Neurorehabilitation and Neural Repair

Twenty-two patients suffering for more than 2 years from spasticity in the lower limbs that was resistant to medicinal treatment were treated with electrical stimulation. Stimulation was performed above the peroneal nerve or directly above the motor point of the anterior tibial muscle. After a mean observation period of 1 year, 18 patients still had subj ective improvement and continued stimulation. Measurements of reflexes were used to evaluate 13 patients both before and 4 weeks after the start of the stimulation treatment. In 20 legs, a significant increase of the threshold of flexor reflex was seen. The mechanism behind the depression of spasticity after electrical stimulation is discussed.

This is the first prospective investigation comparing patients' and their relatives' symptom reports before and after a rehabilitation program for closed head injury (CHI). Twenty-six CHI patients and 26 relatives filled out, in individual interviews, the follow-up interview devised by Levin et al., complemented by an additional 17 questions prior to and immediately after a rehabilitation program. We found that relatives and patients did not manifest significant discrepancies as far as the sums of symptoms were concerned. However, the relatives did tend to emphasize emotional and psychosocial symptoms much more than physical symptoms prior to and after treatment, whereas the CHI patients did not. Interestingly, the patients estimated greater premorbid misadaptation than did the relatives. The patients' symptom report profiles suggested slight perceived improvement following treatment, whereas the relatives' symptom report profiles suggested slight perceived deterioration of the CHI patients following treatment.

During a 7-year period, 44 patients were treated for bladder calculi in our tertiary-care hospital. The rate of bladder calculi was 11 per 1,000 admissions to the Physical Medicine and Rehabilitation Service and 16 per 1,000 admissions to the Urology Service. The two major risk factors were neurological disorders (particularly spinal cord injury), occurring in 30 of 44 cases (68%), and bladder outlet obstruction, occurring in 9 cases (13%). The most common clinical presentations were urinary tract infection (59%), particularly with urease-producing organisms, urinary obstruction (14%), passage of gravel (11%), and hematuria (9%). Most patients were treated successfully with endoscopic methods with minimal morbidity. Bladder calculi remain a treatable cause of morbidity in patients with neurological diseases and bladder outlet obstruction.

This paper reports the results of a pilot study designed to assess the efficacy of intravenous physostigmine and dietary lecithin for treating memory loss in patients with multiple sclerosis (MS). Four patients with definite MS participated in a two-phase (dose-finding and crossover), double-blind clinical trial. In the dose-finding phase, all patients exhibited an improvement in verbal memory (as assessed by the Selective Reminding Test) at the highest of four doses (1.0 mg). In the double-blind, crossover phase, patients were administered placebo or physostigmine (1.0 mg). A significant improvement in verbal memory was observed in three of four patients during the drug condition. None of the patients reported significant medication side effects. This study provides preliminary evidence that cholinergic pharmacotherapy may be useful in treating memory disturbance in MS.

Orthopedic rehabilitation can significantly extend the ability of patients with selected neuromuscular diseases to stand and walk. Surgery is designed to release contracture and correct deformity. Bracing stabilizes the lower extremities and provides torso-pelvic balance. Orthopedic and physiatric methods should be part of the aggressive rehabilitation of these patients.