Search

Objective: To develop and evaluate a measure of clinician-observed and patient-performed self-care function for use during inpatient rehabilitation., Design: Retrospective analysis of self-care assessments collected by therapists using confirmatory factor analysis (CFA) followed by multidimensional item response theory (MIRT)., Setting: Freestanding inpatient rehabilitation hospital in the Midwestern United States., Participants: Inpatients (N=7719) with stroke, traumatic brain injury, spinal cord injury, neurologic disorders, and musculoskeletal conditions., Interventions: Not applicable MAIN OUTCOME MEASURES: A total of 19 clinician-selected self-care measures including the FIM and patient-performed, clinician-rated measures of balance, upper extremity function, strength, changing body position, and swallowing. Clinicians completed assessments on admission and at least 1 interim assessment., Results: CFA was completed for 3 patient groups defined by their highest level of balance (sitting, standing, walking). We reduced the number of items by 47.5% while maintaining acceptable internal consistency; unidimensionality within each item set required development of testlets. A recursive analysis defined a self-care measure with sensitivity (Cohen d max-min =1.13; Cohen d last-first .=0.91) greater than the FIM self-care items (d max-min .=0.94; d last-first .=0.83). The CFA models provided good to acceptable fit (root mean square error of approximations 0.03-0.06). Most patients with admission FIM self-care ratings of total assistance (88%, 297 of 338) made improvements on the MIRT self-care measure that were undetected by the FIM; the FIM detected no change for 26% of these patients (78 of 297). The remaining 74% (219 of 297) improved on the MIRT-based measure an average of 14 days earlier than was detected by the FIM., Conclusions: This MIRT self-care measure possesses measurement properties that are superior to the FIM, particularly for patients near its floor or ceiling. Methods assure accommodation for multidimensionality and high levels of sensitivity. This self-care measure has the potential to improve monitoring of self-care and manage therapy effectively during inpatient rehabilitation., (Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To develop a revised definition of the Bobath concept that incorporates the perspectives of members of the International Bobath Instructors Training Association (IBITA)., Methods: A three-phase consensus building design utilizing (i) focus groups; (ii) survey methods; and, (iii) real-time Delphi. This paper presents the findings from the real-time Delphi, an iterative process to collect and synthesize expert opinions anonymously, provide controlled feedback, with the overall goal of achieving consensus., Results: One hundred and twenty-one IBITA members participated in the real-time Delphi. Over three Delphi Rounds, consensus was reached on six overarching conceptual statements and 11 statements representing unique aspects of Bobath clinical practice. One statement that aimed to describe the Bobath clinical term of "placing" was eliminated in Round One due to participant reservations that a text description was insufficient for this term. Seven statements underwent minor wording revisions in Round Two and Three to improve sentence clarity., Conclusion: Using the real-time Delphi, we were successful in gaining consensus in an expert group on a series of statements on which a revised definition of the Bobath concept could be based., (© 2019 John Wiley & Sons, Ltd.)

Background: Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes., Methods: A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit., Results: During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30-day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not ( P < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65-0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy ( P < 0.001; HR, 0.83; 95% CI, 0.77-0.88)., Conclusion: In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2020 The Korean Academy of Medical Sciences.)

Objectives: This study investigated reciprocal associations between meaning in life and physical quality of life (QOL) in the rehabilitation context. It was hypothesized that a higher level of meaning in life at Time 1 (T1) would predict better physical QOL at Time 2 (T2), and that better physical QOL (T1) would predict a higher level of meaning in life (T2)., Research Method: This longitudinal study enrolled 339 participants (aged 19-84 years, 57.9% women) who provided self-report data (T1) at the beginning of the inpatient rehabilitation for central nervous system diseases (CNSD; e.g., stroke; n = 89) or musculoskeletal system diseases (MSD; e.g., dorsopathies; n = 250), and at the end of the inpatient rehabilitation (T2, 1-month follow-up). Data were collected in 6 inpatient rehabilitation centers. Manifest cross-lagged panel analyses were conducted for the total sample., Results: Path analyses indicated a significant cross-lagged-effect (.126, p < .002 [95% BCI: 0.020, 0.132]) from meaning in life (T1) to physical QOL at the follow-up (T2). Physical QOL (T1) did not precede meaning in life (T2)., Conclusions: Among patients participating in rehabilitation due to CNSD or MSD, a higher level of meaning in life may precede better physical QOL. Interventions aimed at physical QOL improvement among patients who participated in an inpatient rehabilitation may benefit from a focus on raising patients' meaning in life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The factors that lead to the improvement of gait function in patients with diseases of the central nervous system (CNS) who use a hybrid assistive limb (HAL) are not yet fully understood. The purpose of the present study was to analyze these factors to determine the prognosis of the patients' gait function. Patients whose CNS disease was within 180 days since onset were designated as the subacute-phase patients, and patients whose disease onset had occurred more than 180 days previously were designated as chronic-phase patients. Fifteen subacute-phase patients and 15 chronic-phase patients were given HAL training. The study analyzed how post-training walking independence in these patients was affected by the following factors: age, disease, lesion area, lower limb function, balance, period until the start of training, number of training sessions, additional rehabilitation, higher-order cognitive dysfunction, HAL model, and the use of a non-weight-bearing walking-aid. In subacute-phase patients, walking independence was related to lower limb function (r s = 0.35). In chronic-phase patients, there was a statistically significant correlation between post-training walking independence and balance (r s = 0.78). In addition, in patients with a severe motor dysfunction that was accompanied by inattention and global cognitive dysfunction, little improvement occurred, even with double-leg model training, because they had difficulty wearing the device. The results demonstrated that the factors that improved walking independence post HAL training differed between patients with subacute- and chronic-stage CNS diseases. The findings may serve as valuable information for future HAL training of patients with CNS diseases.

Neuroengineering brings tools and techniques from the engineering fields into neuroscience to create new approaches for investigating the central nervous system (CNS). This fusion of disciplines is advancing our knowledge of how the CNS works and how we can enhance our natural cognitive and emotional function and restore neurological functions that are compromised by disease or injury.

The development of rehabilitation has traditionally focused on measurements of motor disorders and measurements of the improvements produced during the therapeutic process; however, physical rehabilitation sciences have not focused on understanding the philosophical and scientific principles in clinical intervention and how they are interrelated. The main aim of this paper is to explain the foundation stones of the disciplines of physical therapy, occupational therapy, and speech/language therapy in recovery from motor disorder. To reach our goals, the mechanistic view and how it is integrated into physical rehabilitation will first be explained. Next, a classification into mechanistic therapy based on an old version (automaton model) and a technological version (cyborg model) will be shown. Then, it will be shown how physical rehabilitation sciences found a new perspective in motor recovery, which is based on functionalism, during the cognitive revolution in the 1960s. Through this cognitive theory, physical rehabilitation incorporated into motor recovery of those therapeutic strategies that solicit the activation of the brain and/or symbolic processing; aspects that were not taken into account in mechanistic therapy. In addition, a classification into functionalist rehabilitation based on a computational therapy and a brain therapy will be shown. At the end of the article, the methodological principles in physical rehabilitation sciences will be explained. It will allow us to go deeper into the differences and similarities between therapeutic mechanism and therapeutic functionalism.

The article is devoted to the comprehensive diagnosis and treatment of perinatal lesions of the nervous system and their consequences in children. Reflects modern approaches to data classification conditions, taking into account ideas on the etiology and pathogenesis of the disease, the clinical manifestations of the main syndromes (excitation and depression, hypertensive, convulsive, movement disorders) as the neonatal period, and in the formation of long-term effects (motor and mental delay and speech development, hyperkinetic syndrome, cerebral palsy and others). Considerable attention is paid to the modern principles of diagnosis (clinical, psychometric, instrumental) and comprehensive rehabilitation (medical, social and psycho-pedagogical) the effects of perinatal lesions of the nervous system. The results of the review of research on the use of the polypeptide and nootropic neurometabolic stimulator - cortexin - in the complex rehabilitation of perinatal lesions of the nervous system and their consequences in children. It is shown that the use of cortexin in treatment of critical conditions in newborns reduced the duration of intensive care and the length of stay of patients in a intensive care unit, the average period of hospital treatment and the stage of the primary neurological rehabilitation 2.5-3 times, but also reduces the frequency of detection of syndromes movement disorders in 2 times, hypertension-hydrocephalic disorders 3 times, vegetative-visceral dysfunctions 5 times. Application cortexin in the rehabilitation of children of the first years of life with the consequences of perinatal CNS indicates a significant improvement in their motor and cognitive functions, as well as predrechevogo and speech development. Application cortexin significantly improved the forecast recovery of motor, cognitive, and neurological status in general, with full compensation by the end of 1 year of life in 90% of patients, and was accompanied by a decline in disability in extremely premature newborns from 13.6% to 4.6% compared to the standard therapy, as well as reduced length of stay in hospital for 14.7 days of hospital stay. Revealed the cumulative effect of the drug: maintained for 6 to 18 months with repeated courses of therapy, his positive influence. High efficiency of cortexin due to a combination of nootropic, neurotrophic, neuroprotective, anticonvulsant and reparative effects, as well as antioxidant, metabolic and anti-stress action, which determines the need for wide application in complex regenerative treatment of perinatal lesions of the nervous system and their consequences.

The goal of regenerative medicine is to restore function through therapy at levels such as the gene, cell, tissue, or organ. For many disorders, however, regenerative medicine approaches in isolation may not be optimally effective. Rehabilitation is a promising adjunct therapy given the beneficial impact that physical activity and other training modalities can offer. Accordingly, "regenerative rehabilitation" is an emerging concentration of study, with the specific goal of improving positive functional outcomes by enhancing tissue restoration following injury. This article focuses on one emerging example of regenerative rehabilitation-namely, the integration of clinically based protocols with stem cell technologies following central nervous system injury. For the purposes of this review, the state of stem cell technologies for the central nervous system is summarized, and a rationale for a synergistic benefit of carefully orchestrated rehabilitation protocols in conjunction with cellular therapies is provided. An overview of practical steps to increase the involvement of physical therapy in regenerative rehabilitation research also is provided., (© 2016 American Physical Therapy Association.)

Decreasing the often-seen multiple disabilities as a consequence of central nervous system impairments requires broadening of the tools of rehabilitation. A promising opportunity for this purpose is the application of physiotherapy robots. The development of such devices goes back a quarter of century. Nowadays several robots are commercially available both for supporting upper and lower limb therapy. The aim is never to replace the therapists, but rather to support and supplement their work. It is worthwhile applying these devices for goal-oriented exercises in high repetition, which one physically fatiguing for the therapist or for the correction of functional movement by various strategies. Robot mediated therapy is also useful for motivation of the patient and making the rehabilitation programme more versatile. Robots can be used for assessment of the neuromotor status as well. Several clinical studies have been executed in this field, all over the world. Meta-analyses based on randomized, controlled trials show that supplementing the traditional physiotherapy with a robot-mediated component presents advantage for the patients. Further studies are necessary to clarify which modality and intensity of the exercises, in which group of patients, in which stage lead to the expected outcome.

Background: Following a neurologic event such as traumatic brain injury (TBI), cerebrovascular accident (CVA), and chronic neurological conditions including Parkinson's disease, multiple sclerosis, and cerebral palsy a shift in the visual midline (egocenter) can directly affect posture, balance and spatial orientation. As a consequence, this increases the risk of fall (RoF) and injury that imposes a major financial burden on the public health system., Objective: To determine if there is a statistically significant change in balance with the intervention of yoked prisms to reduce the risk of fall in subjects with neurological impairments., Methods: Ambulation of thirty-six subjects was evaluated on a pressure sensitive mat before and after intervention with yoked prisms. Changes in gait and balance were analyzed in the anterior-posterior (AP) and medial-lateral (ML) axes during ambulation., Results: T-tests for each measure comparing the difference-of-differences to a zero change at baseline returned statistically significant reductions in both AP (p <  0.0001; 95% CI: 1.368- 2.976) and ML (p = 0.0002; 95% CI: 1.472- 4.173) imbalances using specifically directed yoked prisms to correct the visual midline deviation., Conclusion: These findings demonstrate that yoked prisms have the potential to provide a cost-effective means to restore the visual midline thereby improving balance, reduce RoF and subsequent injury.

Impairments of the central motor system can either be congenital (e. g. cerebral palsy) or acquired (e. g. traumatic brain injury, stroke). These lesions are the most frequent morbidities necessitating neuro-rehabilitative measures in childhood. Robot-assisted rehabilitation in combination with virtual reality can complement conventional therapies and provide a task-specific training, with a high number of repetitions over a prolonged time period. The advantage of virtual reality is that it can provide a real time feedback about the patient's performance. Furthermore, challenging virtual scenarios especially motivate young patients to continue with otherwise monotonous exercises. Preliminary findings indicate that robot-assisted training in children with central motor impairment could be beneficial, but conclusive evidence about its efficacy is still missing.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation tool that is now being widely used in neuroscientific and clinical research in humans. While initial studies focused on modulation of cortical excitability, the technique quickly progressed to studies on motor and cognitive functions in healthy humans and in patients with neurological diseases. In the present review we will first provide the reader with a brief background on the basic principles of tDCS. In the main part, we will outline recent studies with tDCS that aimed at enhancing behavioral outcome or disease-specific symptoms in patients suffering from mild cognitive impairment, Alzheimer's disease, movement disorders, and epilepsy, or persistent deficits after stroke. The review will close with a summary statement on the present use of tDCS in the treatment of neurological disorders, and an outlook to further developments in this realm. tDCS may be an ideal tool to be administered in parallel to intensive cognitive or motor training in neurological disease, but efficacy for the areas of activities and participation still needs to be established in controlled randomized trials. Its use in reducing disease-specific symptoms like dystonia or epileptic seizures is still unclear., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Neural extracellular matrix (ECM) is different from the normal ECM in other organs in that it has low fibrous protein content and high carbohydrate content. One of the key carbohydrate components in the brain ECM is chondroitin sulfate proteoglycans (CSPGs). Over the last two decades, the view of CSPGs has changed drastically, from the initial regeneration inhibitor to plasticity regulators present in the perineuronal nets to the most recent view that certain CSPG isoforms may even be growth promoters. In this chapter, we aim to address a few current progresses of CSPGs in regulating plasticity and rehabilitation in various pathological conditions in the central nervous system.

The present article is concerned with the problem of rehabilitation of the children at the age from 6 to 12 months presenting with perinatal lesions in the central nervous system (CNS) and the role of cerebral hemodynamics in the development of this disease. The results of dynamic clinical and laboratory examination of the children presenting with the consequences of perinatal lesions in the central nervous system are presented with special reference to the influence of the pearl baths on the dynamics of cerebral circulation. The study involving 65 patients showed that the inclusion of bubble bath sin the combined rehabilitative treatment of the children with this condition helps to optimize parameters of the disturbed cerebral blood flow. The positive influence of bubble bath son the dynamics of clinical symptoms and the state of the cardiovascular system has been demonstrated.

The AOTA Centennial Vision outlined in 2007 challenged the occupational therapy profession to become a "powerful, widely recognized, science-driven, and evidence-based" profession that could adapt to changing societal and cultural needs and flourish well into the future. That challenge can be met by simply being effective at what we do; this will increase our value and validate our worth. Neurorehabilitation in occupational therapy can also thrive if we verify that the interventions we use and the strategies we implement are grounded in evidence. Professional effectiveness will emerge by (1) increasing the dissemination of research that supports the methods we use and informs others of the successful patient outcomes we achieve and (2) expanding development and validation of instruments that quantitatively and qualitatively measure functional outcomes. Occupational therapists can individually develop professional effectiveness by fostering greater academic-clinical alliances, objectifying evaluation and intervention methods, and preparing future practitioners appropriately for evidence-driven practice., (Copyright © 2013 by the American Occupational Therapy Association, Inc.)

This paper is designed to report the results of a clinical study of the children presenting with neurologic pathology for the detection of the most common concomitant craniovertebral disorders. In addition, the experience of application of the methods for comprehensive rehabilitation is presented with special reference to remedial exercises, manual therapy, massage, and other physiotherapeutic procedures. Positive experience with the application of orthopedic devices is described including the Shants collars and corsets as well as the observance of the specific orthopedic locomotor regimen. These combined measures are designed to enhance the quality of life of the patients, correct their neurologic symptoms, and improve the compromised academic performance.

This review discusses challenges faced by clinicians and researchers when measuring ambulation in individuals with central neurologic disorders within 3 distinct environments: clinical, laboratory, and community. Even the most robust measure of ambulation is affected by the environment in which it is implemented and by the clinical or research question and the specificity of the hypothesis being investigated. The ability to accurately measure ambulation (one of the most important metrics used to show transition into a community environment) is essential to measure treatment effectiveness and rehabilitation outcomes in populations with central neurologic disorders., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: This article provides rehabilitation professionals and engineers with a theoretical and pragmatic rationale for the inclusion of haptic feedback in the rehabilitation of central nervous system disorders affecting the hand., Method: A narrative review of haptic devices used in sensorimotor hand rehabilitation was undertaken. Presented papers were selected to outline and clarify the underlying somatosensory mechanisms underpinning these technologies and provide exemplars of the evidence to date., Results: Haptic devices provide kinaesthetic and/or tactile stimulation. Kinaesthetic haptics are beginning to be incorporated in central nervous system rehabilitation; however, there has been limited development of tactile haptics. Clinical research in haptic rehabilitation of the hand is embryonic but initial findings indicate potential clinical benefit., Conclusions: Haptic rehabilitation offers the potential to advance sensorimotor hand rehabilitation but both scientific and pragmatic developments are needed to ensure that its potential is realized.

Experience dependent plasticity refers to ability of the brain to adapt to new experiences by changing its structure and function. The purpose of this paper is to provide a brief review the neurophysiological and structural correlates of neural plasticity that occur during and following motor learning. We also consider that the extent of plastic reorganization is dependent upon several key principals and that the resulting behavioral consequences can be adaptive or maladaptive. In light of this research, we conclude that an increased understanding of the complexities of brain plasticity will translate into enhanced treatment opportunities for the clinician to optimize hand function., (Copyright © 2013 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Background: Recently, a new tool for assessing dynamic balance impairments has been presented: the 14-item Mini-BESTest., Objective: The aim of this study was to compare the psychometric performance of the Mini-BESTest and the Berg Balance Scale (BBS)., Design: A prospective, single-group, observational design was used in the study., Methods: Ninety-three participants (mean age=66.2 years, SD=13.2; 53 women, 40 men) with balance deficits were recruited. Interrater (3 raters) and test-retest (1-3 days) reliability were calculated using intraclass correlation coefficients (ICCs). Responsiveness and minimal important change were assessed (after 10 sessions of physical therapy) using both distribution-based and anchor-based methods (external criterion: the 15-point Global Rating of Change [GRC] scale)., Results: At baseline, neither floor effects nor ceiling effects were found in either the Mini-BESTest or the BBS. After treatment, the maximum score was found in 12 participants (12.9%) with BBS and in 2 participants (2.1%) with Mini-BESTest. Test-retest reliability for total scores was significantly higher for the Mini-BESTest (ICC=.96) than for the BBS (ICC=.92), whereas interrater reliability was similar (ICC=.98 versus .97, respectively). The standard error of measurement (SEM) was 1.26 and the minimum detectable change at the 95% confidence level (MDC(95)) was 3.5 points for Mini-BESTest, whereas the SEM was 2.18 and the MDC(95) was 6.2 points for the BBS. In receiver operating characteristic curves, the area under the curve was 0.92 for the Mini-BESTest and 0.91 for the BBS. The best minimal important change (MIC) was 4 points for the Mini-BESTest and 7 points for the BBS. After treatment, 38 participants evaluated with the Mini-BESTest and only 23 participants evaluated with the BBS (out of the 40 participants who had a GRC score of ≥ 3.5) showed a score change equal to or greater than the MIC values., Limitations: The consecutive sampling method drawn from a single rehabilitation facility and the intrinsic weakness of the GRC for calculating MIC values were limitations of the study., Conclusions: The 2 scales behave similarly, but the Mini-BESTest appears to have a lower ceiling effect, slightly higher reliability levels, and greater accuracy in classifying individual patients who show significant improvement in balance function.

We undertook two systematic reviews to determine the levels of respiratory muscle weakness and effects of respiratory muscle training in stroke patients. Two systematic reviews were conducted in June 2011 using a number of electronic databases. Review 1 compared respiratory muscle strength in stroke and healthy controls. Review 2 was expanded to include randomized controlled trials assessing the effects of respiratory muscle training on stroke and other neurological conditions. The primary outcomes of interest were maximum inspiratory and expiratory mouth pressure (maximum inspiratory pressure and maximum expiratory pressure, respectively). Meta-analysis of four studies revealed that the maximum inspiratory pressure and maximum expiratory pressure were significantly lower (P < 0·00001) in stroke patients compared with healthy individuals (weighted mean difference -41·39 and -54·62 cmH(2) O, respectively). Nine randomized controlled trials indicate a significantly (P = 0·0009) greater effect of respiratory muscle training on maximum inspiratory pressure in neurological patients compared with control subjects (weighted mean difference 6·94 cmH(2) O) while no effect on maximum expiratory pressure. Respiratory muscle strength appears to be impaired after stroke, possibly contributing to increased incidence of chest infection. Respiratory muscle training can improve inspiratory but not expiratory muscle strength in neurological conditions, although the paucity of studies in the area and considerable variability between them is a limiting factor. Respiratory muscle training may improve respiratory muscle function in neurological conditions, but its clinical benefit remains unknown., (© 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.)

Several new approaches for treatment of Central Nervous System (CNS) disorders are currently under investigation, including the use of rehabilitation training strategies, which are often combined with electrical and/or pharmacological modulation of spinal locomotor circuitries. While these approaches show great promise in the laboratory setting, there still exists a large gap in knowledge on how to transfer these treatments to daily clinical use. This thematic series presents a cross section of cutting edge approaches with the goal of transferring basic neuroscience principles from the laboratory to the proverbial "bedside".

Transplants of cells and tissues to the central nervous system of adult mammals can, under appropriate conditions, survive, integrate, and function. In particular, the grafted cells can sustain functional recovery in animal models of a range of neurodegenerative conditions including genetic and idiopathic neurodegenerative diseases of adulthood and aging, ischemic stroke, and brain and spinal cord trauma. In a restricted subset of such conditions, cell transplantation has progressed to application in humans in early-stage clinical trials. At the present stage of play, there is clear evidence of clinical efficacy of fetal cell transplants in Parkinson disease (notwithstanding a range of technical difficulties still to be fully resolved), and preliminary claims of promising outcomes in several other severe neurodegenerative conditions, including Huntington disease and stroke. Moreover, the experimental literature is increasingly suggesting that the experience and training of the graft recipient materially affects the functional outcome. For example, environmental enrichment, behavioral activity, and specific training can enhance the recovery process to maximize functional recovery. There are even circumstances where the grafted cells have been demonstrated to restore the neural substrate for new learning. Consequently, it is not sufficient to replace lost cells anatomically; rather, for the grafts to be effective, they need to be integrated functionally into the host circuitry, and the host animal requires training and rehabilitation to maximize function of the reconstructed graft-host circuitry. Such observations require reconsideration of the design of the next generation of clinical trials and subsequent service delivery, to include physiotherapists, cognitive therapists, and rehabilitation experts as core members of the transplant team, along with the neurologists and neurosurgeons that have conventionally led the field., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Sarcoidosis is an inflammatory disease of unknown etiology associated with the development of granulomatous nodules in various organs, most commonly the lungs, eyes, and skin. It rarely affects the central nervous system, with the spinal cord being least common area of involvement. However, when sarcoidosis does affect the central nervous system, it is often the first presentation of the disease, making diagnosis more difficult. Physical examination findings are consistent with spinal cord pathology, and imaging often suggests spinal cord tumor. We present a case of an otherwise healthy young woman with a granulomatous mass in her cervico-thoracic spinal cord presumed to be sarcoid and review the clinical findings, diagnosis, treatment, and prognosis associated with this rare disease.

During developmental critical periods, external stimuli are crucial for information processing, acquisition of new functions or functional recovery after CNS damage. These phenomena depend on the capability of neurons to modify their functional properties and/or their connections, generally defined as "plasticity". Although plasticity decreases after the closure of critical periods, the adult CNS retains significant capabilities for structural remodelling and functional adaptation. At the molecular level, structural modifications of neural circuits depend on the balance between intrinsic growth properties of the involved neurons and growth-regulatory cues of the extracellular milieu. Interestingly, experience acts on this balance, so as to create permissive conditions for neuritic remodelling. Here, we present an overview of recent findings concerning the effects of experience on cellular and molecular processes responsible for producing structural plasticity of neural networks or functional recovery after an insult to the adult CNS (e.g. traumatic injury, ischemia or neurodegenerative disease). Understanding experience-dependent mechanisms is crucial for the development of tailored rehabilitative strategies, which can be exploited alone or in combination with specific therapeutic interventions to improve neural repair after damage.

Background: Neurological disorders lead to walking disabilities, which are often treated using robot-assisted gait training (RAGT) devices such as the driven gait-orthosis Lokomat. A novel integrated biofeedback system was developed to facilitate therapeutically desirable activities during walking. The aim of this study was to evaluate the feasibility to detect changes during RAGT by using this novel biofeedback approach in a clinical setting for patients with central neurological disorders., Methods: 84 subjects (50 men and 34 women, mean age of 58 ± 13 years) were followed over 8 RAGT sessions. Outcome measures were biofeedback values as weighted averages of torques measured in the joint drives and independent parameters such as guidance force, walking speed, patient coefficient, session duration, time between sessions and total treatment time., Results: Joint segmented analysis showed significant trends for decreasing hip flexion activity (p ≤.003) and increasing knee extension activity (p ≤.001) during RAGT sessions with an intercorrelation of r=-.43 (p ≤.001). Further associations among independent variables were not statistically significant., Conclusion: This is the first study that evaluates the Lokomat integrated biofeedback system in different neurological disorders in a clinical setting. Results suggest that this novel biofeedback approach used in this study is not able to detect progress during RAGT. These findings should be taken into account when refining existing or developing new biofeedback strategies in RAGT relating to appropriate systems to evaluate progress and support therapist feedback in clinical settings., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The aim of this educational review is to provide an overview of the clinical application of transcutaneous electrical stimulation of the extremities in patients with upper motor neurone lesions. In general two methods of electrical stimulation can be distinguished: (i) therapeutic electrical stimulation, and (ii) functional electrical stimulation. Therapeutic electrical stimulation improves neuromuscular functional condition by strengthening muscles, increasing motor control, reducing spasticity, decreasing pain and increasing range of motion. Transcutaneous electrical stimulation may be used for neuromuscular electrical stimulation inducing repetitive muscle contraction, electromyography-triggered neuromuscular electrical stimulation, position-triggered electrical stimulation and subsensory or sensory transcutaneous electric stimulation. Functional electrical stimulation provokes muscle contraction and thereby produces a functionally useful movement during stimulation. In patients with spinal cord injuries or stroke, electrical upper limb neuroprostheses are applied to enhance upper limb and hand function, and electrical lower limb neuroprostheses are applied for restoration of standing and walking. For example, a dropped foot stimulator is used to trigger ankle dorsiflexion to restore gait function. A review of the literature and clinical experience of the use of therapeutic electrical stimulation as well as of functional electrical stimulation in combination with botulinum toxin, exercise therapy and/or splinting are presented. Although the evidence is limited we conclude that neuromuscular electrical stimulation in patients with central nervous system lesions can be an effective modality to improve function, and that combination with other treatments has an additive therapeutic effect.

The central nervous system (CNS) has limited capacity for self-repair. Current treatments are often incapable of reversing the debilitating effects of CNS diseases that result in permanent and/or progressive physical and cognitive impairments. One promising repair strategy is transplantation of stem cells, which can potentially replace lost neurons and/or glia or promote repair through secretion of trophic factors. Various types of stem cells exist, each with their own advantages and disadvantages. Although no consensus exists regarding the optimal cell type to use, moderate functional improvements have been shown in animal models of CNS diseases using different types of stem cells. However, the precise mechanism of action behind their beneficial effects remains unknown. In addition, many barriers to clinical use still need to be resolved before transplantation of stem cells can be used as effective biologics. These barriers include--depending on the stem cell type--possible tumor formation, difficulty with harvest, limited in vivo differentiation and integration, and ethical issues regarding use., (Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Objective: To study whether outcomes in patients who have undergone inpatient rehabilitation for stroke, traumatic brain injury (TBI), or traumatic spinal cord injury (TSCI) differ based on antidepressant medication (ADM) use., Design: Retrospective cohort study of 867 electronic medical records of patients receiving inpatient rehabilitation for stroke, TBI, or TSCI. Four cohorts were formed within each rehabilitation condition: patients with no history of ADM use and no indication of history of depression; patients with no history of ADM use but with a secondary diagnostic code for a depressive illness; patients with a history of ADM use prior to and during inpatient rehabilitation; and patients who began ADM therapy in inpatient rehabilitation., Setting: Freestanding inpatient rehabilitation facility (IRF)., Participants: Patients diagnosed with stroke (n=625), TBI (n=175), and TSCI (n=67)., Interventions: Not applicable., Main Outcome Measures: FIM, rehabilitation length of stay (LOS), deviation between actual LOS and expected LOS, and functional gain per day., Results: In each impairment condition, patients initiating ADM therapy in inpatient rehabilitation had longer LOS than patients in the same impairment condition on ADM at IRF admission, and had significantly longer LOS than patients with no history of ADM use and no diagnosis of depression (P<.05). LOS for patients initiating ADM therapy as inpatients even exceeded LOS for patients without ADM history, but who had a diagnosis for a depressive disorder. Deviation in LOS was significantly larger in the stroke and TBI groups initiating ADM in IRF than their counterparts with no history of ADM use, illustrating that the group initiating ADM therapy in rehabilitation significantly exceeded expected LOS. Increased LOS did not translate into functional gains, and in fact, functional gain per day was lower in the group initiating ADM therapy in IRF., Conclusions: Explanations for unexpectedly long LOS in patients initiating ADM in inpatient rehabilitation focus on the potential for ADM to inhibit therapy-driven remodeling of the nervous system when initiated close in time to nervous system injury, or the possibility that untreated sequelae (eg, depressive symptoms or fatigue) were limiting progress in therapy, which triggered ADM treatment., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

This review examines cognitive, neurological, and neuroanatomical recovery associated with abstinence from volatile substance misuse (VSM). Articles describing functional or structural brain changes longitudinally or cross-sectional reports comparing current and abstinent users were identified and reviewed. A significant lack of empirical studies investigating central nervous system recovery following VSM was noted. The few case reports and group studies identified indicated that cognitive and neurological impairments appear to follow a progression of decline and progression of recovery model, with the severity of impairment related to the duration and severity of misuse, blood lead levels among leaded petrol misusers, and the duration of abstinence for recovery. By contrast, severe neurological impairment known as lead encephalopathy from sniffing leaded petrol occurred as more catastrophic or abrupt damage to cerebellar processes that may never fully recover. Neuroanatomical damage may not recover even with prolonged abstinence.

A Brain-Computer Interface (BCI) provides a completely new output pathway and so, an additional possible way a person can express himself if he/she suffers from disorders like amyotrophic lateral sclerosis (ALS), brainstem stroke, brain or spinal cord injury, or other diseases which impair the function of the common output pathways which are responsible for the control of muscles or impair the muscles. Although most BCIs are thought to help people with disabilities, they are mainly tested on healthy, young subjects who may achieve better results than people with impairments. In this study we compare measurements, performed on 10 physically disabled people, to the results of a previous study, taken using 100 healthy participants. We prove that, under certain constraints, most patients are able to control a P300-based spelling device with almost the same accuracy as the healthy ones. Tuning parameters are discussed, as well as criteria for people who are not able to use this device.

Purpose of Review: Cost-effective neurorehabilitation is essential owing to financial constraints on healthcare resources. Technologies have the potential to contribute but without strong clinical evidence are unlikely to be widely reimbursed. This review presents evidence of new technologies since 2008 and identifies barriers to translation of technologies into clinical practice., Recent Findings: Technology has not been shown to be superior to intensively matched existing therapies. Research has been undertaken into the development and preliminary clinical testing of novel technologies including robotics, electrical stimulation, constraint-induced movement therapy, assistive orthoses, noninvasive brain stimulation, virtual reality and gaming devices. Translation of the research into clinical practice has been impeded by a lack of robust evidence of clinical effectiveness and usability. Underlying mechanisms associated with recovery are beginning to be explored, which may lead to more targeted interventions. Improvements in function have been demonstrated beyond the normal recovery period, but few trials demonstrate lasting effects., Summary: Technologies, alone or combined, may offer a cost-effective way to deliver intensive neurorehabilitation therapy in clinical and community environments, and have the potential to empower patients to take more responsibility for their rehabilitation and continue with long-term exercise.

Decades of basic science have clearly demonstrated the capacity of the central nervous system (CNS) to structurally and functionally adapt in response to experience. The field of neurorehabilitation has begun to use this body of work to develop neurobiologically informed therapies that harness the key behavioral and neural signals that drive neural plasticity. The present review describes how neural plasticity supports both learning in the intact CNS and functional improvement in the damaged or diseased CNS. A pragmatic, interdisciplinary definition of neural plasticity is presented that may be used by both clinical and basic scientists studying neurorehabilitation. Furthermore, a description of how neural plasticity may act to drive different neural strategies underlying functional improvement after CNS injury or disease is provided. The understanding of the relationship between these different neural strategies, mechanisms of neural plasticity, and changes in behavior may facilitate the development of novel, more effective rehabilitation interventions., (Copyright © 2010 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

This article describes state of the art concepts of neurological rehabilitation in Germany. In parallel to enormous growth of knowledge in the neurosciences also neurological rehabilitation has made significant progress. The increasing use of concepts of evidence based medicine and an early translation of knowledge from the neurosciences into clinical rehabilitation practice contribute to therapeutic advances. It is now widely accepted, that rehabilitation should start early and should be organized in a multidisciplinary professional team. Therapeutic procedures selected should be evidence based and have to be modified to find custom tailored solutions for individual patients. General rules derived from neuroscientific knowledge have been shown to be useful to design new therapeutic techniques. Neuromodulatory stimulation and special pharmacological treatments provide further options for enhancing results of rehabilitation.

Some patients are no longer able to communicate effectively or even interact with the outside world in ways that most of us take for granted. In the most severe cases, tetraplegic or post-stroke patients are literally 'locked in' their bodies, unable to exert any motor control after, for example, a spinal cord injury or a brainstem stroke, requiring alternative methods of communication and control. But we suggest that, in the near future, their brains may offer them a way out. Non-invasive electroencephalogram (EEG)-based brain-computer interfaces (BCI) can be characterized by the technique used to measure brain activity and by the way that different brain signals are translated into commands that control an effector (e.g., controlling a computer cursor for word processing and accessing the internet). This review focuses on the basic concepts of EEG-based BCI, the main advances in communication, motor control restoration and the downregulation of cortical activity, and the mirror neuron system (MNS) in the context of BCI. The latter appears to be relevant for clinical applications in the coming years, particularly for severely limited patients. Hypothetically, MNS could provide a robust way to map neural activity to behavior, representing the high-level information about goals and intentions of these patients. Non-invasive EEG-based BCIs allow brain-derived communication in patients with amyotrophic lateral sclerosis and motor control restoration in patients after spinal cord injury and stroke. Epilepsy and attention deficit and hyperactive disorder patients were able to downregulate their cortical activity. Given the rapid progression of EEG-based BCI research over the last few years and the swift ascent of computer processing speeds and signal analysis techniques, we suggest that emerging ideas (e.g., MNS in the context of BCI) related to clinical neurorehabilitation of severely limited patients will generate viable clinical applications in the near future.

The present study investigated impact factors on the length of stay in neurological rehabilitation. 161 patients were enrolled in a six months period. As a major result, admission Barthel Index correlated highly significantly with length of stay (correlation coefficient -0.34). Besides diagnosis and age, gender had a significant influence on the duration, too. While the Barthel did not differ significantly, women stayed 2.9 days longer than men. In summary, the admission Barthel Index predicts length of stay in neurological rehabilitation.

Objective: The aim of the present study was to investigate the predictive value of neuropsychological tests for on-road evaluation outcome after inconclusive assessment., Methods and Procedures: Thirty-five patients were assessed neurologically, neuropsychologically by traditional clinical tests and by on-road evaluation. Simple univariate tests, logistic regression and ROC-curve analysis were used to investigate the predictive power of different neuropsychological tests., Main Outcomes and Results: Six measures from the California Computerized Assessment Package (CalCAP) and the Digit-Symbol test from Wechsler Adult Intelligence Scale predicted the outcome of the on-road evaluation. A logistic regression analysis showed that a model with two variables from CalCAP and the Digit Symbol test predicted the results of the on-road driving evaluation with an overall accuracy of 84.8%., Conclusions: The findings indicate that the outcome of on-road assessment is most related to cognitive skills such as attention and processing speed in combination with cognitive flexibility.

Conclusion: The results suggest that after a sudden change in the visual input, postural adaptation is impaired in patients with instability and central nervous system disorders (CNSD)., Objective: The aim of this study was the assessment of postural adaptation, as a transient phenomenon, when sudden changes in visual perception occur in normal subjects and in patients with instability due to different CNSD., Subjects and Methods: Horizontal optokinetic stimulation (40 s and suddenly stopped) was performed in 16 patients with CNSD, and also in 22 normal subjects. Measurements were made of the body center of pressure area (COP) and the body sway velocity (SV) during 10 s before and after the stop and labeling the COP trajectory., Results: Values of COP and SV (Wilcoxon signed rank test, p=0.979 and 0.496, respectively) in normal subjects did not show any significant change before and after the stop. In 15 of the 16 assessed patients with instability associated with CNSD an increase of the COP and SV values (Wilcoxon signed test, p=0.001 and 0.004, respectively) was observed in the 10 s after the visual stop. COP labeling showed 'roaming' of the COP spatial evolution approaching the limits of stability.

In German neurorehabilitation, the ambiguous term "early rehabilitation" reflects the multidisciplinary, rehabilitative treatment of severely impaired patients in continuing need of acute and intensive care (including weaning from the respirator in selected cases). The actual definition of this treatment is discussed, which hitherto corresponded to Phase B according to recommendations of the German Federal Study Group for Rehabilitation (BAR) and now has started to be integrated into the diagnosis-related group system. The tasks and aims of early rehabilitation are to support and enhance neuroplastic remission of nervous system functional loss and continued medical care, improve vigilance, establish cooperativity, and evaluate the rehabilitation potential including compensatory and adaptive strategies organizing posthospital care, reducing the need of nursing support, and improving quality of life. Some special aspects of early rehabilitative care are presented here in more detail. To fulfill these tasks, a multidisciplinary team is required including various therapists qualified for neurorehabilition, physicians (including a neurologist), nurses, and social workers. Outcome data were assessed using our 5-year prospective early rehabilitation registry. Fifty-five percent of patients improved to reach the next step of neurorehabilitation (Phase C), with significant gain in function even in the subgroup of aged and most severely disabled patients. The trend to transfer patients very early in the postacute Phase to early rehabilitation facilities, with open medical problems and increased risk of complications, makes close cooperation and interaction with acute medical centers necessary.

The Bobath concept is a problem-solving approach to the assessment and treatment of individuals following a lesion of the central nervous system that offers therapists a framework for their clinical practice. The aim of this study was to facilitate a group of experts in determining the current theoretical assumptions underpinning the Bobath concept.A four-round Delphi study was used. The expert sample included all 15 members of the British Bobath Tutors Association. Initial statements were identified from the literature with respondents generating additional statements. Level of agreement was determined by using a five-point Likert scale. Level of consensus was set at 80%. Eighty-five statements were rated from the literature along with 115 generated by the group. Ninety-three statements were identified as representing the theoretical underpinning of the Bobath concept. The Bobath experts agreed that therapists need to be aware of the principles of motor learning such as active participation, opportunities for practice and meaningful goals. They emphasized that therapy is an interactive process between individual, therapist, and the environment and aims to promote efficiency of movement to the individual's maximum potential rather than normal movement. Treatment was identified by the experts as having "change of functional outcome" at its center.

The paper is devoted to a neurobionic simulation model for controlling balance in a biomechanical pendulum. The model is realized by a complex of fuzzy regulators and an artificial neural network. Fuzzy regulators are used for simulating the physiological characteristics of the motor system and the functions of the sensory systems. The second level of control is the central integrator. It is realized as an artificial neural network (ANN), which simulates a real process of analysis and synthesis of afferent signals, formation of the model of action, etc.Equilibrium control in a multijoint biomechanical object is a specific example of a self-developing multilevel system of movement control. In the course of elaboration of the model and further examination of its behavior we have received model results which revealed correspondence with the results demonstrated by real subjects in stabilographic tests performed after long-term space flights. We concluded that the model permits us to simulate the peculiarities of human movement control and can be used for creating individual plans of recovery and rehabilitation of patients after long-term motionless or learning movement control in unknown environments.