a very competent central repair capability. The system as a whole can adapt to substantial peripheral vestibular dysfunction. The Achilles' heel of the vestibular system is a relative inability to repair central vestibular dysfunction.

Keywords: Semicircular canals, otoliths, push-pull, common mode rejection, sensorimotor integration, vestibulo-ocular reflex, vestibulospinal reflex, vestibulocollic reflex, velocity storage, internal models, kalman filter, Ewald's second law, adaptive plasticity, context dependency

DOI: 10.3233/NRE-2011-0687

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 127-141, 2011

Authors: Slattery, Eric L. | Sinks, Belinda C. | Goebel, Joel A.

Article Type: Research Article

Abstract: Vestibular function testing plays a critical role in understanding balance disorders. These tests augment a well-performed history and physical exam in providing quantitative information regarding vestibular reflexes, central oculomotor function and postural control strategies. Video-oculography (VOG) and caloric stimulation play a major role in evaluation of both peripheral vestibular and central oculomotor disorders. Rotational chair testing and, more recently the Dynamic Visual Acuity Test (DVAT) and Gaze Stabilization Test (GST) provide information regarding higher frequency vestibulo-ocular reflex (VOR) function. Computerized Dynamic Posturography (CDP) explores the interaction of the vestibular, visual and proprioceptive systems for posture control. Finally, the cervical Vestibular …Evoked Myogenic Potential (cVEMP) test and the Dynamic Subjective Visual Vertical (DSVV) test provide information regarding saccular and utricular function, respectively. New techniques and applications continue to provide knowledge both of disease processes and potential medical, surgical and rehabilitative interventions. Show more

Keywords: Vestibular, balance, vertigo, imbalance, inner ear, vestibulo-ocular reflex (VOR)

DOI: 10.3233/NRE-2011-0688

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 143-151, 2011

Authors: Magnusson, Måns | Karlberg, Mikael | Tjernström, Fredrik

Article Type: Research Article

Abstract: A sudden unilateral loss or impairment of vestibular function causes vertigo, dizziness and impaired postural function. In most occasions, everyday activities supported or not by vestibular rehabilitation programs will promote compensation and the symptoms subside. As the compensatory process requires sensory input, matching performed motor activity, both motor learning of exercises and matching to sensory input are required. If there is a simultaneous cerebellar lesion found during surgery of the posterior cranial fossa, there may be a risk of a combined vestibulo-cerebellar lesion, with reduced compensatory abilities and with prolonged or sometimes permanent disability. On the other hand, a slow …gradual loss of unilateral function occurring as the subject continues well everyday activities may go without any prominent symptoms. We therefore implemented a pre treatment plan before planned vestibular lesions (prehab). This was first done in subject undergoing gentamicin treatment for Meniere's disease (MD). Subjects perform vestibular exercises for 14 days before the first gentamicin installation and then continue doing so until free of symptoms. Most subjects would only experience slight dizziness while losing vestibular function. We then expanded the approach to patients with brainstem tumours requiring surgery but with remaining vestibular function to ease postoperative symptoms and reduce risk of combined cerebello-vestibular lesions. This patient group was given gentamicin installations trans-tympanically before tumour sugary and then underwent prehab. In all cases there was a caloric loss, loss of VOR evident in the head impulse tests, impaired subjective vertical and horizontal, and reduced caloric function induced by the pre-surgery gentamicin treatment. The prehab eliminated spontaneous and positional nystagmus, subjective symptoms, and postural function up before surgery and allowed for rapid postoperative recovery. The concept of ‘pre-lesion rehabilitation’ where training is introduced before a planned lesion and if possible paralleled with a gradual function loss expands the potential of rehabilitation. Here it was used for vestibular lesions but it is possible that similar approaches may be developed for other situations, which include foreseeable loss of function. Show more

Keywords: Vestibular, compensation, prehab, rehabilitation, schwannoma, recovery

DOI: 10.3233/NRE-2011-0689

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 153-156, 2011

Authors: Whitney, Susan L. | Sparto, Patrick J.

Article Type: Research Article

Abstract: The use of vestibular rehabilitation for persons with balance and vestibular disorders is used to improve function and decrease dizziness symptoms. Principles of a vestibular rehabilitation program are described including common exercises and outcome measures used to report change. A review of negative and positive predictive factors related to recovery is also provided.

Keywords: Vestibular rehabilitation, exercise

DOI: 10.3233/NRE-2011-0690

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 157-166, 2011

Authors: Gottshall, Kim

Article Type: Research Article

Abstract: Vestibular complaints are the most frequent sequelae of mTBI. Vestibular physical therapy has been established as the most important treatment modality for this group of patients. Nevertheless there is little work objectively documenting the impact of vestibular physical therapy on this group of patients. Studies have been completed in the past examining clinical measures like the GCS on overall recovery pattern after TBI. But outcomes measures specifically aimed at examining the adequacy of vestibular tests to track vestibular recoveryhave remained lacking. Scherer and Schubert reinforced the need for best practice vestibular assessment for formulation of appropriate vestibular physical therapy treatment …strategies. Now the application of vestibular testing and rehabilitation in this patient population is needed to provide information on objective outcome measures. Vestibular physical therapy is most effective when applied in a customized fashion. While we and others have developed vestibular physical therapy procedures that are applied in best practices for mTBI vestibular patients, these therapies must be customized for the patient entry level of function and expectation level of recovery. Knowledge of the patient's disability and diagnosis is critical to build the foundation for return to activity, work, or sport. Show more

Keywords: Vestibular, physical therapy, mild traumatic brain injury

DOI: 10.3233/NRE-2011-0691

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 167-171, 2011

Authors: Cohen, Helen S.

Article Type: Research Article

Abstract: Vestibular disorders cause functional limitations or decreased ability to perform activities of daily living independently. These problems are not necessarily predicted by vertigo scales or physiologic measures. Therefore, the clinician should evaluate functional ability using self-rated scales or direct observation of specific skills of interest. This paper will review the literature and important issues related to assessment of functional performance and participation in activities of daily living in the vestibular disorders population. Self-rated scales have the benefit of being relatively quick but may be inaccurate. Direct observation may be time consuming and a thorough evaluation of all skills may not …be possible in the context of out-patient or home-based care. This paper reviews the available scales and discusses the major problems in functional assessment of patients with vestibular disorders. Show more

Keywords: Activities of daily living, handicap, disability rating, functional assessment, vestibular impairment

DOI: 10.3233/NRE-2011-0692

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 173-178, 2011

Authors: Staab, Jeffrey P.

Article Type: Research Article

Abstract: Behavioral factors are an integral part of the overall morbidity of patients with vertigo, dizziness, and balance disorders. Anxiety, depression, and more importantly, loss of balance confidence and sense of debility and handicap beleaguer patients with acute and chronic vestibular symptoms. Vestibular rehabilitation originated as a physical therapy, but a careful look at its research development and clinical applications show it to be as much, or perhaps more, a behavioral intervention. More patients referred for vestibular rehabilitation require habituation to chronic vestibular symptoms and motion sensitivity than compensation for active peripheral or central vestibular deficits. Vestibular rehabilitation may exert a …positive effect on behavioral morbidity, but the benefits are somewhat uneven and do not always correlate with physical improvements. Health anxiety (i.e., excessive worry about the cause and consequences of physical symptoms) is an emerging concept in clinical psychiatry and psychology. It may offer an important key to understanding the debility and handicap experienced by many patients with vestibular symptoms and enhance the ability of vestibular rehabilitation to ameliorate their suffering. Show more

Keywords: Chronic dizziness, habituation, balance confidence, handicap, health anxiety

DOI: 10.3233/NRE-2011-0693

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 179-183, 2011

Authors: Wood, S.J. | Loehr, J.A. | Guilliams, M.E.

Article Type: Research Article

Abstract: Exposure to microgravity drives adaptive changes in healthy individuals reconditioned for abnormal gravity states. These changes are maladaptive for return to earth's gravity. The intersubject variability of sensorimotor decrements is striking, although poorly understood. Multisensory integration, which is important for resolving sensory ambiguity on earth, is a critical mechanism for sensorimotor adaptation during and following space flight. The removal of gravitational loading also has profound effects that both negatively impact sensorimotor function and reduce capacity to overcome sensorimotor deficits. Countermeasure strategies include preflight training to facilitate transition to microgravity, pharmaceuticals and restriction of some activities early on orbit, and inflight …exercise to minimize deconditioning during longer duration missions. Active motion is important to promote reconditioning upon return to earth's gravity. A supervised reconditioning program utilizes exercises that challenge multisensory integration with an increasing level of difficulty customized to the individual's state of recovery. This program also serves to increase crew self-awareness of fall risk. New resistive and aerobic exercise capabilities onboard the International Space Station contribute to improved postflight mobility. Lessons learned from inflight and postflight reconditioning programs have implications for future exploration crews that will operate more autonomously, as well as rehabilitation in clinical populations on earth. Show more

Keywords: Vestibular, microgravity, exercise, rehabilitation

DOI: 10.3233/NRE-2011-0694

Citation: NeuroRehabilitation, vol. 29, no. 2, pp. 185-195, 2011