Neurological Rehabilitation Centre Research Articles

Comparison of the efficacy of goals-activity-motor enrichment therapy and neurodevelopment therapy in early intervention of high-risk infants with cerebral palsy

Objective To compare the efficacy of goal-activity-motor environment (GAME) therapy and neurodevelopmental therapy (NDT) in the early intervention of high-risk infants with cerebral palsy (IHRCP), and to provide scientific evidence-based medical basis for early intervention of IHRCP. Methods A total of 62 cases of IHRCP were enrolled in the Children′s Neurological Rehabilitation Center of the First Affiliated Hospital of Anhui Medi-cal University from June 2017 to December 2018.They were divided into GAME group (32 cases) and NDT group (30 cases) according to the admission order.Gross Motor Function Scale (GMFM), Fine Motor Function Measure (FMFM) and Gesell Development Scale (GDS) were used for detection and comparison.The differences among the gross motor, the fine motor score and the developmental quotient (DQ) between two groups before treatment, 9 months after treatment and 12 months after treatment, and the normalization rate and the incidence of cerebral palsy between the two groups at 12 months of age were compared. Results (1) Motor function was as follows: at 9 months[GAME: (32.63±15.83) scores, (30.03±15.88) scores], [NDT: (33.37±15.61) scores, (29.67±12.54) scores] and at 12 months[GAME: (40.56±15.79) scores, (36.31±14.98) scores], [NDT: (40.47±15.50) scores, (36.73±14.58) scores] after treatment, and GMFM and FMFM scores in GAME and NDT groups were significantly higher than those before treatment[GAME: (27.56±14.24) scores, (21.75±11.35) scores], [NDT: (26.93±14.96) scores, (21.30±10.67) scores], and the differences were significant (all P 0.05). (2) DQ had no significant difference in DQ between GAME group(63.59±10.83) and NDT group (61.59±7.96) before treatment (P>0.05). The total DQ at 9 months, 12 months, the total DQ of GAME group (73.67±12.00, 81.59±13.03) was significantly higher than that of NDT group (66.05±9.54, 75.17±1.92) (all P 0.05); the incidence of cerebral palsy was present in 6 cases in GAME group and 5 cases in NDT group, and there was no significant difference between the 2 groups (P>0.05). Conclusions GAME therapy and NDT had significant effects on both gross and fine exercise of IHRCP, and the efficacy of the two methods is similar.Both GAME therapy and NDT can equally promote IHRCP development into normal infants and reduce the incidence of cerebral palsy. Key words: Infants at high-risk of cerebral palsy; Early intervention; Goals-activity-motor enrichment therapy; Neurodevelopmental therapy; Curative effect

Molecular epidemiology study of a nosocomial Moraxella catarrhalis outbreak in a neurological rehabilitation unit

Moraxella catarrhalis is a common agent causing upper and lower respiratory tract infections, particularly of ventilated patients. The bacteria are transmitted between humans by direct and indirect contacts. However, reports of nosocomial outbreaks by this pathogen are scarce. To analyse M.catarrhalis strains isolated during an outbreak in a medical rehabilitation centre to reveal their clonal relationship and to elucidate potential transmission routes. Extensive environmental and medical staff sampling was performed. Phenotypic and genotypic analyses of 15 isolates were executed, including repetitive element palindromic polymerase chain reaction (repPCR) and whole-genome sequencing. Furthermore, an intensified hygiene regimen was installed. The clonal nature of nine patient isolates and a simultaneous presence of separate entities including a strain isolated from a physician during staff screening was confirmed. Although neither asymptomatic carriers among the staff persons nor outbreak strain-contaminated fomites were identified for a specific intervention, the outbreak ceased due to maximum general and specific hygiene precautions. Retrospective analysis showed the increasing prevalence of M.catarrhalis strains over a period of two years before the incidence. Since then and after returning to the regular hygiene regimen, only one patient with a phenotypically diverse M.catarrhalis isolate has been documented. The first M.catarrhalis outbreak involving nine patients of a neurological and trauma rehabilitation centre was reported. Potential transmission pathways were discussed. Comprehensive outbreak analyses insinuated the extension of routine laboratory storage time for defined species.

The organization of a neurological rehabilitation centre

The organization of a neurological rehabilitation centre

Participation after stroke: the influence of depression in outpatient neurological rehabilitation

Depressiveness is aknown and common problem after stroke, which puts a great burden on those affected. The main goal for stroke rehabilitation is to achieve the maximum possible self-determination and participation in the community. This research study examined how depressive symptoms influence the course of participation in outpatient neurological rehabilitation. Stroke rehabilitants from 17German outpatient neurological rehabilitation centers were interviewed in amulticentric observational study. Within the current work, data on participation and depressive symptoms recorded at the beginning and at the end of rehabilitation by self-assessment questionnaires, were evaluated. Data of 342 rehabilitants were considered. Results of amultinomial logistic regression analysis indicated that the depression value at the end of rehabilitation, in particular, proved to be agood predictor for the improvement in participation. The lower the depressiveness, the more likely an improvement in participation. At the beginning of the rehabilitation program there were no significant differences between mean depression scores of patients who improved and patients who deteriorated. Arelationship between depressiveness and participation was shown. The treatment of depressive symptoms through timely administered psychotherapeutic and medicinal care and general activity promotion could influence the participation in abeneficial way.

Temporal evolution of bacterial ecology of pressure ulcers in people with spinal cord injury

Bacterial species and their role in delaying the healing of pressure ulcers (PU) in spinal cord injury (SCI) patients have not been well described. The aim of this study was to characterize temporal evolution of superficial and deep microbiota of PU in SCI population. Patients treated for PU between 05/2015 and 12/2016 at the Propara Neurological Rehabilitation Center in Montpellier (France) were included. After wound debridement, samples for bacterial cultures were obtained by swabs (superficial) and tissue biopsies (deep) at the day of inclusion (D0) and 28 after (D28). Forty-nine patients were included (median age: 56 years; 79.6% men). At deep level, coagulase-negative staphylococci (33.8% at D0; 20% at D28), S. aureus (17% at D0; 21% at D28), Enterococcus sp. (12,3% at D0; 16% at D28) and Corynebacterium sp. (13.8% at D0; 16% at D28) were the most frequent bacterial species isolated. After 28 days, percentage of Enterobacteriaceae had significantly increased (0% at D0; 10.5% at D28; P < 0.05) and percentage of anaerobic bacteria had significantly decreased (10.7% at D0; 5.3% at D28; P < 0.05). During the follow-up, at the intra-individual level, the bacterial species isolated were significantly different between D0 and D28, especially at the deep level. This great variability was also described between the deep and the superficial levels. This study highlights for the first-time the evolution of the ecology of PU during one month. The low proportion of Gram-negative bacilli suggests that these bacteria are often colonizing bacteria that could be eliminated by an efficient surgical or mechanical debridement. Moreover, this work demonstrates the uselessness of superficial swabs that do not reflect the bacterial ecology present in depth of the wound.

Regional disparities in acute and post-acute care of stroke patients in France, 2015

ObjectiveThe aim of this study was to assess regional variations of the hospital management of stroke patients during acute and post-acute phases in France in 2015. Material and methodsHospitalized patients coded with stroke as their main diagnosis or, if hospitalized in several different wards, any main ward diagnosis were identified in the 2015 French national hospital discharge database for acute care. Rates of hospitalization in stroke units (SUs) were assessed at a national level and in all metropolitan and overseas regions. All stroke survivors discharged at the end of the acute phase were subsequently identified in the national database for post-acute rehabilitation hospitalization (PARH) within 3 months. ResultsIn the acute phase, half the stroke patients hospitalized for intracerebral hemorrhage, cerebral infarction or unspecified stroke were admitted to SUs. However, there were variations across metropolitan regions (from 30% to 69%) and in overseas regions (from 1% to 59%); these rates correlated with regional ratios of SU beds/100,000 inhabitants. There were also regional differences in PARH rates—in hemiplegic stroke patients, 62% were admitted for PARH (range: 58% to 67%) in metropolitan regions and, overseas, from 8% to 67%—as well as geographical discrepancies in PARH rates to specialized rehabilitation units. Hospitalization rates of hemiplegic stroke patients in neurological rehabilitation centers were 30% for the whole country, but ranged from 23% to 36% in metropolitan regions and from 2% to 45% in overseas regions. ConclusionThis study focused on hospital-based management of stroke patients. In spite of the creation of new SUs over the past decade in France, there are persistent regional differences in the number of SU beds/100,000 inhabitants and, consequently, in the rate of stroke patients managed in SUs. However, rates continue to improve with the creation of new SUs and the expansion of existing ones. Regional variations were also noted for post-acute hospitalization rates and PARH beds/places.

Fiabilidad y validez de la Escala de la Calidad del Desempeño Sensoriomotor en bebés de 2 a 15 meses de edad, con retraso motor o parálisis cerebral

IntroductionThe Sensory Motor Performance Scale (ECDSM2-15), recently developed using Delphi methodology, is a scale to assess the sensory and motor development of infants aged 2 to 15 months previously diagnosed with motor delay or cerebral palsy. This scale classifies the strategies used by infants into typical/normal, delayed, and atypical/patology and identifies the influence of the components of alignment, movement, and support base on functional outcome. Given its importance, there is a need to analyse the biometric characteristics of this scale. ObjectiveTo determine the reliability and construct validity of the ECDSM2-15 scale. Patients and methodsA descriptive and prospective study was conducted in 454 boys and girls aged 2 to 15 months who showed delayed motor development or were diagnosed with cerebral palsy at the Teletón-Chile Institutes, Pedro Aguirre Cerda National Rehabilitation Hospital, and Amancay Neurological Rehabilitation Center. Reliability and construct validity analyses were performed. ResultsInternal consistency and intra-observer variability showed a Cronbach's alpha > 0.80. Variability of evaluators versus control group showed a Kappa index> 0.60. Factor analysis showed a significant Kaiser-Meyer-Olkin index > 0.7 with Bartlett's sphericity test (p <.0001). The analysis of principal components with varimax rotation in the six subscales explained between 60 and 87% of the variance. ConclusionThe scale is reliable, consistent and valid in its construct and can be used in assessment, clinical follow-up and research.

Effects and Quality of Stroke Rehabilitation of BAR Phase D

Abstract Background Stroke is a major public health problem of enormous epidemiological significance. Each year, approximately 200.000 people in Germany suffer a stroke. Stroke is the third leading cause of death and the most common cause of acquired disabilities in adults. About one fourth of stroke survivors report severe limitations in activities of daily living three months after acute stroke. The most common post-stroke conditions are motor and cognitive dysfunctions as well as affective problems. Stroke rehabilitation plays a crucial role in coping with stroke sequelae. The large number of strokes and the often debilitating consequences raise the question to what extent participation can be increased by medical rehabilitation. Methods A prospective, multicenter survey study was conducted in six neurological inpatient rehabilitation centers. Recruitment focused on patients with recent acute stroke and disease severity corresponding to BAR phase D. Patients completed questionnaires at three points of measurement: at the beginning and at the end of the inpatient rehabilitation and after four months. Primary outcome was participation, secondary outcomes included several parameters of subjective well-being. Furthermore, utilization of aftercare and satisfaction with the rehabilitation program were measured. Results At the beginning of the rehabilitation, patients experienced severe limitations in participation and reduced subjective well-being. At the end of inpatient rehabilitation, significant improvements of small effect sizes for subjective well-being and medium effect sizes for participation were achieved. After four months, effects had decreased, yet improvements compared to baseline were still noticeable. Patient ratings of the rehabilitation program and the outcomes achieved were consistently positive. Two thirds of the patients were advised to make use of aftercare offerings and most patients (83%) participated in an aftercare program of any kind. Conclusions The results of this study support the notion that stroke rehabilitation has significant and sustainable effects. Participation in particular seems to improve through medical rehabilitation. Partly decreased effects after four months raise the question of adequate aftercare.

Trajectory analysis of participation in a sample of stroke patients in German neurological outpatient rehabilitation centres

Objective We used a trajectory analysis to evaluate the course of participation in a sample of stroke patients in German neurological outpatient rehabilitation centres. Among other benefits, the method of trajectory analysis enables exploration of variables that influence the course of rehabilitation. Method In a multicentric observational study, patients at 17 outpatient neurorehabilitation centres were asked to fill in a questionnaire four times: at the time of admission to the rehabilitation center, on discharge and on month 4 and 12 post rehab. Additionally, clinical experts were asked to rate the patients' status at admission and discharge. Results and conclusions We obtained data on 364 stroke patients. There was deterioration in the social participation of 36 (9.9 %) patients, no change was observed in the participation of 173 (47.5 %) patients, and there was improvement in the participation of 155 (42.6 %) patients. 99 patients among the 173 patients that did not show changes in participation had already started with good participation scores. This questions the need for rehabilitation for this group. According to the sociodemographic variables, we could show that only sex and income are important for the course of rehabilitation. Further research is necessary about context factors that influence trajectories.

Results of the first interim analysis of the RAPPER II trial in patients with spinal cord injury: ambulation and functional exercise programs in the REX powered walking aid

BackgroundThe RAPPER II study investigates the feasibility, safety and acceptability of using the REX self-stabilising robotic exoskeleton in people with spinal cord injury (SCI) who are obligatory wheelchair users. Feasibility is assessed by the completion of transfer into the REX device, competency in achieving autonomous control and completion of upper body exercise in an upright position in the REX device. Safety is measured by the occurrence of serious adverse events. Device acceptability is assessed with a user questionnaire.MethodsRAPPER II is a prospective, multi-centre, open label, non-randomised, non-comparative cohort study in people with SCI recruited from neurological rehabilitation centres in the United Kingdom, Australia and New Zealand. This is the planned interim report of the first 20 participants. Each completed a transfer into the REX, were trained to achieve machine control and completed Timed Up and Go (TUG) tests as well as upper body exercises in standing in a single first time session. The time to achieve each task as well as the amount of assistance required was recorded. After finishing the trial tasks a User Experience questionnaire, exploring device acceptability, was completed.ResultsAll participants could transfer into the REX. The mean transfer time was 439 s. Nineteen completed the exercise regime. Eighteen could achieve autonomous control of the REX, 17 of whom needed either no assistance or the help of just one therapist. Eighteen participants completed at least one TUG test in a mean time of 313 s, 15 with the assistance of just one therapist. The questionnaire demonstrated high levels of acceptability amongst users. There were no Serious Adverse Events.ConclusionsThis first interim analysis of RAPPER II shows that it is feasible and safe for people with SCI to use the REX powered assisted walking device to ambulate and exercise in. Participants with tetraplegia and paraplegia could walk and perform a functional exercise program when standing needing only modest levels of assistance in most cases. User acceptability was high.Trial registrationClinicalTrials.gov, NCT02417532. Registered 11 April 2015.

Body Image (BI) of acquired spinal cord injury (SCI) persons. Which patient care in an internal unit of physical and neurological rehabilitation. Experience of the patient care in an internal and neurological unit of PMR of the University Hospital of Liège

Define and develop the acquired SCI patient's BI care within the internal unit of physical and neurological rehabilitation center of the University Hospital of Liège: – explore the patients’ and professionals’ representations and needs of BI care; – estimate the concordances and the dissonances of the visions; – identify if a patient's BI care exists within the unit and what form it takes. Qualitative, retrospective, exploratory and inductive study. Twenty-three acquired SCI patients who had been hospitalized in the unit were individually interviewed. Professionals were interviewed in 8 focused-groups and 4 individuals interviews. BI emerges as a vast and personal notion. The representations of 2 populations are multidimensional and relatively corresponding. Several elements support a positive BI: diverse attitudes of professionals, a relation of quality between professionals and patients, individual care, peer support, an integration in the unit's social life, general information, or even education on the sexual repercussion of the SCI. Professionals report ‘lack of time’ as a limiting factor in patient's BI care. Work experience stands out as a support for the representations of the possible repercussions of the medullary lesion on BI. The link between ‘multidisciplinary care’ and ‘BI’ can be direct or indirect. ‘BI’ and ‘self-esteem’ seem difficult to split, just like ‘BI’ and ‘disabilities’. There is actually a BI care in the unit. Nevertheless, it is not structured, not formal and not connected to the caregiver's profession. Multidisciplinarity care and individualized care seem necessary. Several lines of reflections emerge from the interviews: well-being centered care, levers facilitating the BI discussion, a greater reliable link if a professional takes care regularly of the same person, a common philosophy of patient care, the interest to set up a rising awareness of new professionals, as well as more timesharing of the practical knowledge. In view of our results, relevant elements in the literature can be explored: the formalization of peer support, a BI systematic questioning, the support for coping strategies, the satisfaction follow-up of the hospitalized people, or even the model of Bailey and al (2015) which describes SCI patient's positive BI.

Patient education programme on immunotherapy in multiple sclerosis (PEPIMS): a controlled rater-blinded study

Objective: To investigate the effectiveness of a multi-component evidence-based education programme on disease modifying therapies in multiple sclerosis. Design: Controlled trial with two consecutive patient cohorts and a gap of two months between cohorts. Setting: Three neurological rehabilitation centres. Subjects: Patients with multiple sclerosis within rehabilitation. Interventions: Control group (CG) participants were recruited and received standard information. Two months later, intervention group (IG) participants were recruited and received a six-hour nurse-led interactive group education programme consisting of two parts and a comprehensive information brochure. Main measures: Primary endpoint was “informed choice”, comprising of adequate risk knowledge in combination with congruency between attitude towards immunotherapy and actual immunotherapy uptake. Further outcomes comprised risk knowledge, decision autonomy, anxiety and depression, self-efficacy, and fatigue. Results: A total of 156 patients were included (IG=75, CG=81). The intervention led to significantly more participants with informed choice (IG: 47% vs. CG: 23%, P=0.004). The rate of persons with adequate risk knowledge was significantly higher in the IG two weeks after the intervention (IG: 54% vs. CG: 31%, P=0.007), but not after six months (IG: 48% vs. CG: 31%, P=0.058). No significant differences were shown for positive attitude towards disease modifying therapy (IG: 62% vs. CG: 71%,P=0.29) and for disease modifying therapy status after six months (IG: 61.5% vs CG: 68.6%, P=0.39). Also no differences were found for autonomy preferences and decisional conflict after six months. Conclusion: Delivering evidence-based information on multiple sclerosis disease modifying therapies within a rehabilitation setting led to a marked increase of informed choices.

Unusual case of successful treatment of a ruptured thoracoabdominal aneurysm in elderly woman

We describe a case of a 76-year-old woman who underwent emergent surgery for ruptured thoracoabdominal aneurysm with the use of partial left heart bypass. Dacron prosthesis was implanted into the thoracic and abdominal aorta (up to its bifurcation), and four visceral arteries were reimplanted into the prosthesis. The procedure of implanting the prosthesis into the thoracic part of the descending aorta was supported by left heart bypass. The patient’s postoperative course was complicated by spinal cord ischaemia-induced lower extremities paraparesis. On the 26th postoperative day, she was referred to the regional neurological rehabilitation centre.

Music therapy and cognitive rehabilitation: Screening of music cognition in adult patients with right hemisphere stroke.

Camila F. Pfeiffer and Liliana R. SabeNeurologic Rehabilitation Center FLENI Escobar, Buenos Aires, ArgentinaCamila F. Pfeiffer and Liliana R. Sabe, Music Therapy Department and Department for Cognitive Neurology, Neuropsychology and Neuropsychiatry, Neurologic Rehabilitation Center FLENI, Escobar City, Argentina.Correspondence concerning this article should be addressed to Camila F. Pfeiffer, Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia - Music Therapy, Ruta 9, KM53, Escobar, Argentina. E-mail: cpfeiffer@fleni.org.arCognitive disorders are common consequence of stroke. Impairments of orientation, attention, concentration, velocity of information processing, memory, spatial perception, executive functions, and psychosocial behavior have important functional consequences for stroke survivors. As such, a negative impact on learning processes and rehabilitation outcomes is common, independent of the effect of physical impairment (Barker-Collo, Feigin, Lawes, Parag, & Senior, 2010; Hackett, Yapa, Parag, & Anderson, 2005; Patel, Coshall, Rudd, & Wolfe, 2003; Tatemichi et al., 1994). Thus, everyday functioning can be severely limited and compromise personal safety and independency (Lees, Fearon, Harrison, Broomfield, & Quinn, 2012). Cognitive disorders can negatively affect the usefulness and generalization of rehabilitation strategies, which are necessary to achieve the best possible level of independence and enable reintegration into society and work life-the main goal of rehabilitation.In rehabilitation settings, music therapy has been used to address the functional recovery of patients who suffer from neurologic conditions. Music therapy is an evidence-based practice carried out by a qualified music therapist, commonly functioning as part of a multidisciplinary team. It can be offered in individual, group, and interdisciplinary settings. Music therapists commonly work with patients with hemiparesia, aphasia, neglect, amnesia and attention disorders, breathing and voice disorders, consciousness disorders, balance, gait and fine motor skill disorders, and affective or behavioral disorders, among others. In the past, many music therapists have specialized in neurologic music therapy (NMT), a systematic and researched-based treatment method developed to improve cognitive, communication, and sensorimotor disorders through music. Neurologic music therapists are trained to assess patients' individual needs and to select or design goal-directed interventions to stimulate and recover brain functions involved in movement, cognition, speech, sensory perceptions, emotions, and social behavior. NMT techniques are grounded on a neurobiologic understanding of how music affects the human nervous system and are designed to address specific symptoms caused by neurologic diseases.For example, singing, vocal, and breathing exercises are applied to treat respiration, voice, and speech impairments such as decreased loudness, short phonation time, or a monotonous voice, commonly caused by Parkinson disease, stroke, traumatic brain injuries (TBIs), spinal cord injuries, congenital disorders such as a cleft palate or abnormalities of the vocal apparatus (Baker, Wigram, & Gold, 2005; Haneishi, 2001; Tamplin & Grocke, 2008). Melodic intonation therapy has been proven to be effective in aiding recovery of language production of patients with nonfluent aphasia (Norton, Zipse, Marchina, & Schlaug, 2009; Tomaino, 2012). Rhythm takes a predominant role in motor rehabilitation due to its impact on the auditory-motor system. In speech fluency disorders such as stuttering or dysarthria, pulsed signals or rhythmic patterns can acoustically cue speech production and enhance speech rate control. Here, recovering temporal characteristics of speech such as fluency, articulatory rate, and intelligibility is the main therapeutic goal (Mainka & Mallien, 2014; Van Nuffelen, De Bodt, Vanderwegen, Van de Heyning, & Wuyts, 2010). …

Respiratory Muscle Strength in Chronic Stroke Survivors and Its Relation With the 6-Minute Walk Test

ObjectivesTo compare respiratory muscle strength in stroke survivors (SS) with that in a control group (CG) of healthy people matched by age and sex, as well as to investigate any relation between respiratory muscle strength and the distance walked during the 6-minute walk test (6MWT). DesignCross-sectional study. SettingThis study comprised patients from a private neurological rehabilitation center and a public association for patients with acquired brain injury. ParticipantsChronic SS with a diagnosis of hemiplegia/hemiparesis who were able to walk (n=30) and healthy individuals matched by sex and age (n=30) (N=60). InterventionsNot applicable. Main Outcome MeasuresRespiratory muscle strength was assessed using maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP) with a pressure transducer and a diver nozzle. The distance walked during the 6MWT was also registered for both groups. The motricity index and the Scale Impact of Stroke version 16.0 were also measured in SS. ResultsThe Student t test revealed significantly lower values of MIP and MEP in SS than in the CG (MEP, 95.93±43.12cmH2O in SS vs 158.43±41.6cmH2O in the CG; MIP, 58.7±24.67cmH2O in SS vs 105.7±23.14cmH2O in the CG; P<.001). Moreover, these findings were clinically relevant because both MIP and MEP in SS were <60% of the predicted values. A positive correlation between the 6MWT and MIP was found using the Pearson coefficient (r=.43; P<.018). ConclusionsRespiratory muscle weakness should be considered in a holistic approach to stroke rehabilitation.

(Neuro)psychological Rehabilitation after Stroke: a National Survey of Structures and Practice in Inpatient and Outpatient Neurological Rehabilitation

Structures and practice of psychological units in neurological rehabilitation centres treating post-stroke patients are described. A nationwide survey of psychological services in neurological rehabilitation centres was conducted. Psychologist-patient ratios differed greatly among rehabilitation centres. Post-stroke patients showed a variety of complex problems. Psychological interventions mainly comprised diagnostic evaluation as well as individual interventions and cognitive training. The complex and manifold problems of patients in neurological rehabilitation require a comprehensive knowledge of (neuro)psychological functioning. In order to support appropriate and individual treatment decisions, practice guidelines for psychological interventions in the rehabilitation of post-stroke patients are necessary. The present survey constitutes the basis for developing such practice guidelines.

Balance evaluation with stabilometric platform on hemiplegic patients in a neurological rehabilitation center

To measure the evolution of postural parameters with a stabilometric platform in patient with hemiplegia after stroke and treated in a neurological rehabilitation center. It is a retrospective, analytic and longitudinal study. Eighteen (18) patients with hemiplegia as consequences of a first stroke and who were beneficiary of SATEL® platform evaluation during the first three months after the stroke and with a second evaluation three months later, were selected from our establishment. We collected data of the center of gravity surface projection in patients with open eyes and close eyes. Romberg average coefficient was calculated afterward. Comparing the two evaluations, we found a reduction of the average surface, mostly in patients with close eyes. We also found that the surface was decreased in 14 patients with open eyes and in 16 patients with close eyes. Romberg average coefficient was decreased in the second evaluation. (2.7 vs. 1.6) We found a surface decrease in the majority of patients and also an average surface decrease. However, only 1 patient recovered a normal surface [1]. This decrease was more evident with close eyes. This could be explained by a preference of visual afferents in balance reactions on the early phases [2], [3] of the recovery that would amend on the later phases, which is also revealed by the decrease in the average Romberg coefficient.

Effects of additional, dynamic supported standing practice on functional recovery in patients with sub-acute stroke: a randomized pilot and feasibility trial

Objective: To evaluate the feasibility and preliminary effectiveness of additional dynamic versus static passive standing performed by patients with sub-acute stroke supervised by trained helpers. Design: Assessor blinded, randomized pilot and feasibility trial. Setting: Neurological rehabilitation centre. Participants: Non-ambulatory participants in the sub-acute phase after stroke. Intervention: Usual care plus additional standing training, consisting of either dynamic standing practice in a modified standing frame (intervention group, n=14) or static standing practice in a conventional standing frame (control group, n=14) for 5 weeks. Main measures: Feasibility was assessed through occurrence of adverse events, patient satisfaction and operability of the technical device handled by trained helpers. Preliminary effectiveness was assessed with the Berg Balance Scale (primary outcome) and other measures of physical functioning. Results: Trained helpers were capable to apply the intervention, and no adverse events occurred. Both groups were comparable at baseline. Within-group changes tended to be higher for the intervention group, but did not reach a significant level except for the Functional Ambulation Categories. Specifically, median pre-post improvements in the Berg Balance Scale tended to be higher in the dynamic (20, inter quartile range (IQR): 2–33 points) than in the static standing group (4.5, IQR: 0–16 points; U=62; P=0.052; effect size=0.478). Conclusions: In severely affected individuals after stroke, dynamic supported standing practice can be performed safely by trained helpers. In a larger-scale phase III study, a total of 116 patients would be needed to prove the preliminary effectiveness found in this study.

Interest of Botulinum Toxin for Treatment of Spasticity in Multiple Sclerosis

Background: Pyramidal tract lesions are common in multiple sclerosis (MS) patients and cause symptoms of spasticity, weakness and paralysis. OnabotulinumtoxinA treatment for spasticity is well-recognised, but remains to be defined in MS. Objective: Analysis of practices in the treatment of spasticity in MS in a rehabilitation centre: Treatment of spasticity in MS with on abotulinumtoxinA according to level of disability. Methods: Retrospective patient data review was conducted on MS patients treated with onabotulinumtoxinA from 2007 to 2010 in our neurologic rehabilitation center, with the aim to assess the modalities of use and effectiveness of onabotulinumtoxinA injections in everyday clinical practice. Results: 126 patients (mean age: 49.4 ± 11 years), with a mean Expanded Disability Status Scale (EDSS) score of 5.8 ± 1.7 (range: 2.5-9.5) received onabotulinumtoxinA treatment. Key treatment goals were improved walking in the less disabled patients (mean EDSS: 5 ± 1), and improved comfort and nursing care for the most disabled patients (mean EDSS: 7.7 ± 1). Therapeutic benefit was assessed using a Visual Analogue Scale and results were 6 ± 2.5 and 6.3 ± 3, respectively, with repeat injections for 65% of patients Conclusion: OnabotulinumtoxinA used in daily practice seems to be an effective, well?tolerated treatment in MS, with goals that vary according to the level of disability: i.e., improved walking and patient comfort. Further studies are needed to define the place and the effectiveness of onabotulinumtoxinA treatment in MS.

The Bobath Concept in Walking Activity in Chronic Stroke Measured Through the International Classification of Functioning, Disability and Health.

The aim of this study is to evaluate the effectiveness of a rehabilitation programme based on the Bobath concept in order to improve walking activity in patients with chronic stroke and to show the usefulness of the International Classification of Functioning, Disability and Health (ICF) as a tool for gathering functioning information. This study is a repeated measures study. The setting of this study is an outpatient neurological rehabilitation centre based on a multidisciplinary approach. Twenty-four participants suffering from chronic stroke (>1 year and a half and <5 years post-stroke) and mean age of 65.58 (standard deviation 10.73) were the participants of the study. Multidisciplinary approach based on the Bobath concept principles with three weekly individual physiotherapy sessions of 45 min each over a 6-month period was the intervention for this study. The measures used were Modified Emory Functional Ambulation Profile, 10-m walk test, 6-min walk test, muscle strength testing and subsequent codification of these results into ICF qualifiers. The results of the study showed significant improvement in activities of walking long distances, on different surfaces and around obstacles. There was no significant improvement in the activity of walking short distances or for muscle power functions. A rehabilitation programme based on the Bobath Concept improved walking activities in people with chronic stroke. For this intervention, the use of the ICF qualifiers was sensitive in perceiving post-treatment changes.