Brain Rehabilitation Research Articles

Neuropsychological technologies in rehabilitation.

To provide an introduction and a conceptual context for the articles presented in this special edition of the Journal of Head Trauma Rehabilitation on neuropsychological technologies. Many clinical assessments in neuropsychology are metamorphosing from a psychometric search for a lesion to a functional image of the working brain. Behavioral probes increasingly employ technology to provide more ecologically valid stimuli to elicit diagnostically relevant responses. Intervention strategies include an expanding range of assistive devices and technologically based treatments. The advent of the microprocessor and discipline specific programming have allowed certain aspects of rehabilitation practice to incorporate these new assessment and intervention strategies. For example, the development of neuropsychological technologies has already lead to computer based prosthetics and orthotics, cognitive probes with millisecond accurate links to functional imaging, virtual reality managed ecological assessments, cognitive retraining, assistive devices, and online, and "real-time" database-driven evaluations. Emerging technologies offer the potential for personal, portable, everyday brain imaging and rehabilitation systems. Few psychologists, physiatrists, or allied health professionals are formally trained in technological development. What has emerged thus far is a collection of individual efforts that remain to be integrated into more comprehensive tools for the rehabilitation professions. The selective history of neuropsychological technologies presented here is meant to illustrate past difficulties in the emergence of this sub-specialty and point to new applications and technological integration that may prove fruitful. The convergence of neuroengineering, adaptive assessments, everyday neuroimaging, neuroinformatics, and educational neuroimaging, presage such future developments in neuropsychological technologies.

Social Integration following Traumatic Brain Injury and Rehabilitation

The aim of this qualitative study was to examine the issues involved in social integration for those affected by traumatic brain injury, following a period of rehabilitation. Eighteen patients, their significant other* and members of the rehabilitation team involved in their care were interviewed when the patient was discharged from the ward of a neurological rehabilitation hospital, 6 months later and, again, at one year following discharge from the ward. When the data were analysed at the time of the final interview, two respondents reported social isolation. Although many others felt that the level of social contact was that of their choice, several issues were discussed that affected social relationships. These included the impact of impairments, the social response of others and the fact that social networks change naturally over time irrespective of injury or disability. When the data were considered from a sociological perspective, the themes of self-identity, master status and stranger status emerged. This gave a different insight into issues that could be relevant but had not been discussed widely within the head injury literature. Further consideration of the individual in the context of personhood as well as head injury is recommended as a means to develop understanding.

Cerebral circulation of consciousness disorder patient using near-infrared spectroscopic topography during brain rehabilitation by music exercise therapy

For the purpose of brain activation and regeneration of the consciousness disorder patient, the clinical effect of music exercise therapy, which used the practical music performance jointly on the trampoline moving patient, was scientifically verified. The mapping of the cerebral cortex circulation examined by light topography was derived from the time-dependent measurement of blood hemoglobin (oxy-hemoglobin and deoxy-hemoglobin) at 24 areas of right and left cerebral cortex by the near-infrared radiation spectroscopy, and the value was carried out. It was compared with four different types of music and during the trampoline movement. In the case of a normal person being the control, the right cerebral cortex mainly reacted, and it greatly reacted to the music number, which was especially well known. The significance of brain rehabilitation by music exercise therapy has proven, especially in the case of the consciousness disorder patient, that the trampoline upward and downward motion appealed to the disordered side of the brain, and the reaction was remarkable. The repetition of the music exercise therapy was effective for the prolonged consciousness disorder patient with lesion of the brain, and it is certain that the rehabilitation by music-exercise therapy will promote the regeneration of brain function and/or autonomic nervous function.

Brain injury rehabilitation: what works for whom and when?

Primary objective : This paper reviewed the available evidence that patient characteristics may determine the type of intervention that works best in brain injury rehabilitation. Reasoning behind literature selection : A broad search strategy was used to identify papers which enabled conclusions to be drawn about patient characteristics which determined rehabilitation effectiveness. Six main areas were considered: severity of the brain injury, presenting problem, complicating factors, rehabilitation readiness, demographic, and socio-geographic variables. Critical analysis of literature : A levels of evidence analysis was used to evaluate the studies. Main outcomes and results : Very few studies on rehabilitation effectiveness were found which attempted to define the patient characteristics which predict a good response to rehabilitation. The best evidence relates to injury severity; more intense programmes may be unnecessary for those with less severe injuries. There is some evidence that dysexecutive problems, i.e. difficulties with organization and control of behaviour and emotion, interfere with rehabilitation. Conclusions : Patient characteristics may well determine individual benefits from particular rehabilitation programmes. However, few studies have attempted to provide evidence about this. As health provision focuses on needs-led services, it becomes paramount to investigate effectiveness from the client's perspective.

The role of unilateral spatial neglect in rehabilitation of right brain–damaged ischemic stroke patients: A matched comparison

Paolucci S, Antonucci G, Grasso MG, Pizzamiglio L. The role of unilateral spatial neglect in rehabilitation of right brain-damaged ischemic stroke patients: a matched comparison. Arch Phys Med Rehabil 2001;82:743-9. Objective: To assess the specific influence of unilateral spatial neglect (USN) on rehabilitation outcome. Design: A case-control study in consecutive stroke inpatients. Setting: Rehabilitation hospital. Patients: One hundred seventy-eight patients with sequelae of first stroke, enrolled in homogeneous subgroups, matched for age (within 1yr) and onset admission interval (within 3d), and difference because of the presence of USN, evaluated by a specific neuropsychologic battery. Interventions: All patients received physical rehabilitation: physiotherapy for 60 minutes twice a day (once on Saturday), 6 days a week, within 24 hours of admission. USN-positive (USN+) patients received specific treatment of 5, 1-hour sessions per week, for 8 consecutive weeks: (1) visual scanning, (2) reading and copying, (3) copying of line drawings on a dot matrix, and (4) describing a scene. Patients were assessed with neurologic (Canadian Neurological Scale), neuropsychiatric (Hamilton Depression Rating Scale), neuroradiologic, and functional (Barthel Index, Rivermead Mobility Index [RMI]) examinations. Main Outcome Measures: Length of stay, efficiency (average daily increase in Barthel Index), effectiveness (amount of potential improvement achieved during rehabilitation) of treatment and percentage of low- and high-response patients calculated on the Barthel Index and the RMI, and percentage of urinary incontinence and return home were evaluated. Odds ratios (ORs) of dropouts and of low and high therapeutic response were also quantified. Results: Compared with USN-negative patients, USN+ patients had significantly more severe baseline neurologic and functional status at admission, less effectiveness and efficiency on activities of daily living (ADLs) and mobility, a higher percentage of low responders, longer hospitalization, a higher percentage of persistent incontinence at discharge (20.5% vs 4.9%), and a lower percentage of high responders and patients returning home. The presence of USN was incompatible with a high therapeutic response, for both ADLs (OR = 2.94, 95% confidence interval [CI] = 1.05-8.20; b ± standard error = 1.08 ±.52, p <.05), and mobility (OR = 7.16, 95% CI = 2.78-18.44; b = 1.97 ±.52, p <.001) and was a relevant prognostic factor for institutional discharge (OR = 5.62, 95% CI = 1.63-19.38; b = 1.73 ±.63, p <.01, accuracy 88.41%). Conclusions: The results of this study provide further strong evidence of the relationship between USN and disability in right brain-damaged patients and of its unfavorable impact on rehabilitation, despite the cognitive training performed by all USN+ patients.

Brain Plasticity and Rehabilitation

Brain Plasticity and Rehabilitation

The rehabilitation of brain injured children: the case for including physical exercise and virtual reality

Whilst substantial advances in rehabilitation programmes for brain injured children have been made, there is still a fundamental need to improve understanding of the rehabilitation process and how this can be incorporated into practice. It is argued here that taking a neurological approach to improving cognition, mood and social functioning is likely to be of great benefit to the patient. Theoretical reasons are outlined as to why activities such as interactive exercise can improve both the structure and function of the brain, and it is recommended that further research is carried out to establish the effectiveness of these types of activities.

Reabilitação psicossocial da criança com traumatismo cranioencefálico: conseqüências na afetividade e no emocional

As autoras colocam em pauta a reabilitação psicossocial da criança com traumatismo cranioencefálico, em suas diferentes facetas, considerando-se os déficits físicos, cognitivos e os aspectos afetivos/emocionais. Destacam a posição que os pais ocupam no momento de crise e as conseqüências posteriores no âmbito emocional. Ressaltam a violência que ocorre com as crianças e com os pais, decorrentes de normas culturais e sociais. Concluem, enfatizando a responsabilidade partilhada entre pais, crianças e sociedade com respeito à questão da prevenção.

Senile Dementia is Preventable and Treatable.

Since we developed the new neuropsychological test batteries to diagnose the early dementia 20 years ago, we have accumulated the data of the regional investigation on the incidence of dementia and their severity covering almost all Japan.In most towns and villages, the whole incidence of dementia was from 25% to 30% to those of more than 65 years old, of which the ratio of the mild, the moderate and the severe dementia were mostly 2 to 2 to 1.In our criteria, the patients of the mild dementia has solely the disturbance of the highest brain function or the prefrontal function ; therefore they can not manage the social business because they have the trouble in wit, imagination, planning or attention distribution and so on. On the tests, they fail only on the prefrontal function tests, for example on Kana pick-out test.Those of the moderate dementia have the trouble even in house-keeping jobs ; cooking, cleaning or washing. On the tests, they also fail on the prefrontal function tests and get MMS from 23 to 15 points. Those of severe dementia have the difficulty to take self-care. They get MMS of less than 14 points. Once advanced into this level the recovery becomes almost impossible.As for the cause of dementia, more than 90% of the whole dementia was thought to be derived from the bad life habbits (circumferential). They are characteristically workaholic without any hobby or any favorite arts since young. Soon after the retirement they become tedious and loose volition and interest for anything.The dementia starts 2-3 years thereafter. We called this type as the dementia of senility and disuse atrophy (DSD).The vascular dementia accounted 5% at most by the several examinations in details. The Alzheimer disease of the genetic mutation accounted for only 1.2% which showed the early onset in 40th or 50th of age and became ill in bed within 2 or 3 years. This type was resistent for any treatment, even for the brain rehabilitation.As the treatment for the type of DSD, we made diagnosis as early as possible, at least in the level of mild or moderate and gave them the brain activation therapy or the brain rehabilitation using several games, music, painting and sports.As the results, it was confirmed that about 60% of them could come back to the level of independent home life and other 35% was not worsened. The effect could be continued more than 6 or 7 years.

Community-based empowerment programme for families with a brain injured survivor: an outcome study

Rehabilitation of brain injured persons has been one of the challenges of the modern health care team. Brain injured persons' problems are termed complex and multiple, and may persist long after the acute management stage. Families caring for their brain-injured members are, however, ill prepared to face this long-term rehabilitation process. A previous study of an empowerment framework applicable among these Hong Kong Chinese families resulted in the development of a 52-item empowerment questionnaire with four interpretable factors (efficacy, knowledge, support and aspiration). This can also serve as a valid and reliable outcome measure of their empowerment efforts. As a follow-up of this development, an 8-week community-based empowerment programme was thus designed and implemented for a total of 50 family members in six repeated groups. Outcome indicators including empowerment questionnaire, psychological well-being, self-efficacy, subjective experience of the burdens in care-giving, and support systems were used to monitor changes in empowerment status during the periods of pre- and post-programme, and during the 3 month follow-up. The programmes were found to be effective in empowering family members in the four postulated empowering dimensions, and improving all other outcome measures. The follow-up studies reflect stability in empowerment, though there were no further improvement. From regression analysis, it was suggested that, for optimum empowerment to take place, important predictors included careers' education levels, age ranges and work status.

Brain damage, behavior, rehabilitation, recovery, and brain plasticity

This paper focuses on roles of behavior, both in response to debilitation and in response to therapeutic intervention, in brain and behavioral recovery from brain damage. Recent evidence suggests that the brain damaged animal's behavior may often play a greater role in the recovery process than has been evident in previous work. In many cases, what may initially appear to be “spontaneous” brain adaptations to damage may be mediated by behavioral attempts to compensate for the effects of damage. This is seen in changes in the use of forelimbs following unilateral damage of the adult rat sensorimotor forelimb cortex, which have been shown to be essential to the dendritic growth and synaptogenesis that occurs in the contralateral hemisphere. In other cases, behavioral training can allocate new tissue to the functions targeted by training. In the case of global damage resulting from neonatal alchohol exposure, a therapeutic motor training intervention that “forces” the subject's involvement appears more effective than previous interventions that merely allowed the subjects to passively engage in activity. Properties of the brain damage also affect the recovery process (e.g., sensitizing both damaged and undamaged brain regions to the effects of behavioral compensation). While this paper emphasizes plastic mechanisms associated with active learning, we also review the evidence that mere physical exercise may stimulate protective mechanisms that contribute to both recovery from damage and successful aging. Exercise may protect the brain by regulating trophic and angiogenic processes across the life span, and, because of this, excercise may deserve greater attention in integrated treatment approaches in Parkinson's disease. MRDD Research Reviews 1998;4:231–237, 1998. © 1998 Wiley-Liss, Inc.

Mild resuscitative hypothermia and outcome after cardiopulmonary resuscitation.

Recovery without residual neurological damage after cardiac arrest with global cerebral ischemia is still a rare event. Severe impairment of bodily or cognitive functions is often the result. The individual, emotional, and social aspects of brain damage and rehabilitation are seldom taken into account. Efforts to improve the prevention of brain damage immediately after successful resuscitation of patients are missing. The efficacy of hypothermia in preserving neurologic function when instituted before and during certain no-flow cardiovascular states has been well documented both clinically and experimentally since the 1950s. Most studies have used moderate (28-33 degrees C) to deep (20-28 degrees C) hypothermia to demonstrate these protective effects. Considering the use of hypothermia for preservation and resuscitation, the lack of controlled outcome trials, the long period of time required to reach therapeutic hypothermia, and the incidence of rewarming complications such as infection, arrhythmia, and coagulopathy have made it difficult to apply these methods to emergency situations such as cardiac arrest. Recent experimental evidence in dogs has shown that hypothermia induced after cardiac arrest does indeed mitigate the effects of the postresuscitation syndrome and improves neurologic function and reduces histologic brain damage. More importantly, such benefits can be demonstrated with mild (34-36 degrees C) hypothermia, thus minimizing complications and requiring less time for induction of hypothermia. Ice water nasal lavage, direct carotid infusion of cold fluids, use of a cooling helmet, and peritoneal cooling are promising techniques for clinical cerebral cooling. External auditory canal temperature (e.g., tympanic membrane temperature changes) could provide an approximation to brain temperatures. For accurate temperature monitoring, however, a central pulmonary artery thermistor probe should be inserted. Temperature monitoring is needed to avoid temperature < 30 degrees C. Mild hypothermia may prove to be an important and secure component for cerebral preservation and resuscitation during and after global ischemia; it may also prove to be a useful method of cerebral resuscitation after global ischemic states, thereby promoting the prevention of neuromental diseases.

Neuropsychological Evaluation in the Vocational Rehabilitation of Brain Injured Clients

Clients with history of brain injury or neurological disorder can be challenging for the vocational rehabilitation counselor (VRC) to assess and help rehabilitate. Neuropsychological evaluation provides systematic assessment of deficits in functioning secondary to brain injury. Such assessments can be of great value to the VRC, but may not be widely known or utilized by VRCs in many areas. This paper discusses issues of vocational rehabilitation of brain injured individuals, and proposes guidelines for eliciting relevant information from the client and for making appropriate referral for neuropsychological evaluation. VRCs are in an excellent position to identify individuals for whom neuropsychological evaluation is needed, since cognitive and behavioral deficits resulting from brain injury or neurological disorder are frequently not addressed until the question is raised during the vocational rehabilitation process.

Two evaluation studies of Reitan's REHABIT program for the retraining of brain dysfunctions.

Two evaluation studies of Reitan's REHABIT program, using 26 subjects, showed improvement for 23 persons, ranging from moderate to markedly improved. Three subjects showed no change. t tests for correlated observations on the pre-post Z scores were significant. Follow-up studies on brain rehabilitation are in progress.

Recent developments in brain rehabilitation.

This paper introduces the new area of neuropsychologic rehabilitation. Procedures have been developed that can improve some verbal and nonverbal skills impaired by stroke and other brain insults. Technics are described that are now available to remediate perceptual problems such as spatial neglect, cognition difficulties, and recent memory deficits in people with brain injury.

Rehabilitation of Brain Injured Children

Rehabilitation of Brain Injured Children

Diagnosing and Treating Autism

By Dr. Tal’at bin Hamza al-Wazna, the General Director of Medical Services and Consultant for Diseases of the Brain and Nerve Rehabilitation.

PRESENCE AND ACTION OF ACETYLCHOLINE IN EXPERIMENTAL BRAIN TRAUMA

PRESENCE AND ACTION OF ACETYLCHOLINE IN EXPERIMENTAL BRAIN TRAUMA