NeuroRehabilitation - Volume 30, issue 4

Authors: Hong, Ji Heon | Lee, Jun | Cho, Yoon Woo | Byun, Woo Mok | Cho, Hee Kyung | Son, Su Min | Jang, Sung Ho

Article Type: Research Article

Abstract: We report on a patient with ideomotor apraxia (IMA) and limb-kinetic apraxia (LKA) following cerebral infarct, which demonstrated neural tract injuries by diffusion tensor tractography (DTT). A 67-year-old male was diagnosed as cerebral infarct in the left frontal cortex (anterior portion of the precentral gyrus and prefrontal cortex) and centrum semiovale. The patient presented with severe paralysis of the right upper extremity and mild weakness of the right lower extremity at onset. At the time of DTT scanning (5 months after onset), the patient was able to move all joint muscles of the right upper extremity against gravity, except for …the finger extensors, which he could extend partially against gravity. The patient showed intact ideational plan for motor performance; however, his movements were slow, clumsy, and mutilated when executing grasp-release movements of his affected hand. The patient's score on the ideomotor apraxia test was 20 (cut-off score < 32). DTTs for premotor cortex fibers, supplementary motor area fibers, and superior longitudinal fasciculus of the left hemisphere showed partial injuries, compared with those of the right side, and these injuries appeared to be responsible for IMA and LKA in this patient. Show more

Keywords: Diffusion tensor imaging, ideomotor apraxia, limb-kinetic apraxia, superior longitudinal fasciculus, premotor cortex, supplementary motor area

DOI: 10.3233/NRE-2012-0753

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 255-259, 2012

Authors: Phan-Ba, R. | Calay, P. | Grodent, P. | Delrue, G. | Lommers, E. | Delvaux, V. | Moonen, G. | Nagels, G. | Belachew, S.

Article Type: Research Article

Abstract: Background: No clinical test is currently available and validated to measure the maximum walking speed (WS) of multiple sclerosis (MS) patients. Since the Timed 25-Foot Walk Test (T25FW) is performed with a static start, it takes a significant proportion of the distance for MS patients to reach their maximum pace. Objectives: In order to capture the maximum WS and to quantify the relative impact of the accelerating phase during the first meters, we compared the classical T25FW with a modified version (T25FW+ ) allowing a dynamic start after a 3 meters run-up. Methods: Sixty-four MS patients …and 30 healthy subjects performed successively the T25FW and the T25FW+ . Results: The T25FW+ was performed faster than the T25FW for the vast majority of MS and healthy subjects. In the MS population, the mean relative gain of speed due to the dynamic start on T25FW+ was independent from the EDSS and from the level of ambulation impairment. Compared to healthy subjects, the relative difference between dynamic versus static start was more important in the MS population even in patients devoid of apparent gait impairment according to the T25FW. Conclusion: The T25FW+ allows a more accurate measurement of the maximum WS of MS patients, which is a prerequisite to reliably evaluate deceleration over longer distance tests. Indirect arguments suggest that the time to reach the maximum WS may be partially influenced by the cognitive impairment status. The maximum WS and the capacity of MS patients to accelerate on a specific distance may be independently regulated and assessed separately in clinical trials and rehabilitation programs. Show more

Keywords: Multiple sclerosis, gait, outcome measurement, maximum walking speed, acceleration, disability progression

DOI: 10.3233/NRE-2012-0754

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 261-266, 2012

Authors: Li, Kuan-Yi | Lin, Keh-Chung | Wang, Tien-Ni | Wu, Ching-Yi | Huang, Yan-Hua | Ouyang, Pei

Article Type: Research Article

Abstract: Objective: This investigation examined the demographic characteristics along with 3 measures of motor function in determining outcomes in activities of daily living (ADL) after distributed constraint-induced therapy (dCIT). Methods: The study recruited 69 stroke patients who received 3 weeks of dCIT for 2 hours daily, 5 days a week. The self-reported outcome measures for daily function were the Motor Activity Log (MAL) including the amount of use (AOU) and quality of movement (QOM), Nottingham Extended Activities of Daily Living Questionnaire (NEADL), and the Stroke Impact Scale (SIS). Age, sex, onset, side of stroke, Fugl-Meyer assessment (FMA), Wolf Motor …Function Test (WMFT), and Action Research Arm Test (ARAT) were the potential predictors. Results: The ARAT grasp-grip-pinch score was the most dominant predictor for MAL-AOU and NEADL (P < 0.05), and the ARAT total score for the subscore of the ADL/instrumental ADL section of the SIS (P < 0.05). The FMA wrist-hand score was a significant predictor for MAL-QOM (P < 0.05). Age was the only demographic factor that significantly predicted NEADL performance (P < 0.05). Conclusion: Among the 3 commonly used measures of motor function after stroke, ARAT was the strongest determinant in predicting MAL-AOU, MAL-QOM, and SIS-ADL/instrumental ADL after dCIT. Show more

Keywords: Predictors, stroke, rehabilitation, activities of daily living, patient-reported outcomes

DOI: 10.3233/NRE-2012-0755

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 267-275, 2012

Authors: Bandholm, Thomas | Jensen, Bente R. | Nielsen, Lone M. | Rasmussen, Helle | Bencke, Jesper | Curtis, Derek | Pedersen, Søren A. | Sonne-Holm, Stig

Article Type: Research Article

Abstract: Objective: To compare the effects of physical rehabilitation with (PRT) and without (CON) progressive resistance training following treatment of spastic plantarflexors with botulinum toxin type A (BoNT) in children with cerebral palsy (CP). Methods: Fourteen children with CP performed supervised PRT (n = 7) or CON (n = 7) two times per week for 12 weeks, following the BoNT-treatment. Outcome measurements were performed at baseline (pre BoNT), and 4 and 12 weeks post BoNT. They consisted of: ankle muscle function (maximal torque and submaximal torque steadiness of isometric ankle dorsi- and plantarflexion and associated ankle muscle …[EMG] activity), gait function (3-dimensional gait analysis), balance function (sway analysis), gross motor function (GMFM-66), and spasticity (modified Ashworth). Results: Submaximal torque control (torque steadiness) of isometric dorsiflexion improved similarly in the two groups, and the improvement was related to the reduction in antagonist (soleus) co-activity (P < 0.05). Maximal plantarflexion torque increased after PRT, whereas a reduction was seen after CON (P < 0.05). No changes in function were observed. Conclusions: Both types of physical rehabilitation in combination with BoNT-treatment improved antagonist (ankle dorsiflexion) torque-control to the same extent – which was related to the reduction in antagonist co-activity – but only rehabilitation with PRT increased maximal plantarflexion torque. Show more

Keywords: Cerebral palsy, electromyography, gait, muscle spasticity, psychomotor performance

DOI: 10.3233/NRE-2012-0756

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 277-286, 2012

Authors: Bento, Virgílio F. | Cruz, Vítor Tedim | Ribeiro, David D. | Cunha, João P.

Article Type: Research Article

Abstract: Introduction: Current scientific knowledge reinforces that successful reorganization of surviving nervous tissue supports cognitive and motor recovery after stroke. The development of new neurorehabilitation tools to modulate this physiologic process is needed. In this context, vibratory stimuli are a noninvasive form of proprioceptive stimulation of the nervous system and are freely available and easy to use at a low cost. Objectives: To access the feasibility and tolerability of targeted vibratory stimuli delivered through a wearable device in an early post-stroke setting. Patients and methods: Five stroke patients were recruited from a stroke unit setting having a …first ever medial cerebral artery ischemic stroke with motor deficit. The stimulation device developed delivered external vibratory stimuli to major joints at preprogrammed arrays of intensity, duration and interval of actuation. The tolerability test was set for five-hour duration and during that period data on vital parameters, cognitive, motor and sensitive performance as well as anxiety scores were recorded. Results: The device remained in place throughout and none of the patients or relatives asked to interrupt the tolerability test. There were no major complications during the trial or the ensuing days. Attention to the affected side during stimulation was increased in four patients, and two were reported as clearly more awake during the test. Discussion: This is the first tolerability test focused on the use of targeted vibratory stimulus as a neurorehabilitation tool in stroke patients. There were no hazards to report and most interestingly the majority of patients showed increased awareness to the affected side of the body. These findings will be further analyzed under functional MRI control and on long-term ambulatory use trials. Show more

Keywords: Cortical reorganization, neuronal plasticity, proprioceptive stimulation, rehabilitation, stroke, vibratory stimulus

DOI: 10.3233/NRE-2012-0757

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 287-293, 2012

Authors: Frazzitta, Giuseppe | Bertotti, Gabriella | Morelli, Micaela | Riboldazzi, Giulio | Pelosin, Elisa | Balbi, Pietro | Boveri, Natalia | Comi, Cristoforo | Turla, Marinella | Leva, Serena | Felicetti, Guido | Maestri, Roberto

Article Type: Research Article

Abstract: Goal and objectives: The present study was devised: (a) to test whether an intensive (60 hours in 4 weeks) multidisciplinary rehabilitation treatment (involving physiotherapy, exercises to improve gait and balance using treadmill and stabilometric platform, occupational therapy) for Parkinsonian patients is effective in improving dyskinesia and motor performance compared to a control group undergoing a non-intensive non multidisciplinary rehabilitation treatment (30 hours in 4 weeks involving physiotherapy only); and (b) to verify whether rehabilitation may lead to a reduction in levodopa dosage. Material and Methods: Forty Parkinsonian patients suffering from dyskinesias were admitted to study: 20 for an …intensive multidisciplinary (Group1) and 20 for a non-intensive non multidisciplinary rehabilitation treatment (Group2). The rating scales used for the clinical evaluation were: Unified Parkinson’s Disease Rating Scales (UPDRS) II, III, IV, Parkinson’s disease disability scale (PDDS), Abnormal Involuntary Movement Scale (AIMS). Results: All outcome measurements improved in both groups of patients, but patients Group1 presented better results: UPDRS II was reduced by 33% in Group1 and by 22% in Group2, UPDRS III 29% vs. 22%, UPDRS IV 74% vs. 10%, PDDS 18% vs. 12%, and AIMS 71% vs. 8%. A different behaviour was observed for levodopa dosage at baseline and after treatment: dosage decreased by an average value of 210 mg (p < 0.0001) in Group1 and was virtually unchanged (30 mg reduction, p = 0.08) in Group2. Conclusion: Our findings suggest that a rehabilitation protocol should be considered as a valid non-invasive therapeutic support for patients who show dyskinesias and that there are better results when the treatment is intensive. Show more

Keywords: Parkinson's disease, intensive rehabilitation, dyskinesias

DOI: 10.3233/NRE-2012-0758

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 295-301, 2012

Authors: Yeo, Sang Seok | Jang, Sung Ho

Article Type: Research Article

Abstract: The ipsilateral motor pathway from the unaffected motor cortex to the affected extremity is one of the mechanisms of motor recovery following stroke. We report on a stroke patient who showed the ipsilateral motor pathway without the contralateral motor pathway on functional MRI and diffusion tensor tractography. A 53-year-old left hemiparetic patient with an infarct in the right middle cerebral artery territory was evaluated. During a period of three months after onset, motor function of the affected (left) hand had recovered slowly, to the extent that the patient was able to overcome gravity. FMRI showed that only the unaffected (left) …primary sensorimotor cortex was activated by movements of the unaffected (right) hand or of the affected (left) hand. On diffusion tensor tractography, the corticospinal tract of the left hemisphere originated from the primary sensori-motor cortex and descended through the known corticospinal tract pathway. By contrast, the right corticospinal tract showed a disruption with Wallerian degeneration to the upper medulla. We conclude that the motor function of the affected (left) hand appeared to be controlled only by the ipsilateral motor pathway from the left motor cortex to the left hand. Motor function of the affected hand appeared to have been reorganized to the ipsilateral motor pathway from the unaffected motor cortex to the affected hand. Show more

Keywords: Functional MRI, diffusion tensor imaging, motor recovery, stroke, hemiplegia

DOI: 10.3233/NRE-2012-0759

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 303-306, 2012

Authors: Lee, Dong Ryul | You, Joshua H. | Yi, Chung-Hwi | Jeon, Hye-Seon

Article Type: Research Article

Abstract: Purpose: The present study highlighted a novel motor point location index (MPLI) for the precise localization of the motor point (MP) of the tibialis anterior (TA) using a regression equation. Methods: Twenty healthy young adults (female = 8; mean age ± SD = 18.50 ± 0.32) were volunteered for this study. The regression analysis was performed by correlating the MP locations with anatomical landmarks. The TA muscle’s MP location was bilaterally determined by needle electromyography (EMG) measurement. The anatomical landmarks included lower leg length (LLL), tibial tuberosity-intermalleolar line length (TT-ILL), the knee width (KW) and the leg width …(LW). Results: The excellent correlation between the TT-ILL and the vertical MP location was obtained, R2 = 0.815. Approximately 82% of the variance of the vertical MP location was accounted for by its linear relationship with the TT-ILL. The high correlation between the LW and the horizontal MP location was observed, R2 = 0.764. Approximately 77% of the variance of the horizontal MP location index was accounted for by its linear relationship with the LW. Conclusions: These findings indicate that the anatomical landmarks were useful to accurately predict MP locations for the TA muscle. Clinically, this MP location index using regression equations may be alternative for the current method that was not previously affordable. Show more

Keywords: Electromyography, motor point, regression equation

DOI: 10.3233/NRE-2012-0760

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 307-313, 2012

Authors: Cioncoloni, D. | Piu, P. | Tassi, R. | Acampa, M. | Guideri, F. | Taddei, S. | Bielli, S. | Martini, G. | Mazzocchio, R.

Article Type: Research Article

Abstract: Objective: The modified Rankin Scale (mRS) and the Barthel Index (BI) are the most common clinimetrical instruments for measuring disability after stroke. This study investigated the relationship between the BI and the mRS at multiple time points after stroke. The BI, which is a widely used instrument for longitudinal follow-up post-stroke, was used as reference to determine the effect of time on the sensitivity of the mRS in differentiating functional recovery. Methods: Ninety-two patients with first stroke and hemispheric brain lesion were evaluated using the BI and mRS at 10 days, 3 and 6 months. The Kruskal–Wallis test …was applied to examine median differences in BI among the mRS levels at 10 days, 3 and 6 months with Dunn’s correction for multigroup comparison. The Mann and Whitney test was used to compare median differences in BI scores between two aggregations of mRS grades (mRS = 0–2, mRS = 3–5) at the same time periods after stroke. Results: BI score distribution amongst mRS grades overlapped at 10 days, differentiating only between extreme grades (no disability vs severe disability). At 3 months, independent patients with slight disability could be distinguished from dependent patients with marked disability. At 6 months, grade 2 and 3 overlapped no more, differentiating independence (class 0–2) from dependence (class 3–5). The largest transition to an independent functional status occurred from grade 4, at 3 months. Conclusion: Maximum sensitivity of mRS in differentiating functional recovery is reached at six months post-stroke. Show more

Keywords: Stroke, Barthel Index, modified Rankin Scale, rehabilitation, physiotherapy, functional recovery, prognosis

DOI: 10.3233/NRE-2012-0761

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 315-322, 2012

Authors: Seo, Jeong Pyo | Kim, Oh Lyong | Kim, Seong Ho | Chang, Min Cheol | Kim, Min-Su | Son, Su Min | Jang, Sung Ho

Article Type: Research Article

Abstract: The recent development of diffusion tensor imaging (DTI) allows visualization and estimation of the uncinate fasciculus (UF). We investigated injuries of the UF in patients with diffuse axonal injury (DAI) who showed no specific lesions except for DAI lesions on conventional brain MRI. Twenty-one chronic patients with DAI, and 21 age- and sex-matched normal control subjects were recruited for this study. Diffusion tensor images were acquired using a sensitivity-encoding head coil at 1.5 T and the UF was reconstructed using DTI-Studio software. Fractional anisotropy (FA), apparent diffusion coefficient (ADC) value, and fiber number of the UF were measured. In the …DAI group, the FA values and fiber numbers were significantly decreased compared to those of the control group (P < 0.05). The FA value and fiber number decreased 8.4% and 26.5% in the DAI group compared to those of the control group. By contrast, the ADC value did not show any difference between the DAI and control groups (P > 0.05). Changes in the DTI parameters of the DAI group appeared to indicate neural injury of the UF. We believe that DTI can be a useful evaluation tool for detecting hidden neural injuries of UF in patients with DAI. Show more

Keywords: Diffusion tensor imaging, brain injury, diffuse axonal injury, uncinate fasciculus

DOI: 10.3233/NRE-2012-0762

Citation: NeuroRehabilitation, vol. 30, no. 4, pp. 323-328, 2012