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20.38 Evaluation of rehabilitation process in traumaticbrain injury patients: Stabilography and electroencephalography study
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Chapter 20. Rehabilitation and training
Effect of tai chi chuan on motor control in the elderly: balance and complex choice response
A. Wong, Y.C. Pei, S.W. Chou, H.C. Chen, J.Y. Ke, Y.C. Lin.
Department of Physical Medicine and Rehabilitation and Center for Gerontological Research, Chang Gung Memorial Hospital and Chang Gung University, 199 Tun-Hwa North Road, Taipei 105, Taiwan Introduction: This investigation aimed at evaluating the effect of Tai Chi Chuan (TCC) on motor control in the elderly through balance and choice response time using lower limbs as end effectors. Methods: Thirty-one elderly TCC practitioners (mean age: 68.2±6.8 years) (TCC group), thirty active community-dwelling elderly (Elderly control group) with matched age and body composition, and 13 young people (Young control group) were invited in this investigation. The TCC group has been routinely practicing TCC for over four years, with an exercise frequency of five times per week, a minimum 30 minutes per day. The choice response time assessment was performed on a computerized dance machine. The balance test was conducted by computerized posturography. Results: In the choice response time, significant differences between the two elderly study groups were demonstrated in the dance tests with a complex context and more demanding motor control, but not in the simpler dance tests. In the balance test, substantial differences were shown between the two elderly groups in maximal stability, but not in ankle strategy. There were evident correlations between variables in dance tests and balance tests, particularly in the most challenging conditions. Discussion and Conclusion: This work indicated the effectiveness of TCC in improving motor response of the elderly, especially in more challenging situations. It might be beneficial for prevention of incidental falls and maintaining the daily fitness in the elderly.
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Gait and standing posture in patients with multiple sclerosis
K.E Zabjek 1'2'3, S.W. Hill 1,2,3, W.H. Gage 1,2,3, C.J. Danells 1, V. Closson 1, B.E. Maki 1'3, W.E. McIlroy 1,z3. 1Sunnybrook &
Women~' College Health Sciences' Centre, 2Toronto Rehabilitation Institute, 3University of Toronto, Canada Introduction: Multiple Sclerosis (MS) is an inflammatory disease of the CNS characterized by de-myelination of neurons in the brain and spinal cord. Although MS is known to be debilitating, its effect on the control of balance and gait is poorly understood. The goal of this study was to compare standing posture and gait of MS patients and healthy adults. Methods: Ten healthy adults and 18 adults with MS were evaluated using an AccuSway T M force platform and a GAITRite T M walkway. Of 18 MS patients, 7 ambulated un-assisted (MSU) EDSSmean 4, and 11 with a wheeled walker (MSW) EDSSmean 6. Outcome measures included: Root Mean Square (RMS) AP and ML Centre of Pressure (COP) displacement in standing, and gait velocity, cadence, stride length, and percent double-support. Results: RMS ML CoP was significantly greater in the MSW group than the controls; it showed neither difference between the MSU and MSW, nor between MSU and controls (Control:0.3±0.1 cm; MSU:0.7±0.5cm; MSW:0.8±0.4cm). There was a moderately positive correlation between percent double-support and RMS ML CoP displacement for all groups combined. Healthy participants
had a significantly greater walking velocity than both MS groups (Control:122±18cm/s; MSU:82±26cm/s; MSW:49±16cm/s), accompanied by cadence stride length and a decreased percent doublesupport. Similarly, gait parameters were greater for the MSU than the MSW group. Conclusion: The decreased ML stability found in the MS patients of this study may be a contributing factor to decreased ambulation ability. Ongoing research is currently focused on clarifying the relationship between balance and mobility dysfunction found in this population.
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Evaluation of rehabilitation process in traumatic brain injury patients: stabilography and electroencephalography study
L.A. Zhavoronkova1, O.A. Maksakova 2, O.V.. Zakharov 2, A.V. Boyko 2, G.A. Schekutjev2. 1Institute of Higher Nervous'
Activity and Neurophysiology R,AS, 2 Burdenko Neurosurgery Institute RAMS, Moscow, Russia The creation of objective evaluation of the traumatic brain injury (TBI) patient's condition is one of main problems of neurorehabilitation [1,2]. The new composite approach to monitoring of rehabilitation process is presenting [3]. This one includes stabilography (SG), electroencephalography (EEG) and clinical examination. The comparison of standard SG, EEG and clinical data in TBI-patients (58 persons) to the normative data (32 volunteers) was carried before, during and after rehabilitation. SG indexes included estimation of the displacement human center body pressure (CBP) during Romberg test (standing with open and closed eyes) and static and dynamic tests battery. EEG coherence analysis included calculation of inter- and intrahemispheric coherence for all spectral bands [4,5]. For clinical examination were used FIM and Mayo-Portland scales. At the beginning of rehabilitation EEC coherence was decreased in TBI-patients in comparison to normative data, indicating slackening of integrative brain activity. SG examination demonstrated the specific displacement of CBP in two orthogonal planes (X and Y planes) in standing during Romberg test significantly differing with appropriate parameters of healthy population. Dynamic comparison of SG indexes with EEG coherence parameters revealed rather high correlation, had specific features during different stages of rehabilitation and correspondence to outcomes. Increase of EEG coherence parameters and shift of stabilographic indexes accompanied the positive trend of rehabilitation process to normative values. So, this complex approach is informative and adequate to rehabilitation process of TBI-patients. Besides this method allows to determine some features of the functional deficit with working up the strategy of rehabilitation more precisely.
References [1] Basford J.R., Chou L.S., Kaufman K.R. et al. An assessment of gait and balance deficits after traumatic brain injury. Arch Phys Med Rehabil. 2003; 84:343 349. [2] Geurts A.C., Ribbers G.M., Knopp J.A., Limbeek J. Identification of static and dynamic postural instability following traumatic brain injury. Arch Phys Med Rehabil 1996; 77:639 644. [3] Maksakova O., Lukjanov V., Zhavoronkova L. Psychophysiological method of rehabilitation process estimation in brain injury patients. Abstracts of 6th Euroacadimia multidisciplinaria methodological congress. Moscow. 2001; 110.
I2~
Chapter 20. Rehabilitation and training
Effect of tai chi chuan on motor control in the elderly: balance and complex choice response
A. Wong, Y.C. Pei, S.W. Chou, H.C. Chen, J.Y. Ke, Y.C. Lin.
Department of Physical Medicine and Rehabilitation and Center for Gerontological Research, Chang Gung Memorial Hospital and Chang Gung University, 199 Tun-Hwa North Road, Taipei 105, Taiwan Introduction: This investigation aimed at evaluating the effect of Tai Chi Chuan (TCC) on motor control in the elderly through balance and choice response time using lower limbs as end effectors. Methods: Thirty-one elderly TCC practitioners (mean age: 68.2±6.8 years) (TCC group), thirty active community-dwelling elderly (Elderly control group) with matched age and body composition, and 13 young people (Young control group) were invited in this investigation. The TCC group has been routinely practicing TCC for over four years, with an exercise frequency of five times per week, a minimum 30 minutes per day. The choice response time assessment was performed on a computerized dance machine. The balance test was conducted by computerized posturography. Results: In the choice response time, significant differences between the two elderly study groups were demonstrated in the dance tests with a complex context and more demanding motor control, but not in the simpler dance tests. In the balance test, substantial differences were shown between the two elderly groups in maximal stability, but not in ankle strategy. There were evident correlations between variables in dance tests and balance tests, particularly in the most challenging conditions. Discussion and Conclusion: This work indicated the effectiveness of TCC in improving motor response of the elderly, especially in more challenging situations. It might be beneficial for prevention of incidental falls and maintaining the daily fitness in the elderly.
I2~
Gait and standing posture in patients with multiple sclerosis
K.E Zabjek 1'2'3, S.W. Hill 1,2,3, W.H. Gage 1,2,3, C.J. Danells 1, V. Closson 1, B.E. Maki 1'3, W.E. McIlroy 1,z3. 1Sunnybrook &
Women~' College Health Sciences' Centre, 2Toronto Rehabilitation Institute, 3University of Toronto, Canada Introduction: Multiple Sclerosis (MS) is an inflammatory disease of the CNS characterized by de-myelination of neurons in the brain and spinal cord. Although MS is known to be debilitating, its effect on the control of balance and gait is poorly understood. The goal of this study was to compare standing posture and gait of MS patients and healthy adults. Methods: Ten healthy adults and 18 adults with MS were evaluated using an AccuSway T M force platform and a GAITRite T M walkway. Of 18 MS patients, 7 ambulated un-assisted (MSU) EDSSmean 4, and 11 with a wheeled walker (MSW) EDSSmean 6. Outcome measures included: Root Mean Square (RMS) AP and ML Centre of Pressure (COP) displacement in standing, and gait velocity, cadence, stride length, and percent double-support. Results: RMS ML CoP was significantly greater in the MSW group than the controls; it showed neither difference between the MSU and MSW, nor between MSU and controls (Control:0.3±0.1 cm; MSU:0.7±0.5cm; MSW:0.8±0.4cm). There was a moderately positive correlation between percent double-support and RMS ML CoP displacement for all groups combined. Healthy participants
had a significantly greater walking velocity than both MS groups (Control:122±18cm/s; MSU:82±26cm/s; MSW:49±16cm/s), accompanied by cadence stride length and a decreased percent doublesupport. Similarly, gait parameters were greater for the MSU than the MSW group. Conclusion: The decreased ML stability found in the MS patients of this study may be a contributing factor to decreased ambulation ability. Ongoing research is currently focused on clarifying the relationship between balance and mobility dysfunction found in this population.
•
Evaluation of rehabilitation process in traumatic brain injury patients: stabilography and electroencephalography study
L.A. Zhavoronkova1, O.A. Maksakova 2, O.V.. Zakharov 2, A.V. Boyko 2, G.A. Schekutjev2. 1Institute of Higher Nervous'
Activity and Neurophysiology R,AS, 2 Burdenko Neurosurgery Institute RAMS, Moscow, Russia The creation of objective evaluation of the traumatic brain injury (TBI) patient's condition is one of main problems of neurorehabilitation [1,2]. The new composite approach to monitoring of rehabilitation process is presenting [3]. This one includes stabilography (SG), electroencephalography (EEG) and clinical examination. The comparison of standard SG, EEG and clinical data in TBI-patients (58 persons) to the normative data (32 volunteers) was carried before, during and after rehabilitation. SG indexes included estimation of the displacement human center body pressure (CBP) during Romberg test (standing with open and closed eyes) and static and dynamic tests battery. EEG coherence analysis included calculation of inter- and intrahemispheric coherence for all spectral bands [4,5]. For clinical examination were used FIM and Mayo-Portland scales. At the beginning of rehabilitation EEC coherence was decreased in TBI-patients in comparison to normative data, indicating slackening of integrative brain activity. SG examination demonstrated the specific displacement of CBP in two orthogonal planes (X and Y planes) in standing during Romberg test significantly differing with appropriate parameters of healthy population. Dynamic comparison of SG indexes with EEG coherence parameters revealed rather high correlation, had specific features during different stages of rehabilitation and correspondence to outcomes. Increase of EEG coherence parameters and shift of stabilographic indexes accompanied the positive trend of rehabilitation process to normative values. So, this complex approach is informative and adequate to rehabilitation process of TBI-patients. Besides this method allows to determine some features of the functional deficit with working up the strategy of rehabilitation more precisely.
References [1] Basford J.R., Chou L.S., Kaufman K.R. et al. An assessment of gait and balance deficits after traumatic brain injury. Arch Phys Med Rehabil. 2003; 84:343 349. [2] Geurts A.C., Ribbers G.M., Knopp J.A., Limbeek J. Identification of static and dynamic postural instability following traumatic brain injury. Arch Phys Med Rehabil 1996; 77:639 644. [3] Maksakova O., Lukjanov V., Zhavoronkova L. Psychophysiological method of rehabilitation process estimation in brain injury patients. Abstracts of 6th Euroacadimia multidisciplinaria methodological congress. Moscow. 2001; 110.