Showing papers in "NeuroRehabilitation in 2005"
TL;DR: Gait and step perturbation training resulted in a reduction in falls and improvements in gait and dynamic balance, which is a promising approach to reduce falls for patients with PD.
Abstract: Introduction: Frequent falls and risk of injury are evident in individuals with Parkinson's disease (PD) as the disease progresses. There have been no reports of any interventions that reduce the incidence of falls in idiopathic PD. Purpose: Assess the benefit of gait and step perturbation training in individuals with PD. Design: Randomized, controlled trial. Setting: Outpatient research, education and clinical center in a tertiary care Veterans Affairs Medical Center. Outcome measures: Gait parameters, 5-step test, report of falls Subjects: Eighteen men with idiopathic PD in stage 2 or 3 of the Hoehn and Yahr staging Methods: Subjects were randomly assigned to a trained or control group. They were asked about any falls 2 weeks prior to and after an 8 week period. Gait speed, cadence, and step length were tested on an instrumented walkway. Subjects were timed while stepping onto and back down from an 8.8 cm step for 5 consecutive steps. Gait training consisted of walking on a treadmill at a speed greater than over ground walking speed while walking in 4 directions and while supported in a harness for safety. Step training consisted of suddenly turning the treadmill on and off while the subject stood in the safety harness facing either forwards, backwards, or sideways. Training occurred 1 hour per day, three times per week for 8 weeks. A two-factor (time and group) analysis of variance with repeated measures was used to compare the groups. Results: Substantial reduction occurred in falls in the trained group, but not in the control group. Gait speed increased in the trained group from 1.28 ± 0.33 meters/sec to 1.45 ± 0.37 meters/sec, but not in the control group (from 1.26 to 1.27 m/s). The cadence increased for both groups: from 112.8 to 120.3 steps/min for the trained group and 117.7 to 124.3 steps/min for the control group. Stride lengths increased for the trained group, but not the control group. The 5-step test speed increased in the trained group from 0.40 ± 0.08 steps/sec to 0.51 ± 0.12 steps/sec, and in the control group (0.36 ± 0.11 steps/sec to 0.42 ± 0.11
318 citations
TL;DR: The authors review the literature on the characteristics and features of speech and voice disorders in people with PD, the types of treatment techniques available, including medical, surgical, and behavioral therapies, and provide recommendations for the current efficacy of treatment interventions and directions of future research.
Abstract: Researchers estimate that 89% of people with Parkinson's disease (PD) have a speech or voice disorder including disorders of laryngeal, respiratory, and articulatory function. Despite the high incidence of speech and voice impairment, studies suggest that only 3-4% of people with PD receive speech treatment. The authors review the literature on the characteristics and features of speech and voice disorders in people with PD, the types of treatment techniques available, including medical, surgical, and behavioral therapies, and provide recommendations for the current efficacy of treatment interventions and directions of future research.
193 citations
TL;DR: Higher satisfaction with life in general was demonstrated in respondents with SCI involved in sports or physical recreation compared to those not participating in physical activities.
Abstract: The purpose of this study is to assess satisfaction with life domains in people with spinal cord injuries (SCI) and investigate whether participation in sports and physical recreation is associated with life satisfaction in SCI. 1,748 randomly selected participants with SCI who fulfilled the criteria: SCI at level C5 or below, wheelchair dependent; aged 18-50 at the time of injury; at least 1 year post-injury, were approached to take part in this study. Completed replies were received from 985 individuals with SCI (198 women, 798 men). The measures used included the Sports Participation Questionnaire, the Life Satisfaction Questionnaire and the Hospital Anxiety and Depression Scale. The numbers of hours participating in sports decreased significantly after injury. There was a greater decrease in numbers participating in team sports in comparison to the decrease seen in numbers participating in individual sports. The highest level of satisfaction existed within social domains such as: family life and contacts with friends. The lowest level of satisfaction was found in regard to the participant's sexual life and vocational situation. Higher satisfaction with life in general was demonstrated in respondents with SCI involved in sports or physical recreation compared to those not participating in physical activities.
163 citations
TL;DR: PET data indicate that some vegetative patients are unconscious not just because of a global loss of neuronal function, but due to an altered activity in a critical fronto-parietal cortical network and to abolished functional connections within this network and with non-specific thalamic nuclei.
Abstract: The interest of functional imaging in patients in a vegetative state is twofold First, the vegetative state continues to represent a major clinical and ethical problem, in terms of diagnosis, prognosis, treatment, everyday management and end-of-life decisions Second, it offers a lesional approach to the study of human consciousness and adds to the international research effort on identifying the neural correlate of consciousness Cerebral metabolism has been shown to be massively reduced in the vegetative state However, recovery of consciousness from vegetative state seems not always associated with substantial changes in global metabolism Recent PET data indicate that some vegetative patients are unconscious not just because of a global loss of neuronal function, but due to an altered activity in a critical fronto-parietal cortical network and to abolished functional connections within this network and with non-specific thalamic nuclei Recovery of consciousness was shown to be paralleled by a restoration of this cortico-thalamo-cortical interaction Despite the metabolic impairment, external stimulation still induces neuronal activation as shown by both auditory and noxious stimuli However, this activation is limited to primary cortices and dissociated from higher-order associative cortices, thought to be necessary for conscious perception
137 citations
TL;DR: Improvements in dynamic posturography, falls during balance testing, Berg Balance, UPDRS (Motor Exam), and gait for all groups lead us to believe that neuromuscular regulation can be facilitated in all Parkinson's individuals no matter what treadmill intervention is employed.
Abstract: Our study aims were: 1) to determine whether assisted weight bearing or additional weight bearing is more beneficial to the improvement of function and increased stability in gait and dynamic balance in patients with Parkinsonism, compared with matched controls (treadmill alone). Twenty-three men and women participants (M +/- SD = 74.5 +/- 9.7 yrs; Males = 19, Females = 4) with Parkinsonism were in the study. Participants staged at 1-7 (M +/- SD = 3.96 +/- 1.07) using the Hoehn & Yahr scale. All participants were tested before, after the intervention (within one week), and four weeks later on: 1) dynamic posturography, 2) Berg Balance scale, 3) United Parkinson's Disease Rating Scale (UPDRS), 4) biomechanical assessment of strength and range of motion, and 5) Gaitrite force sensitive gait mat. Group 1 (treadmill control group), received treadmill training with no loading or unloading. Group 2 (unweighted group), walked on the treadmill assisted by the Biodex Unweighing System at a 25% body weight reduction. Group 3 (weighted group), ambulated wearing a weighted scuba-diving belt, which increased their normal body weight by 5%. All subjects walked on the treadmill for 20 minutes per day for 3 days per week for 6 weeks. Improvements in dynamic posturography, falls during balance testing, Berg Balance, UPDRS (Motor Exam), and gait for all groups lead us to believe that neuromuscular regulation can be facilitated in all Parkinson's individuals no matter what treadmill intervention is employed.
132 citations
TL;DR: The practice recommendations proposed by expert panels charged with developing consensus-based definitions and diagnostic criteria for disorders of consciousness are summarized and their implications for existing and future interventions are discussed.
Abstract: Disorders of consciousness continue to be the subject of hot debate in healthcare settings, research consortiums, bioethics departments and media forums. There are no standards of care to guide assessment and treatment decisions resulting in wide disparities in daily practice. In response to this problem, expert panels in neurology and neurorehabilitation were convened and charged with developing consensus-based definitions and diagnostic criteria for disorders of consciousness. The Multi-Society Task Force Report on the persistent vegetative state and the Aspen Workgroup statement on the minimally conscious state represent two such initiatives. This paper summarizes the practice recommendations proposed by these groups and discusses their implications for existing and future interventions.
126 citations
TL;DR: Several variables were demonstrated significantly to distinguish fallers and can be viewed a potentially modifiable during a future intervention trial that aims to reduce falls in those who have Parkinson's disease using multidimensional risk factor modification.
Abstract: Objective: to identify falling risk factors that are potentially modifiable among individuals who have idiopathic Parkinson's disease. Design: a between group comparison of 19 fallers and 21 nonfallers who have Parkinson's disease, across an array of variables that have been identified as falling risk factors among the elderly and among those who have Parkinson's disease. Results: several variables were demonstrated significantly to distinguish fallers: disease duration and severity; dyskinesias associated with the use of dopaminergic agents; freezing; postural instability; depression; fear of falling; impaired fine motor control and motor planning in the feet; decreased proximal strength and muscular endurance in the legs; and a higher level of disability. Conclusions: several of these variables can be viewed a potentially modifiable during a future intervention trial that aims to reduce falls in those who have Parkinson's disease using multidimensional risk factor modification.
116 citations
TL;DR: It is espouse that both ethical and legal debate should take into account results of ERP studies of patients with severe brain damage to gain information about their remaining semantic processing capabilities and to contribute to differential diagnosis.
Abstract: Event-related potentials (ERPs) can provide valuable information about cognitive capabilities in severely brain- damaged patients. This study examined 120 patients with severe brain damage using event related potentials ERPs (N 400) to gain information about their remaining semantic processing capabilities and to contribute to differential diagnosis. Patients were classified into three diagnostic groups: patients in vegetative state (VS), patients in near vegetative state (NEVS) and patients not in vegetative state (NOVS). N400 ERPs were analyzed on an individual basis. All three groups could be differentiated by N400. While VS-patients as a group were least likely to show N400, some VS-patients (approx. 12%) showed clear semantic N400 potentials as an indication of semantic processing capabilities. Patients in NEVS showed significantly more intact semantic capabilities (76.74%) than the VS-group despite little clinical differences between the two groups. Thus, ERPs provide valuable information about patients with brain injury whose clinical conditions often do not allow a true assessment of their cognitive capabilities. Given these findings, we would espouse that both ethical and legal debate should take into account results of ERP studies of such patients.
76 citations
TL;DR: The evidence for the use of selected alkylphenols, benzodiazepines, estrogens, antiandrogens, neuroleptics/antipsychotic, antidepressants, anti-Parkinsonian agents, antipsychotics, anticonvulsants, lithium carbonate, buspirone, beta-blockers, and psychostimulants in agitated TBI survivors is assessed.
Abstract: Agitation, restlessness, and aggression are frequent neurobehavioural sequelae in the early stages of recovery from traumatic brain injury (TBI) These behavioural symptoms disrupt patient care and impede rehabilitation efforts We review the current literature (1985 onwards) examining the pharmacological management of post-TBI agitation in both acute and post-acute conditions This article will assess the evidence for the use of selected alkylphenols, benzodiazepines, estrogens, antiandrogens, neuroleptics/antipsychotics, antidepressants, anti-Parkinsonian agents, antipsychotics, anticonvulsants, lithium carbonate, buspirone, beta-blockers, and psychostimulants in agitated TBI survivors Review of the literature suggests that there is limited evidence to accurately guide clinicians in the management of this patient population
76 citations
TL;DR: Results indicated that strength, as indexed by the generation of maximum expiratory pressure (MEP), increased by 50% in the first 4 weeks of training, consistent with the average strength increase obtained in previous research.
Abstract: The outcome of a 20 week expiratory muscle strength training program (EMST) is documented in a patient with early idiopathic Parkinson's disease. A pressure threshold device was utilized and training occurred in the home setting. The training was intensive with a physiologically challenging load specific to the expiratory muscles, adjusted weekly based on the participant's performance. Results indicated that strength, as indexed by the generation of maximum expiratory pressure (MEP), increased by 50% in the first 4 weeks of training, consistent with the average strength increase obtained in previous research. Strength increases continued beyond the traditional 4 weeks of training with a final improvement in MEP of 158% from baseline over the 20 weeks. When the EMST was discontinued for a period of 4 weeks, the participant's MEP decreased by 16% from the 20 week endpoint measurement. The strength training pattern of the expiratory muscles observed in this study was similar to the pattern previously reported for limb muscles.
72 citations
TL;DR: The pilot study supports on-going development and testing of energy conservation education delivered by teleconference to people with multiple sclerosis.
Abstract: OBJECTIVE: To modify and pilot test a face-to-face group energy conservation education program for delivery by group telephone teleconference to people with multiple sclerosis. PARTICIPANTS: 29 community dwelling individuals with multiple sclerosis. METHODS: The first phase of the study involved the modification of an existing energy conservation education program to accommodate teleconference delivery. The second phase involved a pilot test of the intervention using a basic pre/post intervention design. Licensed occupational therapists delivered the intervention. OUTCOME MEASURES: Fatigue severity, fatigue impact, health related quality of life, self-efficacy for performing energy conservation strategies, and use of energy conservation behaviors. FINDINGS: Using an a priori alpha of p = 0.10, paired t-tests found significant reductions in fatigue severity, fatigue impact, and improvements in the following aspects of quality of life: bodily pain and general health. Average effect size was 0.31. The most used energy conservation strategies after the course were simplifying activities, adjusting priorities, changing body position, resting, and planning the day to balance work and rest. CONCLUSION: The pilot study supports on-going development and testing of energy conservation education delivered by teleconference to people with multiple sclerosis.
TL;DR: Functional and quantitative gait analyses confirm sustained improvement in gait dynamics with bilateral stimulation for periods for more than several years and suggest the combination of deep brain stimulation, pharmacotherapy, and rehabilitation training may result in more effective comprehensive approaches to the reduced mobility associated with Parkinson's disease.
Abstract: Abnormality in gait is a cardinal feature of Parkinson's disease. Walking is characterized by relatively preserved sequencing of trunk and limb movements, but diminished velocity, shortened stride length, increased base, and diminished double stance support time. The principle problem producing the gait abnormalities is dopamine deficiency, which is hypothesized to disrupt pallido-thalamic modulation of cortical motor regions that automatically regulate walking. Deep brain stimulation currently is directed at either the globus pallidum internus (GPi) or subthalamic nucleus (STN) and improves many of the abnormal characteristics of parkinsonian gait with efficacy similar to dopamine replacement. The optimal target for stimulation remains uncertain and is currently being addressed in a large VA cooperative study. Our studies show that unilateral stimulation of GPi or STN improves gait to a similar extent. Functional and quantitative gait analyses confirm sustained improvement in gait dynamics with bilateral stimulation for periods for more than several years. Parkinsonian gait is also improved with rehabilitation training, primarily using external visual or auditory cues. The combination of deep brain stimulation, pharmacotherapy, and rehabilitation training may result in more effective comprehensive approaches to the reduced mobility associated with Parkinson's disease.
TL;DR: The concept of withdrawal of nutrition and hydration is a sensitive issue and clinicians can expect to be considered as not acting in the patient's best interest whatever decision is taken.
Abstract: Withdrawal of nutrition and hydration, is a difficult and sensitive issue for all those working with people in the vegetative state. There are arguments against the decision to withdraw any treatment that might result in the patient deteriorating or dying. These arguments include the view that all life is worth having, that we can never be certain that the patient is not aware, and concerns that there may be new scientific developments in the future from which the patient would benefit. Others argue that the patient has no interests in life; that it is undignified, if not an assault, to insert tubes into a permanently unconscious person; that very few people would want to survive in this condition; and that it prevents loves ones from grieving. These strongly held opposing views can make clinical decision making very difficult for the clinician. Once the decision has been made to withdraw treatment then the clinician has to be certain that the patient is in the vegetative state, that there are no factors preventing the patient demonstrating awareness, that he has received expert assessment and treatment, and that the prognosis for lack of recovery is as clear as it can be. It is important to support family and staff throughout this process. The concept of withdrawal of nutrition and hydration is a sensitive issue and clinicians can expect to be considered as not acting in the patient's best interest whatever decision is taken.
TL;DR: The sensible course for individuals at risk of lightning-related neurologic complications is to learn and follow lightning safety recommendations.
Abstract: Lightning is responsible for a wide spectrum of neurologic complications. Many of the persistent symptoms require long-term neurorehabilitation. The lightning-related neurologic conditions are divided into four categories. Category I consists of signs and symptoms that are temporary and usually benign. Category II conditions are prolonged or permanent produced by significant central nervous system lesions. Two of the most devastating complications are lightning-related encephalopathy and myelopathy. The disabilities that accompany these lesions call for concentrated neurorehabilitation. A large number of patients are afflicted with neurobehavioral symptoms that may last for months or years. Category III contains delayed neurologic syndromes. Category IV encompasses neurologic lesions that are not directly activated by the lightning strike but are the result of trauma secondary to falls or blasts effects. The sensible course for individuals at risk is to learn and follow lightning safety recommendations.
TL;DR: The CIM shows good promise for capturing an individual's perception of community integration, and the factor structure supports the original Model of Community Integration.
Abstract: Objective To examine instrument reliability, validity, factor structure, and conceptual underpinnings of the Community Integration Measure (CIM) with the Community Integration Questionnaire Revised (CIQ-R) and the Satisfaction with Life Scale (SWLS). Design A replication study. Setting Community living. Participants Ninety-one participants: 51 individuals with a brain injury, and 40 without brain injury. Main outcomes Internal consistency, criterion validity, construct validity, discriminant validity factor structure. Results CIM items produced standardized alphas ranging from 0.72 to 0.83. Significant positive correlations were found among the CIM and both the CIQ-R and SWLS, with the CIM performing better with the SWLS than did the CIQ-R. The CIM discriminated between subject samples as well as by living arrangement. The factor loading solution revealed a three-factor model that explained 63.72 percent of the variance. Conclusion The CIM shows good promise for capturing an individual's perception of community integration. The factor structure supports the original Model of Community Integration. Further research is needed to examine the influence of objective items on the CIM and Model of Community Integration.
TL;DR: Preliminary results indicate that lamotrigine relieves the symptoms and improves the life qualities of patients with post polio syndrome.
Abstract: The aim of this study is to find out if lamotrigine gives symptomatic relief and enhances quality of life in patients with post-polio syndrome. Thirty patients were randomly assigned to receive or not to receive lamotrigine treatment. Lamotrigine at a daily dose of 50-100 mg was given to the fifteen patients, and fifteen patients were used as the control group. Interventional advice and home exercises were given to all of the patients. Clinical assessments were made at baseline and repeated at the second and fourth weeks by the physician who was unaware of medication. The severity of pain, fatigue and muscle cramps were rated on a visual analogue scale. Health-related quality of life was measured using the Nottingham Health Profile. The patient's perceived level of fatigue was assessed using Fatigue Severity Scale. Comparing to the baseline values, statistically significant improvements were obtained in the mean scores of VAS, NHP and FSS at two weeks and four weeks in the patients on lamotrigine. No significant improvements were reported in the control group. These preliminary results indicate that lamotrigine relieves the symptoms and improves the life qualities of patients with post polio syndrome.
TL;DR: Information concerning etiology, epidemiology, clinical course, and most importantly, potential for recovery of consciousness and function as well as long-term survival of these patients will be discussed.
Abstract: The vegetative state (VS), a state of wakefulness without awareness, has been well recognized in children despite the fact that little descriptive information has been published [3,14,21,38]. This review will focus on our current understanding of VS from a pediatric and medical perspective. Information concerning etiology, epidemiology, clinical course, and most importantly, potential for recovery of consciousness and function as well as long-term survival of these patients will be discussed. Much of the information contained in this review is based on the deliberations of the Multi-Society Task Force on the Persistent Vegetative State [38].
TL;DR: The literature on pain in Parkinson's disease is reviewed to include the anatomy, pathology, and both basic and clinical science research to include medication management as well as deep brain stimulation.
Abstract: This article reviews the current literature on pain in Parkinson's disease to include the anatomy, pathology, and both basic and clinical science research. It explores treatment methods to include medication management as well as deep brain stimulation.
TL;DR: Studies of lightning and electrical injuries have identified disabling neuropsychiatric changes for some survivors that appear weakly related to litigation status, inconsistently related to injury scenarios, and likely influenced by individual premorbid emotional and coping patterns.
Abstract: Neurobehavioral problems after lightning and electrical injuries are diverse. Commonly reported are decreased cognitive function, pain syndromes, depression, posttraumatic stress disorder, and significant alterations in social and work roles. While the problems resemble those following other kinds of accidents, the injury scenarios for lightning and electrical trauma are unique, and seem to invite more skepticism and controversy in medical and legal realms when the survivors seek help. Studies of lightning and electrical injuries have identified disabling neuropsychiatric changes for some survivors, often persistent and occasionally progressive, that appear weakly related to litigation status, inconsistently related to injury scenarios, and likely influenced by individual premorbid emotional and coping patterns. Standards of care in the fields of brain injury, behavioral medicine, and psychotherapy can inform rehabilitation strategies. Proper assessment is important, as well as an individualized approach to treatment. Multidisciplinary intervention focuses on managing symptoms, learning compensatory skills, providing psychosocial support, and preventing maladaptive behaviors. It has been therapeutic for some patients to become activists for better awareness and prevention.
TL;DR: The efficacy of the multidisciplinary treatment approach to the management of Parkinson's disease was examined at a regional Veteran's Administration Parkinson's Disease Research, Education and Clinical Center and statistical analyses of the individual components of the program did not demonstrate significant differences between improvers and non-improvers.
Abstract: The efficacy of the multidisciplinary treatment approach to the management of Parkinson's disease (PD) was examined at a regional Veteran's Administration Parkinson's Disease Research, Education and Clinical Center (PADRECC). The records of 43 consecutive individuals with PD were examined. The Unified Parkinson's Disease Rating Scale (UPDRS) was employed to assess disease progression. Changes between initial and one-year follow-up UPDRS motor functioning (Part III) scores were compared to expected disease progression from prior research. In this cohort, thirty patients (69.8%) had improved, 2 were unchanged (4.7%) and 11 patients (25.6%) had worsened at the mean 12.2-month follow-up period. The range of multidisciplinary interventions included neurology (100%), physiatrist (93%), and psychology (41.9%) visits, medication changes (60.5%), rehabilitation therapy (62.8%), functional diagnostic testing (16.3%), support group (9.3%), home exercise programs (86%), and disease and wellness education (83.7%). Statistical analyses of the individual components of the program did not demonstrate significant differences between improvers and non-improvers. Clinical implications and study limitations are discussed.
TL;DR: The lower ICoh at the temporal, parietal and occipital derivations in the alpha band implies hypoconnectivity between the right and left hemispheres, which suggests the functional hemispheric differentiation may be diminished in comparison with the controls.
Abstract: Clinical assessment and imaging studies of twenty-six children with hemiparetic cerebral palsy (HCP) were conducted. For each child 20 artifact-free EEG epochs, each of 2 s duration were selected for spectral analysis to calculate spectral power and coherence functions. A fast Fourier transformation alogorithm of signal processing was used to obtain the power spectrum of each lead. The objective of this study was to estimate EEG spectral power as well as the interhemispheric (ICoh) and intrahemispheric (Hcoh) coherence in children with hemiparetic cerebral palsy (HCP) as compared with healthy children. Significant differences between the HCP and control children were noted in the distribution of the alpha, theta and delta rhythms over the left and right hemispheres. In this study we found significant differences between the HCP and control children in the distribution of alpha, theta, delta and beta rhythm over the left and right hemispheres. Significant differences between the HCP and control children were in the distribution of the theta rhythm over the right and left hemispheres. The lower ICoh at the temporal, parietal and occipital derivations in the alpha band implies hypoconnectivity between the right and left hemispheres. The HCoh asymmetry, which implies relative hypoconnectivity within the right and left hemispheres, suggests the functional hemispheric differentiation may be diminished in comparison with the controls.
TL;DR: Despite SSAC states, the majority improve, however profound disability persists, and possible predictors of a worse outcome include tracheostomy, severity of initial disability, initial RLAS II level and presence of central fever.
Abstract: OBJECTIVE To identify and characterize demographics, injury variables, complications, and functional outcomes in Asian patients presenting in States of Severely Altered Consciousness (SSAC). DESIGN Descriptive case series review. SETTING/SUBJECTS Acute rehabilitation unit with intensive, comprehensive neurological rehabilitation program. Thirty consecutive patients diagnosed to be in persistent vegetative state (PVS) or minimally conscious (MCS) state over a 4-year period were included. MAIN OUTCOME MEASURES Disability Rating Scale (DRS), Ranchos Los Amigos Scale (RLAS), Modified Barthel Index (MBI). RESULTS Seventeen (57%) were male, with a mean age of 31.8 years (median 25y, range 15-74, SD 16.3y). Twenty-one (70%) had traumatic brain injury, and median GCS on acute admission was 5. The mean length of stays (LOS) in acute and rehabilitation facilities was 90.1 days and 106.3 days respectively. Tracheostomized patients had longer acute LOS. (p = 0.03). All patients had improvement in their DRS scores upon rehabilitation discharge. The MBI was insensitive in identifying low-level changes; though paired analyses were significant for improvement. Seventeen (57%) patients were in PVS and the rest in MCS on admission to rehabilitation. Twelve patients progressed to a state of awareness, with eye responses as the most frequent first sign. There was a greater spread of higher RLAS categories on rehabilitation discharge. Urinary tract infection (16 patients, 53%) was the most common medical complication. Nineteen (63%) had central fever and this group was more functionally disabled (p = 0.045). The mean number of medications on discharge was 6. The majority of patients (22 patients, 73%) were discharged home, and patients continued to make functional progress post-discharge. CONCLUSIONS Despite SSAC states, the majority improve, however profound disability persists. Possible predictors of a worse outcome include tracheostomy, severity of initial disability, initial RLAS II level and presence of central fever.
TL;DR: The term VS should be dropped and replaced with one that reflects what is truly known and verifiable about the condition and the individual patient.
Abstract: Neurophysiological research on the vegetative state (VS) presupposes a clearly defined patient population. VS has been variously defined in three domains: anatomy, behavior, and consciousness. Research on each conceptual type of "VS" is reviewed. Certain key elements of official VS dogma are cast into doubt or flatly contradicted by recent noninvasive neurophysiological studies. "Behavioral VS" is often the manifestation of a multi-modular disconnection syndrome rather than the complete absence of cortical functioning. Some "behavioral VS" may represent a "super locked-in state," with some primitive awareness of self and environment, including the capacity to experience pain. The term VS should be dropped and replaced with one that reflects what is truly known and verifiable about the condition and the individual patient.
TL;DR: Three conditions of ANS dysfunction of particular concern for L/ET patients are complex regional pain syndrome (CRPS), cardiovascular abnormalities, and keraunoparalysis (KP).
Abstract: Autonomic nervous system (ANS) dysfunction is a serious complication of lightning and electrical trauma (L/ET). The ANS regulates the normal vegetative functioning of many organ systems. When ANS is compromised after lightning and electric trauma, patients are vulnerable to serious medical problems. Three conditions of ANS dysfunction of particular concern for L/ET patients are complex regional pain syndrome (CRPS), cardiovascular abnormalities, and keraunoparalysis (KP). The patient with CRPS presents with pain, hyperpathia, sweating, and edema hours to days after trauma. Neurorehabilitation is exceedingly important. A primary goal is to keep the affected extremity mobile and functional. Some patients benefit from sympathetic blockade. Cardiovascular abnormalities associated with lightning and electrical trauma can be life threatening. Care for these patients require a multidisciplinary team including a cardiologist. Keraunoparalysis is a frightening and distressing complication of lightning strikes. The syndrome consists of limb paralysis, sensory symptoms, pallor, coolness and absent pulses. Release of excessive catecholamines is said to be responsible for these findings. Fortunately, the condition is transient.
TL;DR: 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, is demonstrated.
Abstract: Primary objective: This paper examined the effectiveness of postural training on upper extremity performance in an ataxic individual. The ataxia resulted from a brain stem stroke. Research design: Before-after, single-subject experimental design. Experimental intervention: Four-week course of postural training, comprised of three one-hour sessions/week. Main outcomes and results: 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. Conclusions: 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.
TL;DR: This chapter is to review the biophysical pathways and mechanisms of electrical trauma injury and their relationship to clinical injury manifestations, with a focus on frequency-dependent effects because of the relevance to lightning injury.
Abstract: The passage of damaging quantities of electrical current through the body can produce tissue injury through multiple distinct biophysical energy transduction mechanisms. These mechanisms include the direct action of direct electrical forces on proteins, membranes and other biomolecular structures, as well as the indirect action mediated by the generation of heat. Adding to this complexity are the multiple modes of frequency-dependent tissue-current interactions, the variation in current density along the path through the body, as well as variations in body size, body position and use of protective gear. The dominant mode of injury for any particular trauma victim and how it manifests depends on several different factors. As a result, in no two cases of accidental electrical injury are the injury manifestations identical. The purpose of this chapter is to review the biophysical pathways and mechanisms of electrical trauma injury and their relationship to clinical injury manifestations. The focus will be on frequency-dependent effects because of the relevance to lightning injury. It was written with the hope to provide insight into some of the unusual neurophysiological manifestations.
TL;DR: Rolling sideways in hemiparetic subjects is characterized by a normal relationship between activation levels of the SCM muscles while the relationship between the corresponding PM, ExO and RF muscles is hampered due to reduced activation level of the muscles on the paretic body side.
Abstract: The purpose of this work was to get insight into the role of frontal trunk and proximal extremity muscles in rolling from supine to side lying. Participants were seventeen hemiparetic patients and 14 healthy subjects. Electromyographic (EMG) activity of the Sternocleidomasoid (ScM), Pectoralis Major (PM), External Oblique (ExO) and Rectus Femoris (RF) muscle pairs was recorded during rolling performance. Analysis included the establishment of EMG response times and magnitudes. For all muscles, initiation of EMG activity was delayed in the patients as compared with the controls. Among the healthy subjects, EMG activity level of the SCM was more enhanced on the mobile than on the stable body side, while activation level of the PM muscle was larger on the stable body side. In the hemiparetic group, the SCM demonstrated similar results as the controls yet, PM activity on the paretic side was lower than on the non-paretic side regardless of rolling direction. The difference in activation level between the corresponding ExO and RF muscles showed inconsistency among the healthy subjects, whereas in the hemipareic group the muscles on the paretic side never displayed higher activation levels than on the non-paretic side. In conclusion, rolling sideways in hemiparetic subjects is characterized by a normal relationship between activation levels of the SCM muscles while the relationship between the corresponding PM, ExO and RF muscles is hampered due to reduced activation level of the muscles on the paretic body side.
TL;DR: A small pilot investigation stimulated a patient with severe spasticity of the lower limbs and applied different stimulation frequencies to look for a clinical measurable effect of spastic reduction depending on the applied frequency, but was unable to show such a dependency.
Abstract: Repetitive magnetic stimulation is able to reduce spastic tone increase after applying it at the spinal cord. It was also found to induce frequency-dependent changes in H-reflex. In a small pilot investigation we stimulated a patient with severe spasticity of the lower limbs and applied different stimulation frequencies. The aim was to look for a clinical measurable effect of spastic reduction depending on the applied frequency. We were unable to show such a dependency, but could confirm the spastic-reducing effects of a peripheral repetitive magnetic stimulation using supratheshold intensities.