NeuroRehabilitation - Volume 30, issue 2

Authors: Gaber, Tarek A.-Z.K. | Oo, Wah Wah | Gautam, Vidushi | Smith, Lauren

Article Type: Research Article

Abstract: Background: Several trials have demonstrated improved outcomes following inpatient rehabilitation for Multiple Sclerosis patients. Two populations were studied: patients in relapse and patients with no active medical problems recruited from the community. In every day practice, most admissions for MS inpatient rehabilitation aim to improve function following sudden deterioration. The outcomes of inpatient rehabilitation for this population were never studied. Method: Retrospective case note analysis of consecutive admissions of MS patients from 2005 to 2009 to a specialist neurological rehabilitation unit. Results: Forty-one cases were identified. 26 were females. Age 25–71 (mean 52 ± 12). Disease …duration 0–39 years (mean 13 ± 11). 20 patients were admitted from the community and 21 were transferred from acute hospital beds. Length of stay ranged between 11 to 152 days (mean 49 ± 36). Mean length of stay for wheelchair dependent patients was approximately double the length of stay for ambulatory patients. Improving mobility, transfer or posture were the primary cause of admissions in 37 cases. Sixteen out of 21 ambulatory patients (76%) attained 100% mobility goals. Only 4 out of 20 wheelchair bound patients (20%) achieved 100% mobility goals (P 0.002). Neither the type of MS nor the duration of it influenced the overall outcome. Conclusion: Our results suggest that MS patients admitted for rehabilitation following deterioration secondary to a medical or surgical cause show the same favourable outcome that was demonstrated with MS stable patients or in relapse. Baseline mobility, but not type and duration of MS, seems to have a significant impact on the rehabilitation outcome in terms of gaol achievement. Show more

Keywords: Multiple sclerosis, rehabilitation

DOI: 10.3233/NRE-2012-0731

Citation: NeuroRehabilitation, vol. 30, no. 2, pp. 97-100, 2012

Authors: Overman, Amy A.

Article Type: Case Report

Abstract: Malaria infection is known to cause cognitive impairments in children and adults. To date, very little research has investigated the efficacy of computer-based cognitive rehabilitation after cerebral malaria, particularly in adults. The aim of this study was to examine whether computer-based cognitive training can be employed to rehabilitate memory and attentional deficits after cerebral malaria, particularly in adults. The current study examines the case of a 20-year-old female who acquired malaria on trip to Ghana. One year after her infection she still exhibited below-average performance on a number of neuropsychological assessments. A computer-based cognitive training program was undertaken for 14 …weeks. At the end of training, performance improved on the majority of assessments and was within the normal range for all assessments. The participant also displayed greater improvements from pre-test to post-test than a normal control participant who did not complete cognitive training. The findings extend prior research on cerebral malaria and suggest possible rehabilitation methods for adults who experience cognitive impairments following malaria infection. Show more

Keywords: Cognitive training, cerebral malaria, memory, attention, perceptual processing, rehabilitation, computer-based training

DOI: 10.3233/NRE-2012-0732

Citation: NeuroRehabilitation, vol. 30, no. 2, pp. 101-107, 2012

Authors: Tham, Shuen-Loong | Kong, Keng-He

Article Type: Research Article

Abstract: Anti-NMDAR (N-Methyl-D-Aspartate Receptor) Encephalitis is a rare occurring autoimmune disease that is mediated by antibodies against the NR1 subunit of the NMDA receptor. While this condition has a known predilection for young females with ovarian tumors, heightened awareness has led to increasing recognition of this condition in other population groups as well. Afflicted patients typically evolve through a multi-staged course of neurological, behavioral, cognitive and physical deficits. The diverse nature of this condition often necessitates a multi-disciplinary team for management. As the recovery of patients with anti-NMDAR encephalitis is often protracted, the role of the rehabilitation is important particularly beyond …its acute stages. We describe a case of anti-NMDAR encephalitis in a 17-year-old girl who presented to our rehabilitation centre for management in the gradual recovery phase of her condition. This case illustrates the multiple challenges faced in the rehabilitation of such a patient. Show more

Keywords: Anti-NMDAR encephalitis, N-Methyl-D-Aspartate Receptor, autoimmune, paraneoplastic, rehabilitation

DOI: 10.3233/NRE-2012-0733

Citation: NeuroRehabilitation, vol. 30, no. 2, pp. 109-112, 2012

Authors: Kwon, Hyeok Gyu | Jang, Sung Ho

Article Type: Research Article

Abstract: Locked-in syndrome (LIS) is a rare neurologic condition caused by bilateral pontine lesions. Quadriplegia is one of the most serious clinical manifestations in patients with LIS. However, little is known about the motor recovery mechanism of quadriplegia in patients with LIS. In the current study, we present with a quadriplegic patient with bilateral pontine infarcts, whose motor function appeared to be reorganized into the peri-infarct areas of the infarcted pons, as demonstrated by diffusion tensor tractography (DTT). A 60-year-old was diagnosed as LIS due to bilateral pontine infarcts 6 years ago. The patient presented with complete paralysis of all four …extremities at onset. After slow motor recovery, the patient was able to move all joint muscles against gravity and demonstrated some fine motor activity at the time of DTT scanning (6 years after onset). Results of DTTs for the corticospinal tract (CST) in both hemispheres showed that the CSTs originated from the primary motor cortex, descended along the known CST pathway, and passed through lateral areas of infarcts in the pons. Therefore, motor function of the four extremities of this patient appears to have been recovered by the CST, which passed through the lateral areas to the pontine infarcts. Show more

Keywords: Diffusion tensor imaging, locked-in syndrome, motor recovery, stroke, pons

DOI: 10.3233/NRE-2012-0734

Citation: NeuroRehabilitation, vol. 30, no. 2, pp. 113-117, 2012

Authors: Peter, Claudio | Rauch, Alexandra | Cieza, Alarcos | Geyh, Szilvia

Article Type: Research Article

Abstract: Introduction: Spinal cord lesion due to injury or disease (SCD) has a severe impact on the level of functioning, results in body function impairments, causes restrictions in everyday life, and stress. This stress experience can have an additional negative impact on well-being and health of persons with SCD. Stress reduction is therefore an important aim in order to achieve and maintain health in SCD. Strengthening internal resources of a person can support this endeavor. Objective: To describe the role of internal resources for stress reduction as rehabilitation target in the context of interdisciplinary clinical rehabilitation of SCD using …ICF-based rehabilitation management tools. Methods: Single Case Study. Results: Strengthening internal resources contributed to stress reduction in the rehabilitation of a person with SCD. Active involvement in decision taking increased the patient’s perceived self-determination and reduced stress. Impairments in urination function remained a major stressor and negatively affected the patient’s self-esteem. ICF-based documentation tools highlighted the role of internal resources, stress and functioning in rehabilitation management. Conclusion: Internal resources should be strengthened when aiming at stress reduction in a patient with SCD. ICF-based documentation tools support this undertaking. Show more

Keywords: Stress, internal resource, spinal cord diseases, ICF, resilience, adjustment

DOI: 10.3233/NRE-2012-0735

Citation: NeuroRehabilitation, vol. 30, no. 2, pp. 119-130, 2012

Authors: Lee, Mi Young | Kim, Seong Ho | Choi, Byung Yun | Chang, Cheol Hoon | Ahn, Sang Ho | Jang, Sung Ho

Article Type: Research Article

Abstract: Little is known about the recovery mechanism of somatosensory function in thalamic hemorrhage. We investigated the recovery mechanism of somatosensory function, using functional MRI (fMRI) findings by proprioceptive input in chronic patients with thalamic hemorrhage. Eleven consecutive chronic patients with thalamic hemorrhage who showed severe proprioceptive dysfunction were recruited. The subscale for kinesthetic sensation of the Nottingham Sensory Assessment (NSA) was used for determination of proprioceptive function. fMRI was performed during passive movements of the metacarpophalangeal joint. From fMRI, the laterality index (LI) was calculated for assessment of the relative activity in the ipsilateral versus the contralateral primary sensori-motor cortex …(SM1). The average LI for affected and unaffected hand stimulation was 0.89 and 0.90, respectively, and there was no significant difference between LIs (p > 0.05). In addition, LI of the affected hand stimulation was positively related to NSA scores (r = 0.790, p < 0.05). Our results for LI suggest that the cortical activation pattern of SM1 was similar in the affected and unaffected hemispheres. Therefore, it appears that the proprioceptive function of the affected hand likely recovered by the normally existing medial lemniscus and its thalamocortical pathway in our patients. Show more

Keywords: Stroke, somatosensory recovery, thalamus, hemorrhage, propriception, brain plasticity

DOI: 10.3233/NRE-2012-0736

Citation: NeuroRehabilitation, vol. 30, no. 2, pp. 131-136, 2012

Authors: Passier, P.E.C.A. | Visser-Meily, J.M.A. | van Zandvoort, M.J.E. | Rinkel, G.J.E. | Lindeman, E. | Post, M.W.M.

Article Type: Research Article

Abstract: Objective: To determine the predictive value of physical and psychological factors assessed three months after aneurysmal subarachnoid hemorrhage (SAH) for health-related quality of life (HRQoL) one year after the SAH. Design: Prospective cohort study. Subjects: Patients with SAH (n = 113) who visited our SAH-outpatient clinic three months after SAH and who were living independently in the community one year after SAH. Methods: HRQoL was evaluated using the Stroke Specific Quality of Life scale (SS-QoL). We used Spearman correlations, Somers’d, and linear regression analyses. Independent variables were demographic and SAH characteristics, cognitive and …emotional complaints, depressive symptoms, anxiety, cognitive functioning, and passive coping style. Results: In the regression analysis, female gender (beta value −0.17), cognitive complaints (−0.31 ), cognitive functioning (0.40) and passive coping style (−0.23) were independent predictors, and together explained 45.9% of the variance of the SS-QoL total score. Conclusion: Female gender, cognitive complaints, cognitive functioning and passive coping style assessed at 3 months after SAH are important predictors of HRQoL 1 year after SAH. Early interventions to improve cognitive and emotional functioning should be evaluated for their ability to improve long-term HRQoL after SAH. Show more

Keywords: Prediction, long-term, quality of life, subarachnoid hemorrhage, SAH

DOI: 10.3233/NRE-2012-0737

Citation: NeuroRehabilitation, vol. 30, no. 2, pp. 137-145, 2012

Authors: Jang, Sung Ho

Article Type: Research Article

Abstract: Characteristics of motor recovery mechanisms are known to be linked with motor outcome in stroke. Detailed knowledge of motor outcome and recovery mechanisms in stroke allow for prediction of prognosis and provide the basis for establishment of scientific rehabilitation strategies. Thirteen previous studies with regard to motor outcome (8 studies) and the motor recovery mechanisms (5 studies) in pontine infarct were reviewed. Several motor recovery mechanisms have been reported in pontine infarct: peri-lesional reorganization, and other possible recovery mechanisms (aberrant pyramidal tract, ipsilateral motor pathway, and motor recovery via spared corticospinal tract). Previous studies on motor outcome in pontine infarct …have reported generally good outcome. This good motor outcome appears to be related to the characteristics of the motor recovery mechanisms recovered by the lateral corticospinal tract. We think that further studies on motor outcome and recovery mechanisms should be performed for clarification of various motor tracts including non-corticospinal tract, which can affect the motor outcome and recovery mechanisms in pontine infarct. In addition, the effect of rehabilitation on these topics should also be elucidated. Show more

Keywords: Stroke, pons, infarct, prognosis, rehabilitation, motor recovery, diffusion tensor imaging

DOI: 10.3233/NRE-2012-0738

Citation: NeuroRehabilitation, vol. 30, no. 2, pp. 147-152, 2012

Authors: Roosink, Meyke | Renzenbrink, Gerbert J. | Geurts, Alexander C.H. | IJzerman, Maarten J.

Article Type: Research Article

Abstract: The assessment and treatment of post-stroke shoulder pain (PSSP) is largely based on the assumption that pain is due to biomechanical alterations within the shoulder joint after stroke. However, current treatment often provides limited pain relief, leading to a considerable number of patients with persistent pain. This suggests that PSSP may not be merely due to simple nociception from the shoulder joint. A better understanding of the neurophysiological mechanisms underlying the development and perpetuation of PSSP is needed. Here, a theoretical framework for presumed PSSP mechanisms and their assessment is presented based on key concepts applied in pain research. This …theoretical framework assumes that although pain may be localized in one region of the body, the mechanisms causing pain may occur at any level of the somatosensory neuro-axis. Detailed assessment of pain complaints and somatosensory abnormalities should, therefore, be a key element in clinical PSSP research. Studies aiming to further characterize somatosensory functions in patients with PSSP (initially) need to take a broad methodological approach including both clinical as well as more experimental pain research tools, such as quantitative sensory testing. A better understanding of pain mechanisms may explain why persistent PSSP and unsatisfactory pain relief are common despite active prevention and treatment strategies and may provide a basis for improved clinical management of PSSP. Show more

Keywords: Stroke, shoulder pain, somatosensory function, pain mechanisms

DOI: 10.3233/NRE-2012-0739

Citation: NeuroRehabilitation, vol. 30, no. 2, pp. 153-165, 2012