A comparison of computerized dynamic posturography therapy to standard balance physical therapy in individuals with Parkinson's disease: a pilot study

Postural instability is a common impairment in idiopathic Parkinson's disease (PD). People with PD are prone to balance and walking difficulties. This study analyzed the feasibility of a prospective investigation of Computerized Dynamic Posturography (CDP) and standard Physical Therapy (PT) treatments in individuals with mild-moderate PD. Treatment took place at two sites: 1) CDP therapy at the Southeast Parkinson's Disease Research Education and Clinical Center (PADRECC) within a Veterans Affairs Medical Center and 2) standard physical therapy at a community outpatient rehabilitation center. Final analysis compared 15 patients randomly assigned for therapy to either the CDP or PT treatments. Therapy time was eight weeks (four weeks of CPD or PT followed by home therapy for four weeks). The CDP therapy included gradually intensified closed chain and mobility training. Standard PT consisted of upright, mat, and theraball exercises and gait training. The home exercise phase was identical for both groups. The pilot data demonstrated treatment was tolerated by 68 percent of the sample despite the occurrence of a progressive neurological condition and medical comorbidities. While results failed to reveal any differences between treatment groups, both groups demonstrated improvement on selected outcome measures. An expanded prospective study with methodological improvements appears warranted.     

Comparison of Rehabilitation Outcomes in Violent Versus Non-violent Traumatic SCI

Abstract

This paper represents the results of a cohort study comparing functional outcomes of individuals with violent and non-violent traumatic spinal cord injury (SCI) following inpatient rehabilitation. Twenty-seven consecutive patients with a diagnosis of traumatic SCI of violent etiology (gunshot wound, stabbing or assault) and 27 patients with non-violent etiology (motor vehicle accident and falls) were matched for neurological level of injury and classification. Demographic comparison of violent versus non-violent groups revealed mean age 30 versus 39, gender 93 percent versus 78 percent male, race 89 percent versus 59 percent non-white, 74 percent versus 41 percent unmarried and 56 percent versus 22 percent unemployed, respectively. Violent and non-violent traumatic SCI groups had similar lengths of stay, admission and discharge functional independent measures (FIM), FIM improvement, payor sources, hospital charges and discharge to home rates. Despite the differences noted in the demographics of violent and non-violent traumatic SCI, these two matched groups achieved similar functional outcomes and discharge disposition following inpatient rehabilitation. (J Spinal Cord Med 1998;21:32-36)     

Deep Brain Stimulation for Dystonia: A Meta‐Analysis

Objective. To use a meta‐analysis on all reported cases of deep brain stimulation (DBS) for dystonia to determine which factors significantly influence outcome. The Burke‐Fahn‐Marsden (BFM) movement scale, the most reported measure, was chosen as the primary outcome measure for this analysis. Methods. A MEDLINE search identified 137 patients who underwent DBS for dystonia in 24 studies that had individual BFM scores. Individual patient data, including age at onset of dystonia, age at surgery, gender, distribution of dystonia, etiology of dystonia, presence of associated features, abnormality of preoperative imaging, prior stereotactic surgeries, nucleus stimulated, type of anesthesia used, use of physiologic monitoring, type of imaging used for localization, stimulation parameters used, time of response to stimulation, and timing of outcome assessment were entered into an SPSS database for statistical analysis. Results. The mean BFM percentage change (improvement in postoperative score from baseline) was 51.8% (range ?34% to 100%). Significantly better outcomes were achieved with stimulation of the globus pallidus internus (GPi) than with stimulation of the posterior portion of the ventral lateral (VLp) nucleus of the thalamus (p = 0.0001). The etiology of the dystonia also had a significant effect on outcomes. Statistically significant improvements in outcomes were seen for all etiologic categories, except encephalitis. Dystonia due to birth injury and encephalitis had significantly worse outcomes when compared to other etiologies. However, there were no significant differences in the outcomes of patients who were DYT1 (DYT1 is the gene associated with the disorder Dystonia Musculorum Deformans) gene positive, DYT1 gene negative, or had pantothenate kinase‐associated neurodegeneration (PKAN), tardive dyskinesia, and idiopathic and posttraumatic dystonias. Longer duration of dystonia symptoms correlated negatively with surgical outcome. A regression model using the three variables—stimulation site, etiology of dystonia, and duration of dystonia symptoms—explained 51% of the variance in outcomes. Conclusion. Deep brain stimulation of the GPi provides significant improvement in BFM scores in a variety of dystonic conditions.     

蝙蝠葛碱和粉防己碱对[~3H]WEB 2086与体外牛脑前动脉平滑肌细胞结合的影响(英文)

用标记的血小板活化因子拮抗剂[~3H]WEB 2086,在培养的牛脑前动脉平滑肌细胞上鉴定了血小板活化因子受体。结果表明在25℃时该细胞上存在两种与配基具有不同亲和力的受体结合位点,其中K_(d-1)=22.8±5.0 nmol·L~(-1),K_(d-2)=186+20.5 nmol·L~(-1);B_(max-1)=2.1±0.3 pmol/10~4细胞,B_(max-2)=12.1±1-5 pmol/10~6细胞。蝙蝠葛碱和粉防己碱均能抑制[~3H]WEB2086与上述细胞的结合。     

Do Rehospitalization Rates Differ Among Injury Severity Levels in the NIDRR Traumatic Brain Injury Model Systems Program?

Objective

To compare the rate and nature of rehospitalization in a cohort of patients enrolled in the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) who have disorders of consciousness (DOC) at the time of rehabilitation admission with those in persons with moderate or severe traumatic brain injury (TBI) but without DOC at rehabilitation admission.

Design

Prospective observational study.

Setting

Inpatient rehabilitation within TBIMS with annual follow-up.

Participants

Of 9028 persons enrolled from 1988 to 2009 (N=9028), 366 from 20 centers met criteria for DOC at rehabilitation admission and follow-up data, and another 5132 individuals met criteria for moderate (n=769) or severe TBI (n=4363).

Interventions

Not applicable.

Main Outcome Measures

Participants and/or their family members completed follow-up data collection including questions about frequency and nature of rehospitalizations at 1 year postinjury. For the subset of participants with DOC, additional follow-up was conducted at 2 and 5 years postinjury.

Results

The DOC group demonstrated an overall 2-fold increase in rehospitalization in the first year postinjury relative to those with moderate or severe TBI without DOC. Persons with DOC at rehabilitation admission have a higher rate of rehospitalization across several categories than persons with moderate or severe TBI.

Conclusions

Although the specific details of rehospitalization are unknown, greater injury severity resulting in DOC status on rehabilitation admission has long-term implications. Data highlight the need for a longitudinal approach to patient management.     

The lighthouse strategy: Improving the functional status of patients with unilateral neglect after stroke and brain injury using a visual imagery intervention

This study extends the work of J. Niemeier (1998) by using visual imagery for amelioration of the devastating impact of visual inattention or neglect on recovery from stroke or other brain injuries. Ten individuals with unilateral visual neglect who were undergoing acute physical rehabilitation after brain injury were cued by their interdisciplinary treatment team members to "be like" horizon-illuminating lighthouses and turn their heads left and right during functional and therapy training tasks. These treatment group patients, in comparison with waiting list controls, performed significantly better and more safely on route finding (p <.001), walking or wheelchair (p <.05), and problem solving (p <.05) tasks. The use of visual imagery techniques in rehabilitation of brain injuries is discussed.     

Factors associated with balance deficits on admission to rehabilitation after traumatic brain injury: a multicenter analysis

OBJECTIVE: To evaluate how demographics, measures of injury severity, and acute care complications relate to sitting and standing balance in patients with traumatic brain injury (TBI). DESIGN: Multicenter analysis of consecutive admissions to designated TBI Model Systems of Care (TBIMS). SETTING: Ten National Institute for Disability and Rehabilitation Research TBI Model System centers for coordinated acute and rehabilitation care. PARTICIPANTS: 908 adults with TBI were included in the study. MAIN OUTCOME MEASURES: Sitting and standing balance were assessed within 72 hours of admission to inpatient rehabilitation. RESULTS: Age less than 50 years had a significant association with normal sitting and standing balance (P =.001 and.05, respectively). Measures of severity of traumatic brain injury, including admission Glasgow Coma Score, length of posttraumatic amnesia (PTA), length of coma, and acute care length of stay were each significantly related to impaired sitting and standing balance ratings (P <.01). Initial abnormalities in pupillary response had a significant relationship with impairment of sitting (P =.009) but not standing balance. Incidence of respiratory failure, pneumonia, soft tissue infections, and urinary tract infections were all related to impaired sitting balance (P <.01). Presence of intracranial hemorrhages did not have a significant relationship with either sitting or standing balance. Intracranial compression had a significant relationship with standing (P =.05) but not sitting balance. A discriminant function analysis, which included neuroradiological findings, injury severity, and medical complications, could not accurately predict impaired balance ratings. CONCLUSIONS: This study demonstrated that rehabilitation admission balance ratings have a significant relationship with age, multiple measures of severity, and acute care medical complications after TBI. Prospective studies are indicated to evaluate the role balance at rehabilitation admission plays in the functional prognosis of patients with TBI.