Showing papers in "Neurorehabilitation and Neural Repair in 1989"
TL;DR: The Ashworth Scale is a reliable and reproducible method of evaluating spasticity and has the advantage over other methods of being simple to use and applicable over a wide range of arm and leg movements.
Abstract: Spasticity is an important cause of neurological disability, and many new treatments are emerging to treat it. To assess any therapy, a consistent and reproducible method of measuring spasticity is...
125 citations
TL;DR: Focusing treatment and rehabilitation within this specific time period may enhance eventual outcome for stroke survivors and document improvement in physical function over a relatively short period of time after stroke onset.
Abstract: The time course for functional recovery following stroke has not been well defined. To obtain an unbiased picture, we studied the pace of recovery using standardized neurological, functional, and cognitive tests in stroke survivors in the Framingham cohort over a 4½-year period. Of 119 patients who developed new strokes, 67 survived 1 year; of these, 46 were evaluated at onset, and at 3, 6, and 12 months poststroke. Significant recovery was documented in the Barthel Index, mobility, self-care, and language. This occurred chiefly during the first 3 months, with marginal gains thereafter. Multivariate analyses revealed no differences in the pattern of recovery with regard to clinical or demographic characteristics. These data from a community-based study document improvement in physical function over a relatively short period of time after stroke onset. Focusing treatment and rehabilitation within this specific time period may enhance eventual outcome for stroke survivors. Key Words: Cerebrovascular disease...
94 citations
TL;DR: Achieving and maintaining erections was the most frequently affected sexual function and the only historical association with ED in this group was a history of alcohol consumption in 68.9% of parkinsonian patients.
Abstract: From the Departments of 1Neurology and 2Psychology, University of Miami School of Medicine, Miami, FL, U.S.A. ’This studywas presented in part at the 41st Annual Meeting of the American Academy of Neurology, April 1989. Address correspondence and reprint requests to Dr. C. Singer at Department of Neurology (D4-5), University of Miami School of Medicine, P.O. Box 016960, Miami, FL 33101, U.S.A. We interviewed 48 parkinsonian male patients [mean age, 65.8; age range, 42-84; mean duration of Parkinson’s disease (PD), 8 years; range, 1-25 years, Stages 1-3 only] and a matched sample of 32 elderly healthy nonparkinsonian males (mean age, 70.4; age range, 56-79) with regard to presence of sexual dysfunction (SD). We found a significantly higher prevalence of erectile dysfunction (ED) (60.4% vs. 37.5%) in the parkinsonian patients (p < 0.05). Achieving and maintaining erections was the most frequently affected sexual function. ED preceded the onset of PD in 5 of 29 patients (17.3%). Twenty-nine parkinsonian patients with erectile dysfunction (PD-ED) were compared to 12 patients with normal erectile function (PD-nonED). Although the PD-ED group had a significantly higher Hoehn and Yahr stage [2.3 vs. 1.8 (p = 0.05)], they were not significantly older and did not present with a longer duration of PD or levodopa therapy. Other autonomic symptoms were no more frequent in the PD-ED group. The only historical association with ED in this group was a history of alcohol consumption in 68.9% of
32 citations
TL;DR: It is concluded that rehabilitation of stroke patients should be functionally oriented and be focused on the nonparetic as well as on the paretic extremities.
Abstract: Improvement of function and motor impairment were studied prospectively in 75 consecutive hemiparetic stroke patients admitted to an in-patient stroke rehabilitation unit. Upper extremity (UE) func...
27 citations
TL;DR: Although hypometabolism exists in the cerebellum, it is not clear why there are no cerebellar symptoins and it may be the case that hypometabolic dysfunction represents a different process than a frank lesion of the cerebelum.
Abstract: evoked potential occurred which &dquo;recovered&dquo; in amplitude over time. In addition to changes in electrophysiological parameters, remote metabolic perturbations have been described by Baron. Following frontal cortex injury, reduced metabolic activity exists predominantly in the cerebellum contralateral to the injury. This disturbance was presumably mediated via injury to the corticopontocerebellar pathway. Although hypometabolism exists in the cerebellum, it is not clear why there are no cerebellar symptoins. It may be the case that hypometabolic dysfunction represents a different process than a frank lesion of the cerebellum.
20 citations
TL;DR: The pattern of modulations between ERP and Nd measures and between speed conditions at retest indicates that these modulations are not due to improved attentional selectivity but possibly to increased motivation or attentional effort and improved tonal stimulus processing after cognitive remediation.
Abstract: Auditory event-related potentials (ERPs) were recorded in a binaural listening task to assess neurophysiological correlates of selective attention before and after an intensive computer-dispensed cognitive remediation program (6 months) administered to 21 patients with severe closed head injuries (CHI). With a double-blind procedure, they were compared to a control group of 22 patients with CHI, matched for age (X = 28), sex, and education (X = 11 years), who did not receive cognitive remediation. Analyses of covariance were applied to control for coma duration (X = 57 days), posttrauma interval (X = 6.4 years), and severity of neuropsychological deficits. Error rates were not sensitive to treatment and speed of stimulation effects, but neurophysiological measures were. Distraction of both stimulus and response sets was manifested in all subjects (Ss) at pretest by relatively large P3a amplitudes to task-irrelevant tones at inattention and by an absence of attention modulation of N1 to task-relevant tones...
14 citations
TL;DR: Bohannon et al. as mentioned in this paper studied the relationship between mobility and gait deficiency in patients with neurologic diseases and found that mobility in general and walking in particular are of immense importance to patients.
Abstract: From the School of Allied Health, University of Connecticut, Storrs, CT, U.S.A. Address correspondence and reprint requests to R. W. Bohannon at School of Allied Health, U-101, University of Connecticut, Storrs, CT 06269, U.S.A. Mobility in general and walking in particular are of immense importance to patients with neurologic diseases, their families, and the clinicians who work with them (1-4). For clinicians who spend much of their time evaluating and treating gait deficiencies in such patients, it is important to know which variables underlie the deficiencies. Since the time of clinicians and
12 citations
TL;DR: There is a need for more research on the effect of improved nutritional status on medical complications and functional outcome during rehabilitation and the incidence of malnutrition in brain-injured patients may be underestimated.
Abstract: Head-injured patients are at high risk for malnutrition due to trauma, complications, dysphagia, and other effects of brain damage. Malnutrition in the patient recovering from closed head injury may have a detrimental effect on rehabilitation progress and outcome. Little information is available to date on the incidence, etiology, assessment, or therapy of malnutrition in head-injured patients after the acute phase. Nutrition after closed head injury was assessed by clinical, laboratory, and anthropometric data. Fifty-three consecutive head injury patients were studied on admission and during their rehabilitation stay. Of this group, 60.4% were below 90% of their ideal body weight. The average weight loss from injury to admission was 29 lb. On the average, these patients were 86.9% of their ideal body weight. Furthermore, 31% had a low serum albumin, and 56% of them had dysphagia. Admission body weight had a low predictive value for the discharge functional measures of mobility, activities of daily living...
11 citations
TL;DR: It is suggested that ANS influence on exercise capacity in MS patients is more complex than simple temperature regulation.
Abstract: Sixteen well-characterized MS patients with a prominent complaint of fatigue underwent exercise testing, with temperature monitoring, and autonomic nervous system (ANS) testing. It was postulated t...
10 citations
TL;DR: It is suggested that SA in MS may be more frequent than suspected, and it can be associated to significant oxygen desaturation in some cases, and the potential impact ofSA in MS deserves further evaluation.
Abstract: We performed polysomnography on eight randomly chosen male patients who met Poser's criteria for definite multiple sclerosis (MS), to obtain an idea of the frequency and severity of sleep apnea (SA) in this population. Ages ranged from 27 to 67 years (mean, 50 years). The mean Kurtzke's disability score was 6.1. Only one complained of awakenings with shortness of breath. Otherwise, none had a history of sleep disorder or significant pulmonary disease. We found that two patients had an apnea index greater than 5, with oxygen desaturation to 60% in one. Two others had apnea indices less than 5, but had oxygen desaturation to 59% and 81% during the apneas. Two patients had apnea indices less than 5 without oxygen desaturation. The apneas were mainly central type, except in one who had a mixed central-obstructive pattern. These preliminary results suggest that SA in MS may be more frequent than suspected, and it can be associated to significant oxygen desaturation in some cases. The potential impact of SA in ...
6 citations
TL;DR: Presented as the Keynote Address at the Consensus Conference, Consortium of Multiple Sclerosis Centers Annual Meeting, Los Angeles, California, May 20, 1989.
Abstract: Presented as the Keynote Address at the Consensus Conference, Consortium of Multiple Sclerosis Centers Annual Meeting, Los Angeles, California, May 20, 1989. From the Department of Rehabilitation Medicine, University of Washington Multiple Sclerosis Clinical Center, University of Washington, Seattle, WA, U.S.A. Address correspondence and reprint requests to Dr. G. H. Kraft at Department of Rehabilitation Medicine, RJ-30, BB919 Health Sciences Building, University of Washington, Seattle, WA 98195, U.S.A. People who want to make a living from the treatment of
TL;DR: The pathogenesis of bladder and sexual dysfunction in the MS patient is reviewed and available diagnostic and treatment modalities are discussed.
Abstract: Multiple sclerosis (MS) is a devastating degenerative neurological disease that has among its sequelae significant urological pathology. Sexual and bladder dysfunction are the most common. Both of these sequelae can have a major effect on a patient's ability to function emotionally and socially. We shall review the pathogenesis of bladder and sexual dysfunction in the MS patient and discuss available diagnostic and treatment modalities.
TL;DR: Observed patterns of neglect relative to a theory of hypoarousal are discussed and the importance of neglect to prognosis for recovery from stroke is suggested.
Abstract: We studied the severity and task-specific nature of neglect in relation to brain lesion size and locus in 23 right hemisphere stroke patients. We used five visuospatial tasks, including reading and writing. No single task identified hemispatial neglect in all patients. Drawing from memory was most sensitive, whereas writing was least sensitive. Neglect was not limited to parietal disease, but occurred following lesions in several cortical and subcortical locations. Severity of neglect correlated significantly with lesion locus (it was most severe with central lesions), but not with lesion size. We discuss observed patterns of neglect relative to a theory of hypoarousal and suggest the importance of neglect to prognosis for recovery from stroke.
TL;DR: This is a study of the use of an industrial robot-manipulator training device with control panels modified for use by two late-stage Duchenne muscular dystrophy patients who were able to employ the manipulator for enhanced independence in activities of daily living.
Abstract: This is a study of the use of an industrial robot-manipulator training device with control panels modified for use by two late-stage Duchenne muscular dystrophy (DMD) patients. Neither patient had ...
TL;DR: Patients who underwent total excision of their meningioma showed more satisfactory rehabilitation outcomes than those with an incomplete extirpation, which were comparable to those of patients following stroke.
Abstract: During a 10-year period (1977-1986), 76 patients were admitted for rehabilitation following surgical extirpation of intracranial meningioma. Medical records of these patients were studied retrospectively. The distribution of patients according to age, sex, presenting symptoms, location of tumors, and neurological deficit at admission for rehabilitation as well as rehabilitation outcomes are reported. Fifty-five patients (72.3%) were graded as severe or very severe at admission. Patients who underwent total excision of their meningioma showed more satisfactory rehabilitation outcomes than those with an incomplete extirpation. The majority of patients had satisfactory rehabilitation outcomes, which, along with the average length of time invested, were comparable to those of patients following stroke.
TL;DR: It is proposed that abnormalities within the motor system controlling gait and postural reflexes are major causes of impaired mobility and falls in older individuals without other defined neurologic disease.
Abstract: While impaired joint function and general debility are relevant to function, we propose that abnormalities within the motor system controlling gait and postural reflexes are major causes of impaired mobility and falls in older individuals. Neurologic disease impairs this system at different foci, producing characteristic deficits. Thus, bilateral frontal lobe disease produces a characteristic gait and balance dysfunction along with a mild dementia and incontinence, whereas Parkinson's disease produces a different set of motor abnormalities. Other loci of involvement include spinal cord, peripheral nerve, and muscle. Recently, we observed that lesions within the subcortical white matter (presumably ischemic in origin) may be an important factor in gait and balance dysfunction in older individuals without other defined neurologic disease. Key Words: Falls—Aging—Neurologic disease—Diagnosis.
TL;DR: A 62-year-old dextral man with a pragmatic communicative disorder following cerebral infarction of the nondominant hemisphere is described.
Abstract: A 62-year-old dextral man with a pragmatic communicative disorder following cerebral infarction of the nondominant hemisphere is described. He had difficulty attuning his train of thought to keep up with the conversation and had difficulty in controlling speech output.
TL;DR: In this article the retrograde effect of muscle on the motoneuron will not be discussed, and discussion will be restricted to considerations of the trophic interactions between cells.
Abstract: From the Department of Anatomy and Developmental Biology, University College London, London, England. Reprinted from Neuromuscular Stimulation: Basic Concepts and Clitzical Ittiplicatiotis, edited by F. Clifford Rose, Rosemary Jones, and Gerta VrbovS, Demos Publications, New York, 1989. Address correspondence and reprint requests to Dr. Vrbov6 at Department of Anatomy and Developmental Biology, University College Hospital, Gower Street, London WC2E 6BT, England. The idea of trophic interactions between cells is best exemplified by clinical observations on the neuromuscular system. The motoneuron is critically dependent on its interaction with the skeletal muscle, and this is particularly marked during early development of all vertebrates. If by a certain stage the motoneuron fails to establish contact with its target muscle it dies. In this article the retrograde effect of muscle on the motoneuron will not be discussed, and discussion will be restricted to considerations of the
TL;DR: Insomnia is usually associated with long coma and severe diffuse brain lesions in MHI patients and has a much more severe prognosis than hypersomnia in these patients.
Abstract: Twenty patients who had suffered missile head injuries (MHI) during the Lebanese War were separated into three groups, based on clinical criteria. All the patients were monitored polysomnographically (PSG) 3 and 12 months after the injury. The records were double-blind scored. The clinical and PSG data were compared, and discrepancies were found between the clinical and PSG evaluation of sleep in MHI patients. Sleep disturbance is not an obligatory feature of MHI patients. MHI associated with hypersomnia was found to have a good prognosis. Insomnia is usually associated with long coma and severe diffuse brain lesions in MHI patients and has a much more severe prognosis than hypersomnia in these patients.
TL;DR: Two cases of focal pedal dystonia, unresponsive to pharmacological or other therapies, were treated by surgery and bracing and Muscle biopsy revealed normal neuromuscular junction anatomy, but a Type I fiber hypertrophy associated with exercise was noted.
Abstract: Two cases of focal pedal dystonia, unresponsive to pharmacological or other therapies, were treated by surgery and bracing. Where tenotomy was performed, a percutaneous technique was utilized. Muscle biopsy in one case revealed normal neuromuscular junction anatomy, but a Type I fiber hypertrophy associated with exercise was noted. Intracompartmental pressure was elevated. Magnetic resonance spectroscopy demonstrated changes in phosphocreatine and ATP. Surgery may prove effective in selected cases of focal foot dystonia.
TL;DR: Most patients showed progress on computerized cognitive retraining tasks, but the extent to which this progress generalized to everyday functioning was quite variable and did not always accompany functional improvement.
Abstract: Neuropsychological rehabilitation is a new and unproven therapeutic concept. Despite the increasing availability and popularity of this kind of therapy, its efficacy remains to be established. We studied the outcome after an outpatient neuropsychological rehabilitation program in 16 patients, most of whom were young men with closed head injury. The program involved extensive pre-entry screening, cognitive retraining, traditional counseling services, and neurological and medical care. Most patients had pre-entry and postexit neuropsychological testing, and other outcome criteria were also assessed. Four patients were judged to have a good outcome in terms of changes in everyday functioning, nine to have a fair outcome, and three a poor outcome. Factors that tended to be associated with a poor outcome were substance abuse, emotional disturbance, unawareness of deficits, and poor motivation to participate. Neuropsychological test improvement was not impressive and did not always accompany functional improvem...
TL;DR: The top-ranked singular deficiency was poor conceptualization of problem or approach, and flaws warranting lowering of potential scores by reviewers included excessive budget requests, duplication of effort with ongoing supported research, inadequate background of investigator, and weak dissemination and utilization plans.
Abstract: This article attempts to identify and describe those deficiencies determined by nonfederal peer reviewers during the most recent 1989 NIDRR (National Institute on Disability and Rehabilitation Research) research competition to diminish successful funding opportunities from the lead federal agency concerned with medical rehabilitation research. The NIDRR scientific-technical review process is based on policies of the Education Department Grants Administration Regulations, which require announcement of all research competitions in the Federal Register and an ad-hoc nonfederal review of all applications. A total of 232 field-investigator-initiated research applications were received in response to the Federal Register announcement. Of these, 57, or 24.5%, were assigned to the Medical Sciences Programs office (MSP). Following assignment and review of four nonfederal panels and MSP staff, six applications were ultimately approved and funded (10.7%). The remaining 51 (89.5%) were statistically analyzed to deter...
TL;DR: The results indicate that, in the presence of motor deficits, the severity of aphasia in the chronic stage may or may not additionally influence the long-term outcome following left or left and right hemispheric cerebral infarction, depending on the choice of the target variables.
Abstract: The prognostic significance of aphasia with motor deficits caused by ischemic stroke is still a matter of debate. To further clarify this issue, we personally reassessed 111 patients with cerebral infarction in either the left or right hemisphere (ascertained by computed tomography) after a mean follow-up of 53.8 months (±17.3 months). Aphasia, viewed on its own, was a strong predictor both of survival and of activities of daily living. Since a strong correlation between severity of aphasia and severity of motor deficits exists in left hemisphere strokes, both variables may be better differentiated when compared with right hemisphere infarcts. Nevertheless, in our sample aphasia was of no additional prognostic value to hemiparesis with regard to contact with other people, degree of incapacity, and self-care status. However, vocational status and several daily activities more or less overtly dependent on language skills (using a phone, reading the newspaper, writing letters, watching television, following ...