Neurological Rehabilitation Program Research Articles

Extracorporeal Shock Wave Therapy with Low-Energy Flux Density Treatment Applied to Hemiplegia Patients on Somatosensory Functions and Spatiotemporal Parameters.

We aimed to investigate the efect of Extracorporeal Shock Wave Therapy (ESWT) applied to patients with hemiplegia on somatosensory data, spatiotemporal parameters, posture, and muscle tone. This was a double-blind, randomised, controlled trial. Patients were randomised within pairs to either the experimental (ESWT) group (n=20) or the control group (n=20). All patients participated in the same conventional stroke rehabilitation program for 60 minutes of treatment a day, 5 times a week for 6 weeks (30 sessions). Patients assigned to the ESWT group received additional ESWT over the plantar fascia 3 days/week for 6 weeks. Timed Up and Go (TUG) test, Modified Ashworth Scale (MAS) score, Posture Assessment Scale for Stroke Patients (PASS), spatiotemporal parameters, Semmes-Weinstein monofilament (SWM) test, and vibration sensation test (VST) were performed in all participant before and after treatment. In the ESWT and control groups, statistically, significant diferences were obtained in the posttreatment analysis than pre-treatment. Significant diferences were found in foot angle, step cycle duration, swing phase, cadence, gait cycle distance, and VST values after ESWT treatment (P < .01). When combined with a neurological rehabilitation program, it was determined that ESWT applied to the plantar face of the foot in individuals with hemiplegia increased somatosensory functions and was more successful in developing postural control and balance.

Effects of a respiratory and neurological rehabilitation treatment plan in post Covid-19 affected university students. Randomized clinical study.

COVID-19 demonstrated the possibility of neurological complications such as loss of sense of smell and taste, together with respiratory problems. Respiratory training and rehabilitation of neurological sequelae are essential to improve respiratory function and thus quality of life, and the aim of this study is to evaluate the efficacy of a pulmonary and neurological rehabilitation program. To apply a treatment to reduce dyspnea, increase exertional capacity, increase vital capacity and respiratory muscle strength, together with an increase in olfactory and gustatory sensitivity in post-SARS-CoV-2 patients. A randomised controlled experimental study was conducted in 220 patients with a medical diagnosis of COVID-19 and more than 5months of evolution, dyspnoea or perceived fatigue, including olfactory and gustatory perception problems, of whom 200 patients completed the study. 100 patients were randomly assigned to the intervention group, consisting of an inspiratory training treatment plan (Powerbreathe Plus®) combined with aerobic exercise and olfactory gustatory treatment for 31days, and 100 patients to the control group, for 31days without any type of therapy. The study was conducted in post-Covid-19 patients for 5months. Two hundred patients were divided into an intervention group (n = 100) and a control group (n = 100). The comparison between the groups showed significant differences in spirometric variables; forced vital capacity (p < .001; Eta2 (0.439); Mean: 0,6135), the ratio between both FEV1/FVC (p < 0.01; Eta2 (0.728); Mean:9,313), peak inspiratory pressure (p < 0.01; Eta2 (0.906); Mean:4,526); changes were observed in dyspnoea measured with the modified Borg scale (p < 0.01; Eta2 (0.811); Mean:1,481) and the modified Medical Research Council scale (p < 0.01; Eta2 (0.881); Mean: 0.777); finally, changes were found in neurological variables, in the questions of the Singapore Smell and Taste Questionnaire, How was your sense of smell after treatment? (p < 0.01; Eta2 (0.813); Mean: 1,721) and How is your sense of taste after treatment? (p < 0.01; Eta2 (0.898); Mean: 1,088). The implementation of a respiratory rehabilitation treatment plan with the Powerbreathe Plus® device, aerobic exercise and neurorehabilitation with olfactory and gustatory training, is a therapeutic option against respiratory and neurological sequelae in patients who have suffered such sequelae due to the SARS-CoV-2 virus. Clinicaltrials.gov: NCT05195099. First posted 18/01/2022; Last Update Posted 29/06/2022.

Upper limb movement during locomotion in patients with neurological disorders: a wearable-based approach

The contribution of upper limbs during walking is crucial in maintaining balance and stability: humans, in fact, swing each upper limb in phase with contra-lateral lower limb at their comfortable walking speed, with a ratio of 1:1 [1], thus counteracting the angular momentum, reducing the energy expenditure, and improving the overall gait efficiency [2,3]. In people who suffer from neurological disorders, like Multiple Sclerosis (MS) or Traumatic Brain Injury (TBI), upper limb function is often impaired, resulting in differences in arm swing frequency, amplitude, symmetry, as well as in the ratio between step and arm swing frequency, compared to healthy people [2]. Although it is known that a neurological rehabilitation program should focus on the recovery of a proper gait also emphasizing the contribution of upper limbs [1], few studies analyzed the contribution of the upper arms during locomotion in people with neurological disorders. The aim of this study is to explore a wearable sensor-based protocol for the assessment of the upper limb movement in patients with MS and TBI compared to healthy participants. Thirty-three patients suffering from MS (24 F; 49.8±9.3 y; EDSS 4.0±1.6), 8 patients suffering from TBI (2 F; 32.3±14.1 y; DGI 18.3±5.9), and 20 healthy adults (HC) (9 F; 37.0±19.9 y) were enrolled in this study (CE/PROG.700). Each participant performed a 10-meter Walking Test (10mWT) while wearing 5 synchronized inertial measurement units (IMUs) located at sternum, both wrists and distal tibiae level. Stride segmentation was performed using tibiae-mounted IMUs and the following parameters were estimated from wrist- and sternum-mounted IMUs [4]: arm oscillation frequency, peak and range of the angular velocity norm, as well as step to arm oscillation frequency ratio for the right (RW) and left (LW) wrists (freq, gyro peak, gyro range, Step-freq ratio). The range of the sternum cranio-caudal angular velocity was also obtained (sternum gyro range), together with a measure of symmetry (Symmetry Index [5]) between RW and LW angular velocity ranges. After checking for data normality, a one-way ANOVA was used to test for significant differences among MS, TBI, and HC. Post-hoc analysis was performed using Bonferroni-Holmes correction for multiple comparisons. Results are depicted in Fig. 1 (the larger the spider, the better the performance). Significant differences were found in frequency, symmetry, and angular velocity parameters among the MS, TBI, and HC. Patients with TBI seem to be characterized by a reduced performance with respect to MS, except for the step to arm swing ratio. The proposed assessment protocol demonstrates a potential clinical value in discriminating not only patients with neurological disorders from HC, but also patients with MS from TBI, who showed significant differences in terms of swing frequency, angular velocity range, and symmetry. This information could be useful in tailoring rehabilitation treatments involving the upper limbs during gait exercises [1]. Although in the present study, no significant difference was found among the three populations walking speed, the effect of the latter on the proposed metrics should be better investigated in further studies.

Investigating the correlation between pulmonary function tests and ultrasonographic diaphragm measurements and the effects of respiratory exercises on these parameters in hemiplegic patients

ABSTRACT Objective To investigate the correlation of DUS and pulmonary function tests (PFTs), and investigate the effects of respiratory exercises on the above parameters. Methods For the treatment group (n=20), neurological rehabilitation and respiratory exercise program, and for the control group (n=21), only a neurological rehabilitation program was implemented for 30 sessions. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), end-inspiration diaphragm thickness (IDT), end-expiratory diaphragm thickness (EDT), and diaphragm thickening ratio (DTR) were measured pre- and post-treatment. Results IDTs and EDTs as well as DTRs of affected side (p < .001, .001, and .03, respectively) and intact side (p < .001, .001, and .02, respectively) were found to improve post-treatment than before treatment in the treatment group. Similarly, FVC, FEV1, and FEV1/FVC, were better post-treatment than before treatment in the treatment group. Moreover, the affected side IDT was positively correlated with FVC and FEV1 before treatment (r = .38, p = .03 and r = .35, p = .02) and post-treatment (r = .46, p = .02 and r = .39, p = .03). The affected side DTR was positively correlated with FVC and FEV1 before treatment (r = .44, p = .01 and r = .40, p = .02) and post–treatment (r = .32, p = .03 and r = .40, p = .04). Conclusion DUS can be used for the evaluation of respiratory problems in stroke patients. Moreover, breathing exercises improve these parameters in stroke patients, and they can be followed up by DUS.

Effects of Inspiratory Muscle Training on Respiratory Muscle Strength, Trunk Control, Balance and Functional Capacity in Stroke Patients: A single-blinded randomized controlled study

ABSTRACT Objective Aim of the study was to examine the effects of inspiratory muscle training (IMT) on respiratory function, respiratory muscle strength, trunk control, balance, and functional capacity in stroke patients. Methods 21 stroke individuals were randomly divided into two groups as control group and treatment group. Respiratory function test, Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) were evaluated. Also, Trunk Impairment Scale (TIS), Timed Up and Go Test (TUG) Berg Balance Scale (BBS), and Six-Minute Walk Test (6MWT) were performed. Neurodevelopmental treatment program was performed in both groups for 5 days a week for 6 weeks, and IMT was given to the treatment group. IMT was started from 40% of MIP. Results After treatment, respiratory functions, respiratory muscle strength, and trunk control and balance improved in the treatment group. In the control group; however, only the balance level was improved. When the changes in the evaluation parameters between the groups were compared, there were only statistically significant differences in the TIS, Peak Expiratory Flow (PEF) and MIP in the treatment group (p˂0.05), the change amounts in other evaluation parameters were similar (p˃0.05). When the effect size of the groups was compared, the effect size of the variables in the treatment group was found to be higher. Conclusion As a conclusion, IMT, which was given in addition to the neurological physiotherapy and rehabilitation program to our patients, improved inspiratory muscle strength and trunk control. We believe that this result will raise awareness for physiotherapists working in the field of neurological rehabilitation about including respiratory muscle training in the rehabilitation program of stroke patients.

Neurological rehabilitation for a patient with chronic Rasmussen encephalitis: a case report.

ABSTRACTRasmussen encephalitis is a rare disease consisting of a chronic, slowly progressive inflammatory reaction of brain tissues. The objective of this study was to describe the case of an 18-year-old female patient, studying on the fourth grade of elementary school, and right-handed, who underwent left hemispherectomy in a neurological rehabilitation program. Her seizures began at 10 years of age and were unresponsive to drug treatment, with functional repercussions. She underwent hemispherectomy in March 2019, with 7 years of ongoing disease, and was admitted for the rehabilitation program with a multidisciplinary team in June 2020. The quality-of-life questionnaire (WHOQOL-BREF) was applied as a comparison measure before and after the rehabilitation program, along with measures of participation on the program activities. Despite the patient’s short time in a rehabilitation program, data show the importance of an interdisciplinary intervention through the establishment of specific and contextualized objectives in chronic patients.

Improvements in Cognition, Chronic Migraine Headaches with Aura and Benign Paroxysmal Positional Vertigo (BPPV) in a 35-year-old Female Patient Following Neurological and Vestibular Rehabilitation.

Event Abstract Back to Event Improvements in Cognition, Chronic Migraine Headaches with Aura and Benign Paroxysmal Positional Vertigo (BPPV) in a 35-year-old Female Patient Following Neurological and Vestibular Rehabilitation. Trevor D. Eason1* 1 Carrick Institute, United States Presentation: A 35-year-old female patient presented with cognitive decline, persistent episodes of benign paroxysmal positional vertigo, and chronic, persistent migraine headaches. The history included episodes of chronic migrainous headaches originating when she was 12-years-old. The migraine headaches are normally preceded by scintillations. The patient stated that she had never been able to ride in the back of a car, participate at amusement parks and has frequent dizziness and described oscillopsia. The origination of the episodes of benign paroxysmal positional vertigo occurred 2 years ago spontaneously upon arising one morning. The patient stated that medication she has been prescribed does not have the same effect as it once did concerning her migraine episodes. Findings: During neurocognitive testing on the C3 Logix program, upon intake, Trails A time was measured at 40.8 seconds while Trails B time was measured at 45.2 seconds. Her simple reaction time was 383 milliseconds and her choice reaction time was 411 milliseconds. Her initial symptom severity score was 86% based on the associated subjective questionnaire where 0% is no symptoms. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing the patient's balance and stability, on both a solid and foamed surface, with his eyes opened, eyes closed, and with multiple head positions. Her average balance and stability score on intake was calculated as 27.12%. Videonystagography (VNG®) demonstrated mixed torsional, geotropic, upbeat nystagmus when placed in a Dix-Halpike maneuver for the right posterior canal. A 2-3 Hz. left beat nystagmus was also observed with gaze fixation eliminated in primary position. Methods: A 12-day multi-modal neurological rehabilitation program was administered in 12 one-hour treatment sessions (Carrick, 2017). Initial treatment consisted of an Epley maneuver to alleviate the right posterior canal debris. Each session after consisted of neurological and vestibular rehabilitation exercises directed towards the right vestibular apparatus and cerebellum integration, somatosensory evoked potentials, cognitive exercises, orthoptic training, and off-vertical axis rotation (Gdowski 1999) using a multi-axis rotational chair. Initially, she was placed on a paleo diet and a supplement protocol. Based on clinical symptoms indicating alterations in energy production, she was placed on multiple nutrient formulas containing Vitamin E (11 mg), docosahexaenoic acid (1200 mg), Phosphatidylcholine (60 mg) 1 x daily. CoQ10 (200 mg) and Pyrroloquinoline quinone disodium salt (PQQ) (5 mg) were also administered in a 5 ml. dose 1 x daily. She was advised to reduce smoking and enroll in smoking cessation counseling. Outcomes: Upon discharge, Trails A time decreased to 23.5 seconds (-42.4%), and Trails B time decreased to 32.7 seconds (-27.7%). Simple reaction time decreased to 277 seconds (-27.7%), and choice reaction time decreased to 312 seconds(-24.1%). Symptom severity score decreased to 7 (-91.9%) where 0 is no symptoms. The average balance and stability score improved resulting in a score of 85.37% (+214.9%). Upon Videonystagography (VNG®), no mixed torsional, geotropic, upbeat nystagmus was observed when placed in a Dix-Halpike maneuver for the right posterior canal. No nystagmus was observed with gaze fixation eliminated in a neutral gaze or primary ocular position. Concurrently, full resolution of her migraine headaches occurred after the BPPV was eliminated. Conclusions: The author suggests further investigation into the use of multi-modal neurological, vestibular rehabilitation strategies and supplemental clinical nutrition strategies for the treatment of BPPV, and migraine headaches with aura. The author also suggests further investigation into multi-modal, intensive approaches to improve stability scores, simple and choice reaction times, symptom severity scores and stability of eye movements associated with proper neurological and vestibular function. Acknowledgements The author would like to thank and acknowledge Professor Frederick Carrick and his pioneering work in the field of clinical neuroscience. The author would also like to thank the Carrick Institute for providing the education utilized to create the multi-modal treatments implemented in this case study.

Improvements in Social Cognition, Executive Functioning, and Trichotillomania with Characteristics of Trichophagia in a 26-year-old Female Patient Following Neurological Rehabilitation.

Event Abstract Back to Event Improvements in Social Cognition, Executive Functioning, and Trichotillomania with Characteristics of Trichophagia in a 26-year-old Female Patient Following Neurological Rehabilitation. Trevor D. Eason1* 1 Carrick Institute, United States Presentation: A 26-year-old female patient presented with social cognitive impairment, memory decline, executive function limitations, persistent episodes of pica via trichophagia, and trichotillomania. The history included episodes of hair pulling and ingestion with no memory or recollection of the episode. Social cognition and executive functioning cues were slow and mild cognitive impairment had been made evident in the previous diagnosis. The patient stated that she had never been able to act appropriately in society after a history of multiple streptococcus A and mycoplasma pneumonia infections when she was 2 years old. The patient's mother stated that the mental processing of the patient is evident yet slower than the expected norm. Findings: During neurocognitive testing on the C3 Logix program, upon intake, Trails A time was measured at 49.1 seconds while Trails B time was measured at 55.9 seconds. Her simple reaction time was 423 milliseconds and her choice reaction time was 511 milliseconds. Her initial symptom severity score was 56% based on the associated subjective questionnaire where 0% is no symptoms. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing the patient's balance and stability, on both a solid and foamed surface, with his eyes opened, eyes closed, and with multiple head positions. Her average balance and stability score on intake was calculated as 67.12%. Comprehensive behavioral Intervention score of 23.5%. Videonystagography (VNG®) demonstrated saccadic oscillations. These eye movements were observed with similar frequency (15-20 Hz.) and equality sided to side with gaze fixation eliminated in primary position. Methods: A 12-day multi-modal neurological rehabilitation program was administered in 12 one-hour treatment sessions (Carrick, 2017). Each session consisted of neurological and vestibular rehabilitation exercises directed towards the cerebellum and basal ganglia integration, somatosensory evoked potentials, comprehensive behavioral intervention for tics (CBIT) treatment associated with habit reversal training and function-based treatments, orthoptic training, and off-vertical axis rotation (Gdowski 1999) using a multi-axis rotational chair. Based on clinical symptoms indicating alterations in energy production, she was placed on multiple nutrient formulas containing pantothenic acid (300 mg), L-α glycerylphosphorylcholine (100 mg), acetyl L-carnitine hydrochloride (25 mg), Butyric acid and calcium propionate blend (575 mg) and Huperzia serrata (75 mcg) 3 times daily. Also, the patient administered a gastrointestinal tissue repair compound containing a proprietary blend of sodium (10 mg), L-Glutamine (3.5 g), deglycyrrhizinated licorice extract (500 mg), aloe vera gel concentrate (50 mg), ginger extract (40 mg), and an enzymatic blend once daily with a meal. Outcomes: Upon discharge, Trails A time decreased to 37.6 seconds (-23.4%), and Trails B time decreased to 42.7 seconds (-23.6%). Simple reaction time decreased to 347 seconds (-18.0%), and choice reaction time decreased to 386 seconds (-24.5%). Symptom severity score decreased to 23 (-58.9%) where 0 is no symptoms. The average balance and stability score improved resulting in a score of 79.17% (+18.0%). Upon Videonystagography (VNG®), saccadic oscillation frequency was diminished per time observed with gaze stability in primary position, 20 degrees horizontally and 15 degrees vertically (circumferentially). Comprehensive behavioral Intervention score 49.8% (+111.9 %). No nystagmus was observed with gaze fixation eliminated in primary gaze position. Concurrently, the patient is now able to implement awareness strategies to compete against her trichotillomania and trichophagia episodes which ultimately proves an increase in executive functioning. Conclusions: The author suggests further investigation into the use of multi-modal neurological rehabilitation strategies, comprehensive behavioral interventions and supplemental clinical nutrition strategies for the treatment of trichotillomania with associated trichophagia, and cognitive impairment.​ The author also suggests further investigation into multi-modal, intensive approaches to improve stability scores, simple and choice reaction times, symptom severity scores and multimodal integration associated with proper neurological and cognitive function. Acknowledgements The author would like to thank and acknowledge Professor Frederick Carrick and his pioneering work in the field of clinical neuroscience. The author would also like to thank the Carrick Institute for providing the education utilized to create the multi-modal treatments implemented in this case study.

Improvements in Balance Stability Scores, Cognition, and 67% Reduced Symptom Severity Score Following Neurological Rehabilitation for a 37-year-old Female with Post-Concussive Syndrome

Event Abstract Back to Event Improvements in Balance Stability Scores, Cognition, and 67% Reduced Symptom Severity Score Following Neurological Rehabilitation for a 37-year-old Female with Post-Concussive Syndrome Angela M. Gabella1, 2* 1 Carrick Institute, United States 2 Precision Brain Center, United States Presentation: A 37-year-old female patient presented to Precision Brain Center for evaluation and treatment of post-concussive syndrome (PCS). She presented with the following symptomatology: chronic dizziness, short-term memory loss, confusion, poor concentration, cognitive decline, severe anxiety, Irritability, full body tremors, feels like her insides are vibrating, vision problems, fatigue, brain fog, weakness in her right arm and hand, and bilateral swelling in her legs. Her symptom first started 2 years ago with insidious onset then in 2018 she got dizzy while working out and fell and hit her head on a dumbbell. After suffering a concussion her symptoms immediately worsen. Findings: A comprehensive neurological examination revealed a right ocular esotropia, left ocular hypertropia, corectasia of right pupil, a decreased perception of pinprick on right face when compared to the left, decreased palate elevation on the right. Anti-saccade test revealed multiple ocular pro-saccadic errors. Fundoscopic exam with occluded vision revealed up beating nystagmus with right square wave jerks. In accordance to the UPDRS guidelines finger tapping test was a grade 2 on the left, finger to nose test was grade 2 left with dysmetria, supination-pronation arm test was grade 2 on the left, gait test grade 2 left decrease arm swing, gait with dual tasking test was grade 3, abolished left arm swing & freezing. When asked to rate her symptoms on a Post-Concussion Symptoms Scale (PCSS) (SCAT5 2017), she reported a score of 104 (0-132 scale). On the standardized assessment of concussion (SAC), she scored 14 out of 30. An Assessment of the balance system using The Balance Error Scoring System (BESS) was performed assessing balance and stability, on a solid and foamed surface, with eyes closed, and in double leg, single leg, and in tandem stance. The BESS score was 22 (total errors) out of 60. Methods: A multi-modal program of neurological exercises was administered in 18 one-hour treatment sessions over a 9 week period. Each session consisted of various combinations of eye-head vestibular motion therapy, repetitive peripheral somatosensory stimuli, proprioception retraining, vestibular rehabilitation, cognitive training, and eye movement exercises. All exercises were precisely designed and modified to address the patient’s individual neurological deficits and physical exam findings were continually reassessed throughout treatment. Outcome: Upon exit, the symptom severity score (PCSS) decreased to 34 (-67.3%). Her SAC score increased to 26 out of 30 (85.7%). BESS balance scores improved to 10 (total errors) (-54.54%) out of 60. A 67% improvement in total symptom score was recorded after a multimodal neurological rehabilitation program was performed in 18 one-hour treatment sessions. Conclusion: The author suggests further investigation into multi-modal neurological exercises as a clinical approach to decrease symptom severity, improve SAC scores, and increase balance and stability scores in patients with PCS. Acknowledgements The authors would also like to thank the Carrick Institute for providing the clinical education utilized to develop the multi-modal treatments implemented in this case study.

Análise da relação entre sintomas urinários e topografia da lesão cerebral em pacientes com acidente vascular cerebral

Objetivo: Analisar a relação entre a topografia da lesão cerebral e disfunção vesical em pacientes com acidente vascular cerebral (AVC) isquêmico e hemorrágico comparando a região cerebral afetada com os sintomas do trato urinário inferior (STUI).Materiais e Métodos: Estudo retrospectivo, desenvolvido no Hospital da Rede SARAH de Neurorreabilitação, Brasil, com 132 pacientes com AVC crônico atendidos no programa de reabilitação neurológica adulto, no período de janeiro de 2008 a dezembro de 2011.Resultados: Cento e seis pacientes (80,3%) apresentaram sequela de acidente vascular cerebral isquêmico e 26 (19,7%) acidente vascular cerebral hemorrágico. A média de idade foi de 56±13,1 anos e o tempo médio da ocorrência do AVC foi de 21,4 meses. Em relação ao comportamento miccional, 35,6% (n=47) eram continentes vesicais, 45,5% (n=60) com sintomas do trato urinário inferior, e 18,9% (n=25) com incontinência urinária contínua. Observou-se que na ocorrência de lesões extensas acometendo a área frontal parietal-temporal-occiptal (p=0,001), alterações cognitivas (p=0,001) e afasia (p=0,001) houve relação estatística significativa com a presença de incontinência urinária contínua nestes pacientes. Nos pacientes com lesão fronto-parietal houve associação com o sintoma urgência (p=0,050), urgeincontinência urinária (p=0,042), incontinência urinária de esforço (p=0,019) e polaciúria (p=0,042).Conclusão: Segundo a amostra estudada, observamos que alterações cognitivas e afasia tiveram correlação com a incontinência urinária contínua. Em relação a topografia de lesão cerebral houve associação entre lesões em região fronto-parietal com os sintomas de urgência, urgeincontinência, incontinência de esforço e polaciúria; e na ocorrência de lesão cerebral extensa houve prevalência de incontinência urinária contínua.

Ischemic Stroke in Young Adults: Profile of SARAH Hospital Brasília From 2008 to 2012.

The societal and economic impact of ischemic stroke in young adults is considerable. The etiological investigation of ischemic stroke in this population is also challenging. To describe the characteristics of young patients with ischemic stroke admitted to a neurological rehabilitation program in Brazil. This transversal retrospective study analyzed data from the electronic health records of 134 patients aged 18 to 45 years with ischemic stroke admitted from 2008 to 2012. The average patient age at the time of ictus was 33 years; 56% of the subjects were female, and 29.3% had undetermined etiologies of stroke, on the basis of both TOAST and SSS TOAST criteria. Further, 48.7% of the subjects had a known vascular risk factor, which was arterial hypertension in most cases. The results of thrombophilia testing were positive in 13.7% of patients, but in only 3.7% of patients, thrombophilia was determined to be the causal mechanism of the stroke. There was a significant association between thrombophilia and patent foramen ovale, but no significant association was found between thrombophilia and arterial dissection. Among the patients with artery dissections, 46% had a history of trauma, which was statistically significant. Etiological diagnosis of stroke in the young is challenging for clinicians. Hence, a more effective classification scheme, better investigative mechanisms, and correct determination of causal associations in ischemic stroke are needed. Thrombophilia screening should be performed in the presence of relevant clinical signs and/or family history.

P011 Motor recovery of the affected hand in subacute stroke correlates with changes of contralesional cortical hand motor representation

Objective To investigate the relationship between changes of cortical hand motor representation and motor recovery of the affected hand in subacute stroke. Methods 17 patients with motor impairment of the affected hand were enrolled in an in-patient neurological rehabilitation program. Hand motor function tests (Wolf Motor Function Test, Action Research Arm Test) and the neurophysiological evaluations (resting motor threshold, motor evoked potentials, motor map area size, motor map area volume, motor map area location) were obtained from both hands and hemispheres at baseline, and two, four and six weeks of in-patient neurological rehabilitation. Results There was a wide spectrum of hand motor impairment at baseline and hand motor recovery over time. Hand motor function and recovery correlated significantly with (i) reduction of cortical excitability, (ii) reduction in size and volume of cortical hand motor representation and (iii) a medial and anterior shift of cortical hand motor representation within the contralesional hemisphere. Conclusion Recovery of motor function of the affected hand after stroke is accompanied by definite changes in excitability, size, volume and location of hand motor representation over the contralesional primary motor cortex. These measures may serve as surrogate markers for the outcome of hand motor rehabilitation after stroke.

Motor Recovery of the Affected Hand in Subacute Stroke Correlates with Changes of Contralesional Cortical Hand Motor Representation

Objective. To investigate the relationship between changes of cortical hand motor representation and motor recovery of the affected hand in subacute stroke. Methods. 17 patients with motor impairment of the affected hand were enrolled in an in-patient neurological rehabilitation program. Hand motor function tests (Wolf Motor Function Test, Action Research Arm Test) and neurophysiological evaluations (resting motor threshold, motor evoked potentials, motor map area size, motor map area volume, and motor map area location) were obtained from both hands and hemispheres at baseline and two, four, and six weeks of in-patient rehabilitation. Results. There was a wide spectrum of hand motor impairment at baseline and hand motor recovery over time. Hand motor function and recovery correlated significantly with (i) reduction of cortical excitability, (ii) reduction in size and volume of cortical hand motor representation, and (iii) a medial and anterior shift of the center of gravity of cortical hand motor representation within the contralesional hemisphere. Conclusion. Recovery of motor function of the affected hand after stroke is accompanied by definite changes in excitability, size, volume, and location of hand motor representation over the contralesional primary motor cortex. These measures may serve as surrogate markers for the outcome of hand motor rehabilitation after stroke.

Evaluation of dance therapy effects on gait pattern in patients with previous cerebrovascular events: Randomized study results from a single center

Aims: As stroke is a complex medical condition involving physical, psychological and cognitive impairments, and also causes restrictions in daily activities and social participation, its rehabilitation is very important, but challenging. Therefore, we aimed to investigate the effects of therapeutic dance programs on walking ability and balance in post-stroke patients, when combined with botulinum toxin A (BTX-A) injections and conventional rehabilitation program. Methods: A total of 51 post-stroke hemiplegic patients treated with BTX-A, who attended the conventional neurological rehabilitation program of the Physical Therapy and Rehabilitation Clinic of Kocaeli University Medical School between November 2014 and December 2015, were included in this prospective, randomized, single center study. Patients were randomized as 1:1 into adapted tango classes (n = 27) and control group (n= 24). Clinical and functional outcomes were evaluated by the Modified Ashworth Scale (MAS), BBS, and Timed Up and Go (TUG) tests. Results: Patients in the tango and control groups were well-matched in age, gender, and stroke side during randomization. There were statistically significant improvements in the tango group in MAS (p = 0.002), in TUG (p lessthan 0.001), and Berg Balance Scale (BBS) (p lessthan 0.001) when compared with the control group, respectively (p lessthan 0.001, p=0.042, p lessthan 0.001). Balance improvement was more prominent in the tango group than in the control group (p= 0.003). Conclusion: Partner adapted tango dance therapy accompanying BTX-A injections may improve postural balance in ambulatory post-stroke patients, who are treated with the conventional rehabilitation program.

Is 25(OH)D Associated with Cognitive Impairment and Functional Improvement in Stroke? A Retrospective Clinical Study

In recent years, vitamin D deficiency has been suggested as a risk factor for ischemic stroke and stroke severity in both animal models and clinical studies. In this retrospective study, we investigated the relationship between 25-hydroxyvitamin D [25(OH)D] levels and functional outcomes in stroke patients during neurological rehabilitation program. We also investigated whether there is an association between 25(OH)D levels and cognitive impairment. The study included the medical records of 120 stroke patients who participated in a neurological rehabilitation program. The motor and cognitive components of the Functional Independence Measurements of all patients at admission and discharge were recorded. The Functional Ambulatory Scale was used to assess motor functional status, and the Turkish-validated version of the minimental state examination test was used to assess cognitive status. A significant correlation was found between 25(OH)D level and cognitive impairment among patients who had ischemic strokes. High levels of 25(OH)D were associated with greater functional gain during the rehabilitation program in both ischemic stroke patients and hemorrhagic stroke patients. High 25(OH)D levels might be associated with greater functional improvement and with less cognitive impairment in stroke patients.

Improvement in achalasia following a neurological rehabilitation program: a case study

Event Abstract Back to Event Improvement in achalasia following a neurological rehabilitation program: a case study George Michalopoulos1, Fili Talamantez1 and Derek Barton2* 1 Illinois Neuro and Physical Rehabilitation, United States 2 Carrick Institute, United States Background A 32-year-old female patient presented to a functional neurology practice with complaint of achalasia that came on 10 years prior. The patient had previously used surgical intervention to manage the condition with some success, however, her condition began to worsen over the past several months before her visit. The patient presented with complaints of difficulty swallowing and digesting food. Barium swallow studies showed persistence of contrast agent in the esophagus after five minutes. Methods Neurological examination revealed left beating nystagmus. Pursuits had saccadic intrusions with eye movements up and to the right and down and to the left. The patient had decreased amplitude of optokinetics to the left. The patient had absence of her gag reflex and finger to nose was dysmetric on the right. The patient was diagnosed with achalasia. A treatment plan consisting of intense parasympathetic stimulation and brain-based therapy was implemented. The patient performed manual stimulation of the gag response, gaze stability exercises, complex movements of the extremities, and vibration exercises on the left side. Results The patient reported improvement in her ability to swallow and digest food. A follow-up barium swallow study showed the patient was able to clear the contrast in under one minute. Conclusions A patient scheduled for esophageal surgery finds relief through conservative neurological rehabilitation. Further research is suggested to investigate this approach in a larger population of achalasia patients. Acknowledgements Joseph Lawrence, Ralph DeStephano, Anthony Lemmo Keywords: Achalasia, Parasympathetic Nervous System, Neurorehabilitation, conservative treatment, Esophagus Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Michalopoulos G, Talamantez F and Barton D (2015). Improvement in achalasia following a neurological rehabilitation program: a case study. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00016 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 Nov 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Derek Barton, Carrick Institute, Cape Canaveral, FL, United States, derekabarton@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers George Michalopoulos Fili Talamantez Derek Barton Google George Michalopoulos Fili Talamantez Derek Barton Google Scholar George Michalopoulos Fili Talamantez Derek Barton PubMed George Michalopoulos Fili Talamantez Derek Barton Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Hand Bone Mineral Density in Hemiplegia and Their Clinical Corelation

Objective: The aim of this study was to evaluate the hand bone mineral density (BMD) measurements and to assess the relationship between demographic and clinical parameters. Material and Methods: The study included 119 (46 women, 63 men) hemiplegic patients. Brunnstrom stage of the upper extremity and Modified Ashworth scale was used, for the evaluation of motor function and spasticity. The level of functional independence in patients were evaluated with the functional independence measure (FIM). Hand dual energy x-ray absorptiometry (DEXA; Lunar Prodigy Advance, Lunar Corp., USA) for the assessment of bone mineral density of both hands were used. Results: In the entire group (p<0.01) and women (p<0.01) and in males (p<0.05) the paretic hand BMD values were significantly lower than the non-paretic side. Non-paretic hand BMD in women, were significantly lower than men (p<0.05). BMD on the hemiplegic hand was correlated with the hand and upper extremity spasticity severity (p<0.05), Brunnstrom stage (p<0.01), age in women (p<0.05) and FIM score (p<0.01). There were no statistically significant correlation between hand BMD and disease duration. Regression analysis revealed that the strongest predictors of BMD of the hemiplegic side were Brunnstrom stage (OR=4.701, p=0.001), FIM (OR=4.022, p=0.001) and women age (OR=1.220, p=0.050), respectively. Conclusion: To avoid an increase in fractures and associated morbidity due to a decrease in BMD of the upper extremity; the improvement in motor paresis and spasticity and functional independence, should take place in neurological rehabilitation program.

Knowledge translation and improving practices in neurological rehabilitation: managers' viewpoint

Studies in neurological rehabilitation have been undertaken in recent years to improve knowledge transfer. The manager is an important player in the health care system, yet few studies have examined their role in knowledge transfer. The main objective was to explore the importance of knowledge transfer and improving practices from the viewpoint of managers of neurological rehabilitation programs. An exploratory qualitative research design was used. Three case studies were conducted by way of semi-structured one-on-one interviews with neurological rehabilitation program managers. To be eligible, managers had to give their informed consent and have had responsibilities directly related to the coordination of clinicians working in neurological rehabilitation for at least a year. Data collected were recorded and transcribed. Each interview was synthesized and its content was carefully analysed. The three managers' experience in neurology varied from a year to several decades. They believe that knowledge transfer is important but it appears to be less of a priority because of their numerous other responsibilities. Participants said they perceived their role in this process as being a coach, facilitator, motivator, organizer, guide and ambassador. They mentioned reacting to the needs expressed by the clinicians but, when asked, said they would like to be more proactive and structured in their approach. This study points up the lack of organizational structure fostering uniform knowledge translation across all clinicians, although the managers expect it to happen in the near future or would like to see it in an ideal world.

Ideal timing to transfer from an acute care hospital to an interdisciplinary inpatient rehabilitation program following a stroke: an exploratory study.

BackgroundTimely accessibility to organized inpatient stroke rehabilitation services may become compromised since the demand for rehabilitation services following stroke is rapidly growing with no promise of additional resources. This often leads to prolonged lengths of stays in acute care facilities for individuals surviving a stroke. It is believed that this delay spent in acute care facilities may inhibit the crucial motor recovery process taking place shortly after a stroke. It is important to document the ideal timing to initiate intensive inpatient stroke rehabilitation after the neurological event. Therefore, the objective of this study was to examine the specific influence of short, moderate and long onset-admission intervals (OAI) on rehabilitation outcomes across homogeneous subgroups of patients who were admitted to a standardized interdisciplinary inpatient stroke rehabilitation program.MethodsA total of 418 patients discharged from the inpatient neurological rehabilitation program at the Montreal Rehabilitation Hospital Network after a first stroke (79% of all cases reviewed) were included in this retrospective study. After conducting a matching procedure across these patients based on the degree of disability, gender, and age, a total of 40 homogeneous triads (n = 120) were formed according to the three OAI subgroups: short (less than 20 days), moderate (between 20 and 40 days) or long (over 40 days; maximum of 70 days) OAI subgroups. The rehabilitation outcomes (admission and discharge Functional Independence Measure scores (FIM), absolute and relative FIM gain scores, rehabilitation length of stay, efficiency scores) were evaluated to test for differences between the three OAI subgroups.ResultsAnalysis revealed that the three OAI subgroups were comparable for all rehabilitation outcomes studied. No statistical difference was found for admission (P = 0.305–0.972) and discharge (P = 0.083–0.367) FIM scores, absolute (P = 0.533–0.647) and relative (P = 0.496–0.812) FIM gain scores, rehabilitation length of stay (P = 0.096), and efficiency scores (P = 0.103–0.674).ConclusionOAI does not seem to affect significantly inpatient stroke rehabilitation outcomes of patients referred from acute care facilities where rehabilitation services are rapidly initiated after the onset of the stroke and offered throughout their stay. However, other studies considering factors such as the type and intensity of the rehabilitation are required to support those results.

Development of a Music Therapy Service in an Australian Public Rehabilitation Hospital

It is often challenging to find information about the details and development of clinical music therapy programs in other parts of the world. This article addresses a gap in the literature by describing the evolution of a neurological rehabilitation program over the past two years in Melbourne, Australia. After providing some local details on the development of rehabilitation music therapy in this part of the world, a brief rationale is offered for the place of music therapy in clinical rehabilitation services. This is followed by a detailed description of the implementation, operation and evaluation of the music therapy program established at the Royal Talbot Rehabilitation Centre in 2004. Music therapy in adult neurological rehabilitation is still an emerging area of practice in Australia. Although the first music therapy service for adult rehabilitation was piloted and developed here over 13 years ago, few rehabilitation facilities currently employ music therapy as a standard part of rehabilitation service. Although research and practice of music therapy in rehabilitation internationally is relatively new, it has been practiced for around 20 to 30 years in the United Kingdom and the United States of America respectively. The scarcity of music therapy positions in rehabilitation facilities in Australia is possibly a reflection of the lack of understanding of music therapy on the part of funding bodies and the shortage of rigorous music therapy research in this field. The establishment of new music therapy positions in rehabilitation facilities reflects the development of music therapy in neurorehabilitation internationally in terms of research, clinical practice and publications.