Is it possible to actively and purposely make use of plasticity and adaptability in the neurorehabilitation treatment of multiple sclerosis patients? A pilot project

OBJECTIVE: To investigate whether neurorehabilitation is able to influence clinical parameters and brain function measured radiologically. DESIGN: A group of healthy probands was compared with two groups of multiple sclerosis (MS) patients, one of which received rehabilitative therapy. SETTING: Outpatient in a university hospital. SUBJECTS: Twenty-eight patients with multiple sclerosis (MS), 17 of whom received rehabilitative therapy, and 13 healthy controls. INTERVENTIONS: Two months of rehabilitative eclectic therapy based on principles of sensorimotor learning and adaptation. MAIN MEASURES: Multiple Sclerosis Functional Composite, Modified Fatigue Impact Scale, Beck Depression Inventory Score, Barthel Index, Environment Status Scale and Multiple Sclerosis Quality of Life--54, and functional magnetic resonance imaging (fMRI). RESULTS: Patients who underwent neurorehabilitation showed a greater drop in fatigue, depression, impairment, disability and handicap and more improvement in quality of life than those who did not receive therapy. Correlation of brain activity between the right and the left hemisphere is greater in healthy individuals than in MS patients. Neurorehabilitation resulted in a trend for increased correlation between the left and the right hemisphere in patients (approaching the standard). In comparison with control groups, signal amplitudes in anatomical areas did not show any significant changes. CONCLUSION: Clinical changes seen with neurorehabilitation were not associated with any detectable changes in fMRI observations.     

Practical research-based guidance for motor imagery practice in neurorehabilitation

Purpose: The purpose of this appraisal is to offer guidance to clinicians on applying motor imagery in neurorehabilitation and provide guidance to support this process.

Method: We used evidence from a variety of fields as well as clinical experience with motor imagery to develop guidance for employing motor imagery during neurorehabilitation.

Results: Motor imagery is a relatively new intervention for neurorehabilitation supported by evidence from areas such as cognitive neuroscience and sports psychology. Motor imagery has become a very popular intervention modality for clinicians but there is insufficient information available on how to administer it in clinical practice and make deliberate decisions during its application.

Conclusions: We provide evidence-based guidance for employing motor imagery in neurorehabilitation and use the principles of motor learning as the framework for clinical application.

Implications for Rehabilitation

• Motor imagery has become a very popular technique for clinicians in neurorehabilitation; however, research reports provide insufficient information for clinicians to employ motor imagery in the clinic.

• The principles of motor learning can be used as a useful framework for employing motor imagery in neurorehabilitation.

• We provide clear guidance to deliver individual-tailored motor imagery in neurorehabilitation based on evidence.

     

Gender and deprivation and rates of referral and thereby admission to a national neurorehabilitation service

OBJECTIVE: To investigate the association between gender and deprivation and rates of admission to a national neurorehabilitation facility following subarachnoid haemorrhage or traumatic brain injury. DESIGN: Retrospective analysis of hospital activity data. SETTING: Lothian Health Board hospital activity; national neurorehabilitation centre. SUBJECTS: Patients with subarachnoid haemorrhage or traumatic brain injury. METHODS: We obtained data for hospital discharge for subarachnoid haemorrhage and traumatic brain injury for patients living in the Lothian Health Board area for the five years 1995 to 1999 by age (15 and over), sex and deprivation category of home residence from nationally held data sets. Similar data were extracted for discharges from the national neurorehabilitation unit. MAIN MEASURES: Rates of neurorehabilitation admission per 1000 hospital admissions. Chi-squared testing was used to assess statistical significance. RESULTS: Data for 13338 hospital admissions and 329 neurorehabilitation admissions were available. We observed higher than expected rates of rehabilitation admission for men with subarachnoid haemorrhage and for patients from more affluent postcode sectors with traumatic brain injury. CONCLUSION: Higher rehabilitation rates are seen among men following subarachnoid haemorrhage and may indicate a focus on return-to-work in the referral or assessment of those suitable for or requiring neurorehabilitation. Higher rehabilitation rates in head injury in those from Carstairs Deprivation Category (DepCat) 2 postcode sectors may represent a bias favouring those from affluent areas in the interaction between the individual and the health service in this group.     

Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study

OBJECTIVES: To establish: (1) inter-rater and test-retest reliability of standardized guidelines for the Fugl-Meyer upper limb section, Action Research Arm Test and Box and Block Test in patients with paresis secondary to stroke, multiple sclerosis or traumatic brain injury and (2) correlation between these arm motor scales and more general measures of impairment and activity limitation. DESIGN: Multicentre cohort study. SETTING: Three European referral centres for neurorehabilitation. SUBJECTS: Thirty-seven stroke, 14 multiple sclerosis and five traumatic brain injury patients. MAIN MEASURES: Scores of the Fugl-Meyer Test (arm section), Action Research Arm Test, and Box and Block Test derived from video information. RESULTS: All three motor tests showed very high inter-rater and test-retest reliability (ICC and rho for main variables > 0.95). Correlation between the motor scales was very high (rho > 0.92). Motor scales correlated moderately highly with the Hemispheric Stroke Scale, a measure of impairment (rho = 0.660-0.689), but not with the Modified Barthel Index, a measure of the ability to cope with basic activities of daily living (rho = 0.044-0.086). CONCLUSIONS: The standardized guidelines assured comparability of test administration and scoring across clinical facilities. The arm motor scales provided information that was not identical to information from the Hemispheric Stroke Scale or the Modified Barthel Index.     

MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study

This study presents results from a randomized controlled clinical trial of the Mirror Image Movement Enabler (MIME) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients, including data on the use of its bilateral training mode. MIME incorporates a PUMA 560 robot (Staubli Unimation Inc, Duncan, South Carolina) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions. Robot-assisted treatment (bilateral, unilateral, and combined bilateral and unilateral) was compared with conventional therapy. Similar to a previous study in chronic stroke, combined unilateral and bilateral robotic training had advantages compared with conventional therapy, producing larger improvements on a motor impairment scale and a measure of abnormal synergies. However, gains in all treatment groups were equivalent at the 6-month follow-up. Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training, although the combined group had more hypertonia and less movement out of synergy at baseline. Robot-assisted treatment gains exceeded those expected from spontaneous recovery. These results are discussed in light of the need for further device development and continued clinical trials.     

Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Objective

To systematically review evidence on the effects of timing and intensity of neurorehabilitation on the functional recovery of patients with moderate to severe traumatic brain injury (TBI) and aggregate the available evidence using meta-analytic methods.

Preliminary investigation of the reliability and validity of the BIRT Independent Living Scale

Abstract

Purpose: Neurorehabilitation aims to increase independence and participation in ordinary life. It is argued that the fundamental indices of this are independent living and engagement in occupational or productive activity. The Brain Injury Rehabilitation Trust Independent Living Scale was designed to capture change in levels of participation and independence following neurorehabilitation. With greater use of outcome measures in health care, it becomes necessary to develop tools which are simple to use and that capture the holistic impact of rehabilitation. This study examines the inter-rater reliability and validity of the Brain Injury Rehabilitation Trust Independent Living Scale, which comprises two single item, multiple-choice sub-scales.

Method: Inter-rater reliability was assessed by comparing the ratings on the Brain Injury Rehabilitation Trust Independent Living Scale, by five pairs of graduate psychologists, of 37 individuals who had undergone neurorehabilitation. Retrospective data collected by other members of the clinical team for the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and Care And Needs Scale were correlated with the Brain Injury Rehabilitation Trust Independent Living Scale to establish concurrent validity.

Results: Weighted kappa coefficients revealed moderate (occupation) to strong (accommodation) inter-rater reliability for the two sub-scales. All correlations between the Brain Injury Rehabilitation Trust Independent Living Scale and the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and the Care And Needs Scale were high, demonstrating good concurrent validity.

Conclusions: This study highlights some of the psychometric properties of the Brain Injury Rehabilitation Trust Independent Living Scale and demonstrates its utility in assessing independent living ability and level of social participation after neurorehabilitation.

• Implications for rehabilitation

• The BIRT Independent Living Scale is a validated method for ranking accommodation and occupation status as an indicator of independent living ability and occupational activity.

• The two freely available single-item scales emerging from this study provide a brief method for measuring independent living ability and participation following rehabilitation in research and clinical practice.

• The BIRT Independent Living Scale’s simplicity means it does not require specific training to administer, facilitating its use by a wide range of multidisciplinary staff members and researchers.

     

Rehabilitation of postural disturbances of hemiplegic patients by using trunk control retraining during exploratory exercises

OBJECTIVE: To assess use of the Bon Saint C?me device for axial postural rehabilitation in hemiplegic patients, a technique based on voluntary trunk control during exploratory retraining. DESIGN: A 3-month randomized controlled trial. SETTING: A public neurorehabilitation center. PATIENTS: Twenty consecutive hemiplegic patients with axial postural disturbance resulting from recent stroke were randomly assigned to a device group (DG) or control group (CG). The 2 groups of 10 patients were similar. INTERVENTION: For 1 month, the DG patients followed an experimental program for 1 hour daily and conventional neurorehabilitation for 1 hour daily, whereas CG patients had conventional neurorehabilitation for 2 hours daily. For the next 2 months, all 20 patients had conventional neurorehabilitation for 2 hours daily. MAIN OUTCOME MEASURES: Patients were assessed on days 0, 30, and 90 by using a battery of postural tests, gait evaluation, the Bells neglect test, and the FIM instrument. RESULTS: On day 30, postural and neglect tests improved significantly more in DG than in CG. The benefit remained at day 90. Gait improved earlier in DG than in CG. FIM scores improved equally. CONCLUSIONS: Voluntary trunk control retraining during spatial exploration with the Bon Saint C?me device appears to be a useful approach for rehabilitation of postural disorders in hemiplegic patients. Treatments designed to improve spatial cognition deficits probably enhance postural disorder recovery in hemiplegia.     

Multivariate analysis of the Fugl-Meyer outcome measures assessing the effectiveness of GENTLE/S robot-mediated stroke therapy

Background  

Robot-mediated therapies offer entirely new approaches to neurorehabilitation. In this paper we present the results obtained from trialling the GENTLE/S neurorehabilitation system assessed using the upper limb section of the Fugl-Meyer (FM) outcome measure.     

Testing the potential of a virtual reality neurorehabilitation system during performance of observation,imagery and imitation of motor actions recorded by wireless functional near-infrared spectroscopy (fNIRS)

Background  

Several neurorehabilitation strategies have been introduced over the last decade based on the so-called simulation hypothesis. This hypothesis states that a neural network located in primary and secondary motor areas is activated not only during overt motor execution, but also during observation or imagery of the same motor action. Based on this hypothesis, we investigated the combination of a virtual reality (VR) based neurorehabilitation system together with a wireless functional near infrared spectroscopy (fNIRS) instrument. This combination is particularly appealing from a rehabilitation perspective as it may allow minimally constrained monitoring during neurorehabilitative training.     

Impact of perceived cognitive impairment in breast cancer survivors

PurposeCognitive impairment is commonly reported by breast cancer survivors, yet little is known regarding its impact on quality of life. The purpose of this study was to obtain a better understanding of breast cancer survivors' experiences of perceived cognitive impairment, its trajectory, and its impact on relationships, daily functioning, work and overall life satisfaction after breast cancer diagnosis and treatment.MethodsThe results are based on qualitative interviews with 22 breast cancer survivors who reported cognitive impairment and who were at least 1 year post-chemotherapy treatment. Interviews were recorded, transcribed verbatim, and analyzed using a content analysis approach.ResultsBreast cancer survivors' primarily expressed concerns in 6 major domains including: short-term memory, long-term memory, speed of processing, attention and concentration, language and executive functioning. Concerns emerged as salient after treatment ended as other problems resolved. All of the survivors found these impairments frustrating, and some also reported these changes as detrimental to their self-confidence and social relationships. Employed survivors reported working harder to perform tasks and use of compensatory strategies to complete work tasks. Validation of perceived cognitive impairment by family, friends, and healthcare providers was perceived as important to adjustment.ConclusionsPerceived cognitive deficits have broad implications for the well-being of breast cancer survivors. Study findings underscore the broad consequences of this symptom, provide direction for theory development, measurement selection, and additional intervention targets. A greater understanding of cognitive impairment in breast cancer survivors may lead to the development of effective treatment of this symptom.     

细胞生长因子在神经康复与神经可塑性中的研究进展北大核心CSCD

细胞生长因子是一类具有刺激细胞生长分裂活性的多肽类因子,具有广泛的生物学作用。细胞生长因子不仅调控机体生长发育等正常生理功能,还在神经损伤等病理过程中调节神经康复及神经可塑性,具体表现为促进神经元存活;促进神经再生,调节突触可塑性;促进细胞分化与血管再生,调节微环境;促进神经纤维髓鞘形成,改善神经传导。本文旨在探讨细胞生长因子在神经康复与神经可塑性中的作用机制和应用,以期提供细胞生长因子在康复领域的研究进展和在临床神经康复治疗中的应用前景。     

Using behavioural methods to manage faecal incontinence

Faecal incontinence is a common problem for patients who have suffered a stroke. However, patients arriving at a neurorehabilitation unit are often reluctant to disclose their problem, and transfer documentation is sometimes incomplete. Nurses need to be aware that this is a sensitive area for patients, which can adversely affect their rehabilitation progress. Nurses and other professional practitioners must work together as a team, as the impact of faecal incontinence can be highly distressing for patients, and can result in inefficient use of therapy time. This article examines how the rehabilitation nurse, using evidence-based practice, can manage faecal incontinence effectively within a structured assessment and therapy programme, and shows it is possible to manage patients' bowel actions proactively. The benefits of this include maximizing therapy and nursing time and preventing delayed discharges. This article is based on a thorough assessment originating from a case study.     

Validation of the Middlesex Elderly Assessment of Mental State (MEAMS) as a cognitive screening test in patients with acquired brain injury in Turkey

PURPOSE: Assessment of cognitive impairment with a valid cognitive screening tool is essential in neurorehabilitation. The aim of this study was to test the reliability and validity of the Turkish-adapted version of the Middlesex Elderly Assessment of Mental State (MEAMS) among acquired brain injury patients in Turkey. METHODS: Some 155 patients with acquired brain injury admitted for rehabilitation were assessed by the adapted version of MEAMS at admission and discharge. Reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and person separation index; internal construct validity by Rasch analysis; external construct validity by associations with physical and cognitive disability (FIM); and responsiveness by Effect Size. RESULTS: Reliability was found to be good with Cronbach's alpha of 0.82 at both admission and discharge; and likewise an ICC of 0.80. Person separation index was 0.813. Internal construct validity was good by fit of the data to the Rasch model (mean item fit -0.178; SD 1.019). Items were substantially free of differential item functioning. External construct validity was confirmed by expected associations with physical and cognitive disability. Effect size was 0.42 compared with 0.22 for cognitive FIM. CONCLUSION: The reliability and validity of the Turkish version of MEAMS as a cognitive impairment screening tool in acquired brain injury has been demonstrated.     

Is the Berg Balance Scale an Internally Valid and Reliable Measure of Balance Across Different Etiologies in Neurorehabilitation? A Revisited Rasch Analysis Study

La Porta F, Caselli S, Susassi S, Cavallini P, Tennant A, Franceschini M. Is the Berg Balance Scale an internally valid and reliable measure of balance across different etiologies in neurorehabilitation? A revisited Rasch analysis study.ObjectivesTo assess, within the context of Rasch analysis, (1) the internal validity and reliability of the Berg Balance Scale (BBS) in a sample of rehabilitation patients with varied balance abilities; and (2) the comparability of the BBS measures across different neurologic diseases.DesignObservational prospective study.SettingRehabilitation ward of an Italian district hospital.ParticipantsConsecutively admitted inpatients and outpatients (N=217); for 85 participants, data were collected both on admission and discharge, giving a total sample of 302 observations.InterventionNot applicable.Main Outcome MeasureBBS.ResultsMost of the BBS items had to be rescored, and 2 items (static sitting and standing balance) had to be deleted, to attain adequate internal construct validity (χ²₂₄=35.68; P=.059). The reliability of the Rasch-modified BBS (BBS-12) (total score, 0–35) was high (.957), indicating precision of measurement at the individual level. The analysis of differential item functioning (DIF) showed invariance of the item calibrations across patients' sex, age, and etiology. After adjusting for the possible effect of repeated measurements on person estimates, the analysis of DIF by timing of assessment confirmed the stability of the item hierarchy across time. A practical ruler was provided to convert item raw scores into Rasch estimates of balance ability.ConclusionsThis study supports the internal validity and reliability of the BBS-12 as a measurement tool independent of the etiology of the neurologic disease causing the balance impairment. In view of some sample-related issues and that not all possible etiologies encountered in the neurorehabilitation settings were tested, a larger multicenter study is warranted to confirm these findings.     

Milieu-based neurorehabilitation in patients with traumatic brain injury: outcome at up to 11 years postdischarge

OBJECTIVE: To examine the rate of productivity and competitive activity in participants with traumatic brain injury (TBI) at a milieu-based day treatment neurorehabilitation program. DESIGN: Follow-up data in a cross-sectional design sought from all admissions from May 1986 to May 1998 at 3 months and at year 1, 3, 5, 7, 9, and 11. SETTING: Outpatient milieu-based interdisciplinary day treatment program. PATIENTS: One hundred twelve participants with TBI, representing 78.9% of TBI patients successfully discharged from the program. INTERVENTIONS: Milieu-based interdisciplinary neurorehabilitation (mean length of treatment, 6.2 mo). MAIN OUTCOME MEASURES: Productivity, defined as gainful employment, school, and/or volunteer work, and competitive activity, defined as work for pay or enrollment in school. RESULTS: 88.4% of patients were productive up to 11 years after discharge, with 76.8% engaged in competitive activity and with no decline in productivity seen over time from discharge. CONCLUSIONS: A large majority of patients suffering from TBI are able to return to work or a productive life situation after milieu-based neurorehabilitation. Level of outcome did not significantly decline over an 11-year follow-up interval.     

Expanding speech pathology services for older people with hearing impairment

Hearing impairment is the most common communication disability in the older population, yet few speech pathologists provide a service to this group. The aim of this paper is to present a rationale and describe a new role for speech pathologists working with older people who have hearing impairment, both those living in the community and those in aged care. The major issues for this population are the high prevalence of hearing impairment, the fact that the majority of older people do not seek audiological interventions, and the serious impact of the impairment on communication and on the quality of life of older people and their families. It is recommended here that speech pathologists expand their current roles with this population and consider interventions that optimize the communication of older people with hearing impairment and their frequent conversational partners (using programs such as Active Communication Education (ACE) described here), as well as taking greater responsibility for hearing issues in aged care facilities and promoting interventions that enhance the communicative environment for older people with a hearing impairment in an aged care facility.     

Perspectives on functional writing following acquired brain impairment

The aim of this paper is to examine different theoretical perspectives on written language and writing disorder accompanying acquired brain impairment. Writing is viewed as a sociocultural practice that provides an alternative for social/linguistic interaction not met by spoken communication, and fulfils different social and personal needs at different stages of a person's life. Consequently, loss or interrupted development of written language is significant for individuals of any age, yet management of writing impairment is not a priority in speech?–?language pathology practice. While writing impairment has historically been reported in association with aphasia and cognitive-language impairment, very little research has examined its nature and impact. Reasons for this dearth of knowledge are examined together with three theoretical perspectives that have been utilized in research to date. The need for further research within a sociocultural framework is discussed.