NeuroRehabilitation

To characterize the clinical profiles of individuals with dementia who do and do not report a history of TBI.

Some evidence suggests that a history of traumatic brain injury (TBI) is associated with an increased risk of dementia later in life. The clinical features of dementia associated with TBI have not been well investigated. While there is some evidence that TBI is associated with increased risk of Alzheimer’s disease (AD), there are also indications that dementia associated with TBI has prominent behavioral, affective, and motor symptoms, making it distinct from AD.

The current study involves secondary analysis of baseline data from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS).

Individuals with dementia who reported a history of TBI had higher fluency and verbal memory scores and later onset of decline, but they are on more medications, had worse cardiovascular and cerebrovascular health, were more likely to have received medical attention for depression, and were more likely to have a gait disorder, falls, and motor slowness.

These findings suggest that dementia among individuals with a history of TBI may represent a unique clinical phenotype that is distinct from known dementia subtypes.

To determine the frequency of neurobehavioral signs and symptoms reported in every published case of traumatic encephalopathy with a view toward the development of clinical diagnostic criteria with predictive validity.

Cases of persistent or progressive neurological or neurobehavioral change following exposure to one or more head injuries have been reported since 1928. This condition is often referred to as traumatic encephalopathy (TE). To date, however, no diagnostic criteria have been advanced or accepted for the clinical diagnosis of TE. Provisional research diagnostic criteria are required not only for meaningful diagnosis but also to facilitate research to determine the epidemiology, etiology, course, prognosis, imaging and biomarkers, neuropathological features and potentially effective treatments of TE.

All 436 published cases of TE in all languages were reviewed. All symptoms and signs reported in these cases were classified and enumerated.

Ninety-seven cases met inclusion criteria based on sufficient documentation of the history and neurobehavioral examination. Provisional research diagnostic criteria for clinically probable and clinically possible TE were developed based on the most frequently reported clinical features.

The provisional diagnostic criteria for TE presented here are the first published criteria for this condition based upon a systematic analysis of its clinical characteristics. This is the first a step toward scientifically derived consensus criteria, which are essential to accelerate progress in the investigation of this important condition.

Although there has been a decline in the incidence of TBI in the general population, the rate of TBI in older adults has increased. Increased age has been long recognized as a predictor of worse outcomes after TBI. Despite the growing number of TBI in the elderly, our understanding of the long-term consequences of TBI is quite limited.

Chart review; individuals 55 years and older, who completed inpatient acute rehabilitation during the period 2003âĂŞ2009 and who died one to four years after injury, were compared to matched patients who did not die.

There were a significantly higher proportion of deceased subjects with a diagnosis of Abnormality of Gait (53%), respiratory medications at admission (32%) and discharge (17%). Deceased participants were more likely to be prescribed diabetes medication at discharge (35%) while controls were more likely to be prescribed cholesterol-lowering medications (27%) at admission. Deceased patients were discharged with significantly more medications,

The results suggest the need for medical and lifestyle interventions for selected elderly TBI patients. The factors related to death following TBI in the elderly are in need of more research.

Elderly persons with traumatic brain injury (TBI) are increasingly admitted to inpatient rehabilitation, but we have limited knowledge of their characteristics, the treatments they receive, and their short-term and medium-term outcomes. This study explored these issues by means of comparisons between age groups.

Data on 1419 patients admitted to 9 inpatient rehabilitation facilities for initial rehabilitation after TBI were collected by means of (1) abstraction from medical records; (2) point-of care forms completed by therapists after each treatment session; and (3) interviews at 3 months and 9 months after discharge, conducted with the patient or a proxy.

Elderly persons (65 or older) had a lower brain injury severity, and a shorter length of stay (LOS) in acute care. During rehabilitation, they received fewer hours of therapy, due to a shorter LOS and fewer hours of treatment per day, especially from psychology and therapeutic recreation. They regained less functional ability during and after inpatient rehabilitation, and had a very high mortality rate.

Elderly people can be rehabilitated successfully, and discharged back to the community. The treatment therapists deliver, and issues surrounding high mortality need further research.

Telephone cognitive batteries are useful for large-scale screening and epidemiological studies, but their brevity and lack of content depth may cause psychometric limitations that hinder their utility.

The current study addressed some of these limitations by rescaling the Brief Test of Adult Cognition by Telephone (BTACT; Tun & Lachman, 2006) using modern psychometric methods.

Archival data were obtained from a national sample of 4,212 28 to 84-year-old volunteers in the National Survey of Midlife Development in the United States (Ryff et al., 2007) Cognitive Project (Ryff & Lachman, 2007). We fit a bi-factor model to a combination of item-level, subscale-level, and scale-level data.

The best fitting model contained a general factor and secondary factors capturing test-specific method effects or residual correlations for Number Series, Red/Green Test, and the Rey Auditory Verbal Learning Test. Factor scores generated from this model were compared with conventional BTACT scores. Important score differences (i.e., >0.3 standard deviation units) were found in 28% of the sample. The bi-factor scores demonstrated slightly superior validity than conventional BTACT scores when judged against a number of clinical and demographic criterion variables.

Modern psychometric approaches to scoring the BTACT have the benefit of linear scaling and a modest criterion validity advantage.

The purpose of this paper is to review the literature on psychosocial outcomes in older adults with TBI and identify factors associated with positive outcomes in this population.

Rates of TBI in older adults have increased in recent years. Little is known regarding the factors and cohort specific characteristics that contribute to long-term healthy psychosocial functioning in this population.

Review of literature.

A multitude of factors that impact psychosocial outcomes are discussed, including injury characteristics, individual characteristics, aging and cohort issues, and external environmental factors.

There is limited research examining psychosocial functioning in older adults who have sustained a TBI. Recommendations to guide clinical care and future research are provided.

The purpose of this study was to compare topographical maps using a novel EEG-based brain mapping system with fMRI in normal and children with cerebral palsy (CP) during a grasping motor task.

A normal child (mean ± SD = 13 ± 0 yrs) and four children with CP (mean ± SD = 10.25 ± 2.86 yrs) were recruited from a local community school and medical center. A novel EEG-based brain mapping system with 30 scalp sites (an extension of the 10–20 system) and a 3T MR scanner were used to observe cortical activation patterns during a grasping motor task.

Descriptive analysis.

In the EEG brain mapping data, the sensorimotor cortex (SMC) and inferior parietal cortex (IPC) were activated in all of the children. The children with CP showed additional activation areas in the premotor cortex (PMC), superior parietal cortex (SPC), and prefrontal cortex (PFC). In the fMRI brain mapping data, SMC activation was observed in all of the children, and the children with CP showed additional activation areas in the PMC and primary somatosensory cortex (PSC).

The EEG-based topographical maps were equivalent to the maps obtained from fMRI during the grasping motor task. The results indicate that our novel EEG-based brain mapping system is useful for probing cortical activation patterns in normal children and children with CP.

Attention and executive function play an important role in fluent speaking. The aim of the present study is to evaluate effect of attention training in rehabilitation of stuttering.

In this random clinical trial 30 children with developmental stuttering participate in a random allocation sampling in case or control group. In case group, we trained patient with NEurocognitive Joyful Attentive Training Intervention (NEJATI) in 12 sessions. Riley Stuttering severity instrument-3 (SSI-3), Wisconsin Card Sorting Test (WCST), and Stroop Color Word Test (SCWT) are used for evaluation of executive function before and after intervention. Dependent T-Test was used for analysis.

Comparing case group before and after intervention showed a significant enhancement in executive function and reduced stuttering severity.

Attention training propose as a non lingual method of language and speech rehabilitation in developmental stuttering.

To evaluate the correlation between the trunk impairment and balance in patients with chronic stroke.

Thirty subjects with chronic stroke participated in the study. The subjects were evaluated with the trunk impairment scale (TIS) and Tinetti balance scale (TBS).

Spearman’s correlation showed highly significant correlation between TIS and TBS scores (rho = 0.911).

The study reveals that the trunk impairment and balance in subjects with stroke are positively correlated with each other.

Using heart rate recovery (HRR) after exercise as an index of autonomic function, we evaluate the effects of aerobic cycling training on HRR and cardiovascular fitness (peak VO₂) in chronic stroke patients and investigate the relationship between changes in HRR and those in peak VO₂.

128 participants with chronic stroke were randomized to a 12-week (5×/week) progressive aerobic cycling training group (n = 65) or a control group (n = 63). Peak VO₂, muscle strength, 6-minute walking distance (6MWD) and HRR were measured before and after the intervention.

Cycling training leads to significant increase in peak VO₂, HRR, muscle strength and 6MWD. In the cycling group, percent changes in peak VO₂ were positively associated with those in paretic and nonparetic muscle strength and HRR. Linear regression revealed that percent increases in peak VO₂ were significantly correlated with percent changes in HRR when controlling for pre-peak VO₂, age, gender, duration since stroke and improved muscle strength.

Aerobic cycling training can favorably modify HRR in stroke survivors. Rapid HRR, as an indicator of enhanced autonomic function, is useful for predicting gains in cardiovascular fitness. These findings indicate the underlying importance of autonomic modulation on cardiovascular adaptations to stroke exercise rehabilitation.

To document temporal recovery of upper extremity dexterity and establish predictors of limb dexterity in a cohort of stroke patients in the first year after stroke.

Prospective cohort study.

One hundred patients with a first-ever ischemic stroke admitted to a rehabilitation centre.

Assessment of upper extremity dexterity, motor power and selfcare function using the Motor Assessment Scale (MAS), Upper Extremity Motor Index (UEMI) and Modified Barthel Index (MBI) respectively.

Eighteen percent, 25.5% and 31.6% of patients recovered limb dexterity at 3, 6 and 12 months after stroke respectively. Patients who recovered dexterity late (⩾6 months after stroke) were significantly younger with lower rehabilitation admission UEMI scores than those who recovered dexterity early. The UEMI score was the most significant correlate of limb dexterity at all follow up periods. Recovery of limb dexterity at 12 months was predicted by UEMI (OR1.54, 95% CI 1.13–2.10) and MBI (OR 1.03, 95% CI 1.00–1.07) scores on admission to rehabilitation.

In this study, 31.6% of patients recovered upper extremity dexterity at 12 months after stroke. Although late recovery of dexterity occurs only in a small proportion of patients, this finding is still pertinent given the significant impact of dexterity on upper limb and selfcare function.

A high incidence of depression following a stroke has been reported. Many studies exclude those with communication impairments. However, there is an increased risk of psychosocial issues for individuals with communication difficulties. Psychosocial issues have a significant impact on the individual and their families. There is very limited research in this area.

A retrospective case review of the assessment and intervention with three individuals with significant communication difficulties following stroke was completed. Key interdisciplinary intervention factors were identified.

Psychosocial issues were identified in all three cases. The assessment of cognitive difficulties, interdisciplinary intervention targeting communication between family members, facilitation of emotional expression and liaison with appropriate community services were identified as key interventions. These interventions targeted at psychosocial issues resulted in a positive outcome for the individuals and their family.

Psychosocial issues are prevalent in individuals and their families with significant communication impairments following stroke. Clinically, these issues may be overlooked. The complexity of working with individuals with cognitive and communication impairments also contributes to poor identification of psychosocial issues. This case series clearly highlights that intervening at the psychosocial level through interdisciplinary working can facilitate meaningful outcomes for the individual and their family.

The aim of this study is to investigate whether progressive resistive training with closed-kinetic chain (CKC) and open-kinetic chain (OKC) exercises could change plantar pressure distribution during walking in patients with stroke.

Thirty-nine stroke patients were recruited and randomly divided into a CKC exercise group (n = 13), an OKC exercise group (n = 13), and a control group (n = 13). Both CKC and OKC exercise groups performed their own respective training programs 5 times per week for 6 weeks, whereas no training was done in the control group. Barefoot plantar pressure distribution was measured during walking in terms of contact area (CA), peak contact force (PCF), and contact impulse (CI) on each of three foot regions (i.e. forefoot (FF), midfoot (MF), and hindfoot (HF)).

In the CKC exercise group, there were significant changes in only the CA and PCF of HF. In the OKC exercise and control groups, no significant differences were found for all variables of plantar pressure distributions.

We found that resistive training with closed kinetic chain exercises could be an effective treatment method for improving normal gait patterns in stroke patients. These findings may be attributed to the fact that CKC exercise induced use of the ankle and knee muscles and provided repetitive sensory input from the affected foot.

To explore the role of rs11053646 polymorphism of oxidized low-density lipoprotein receptor 1 (OLR-1) gene in the susceptibility and prognosis of ischemic stoke (IS).

A total of 304 IS patients and 377 age and sex-matched healthy controls were recruited. Patients were followed up for 6 months for recovery evaluation of stroke. Genotyping analyses of the rs11053646 G > C polymorphisms of OLR1 gene were performed.

The genotype frequencies and alleles frequencies at rs11053646 were significantly differed between stroke subjects and control subjects (both P < 0.001). The presence of CC genotype was significantly higher in IS subjects than in controls (38% vs. 25%, P = 0.001). Similarly, the C allele carriage in IS was significantly higher than controls (59% vs. 49%, P < 0.001). Regression analysis showed the CC homozygote had a significantly increased risk for stroke (adjusted OR = 2.080; P = 0.001). The genotype of rs11053646 were not associated with the IS subtype and severity at admission, but determine the clinical outcome at 6 months after discharge from hospital.

The rs11053646 polymorphism of OLR1 gene be used as a molecular marker for the susceptibility and prognosis of IS in Chinese population.

Primary blast forces may cause dysfunction from mild traumatic brain injury (mTBI).

To investigate the effects of primary blast forces, independent of associated blunt trauma and post-traumatic stress disorder, on sensitive post-concussive measures.

This study investigated post-concussive symptoms, functional health and well-being, cognition, and positron emission tomography (PET) neuroimaging among 12 Iraq or Afghanistan war veterans who sustained pure blast-force mTBI, compared to 12 who sustained pure blunt-force mTBI.

Both groups had significantly lower scores than published norms on the Rivermead Post-Concussion Questionnaire (RPQ) and the SF36-V Health Survey. Compared to the Blunt Group, the Blast Group had poorer scores on the Paced Auditory Serial Addition Test (PASAT) and greater PET hypometabolism in the right superior parietal region. Only the Blast Group had significant correlations of their RPQ, SF36-V Mental Composite Score, and PASAT scores with specific regional metabolic changes.

This pilot study suggests that pure blast force mTBI may have greater post-concussive sequelae including deficits in attentional control and regional brain metabolism, compared to blunt mTBI. A disturbance of a right parietal-frontal attentional network is one potential explanation for these findings.

The objective of this study was to determine rates of functional outcomes, based on Glasgow Outcome Scale scores, among older adults (>60 years) after a traumatic brain injury.

An extensive database search was conducted. To be included all articles were published in English, included individuals 60 years or older, explicitly stated in-hospital GCS scores and GOS scores within one year post-TBI. Data was pooled on patient characteristics, mortality rates, time to death, and study design.

A total of 11 studies were included in this review. Among individuals with severe TBI, favourable, unfavourable, and fatal outcomes were observed in 7.9% (CI 5.3%–11.8%), 13.8% (CI 10.0%–18.8%) and 79.3% (CI 73.2%–84.4%), respectively. Among those with moderate TBI, favourable, unfavourable, and fatal outcomes were observed in 32.2% (CI 18.0%–50.7%), 29.5% (CI 16.5%–47.0%), and 42.5% (CI 26.1%–60.7%), respectively. Among those with mild TBI, favourable, unfavourable, and fatal outcomes were observed in 80.5% (CI 53.2%–93.7%), 7.0% (CI 1.9%–22.7%), and 10.7% (CI 3.1%–30.9%), respectively.

This study has demonstrated the significant interaction between GCS and GOS among older adults. Although older adults may require aggressive and comprehensive treatment to achieve these favourable outcomes, high rates of unfavourable outcome should not justify the use of conservative treatment.

Resistance exercise is effective in improving muscle strength and preventing muscle weakness in multiple sclerosis (MS) patients. Control of resistance training intensity based on perceived muscular effort is applicable to healthy individuals, yet there is no evidence of its utility for MS patients.

To compare perception of muscular effort in MS patients to healthy controls.

Based on their perception of muscular effort, twenty-five MS patients and twenty-eight controls adjusted static elbow extension tasks according to five levels on the OMNI-Resistance Exercise Scale. Elbow extension strength and muscle activity were measured via load cell dynamometer and surface electromyography (EMG) and related to each participant’s maximal voluntary contraction (MVC) strength and muscle activity. Two-way analysis of variance was used to evaluate statistical significance.

There were no statistically significant differences between MS patients and healthy controls, they produced similar relative torque values (F₁ = 0.196; p > 0.05) and extensor muscle activities (F_2,617 = 1.556; p > 0.05) across all effort levels.

No differences were found in the perception of muscular effort in MS patients and the age-matched control group. Future studies should explore, whether rating of perceived exertion is an effective instrument to control resistance training intensity in MS patients.

This study aimed to describe a community-based ambulation training for ambulatory patients with incomplete spinal cord injury (SCI) and then to report the results of the training.

Four patients with incomplete SCI participated in this study. The indoor and outdoor walking function was assessed at four intervals: pre-training, post-training, and at 4-week and 1-year follow-ups after successful completion of the community-based ambulation training. Training consisted of the four-staged ambulation protocol with weekly-increased environmental demands, which consisted of 1-hour sessions six times a week for a 4-week period (i.e., a total of 24 sessions).

The walking function of all patients was remarkably improved after the training, and these effects were favorably maintained at the 4-week and 1-year follow-ups.

These findings suggest that the use of community-based ambulation training is a beneficial therapeutic option to improve the walking function of ambulatory patients with incomplete SCI and to offer better opportunities for reintegration into community life.