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Posture influence on the pendulum test of spasticity in spinal cord injured patients
Abstracts / Journal of the Neurological Sciences 333 (2013) e537–e578
peptide levels in the striatum at the 24 h time point, and R-TBI but not LTBI produced Dyn A changes in the striatum and frontal cortex at 7 days after the injury. Injury to the R-side induced changes that were similar in both left and right hemispheres. Thus, trauma may uncover an existing lateralization in the mechanism mediating the response of Dyn A-expressing neuronal networks in the brain. These networks may differentially mediate effects of left and right brain injury on the lateralized brain functions. doi:10.1016/j.jns.2013.07.1984
Abstract—WCN 2013 No: 1263 Topic: 10—Neurorehabilitation Repetitive sensory stimulation in stroke rehabilitation—Perspectives and potential H.R. Dinsea, J.C. Kattenstrotha, T. Kalischb, M. Tegenthoff b. a Institute for Neuroinformatics, Neural Plasticity Lab, Germany; b Dept. of Neurology, BG-Kliniken Bergmannsheil, Ruhr-University Bochum, Bochum, Germany Background: Rehabilitation employs task specific training and massed practice to drive neuroplasticity mechanisms. However, since many patients suffer from restricted mobility and sensory loss, development of additional and alternative approaches that could supplement, enhance, or even replace conventional training procedures would be advantageous. Objective: We report effectiveness and feasibility of repetitive sensory stimulation for rehabilitation. The rational is to target plasticity processes within and around those brain areas that became dsyfunctional. Patients and methods/material and methods: We summarize findings from several subacute and chronic stroke patient studies with left or right cerebral artery thromboembolic infarction. We use high-frequency intermittent electrical stimulation of all fingers of the affected hand applied via custom-made stimulation gloves. Treatment time was 2 weeks in subacute, and several months in chronic patients. For the healthy and the affected limp we assessed performance for touch perception and discrimination, haptic exploration, proprioception, dexterity and grip force. Results: Repetitive stimulation induced substantial improvement of tactile and sensorimotor performance long lastingly when applied over weeks. Furthermore, positive effects of sensory, motor and proprioceptive functions emerged after months of stimulation in long-term chronic patients. Conclusion: This effectiveness together with the advantage of usage under everyday conditions by laypeople at their homes, make repetitive stimulation-based principles prime candidates for intervention. A particular advantage of repetitive stimulation is its passive nature, which does not require active participation or attention. Therefore, it can be applied in parallel to other occupations, making it easier to implement and more acceptable to the individual. doi:10.1016/j.jns.2013.07.1985
Abstract—WCN 2013 No: 1241 Topic: 10—Neurorehabilitation Rehabilitation of the patients with deep brain stimulation for consciousness recovery—Our results I. Scurica, I. Dubrojaa, S. Martinecb, M. Grdovicc, V. Pavic-Haluzanb, Z. Bakranc. aNeurology, Special Hospital Krapinske Toplice, Krapinske Toplice, Croatia; bPaediatric Rehabilitation, Special Hospital Krapinske Toplice, Krapinske Toplice, Croatia; cNeurological Rehabilitation, Special Hospital Krapinske Toplice, Krapinske Toplice, Croatia
e567
Aim: To compare the condition of patients with severe consciousness disorder (persistent vegetative state or minimally conscious state) as a result of brain trauma or global hypoxia/ischemia and with implanted electrodes for deep brain stimulation for consciousness recovery, at the beginning of rehabilitation and at discharge. Methods: We obtained data from 9 patients on stationary neurological rehabilitation, 22% were women. Average age was 23.7 ± 10.1 years. Hypoxic–ischemic brain injury was present in 66%, and traumatic brain injury in 34%. There was an average interval of 197.1 ± 137.9 days between injury and DBS implementation, with one of the patients with bilaterally implanted electrodes (on two occasions). Glasgow Coma Scale (GCS) after injury and Functional Independence Measure (FIM) index on admission to rehabilitation and GCS, FIM and Glasgow Outcome Scale (GOS) at discharge were determined. Patients spent an average of 163.0 ± 105.8 days on stationary rehabilitation. Results: Recovery of consciousness was observed measured by GCS (4.2 ± 2.7 vs. 10.9 ± 1.8, p b 0.0001), but not at FIM index (19.7 ± 5.0 vs 24.3 ± 17.7, p = 0.4). In the majority of the patients (56%) GOS at discharge was SD (severe disability), 33% was CV (coma vigile) and one patient was GR (good recovery). Conclusion: The number of patients is too small to draw conclusions about the effect of deep brain stimulation on the recovery of patients with severe brain injury. There has been a recovery of consciousness (GCS), but no significant functional recovery (FIM, GOS), except for sporadic cases. A thorough neurophysiological assessment of candidates for DBS and a larger number of patients is needed. doi:10.1016/j.jns.2013.07.1986
Abstract—WCN 2013 No: 1146 Topic: 10—Neurorehabilitation Posture influence on the pendulum test of spasticity in spinal cord injured patients E. Azevedoa, K. Alonsoa, R. Mariaa, F. Beinottia, A. Cliquet Jr.a,b. a Unicamp, Campinas, Brazil; bUniversidade de São Paulo, São Paulo, Brazil Background: The pendulum test has been used for the assessment of spasticity in patients with different diseases, including spinal cord injury (SCI). However, there is not a standard position for the test. Objective: To assess whether different patient postures do interfere on spasticity results. Material and methods: Three individuals with tetraplegia and two with paraplegia went through the pendulum test in three different positions: supine, semi-supine at an angle of 30° and sitting up at an angle of 60°. An electrogoniometer was attached to the right leg for measurement of knee joint angles. All situations were performed five times on different days and the averages were taken for analysis. Results: Relaxion index (RI), test duration in seconds, initial flexion angle (Fang) and resting angle (Rest ang) were analyzed at three different positions. Supine: RI (mean/sd) 0.93/0.32; test duration 6.9/ 1.7; Fang 72.6/22.6; Rest ang 55.7/14.2. Semi-supine: RI 0.97/0.39; test duration 8.9/2.7; Fang 75.7/17.8; Rest ang 63.3/5.3. Sitting up: RI 0.62/0.08; test duration 13.9/4.1; Fang 87.9/13; Rest ang 54.8/12.8. Differences are shown for sitting up position. Conclusion: Spasticity reduction and an increase in quadriceps femoris relaxion were observed in the sitting up position due to muscles shortening in that position, when compared to the others. Furthermore, in supine and semi-supine positions autonomic dysreflexia symptoms (i.e. arterial hypertension) were observed during the tests.
doi:10.1016/j.jns.2013.07.1987
peptide levels in the striatum at the 24 h time point, and R-TBI but not LTBI produced Dyn A changes in the striatum and frontal cortex at 7 days after the injury. Injury to the R-side induced changes that were similar in both left and right hemispheres. Thus, trauma may uncover an existing lateralization in the mechanism mediating the response of Dyn A-expressing neuronal networks in the brain. These networks may differentially mediate effects of left and right brain injury on the lateralized brain functions. doi:10.1016/j.jns.2013.07.1984
Abstract—WCN 2013 No: 1263 Topic: 10—Neurorehabilitation Repetitive sensory stimulation in stroke rehabilitation—Perspectives and potential H.R. Dinsea, J.C. Kattenstrotha, T. Kalischb, M. Tegenthoff b. a Institute for Neuroinformatics, Neural Plasticity Lab, Germany; b Dept. of Neurology, BG-Kliniken Bergmannsheil, Ruhr-University Bochum, Bochum, Germany Background: Rehabilitation employs task specific training and massed practice to drive neuroplasticity mechanisms. However, since many patients suffer from restricted mobility and sensory loss, development of additional and alternative approaches that could supplement, enhance, or even replace conventional training procedures would be advantageous. Objective: We report effectiveness and feasibility of repetitive sensory stimulation for rehabilitation. The rational is to target plasticity processes within and around those brain areas that became dsyfunctional. Patients and methods/material and methods: We summarize findings from several subacute and chronic stroke patient studies with left or right cerebral artery thromboembolic infarction. We use high-frequency intermittent electrical stimulation of all fingers of the affected hand applied via custom-made stimulation gloves. Treatment time was 2 weeks in subacute, and several months in chronic patients. For the healthy and the affected limp we assessed performance for touch perception and discrimination, haptic exploration, proprioception, dexterity and grip force. Results: Repetitive stimulation induced substantial improvement of tactile and sensorimotor performance long lastingly when applied over weeks. Furthermore, positive effects of sensory, motor and proprioceptive functions emerged after months of stimulation in long-term chronic patients. Conclusion: This effectiveness together with the advantage of usage under everyday conditions by laypeople at their homes, make repetitive stimulation-based principles prime candidates for intervention. A particular advantage of repetitive stimulation is its passive nature, which does not require active participation or attention. Therefore, it can be applied in parallel to other occupations, making it easier to implement and more acceptable to the individual. doi:10.1016/j.jns.2013.07.1985
Abstract—WCN 2013 No: 1241 Topic: 10—Neurorehabilitation Rehabilitation of the patients with deep brain stimulation for consciousness recovery—Our results I. Scurica, I. Dubrojaa, S. Martinecb, M. Grdovicc, V. Pavic-Haluzanb, Z. Bakranc. aNeurology, Special Hospital Krapinske Toplice, Krapinske Toplice, Croatia; bPaediatric Rehabilitation, Special Hospital Krapinske Toplice, Krapinske Toplice, Croatia; cNeurological Rehabilitation, Special Hospital Krapinske Toplice, Krapinske Toplice, Croatia
e567
Aim: To compare the condition of patients with severe consciousness disorder (persistent vegetative state or minimally conscious state) as a result of brain trauma or global hypoxia/ischemia and with implanted electrodes for deep brain stimulation for consciousness recovery, at the beginning of rehabilitation and at discharge. Methods: We obtained data from 9 patients on stationary neurological rehabilitation, 22% were women. Average age was 23.7 ± 10.1 years. Hypoxic–ischemic brain injury was present in 66%, and traumatic brain injury in 34%. There was an average interval of 197.1 ± 137.9 days between injury and DBS implementation, with one of the patients with bilaterally implanted electrodes (on two occasions). Glasgow Coma Scale (GCS) after injury and Functional Independence Measure (FIM) index on admission to rehabilitation and GCS, FIM and Glasgow Outcome Scale (GOS) at discharge were determined. Patients spent an average of 163.0 ± 105.8 days on stationary rehabilitation. Results: Recovery of consciousness was observed measured by GCS (4.2 ± 2.7 vs. 10.9 ± 1.8, p b 0.0001), but not at FIM index (19.7 ± 5.0 vs 24.3 ± 17.7, p = 0.4). In the majority of the patients (56%) GOS at discharge was SD (severe disability), 33% was CV (coma vigile) and one patient was GR (good recovery). Conclusion: The number of patients is too small to draw conclusions about the effect of deep brain stimulation on the recovery of patients with severe brain injury. There has been a recovery of consciousness (GCS), but no significant functional recovery (FIM, GOS), except for sporadic cases. A thorough neurophysiological assessment of candidates for DBS and a larger number of patients is needed. doi:10.1016/j.jns.2013.07.1986
Abstract—WCN 2013 No: 1146 Topic: 10—Neurorehabilitation Posture influence on the pendulum test of spasticity in spinal cord injured patients E. Azevedoa, K. Alonsoa, R. Mariaa, F. Beinottia, A. Cliquet Jr.a,b. a Unicamp, Campinas, Brazil; bUniversidade de São Paulo, São Paulo, Brazil Background: The pendulum test has been used for the assessment of spasticity in patients with different diseases, including spinal cord injury (SCI). However, there is not a standard position for the test. Objective: To assess whether different patient postures do interfere on spasticity results. Material and methods: Three individuals with tetraplegia and two with paraplegia went through the pendulum test in three different positions: supine, semi-supine at an angle of 30° and sitting up at an angle of 60°. An electrogoniometer was attached to the right leg for measurement of knee joint angles. All situations were performed five times on different days and the averages were taken for analysis. Results: Relaxion index (RI), test duration in seconds, initial flexion angle (Fang) and resting angle (Rest ang) were analyzed at three different positions. Supine: RI (mean/sd) 0.93/0.32; test duration 6.9/ 1.7; Fang 72.6/22.6; Rest ang 55.7/14.2. Semi-supine: RI 0.97/0.39; test duration 8.9/2.7; Fang 75.7/17.8; Rest ang 63.3/5.3. Sitting up: RI 0.62/0.08; test duration 13.9/4.1; Fang 87.9/13; Rest ang 54.8/12.8. Differences are shown for sitting up position. Conclusion: Spasticity reduction and an increase in quadriceps femoris relaxion were observed in the sitting up position due to muscles shortening in that position, when compared to the others. Furthermore, in supine and semi-supine positions autonomic dysreflexia symptoms (i.e. arterial hypertension) were observed during the tests.
doi:10.1016/j.jns.2013.07.1987