Neurorehabilitation

This paper examined the effectiveness of postural training on upper extremity performance in an ataxic individual. The ataxia resulted from a brain stem stroke. Before-after, single-subject experimental design. Four-week course of postural training, comprised of three one-hour sessions/week. The patient demonstrated an increase in function of the ataxic limb, as evidenced by appreciable increases in the Fugl-Meyer score and modest increases in the Postural Assessment Scale for Stroke Patients (PASS) score. Improvement in postural control influences upper extremity function affecting the speed and accuracy of the movement. We demonstrate the effectiveness of using postural training as an intervention towards reducing the effects of ataxia, a movement coordination impairment for which relatively few therapeutic techniques have been specifically developed or evaluated.

To compare the effectiveness of errorless learning versus trial and error learning for teaching activities of daily living to patients with acute stroke with or without explicit memory impairments. Randomized crossover. Rehabilitation hospital. Thirty-three adult subjects following an acute stroke. Subjects were taught to prepare a wheelchair for a transfer and to put on a sock with a sock-donner. Tasks were taught using errorless learning or trial and error learning. Explicit memory was assessed using the Neurobehavioral Cognitive Status Exam. Days until subject was able to demonstrate retention of the task, and success or failure at carry-over to a similar task. No significant differences were found in days to retention for either functional task when taught using errorless learning or trial and error learning in subjects with or without explicit memory impairments. Carry-over was significantly better when trial and error learning was used for learning sock donning. When choosing ...

To compare the treatment of heterotopic ossification (HO) within the traumatic brain and spinal cord injured populations. MEDLINE/Pubmed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing treatment of HO post-injury. Articles were constrained to: English language and human subjects. Studies were included if: n ≥ 50% of the subjects had a spinal cord injury (SCI) or a traumatic brain injury (TBI), n ≥ 3 SCI or TBI subjects, and study subjects participated in a treatment or intervention. Study quality, for randomized control trials (RCTs), were assessed using the PEDro assessment scale, while non-RCTs was assessed using the Downs and Black evaluation tool. A modified Sackett scale was used to apply levels of evidence for each intervention. In total 26 studies (NTBI = 12; NSCI = 14) met inclusion criteria. The majority of studies (10/12) conducted in the TBI population were surgical interventions. Studies conducted with the SCI population investigated diverse...

Robotic guidance has been shown to facilitate motor skill acquisition, through altered sensorimotor control, in neurologically impaired and healthy populations. To determine if robot-guided practice and online visual feedback availability primarily influences movement planning or online control mechanisms. In this two-experiment study, participants first performed a pre-test involving reaches with or without vision, to obtain baseline measures. In both experiments, participants then underwent an acquisition phase where they either actively followed robot-guided trajectories or trained unassisted. Only in the second experiment, robot-guided or unassisted acquisition was performed either with or without online vision. Following acquisition, all participants completed a post-test that was the same as the pre-test. Planning and online control mechanisms were assessed through endpoint error and kinematic analyses. The robot-guided and unassisted groups generally exhibited comparable chan...

This study analyzed the Rehabilitation Services Administration (RSA) case service report (RSA-911) data for fiscal year 2004 to examine effects of demographic characteristics, work disincentives, and vocational rehabilitation services patterns on employment outcomes of persons with traumatic brain injuries (TBI). The results indicated that European Americans (53%) had appreciably higher competitive employment rates than Native American (50%), Asian Americans (44%), African Americans (42%), and Hispanic/Latino Americans (41%). Clients without co-occurring psychiatric disabilities had a higher employment rate (51%) than those with psychiatric disabilities (45%). Clients without work disincentives showed better employment outcomes (58%) than those with disincentives (45%). An important finding from this analysis was the central role of job search assistance, job placement assistance, and on-the-job support services for persons with TBI in predicting employment outcomes. A data mining technique, the exhaustive CHAID analysis, was used to examine the interaction effects of race, gender, work disincentives and service variables on employment outcomes. The results indicated that the TBI clients in this study could be segmented into 29 homogeneous subgroups with employment rates ranging from a low of 11% to a high of 82%, and these differences can be explained by differences in work disincentives, race, and rehabilitation service patterns.

Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy....

Tai Chi is a Chinese traditional mind-body exercise and is well known for its slow and graceful movements. Tai
Chi has been practiced for centuries and has become a popular exercise worldwide in recent years. Tai Chi is beneficial to cardiorespiratory function, muscular strength, balance, flexibility, microcirculation,  psychological profile and quality of life. Tai Chi can be prescribed as an alternative exercise programme for selected patients with cardiovascular, orthopaedic,
or neurological diseases. Recent studies prove that Tai Chi is safe and effective for patients with neurological diseases (e.g., stroke, Parkinson’s disease, traumatic brain injury, multiple sclerosis, cognitive dysfunction). Tai Chi appears to be beneficial for the rehabilitation of stroke, a leading cause of disability worldwide.

Objectives: Physicians may be asked by attorneys or other patient advocates to help plan for the long-term needs of children with cerebral palsy (CP) and developmental disability (DD). The first step in such planning is to thoroughly examine the literature dealing with life expectancy in these populations. This review paper comprehensively reviews the literature relating to survival in children with

The Semmes-Weinstein Monofilament Test (SWMT) is a clinical widely used test to quantify the sensibility in patients with Carpal Tunnel Syndrome (CTS). No study has investigated the relationship between the SWMT and sensory nerve conduction studies (SNCS) in patients with CTS. To assess the relationship between the SWMT and SNCS findings in patients with CTS. This cross-sectional clinical measurement study included 35 patients with CTS (55 hands) with a mean age of 45 ± 12 years. The outcome measures were the SWMT and SNCS measures of distal latency (DLs), amplitude (AMPs), and nerve conduction velocity (NCV). The median innervated fingers were tested using SWMT and electrodiagnostic tests. The primary outcome was the correlations between the SWMTs and NCS measures. All of the patients/hands had abnormal NCS findings. When looking at the three digits of interest (thumb, index and middle), the thumb SWMTs had the highest number of abnormal findings (58.2%), with the middle digit havi...

PURPOSE. to investigate the acceptability, efficacy, and effect duration of translingual neurostimulation (TLNS) plus standard therapeutic exercise program (TEP) to improve motor skills in children with cerebral palsy (CP). Methods: Participants aged 2-17 years (n = 134) diagnosed with spastic diplegia CP with coordination and mobility symptoms were enrolled at Sestroretsk City hospital № 40. Participants were offered one of two treatment regimens: either TEP plus TLNS with the Portable Neuromodulation Stimulator (PoNS™) - experimental arm or TEP alone (control). the treatment course continued for ten days (2 weeks, excluding two weekend days). In the experimental group and TEP, TLNS was applied twice a day, 20 minutes each during exercises, morning, and afternoon, at least 3 hours between sessions. Assessments before and after therapy courses measured spasticity, balance, and motor skills. Either treatment could be repeated several times (6-12 months between courses). All children were assessed before and after a course round of therapy using standard scales for spasticity, balance, and motor skills (Ashworth scale, berg scale, Gross motor function Classification System, functional movement Screen). Results: Both groups of patients showed improvement; however, the improvement was significantly more significant in the experimental group across all scales, observed in all ages, and largely sustained for 6-12 months. CONCLUSIONS. TLNS plus TEP can be considered as a novel and promising strategy to improve neurorehabilitation outcomes in children with CP, offering broad implications for the development and use of TLNS in CP.

El propósito de este capitulo es poder brindar una base conceptual sobre la cual fundamentar la toma de decisiones clínicas que guíen el proceso terapéutico en neuropediatría lo cual a su vez permita tomar decisiones respecto de aplicaciones de vendaje elástico en pacientes infantiles con trastornos del desarrollo sensoriomotor durante el primer año de vida dando énfasis en el desarrollo del control postural como principal estrategia de abordaje terapéutico.

Existen ciertos académicos que recomiendan, para el estudio de las ciencias “humanas”, no sólo leer libros técnicos de la especialidad, si no y sobretodo literatura general. Así como
la muerte de Ivan Ilich de Tolstoi resulta una recomendable herramienta para conocer el proceso personal de alguien
padeciendo dolor crónico.
Este libro de Ecco, resulta notable para comprender - a escala individual - la asociación entre memoria e identidad, así como los procesos o estrategias vinculadas a una recuperación o rehabilitación neuropsicológica

Recent experimental evidence suggests that rapid advancement of virtual reality (VR) technologies has great potential for the development of novel strategies for sensorimotor training in neurorehabilitation. We discuss what the adaptive and engaging virtual environments can provide for massive and intensive sensorimotor stimulation needed to induce brain reorganization.Second, discrepancies between the veridical and virtual feedback can be introduced in VR to facilitate activation of targeted brain networks, which in turn can potentially speed up the recovery process. Here we review the existing experimental evidence regarding the beneficial effects of training in virtual environments on the recovery of function in the areas of gait,upper extremity function and balance, in various patient populations. We also discuss possible mechanisms underlying these effects. We feel that future research in the area of virtual rehabilitation should follow several important paths. Imaging studies ...

La camptocormia e la sindrome di Pisa sono alterazioni posturali estremamente invalidanti che possono manifestarsi all'interno del corteo sintomatologico della malattia di Parkinson. L'eziologia di queste condizioni è sconosciuta e le opzioni di trattamento sono limitate e spesso non risolutive. In un recente studio è stato descritto come l'inoculazione di lidocaina nei muscoli obliqui esterni associata a fisiochinesiterapia porti ad un miglioramento della suddetta alterazione posturale con conseguente riduzione dell'atteggiamento in flessione in condizioni statiche.
L'obiettivo del nostro studio è stato quello di verificare l'efficacia clinica di un nuovo approccio riabilitativo, composto da iniezioni giornaliere di lidocaina (nel muscolo obliquo esterno, uni\bi-lateralmente) associate ad un protocollo standardizzato di fisiochinesiterapia, nei disturbi posturali della malattia di Parkinson e di quantificare le eventuali modificazioni del pattern deambulatorio tramite l'utilizzo della GaitAnalysis.
A questo scopo abbiamo reclutato 7 pazienti (5 maschi, 2 femmine; età media 71,4) affetti da MP, 3 dei quali con camptocormia e 4 con sindrome di Pisa, che presentavano attività aberrante della muscolatura addominale, in particolare dei muscoli obliqui esterni mono\bilateralmente, documentata tramite elettromiografia. I pazienti sono stati valutati all'inizio e a termine del trattamento tramite test funzionali quali: 6 Minutes Walking Test (6MWT), 10 Meter Walk Test (10MWT), Time Up & Go test (TUG), Berg Balance Scale (BBS). Hanno inoltre effettuato Gait Analysis con registrazione di parametri spazio-temporali, cinematici ed elettromiografici di superficie. E' stato poi somministrato il Camptocormia Questionnaire (CQ), un questionario che comprende la misurazione dell'angolo di flessione del tronco, il dolore lombare e l'impatto del disturbo posturale sulle ADL. Il trattamento è
consistito in inoculazioni di 50mg di lidocaina nei muscoli interessati per 5 giorni consecutivi seguite da un protocollo standardizzato di esercizi fisioterapici (della durata di 1 ora) per la prima settimana. In seguito i pazienti hanno continuato ad effettuare il solo protocollo di esercizi per i 5 giorni successivi. I risultati hanno evidenziato un miglioramento in tutti i test effettuati, in particolare un miglioramento statisticamente significativo nella BBS e nel 6MWT. La Gait Analysis ha evidenziato un aumento statisticamente significativo del ROM dell'anca sul piano sagittale al
termine del trattamento. Questo si traduce in un miglioramento dell'equilibrio, della resistenza allo sforzo e del pattern deambulatorio.
L'approccio terapeutico proposto si è dimostrato efficace dal punto di vista
soggettivo, funzionale e strumentale. Appare dunque applicabile in questa tipologia di pazienti previa un'accurata valutazione clinico-strumentale che individui i soggetti idonei al trattamento.
Al fine di ottenere un effetto a lungo termine è possibile pensare ad un blocco neuromuscolare prolungato con farmaci differenti dalla lidocaina, come ad esempio, la tossina botulinica.

One innovation currently influencing physical medicine and rehabilitation is brainecomputer interface (BCI) technology. BCI systems used for motor control record neural activity associated with thoughts, perceptions, and motor intent; decode brain signals into commands for output devices; and perform the user's intended action through an output device. BCI systems used for sensory augmentation transduce environmental stimuli into neural signals interpretable by the central nervous system. Both types of systems have potential for reducing disability by facilitating a user's interaction with the environment. Investigational BCI systems are being used in the rehabilitation setting both as neuroprostheses to replace lost function and as potential plasticity-enhancing therapy tools aimed at accelerating neurorecovery. Populations benefitting from motor and somatosensory BCI systems include those with spinal cord injury, motor neuron disease, limb amputation, and stroke. This article discusses the basic components of BCI for rehabilitation, including recording systems and locations, signal processing and translation algorithms, and external devices controlled through BCI commands. An overview of applications in motor and sensory restoration is provided, along with ethical questions and user perspectives regarding BCI technology.

The aim of this study was to investigate the intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the upper limb of patients with hemiparesis and to determine the effect of pain and contracture presence on the reliability of the MMAS. For this test-retest study 30 patients with hemiparesis were included. One physiotherapist using the MMAS, randomly rated the spasticity of shoulder adductors, elbow flexors, and wrist flexors in the affected upper limb of each patient with hemiparesis twice with at least a 1 week interval between testing sessions. The presence of pain and contracture during passive stretch was recorded. The magnitude of the contracture was measured by a goniometer. The quadratic weighted kappa statistics was very good for the upper limb spasticity (κw= 0.84). Intra-rater reliability was good for shoulder adductors (κw=0.75), and very good for elbow flexors and wrist flexors (κw 0.86 and 0.90, respectively). There were no differences between the we...

"Maria Pachalska and Michel Weber (eds.), Neuropsychology and Philosophy of Mind in Process. Essays in honor of Jason W. Brown, Frankfurt / Lancaster, ontos verlag, Process Thought XVIII, 2008. (443 p. ; 978-3-86838-010-1 ; 139 €)
This volume celebrates the life achievement of Jason W. Brown, who, along with Jean Piaget, Heinz Werner, Alexander Luria and the Würzburg school, has significantly contributed to the development of microgenetic theory as an intellectual paradigm capable of application in both clinical practice (behavioral neurology, neuropsychology) and theoretical speculations (psychoanalysis, philosophy of mind). Essays with a range of focus as wide as Brown's expertise have been collected in three major divisions: neuropsychology (microstructure of action, symptomatology, neuro-rehabilitation, neurolinguistics, locationism), theoretical psychology (consciousness, hypnosis, morphogenesis, personality development, psychoanalysis, Buddhist psychology), and philosophy of mind (evolutionary epistemology, emergence/novelty/creativity, subjectivity, will and action, Whiteheadian process philosophy).
Table of contents
Foreword
Maria Pachalska & Michel Weber
Preface
Jason W. Brown
Part I. Papers in honor of Jason W. Brown
Chapter 1. An authentic life for process thinking
Harold Atmanspacher & Jack Martin
Chapter 2. How does microgenetic theory square with evidence from cognitive
neuroscience?
Talis Bachmann
Chapter 3. Microgenesis of mystical awareness
David T. Bradford
Chapter 4. Sublexical phonological processing and paraphasia: Recent topics
in the neurolinguistics of production in aphasia
Hugh W. Buckingham & Sarah Christman
Chapter 5. The scope of relevance of process thought
John B. Cobb, Jr.
Chapter 6. The microgenesis of antisociality: A process-relational perspective
Mark Germine
Chapter 7. The brain and the mind
Bożydar L.J. Kaczmarek & Katarzyna Markiewicz
Chapter 8. Moral values in focus: knowledge and values in the embodied mind
George Kurian
Chapter 9. Identity, autobiography, and the microgenesis of the self
Bruce Duncan MacQueen
Chapter 10. Neuropsychology of creativity
Nikolay N. Nikolaenko
Chapter 11. Re-membering: the recovery of artistic vision after right-
hemisphere stroke
Maria Pachalska
Chapter 12. Let’s face it! Phonagnosia happens, and voice recognition is fi-
nally familiar
Diana Sidtis & Jody Kreiman
Chapter 13. Process unveiled in the laboratory
Gudmund Smith
Chapter 14. Reality: outside there or inside here?
Kobi Tiberg & Avraham Schweiger
Chapter 15. On microgenesis and psychoanalysis
Michael Trupp
Chapter 16. Self-organizing ontogenesis on the phyletic frame
Don M.Tucker
Chapter 17. Process and individuality
Michel Weber
Part II. Biography
Chapter 18. Jason Walter Brown: an authentic life
Maria Pachalska
Author index
Subject index
"

Neurological disorders affect one billion people worldwide and have significant disability-burden with longer-term functional and psychosocial issues that need comprehensive management, including rehabilitation. The prevalence of disability due to neurological conditions is escalating worldwide. These add to the economic burden for healthcare systems (particularly in low-resourced countries), where despite improved acute health care systems, health policies have not extended to include rehabilitation. Neurorehabilitation is interdisciplinary and cross-sectorial, requiring collaborative coordinated effort of diverse sectors, professions, patients and community. This article provides a narrative overview of literature on neurorehabilitation in developing countries and highlights some of the challenges in implementation of the World Health Organization's Global Disability Action Plan (DAP), focusing on rehabilitation (Objective 2) within the context of neurological conditions. Several issues related to neurorehabilitation are discussed for a systematic approach to build horizontal health care systems that are sustainable and responsive; involvement of bilateral agencies using multi-sectorial approach, new partnerships, strategic collaboration; provision of technical assistance, research and development; and capacity-building for a strong interdisciplinary workforce. Other factors that need to be addressed include governance for strengthening health care systems through logistics, surveillance and service delivery; and adequate scaling. The DAP provides comprehensive summary actions to tackle global disability, including neurological disorder-related disability, and offers governments, policy-makers and other relevant stakeholders a blueprint for implementing recommendations of the World Disability Report and the Convention on the Rights of Persons with Disabilities, and facilitate social inclusion of persons with neurological conditions, in countries at all stages of development.

Logopäden und Logopädinnen sind die Experten und Expertinnen im Bereich von MS-bedingten Sprach-, Sprech-, Stimm- oder Schluckstörungen. Die Vorgehensweise orientiert sich an den Säulen der evidenzbasierten Praxis. Neben den Patienten und -Patientinnenwünschen leiten externe Evidenzen das Vorgehen in der logopädischen Diagnostik und Therapie. Neue Erkenntnisse und Therapieverfahren reflektieren das bisher angewendete logopädische Handeln und orientieren sich damit noch stärker am Ziel einer erhöhten Lebensqualität für die Betroffenen und ihrem sozialen Umfeld.

Spasticity is a common symptom that can be detrimental to the quality of life and daily function of patients with stroke. To introduce the use of dry needling (DN) as a novel method for the treatment of affected upper limb spasticity in a patient with chronic ischemic stroke who was admitted at the Stroke Physiotherapy Clinic. The pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) on the affected side were needled. The patient received deep DN for 1 session, and the duration of needling for each muscle was 1 minute. The main outcomes were the Modified Modified Ashworth Scale (MMAS) muscle spasticity score, and the Hmax/Mmax ratio which were measured before (T0), immediately after (T1), and 15 minutes after the end of needling (T2). The case was a 53-year-old man with a 13-year history of right hemiparesis poststroke. After DN, the spasticity scores improved and maintained as indicated in the MMAS grades (PT 3 to 2, finger flexors 1 to 0) and the Hmax/Mm...

The Mini-BESTest is a relatively new outcome measure used to measure dynamic balance. This talk discusses advantages and disadvantages of using the Mini-BESTest. Reliability, validity, and accuracy of the Mini-BEST are compared with other commonly used balance outcome measures. Finally, clinical applicability of the outcome measure is discussed.

This review presents technologies used in and assesses the main clinical outcomes of electrical therapies designed to speed up and increase functional recovery in stroke patients. The review describes methods which interface peripheral systems (e.g., cyclic neural stimulation, stimulation triggered by electrical activity of muscles, therapeutic functional electrical stimulation) and transcranial brain stimulation with surface and implantable electrodes. Our conclusion from reviewing these data is that integration of electrical therapy into exercise-active movement mediated by electrical activation of peripheral and central sensory-motor mechanisms enhances motor re-learning following damage to the central nervous system. Motor re-learning is considered here as a set of processes associated with practice or experience that leads to long-term changes in the capability for movement. An important suggestion is that therapeutic effects are likely to be much more effective when treatment ...

Introduction: Infants with asymmetric brain lesions are at high risk of developing congenital hemiplegia. Action–observation  training (AOT) has been shown to effectively improve upper limb motor function in adults with chronic stroke. AOT is based on action
observation, whereby new motor skills can be learnt by observing motor actions. This process is facilitated by the Mirror Neuron System, which matches observed
and performed motor actions. This study aims to determine the efficacy of AOT in: (1) influencing the early development of reaching and grasping of typically developing infants and (2) improving the upper limb activity of infants with asymmetric brain lesions. Methods and analysis: This study design comprises two parallel randomised sham-controlled trials (RCTs) in: (1) typically developing infants (cohort I) and
(2) infants with asymmetric brain lesions (eg, arterial stroke, venous infarction, intraventricular haemorrhage or periventricular leukomalacia; cohort II). Cohort II will be identified through  a neonatal ultrasound  or neonatal MRI. A sham control will be used for both RCTs,
taking into consideration that it would be unethical to give no intervention to an at-risk population. Based on a two-tailed  t test of two independent means, with a significance (α) level of 0.05, 80% power, predicted effect size of 0.8 and a 90% retention rate, we require
20 participants in each group (total sample of 40) for cohort I. The sample size for cohort II was based on the assumption that the effect size of the proposed training would be similar to that found by Heathcock
et al in preterm born infants (n=26) with a mean effect size of 2.4. Given the high effect size, the calculation returned  a sample of only four participants per group, on a two-tailed  t test, with a significance  (α) level of
0.05 and 80% power. As cohort II will consist of two subgroups of lesion type (ie, arterial stroke and venous infarction),  we have quadrupled the sample to include

16 participants in each group (total sample of 32). Infants will be randomised to receive either AOT or standard Toy Observation Training (TOT). Both interventions will be of 4 weeks’ duration, from the infant’s 9th–13th post-term week of age. Three sessions of 5 min each will be performed  each day for
6 days/week (total of 6 h over 28 days). Parents of the AOT group will repeatedly show the infant a grasping action on a set of three toys, presented in random order. Parents of the TOT group will show the infant the same set of three toys, in random order, without demonstrating the grasping action. At 14, 16 and
18 weeks, the quantity and quality of reaching and grasping will be measured using the Grasping and Reaching Assessment of Brisbane; symmetry of reaching and grasping will be measured using the Hand Assessment of Infants (HAI) and pressure of grasping for each hand with a customised  pressure sensor. At 6 months’ corrected age, the primary outcome measures will be the HAI and Bayley Scales of Infant and Toddler Development (third edition; BSID III), to measure cognitive and motor development. At 8 months,  HAI and EEG will be used to measure brain activity and cortical coherence. At
12 months, the primary outcome measures will again be HAI and BSID III.
Dissemination:  This paper outlines the theoretical basis, study hypotheses and outcome measures for two parallel RCTs comparing  the novel intervention Action–observation training with standard  TOT in: (1) influencing the early development of reaching and grasping of typically developing infants and
(2) improving the upper limb motor activity of infants with asymmetric brain lesions.
Trial Registration:  ACTRN1261100991910. Web address of trial http://www.ANZCTR.org.au/ ACTRN12611000991910.aspx