bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical predictors of urinary tract infection in the neonatal intensive care unit
Authors: Foglia E.E. , Lorch S.A.
Published: December 2019

Objective: To identify clinical predictors associated with urinary tract infections (UTI) in patients in a referral neonatal intensive care unit (NICU). Study design: We performed a nested case control study of all NICU patients with urine cultures obtained as part of late-onset sepsis evaluations from January 1, 2007 through December 31, 2007 (N = 266). Clinical factors and laboratory results were compared between subjects with positive urine cultures (cases, N = 27) and randomly selected subjects with negative cultures (controls, N = 54). Results: Cases were significantly older than controls at the time of urine culture (75 days vs. 29 days, p = 0.003). Maximal peripheral white blood cell (WBC) count and C-reactive protein (CRP) did not differ between cases and controls. Only 24% of cases had a simultaneously positive blood culture. In multivariable analysis, only increased chronological age was statistically associated with a positive culture (OR 3.02, 95% CI 1.09, 8.39). Conclusion: Limited clinical factors exist to identify NICU patients at increased risk for UTI. Peripheral WBC count and CRP do not help discriminate between patients with and without UTI. Clinicians should evaluate chronologically older NICU patients for infection like other young infants, including a urine culture, to adequately identify potential sources of infection.
Magnetic resonance imaging versus ultrasound at early post-term age in brain imaging of preterm infants
Authors: Petropoulou C. , Bouza H. , Nikas I. , Chrousos G. , Anagnostakou M. , Gouliamos A. , Alexopoulou E.
Published: December 2019

Objective: To compare the incidence of brain lesions detected on cranial ultrasonography (US) and magnetic resonance imaging (MRI) at early post-term age in a group of preterm infants. Subjects and methods: In this prospective study, entry criteria were very preterm infants with birth weight ≤1250 g or gestational age ≤30 weeks, or brain lesions on early US scan. 73 neonates were included in the study. All infants underwent sequential cranial US scans and an US and MRI scan at early post-term age. Results: Abnormal US and MR findings were detected in 53.4% and 84.9% of neonates respectively. US underestimated the diffuse white matter damage shown in 6.9% and on MRI in 26.4% of neonates, the increase of the subarachnoid space shown on US in 19.2% and on MRI in 43.1% of neonates and thinning of the corpus callosum detected on US in only 5.5% and on MRI in 27.4% of neonates. MRI was the only method to detect abnormalities in the posterior fossa, basal ganglia, cortex and the posterior limb of the internal capsule. US detected with high sensitivity the presence of cystic periventricular leukomalacia, ventricular enlargement, persistent germinal matrix/intraventricular hemorrhage and porencephalic cyst as a result of periventricular hemorrhagic infraction. Conclusion: MRI offers more complete visualization of brain lesions in preterm neonates and is more informative in regard to diagnosis. Follow up assessment of these neonates is needed to show the relationship to neurodevelopment outcome.
A rare association: Sirenomelia with adrenalomegaly in an infant of diabetic mother
Authors: Ozturk M.A. , Bastug O. , Halis H. , Korkmaz L. , Memur S. , Sarici D. , Kara A.
Published: December 2019

Sirenomelia or the Mermaid syndrome is a rare congenital anomaly with an incidence of one in 60,000 to 70,000 pregnancies. Sirenomelia is characterized by complete fusion of the lower limbs, commonly associated with renal agenesis, absent external genitalia and other gastrointestinal defects. A 37-week, 3040-g infant was born to a 35-year-old multigravida mother with type 2 diabetes mellitus and hyperlipidemia. To our knowledge, this is the first case of sirenomelia with adrenalomegaly.
Implementation of a simple method to measure total umbilical cord length
Authors: Olaya-C M. , Silva J.L. , Bernal J.E.
Published: December 2019

INTRODUCTION: Umbilical cord (UC) alterations are involved in fetal and neonatal complications, and even deaths. Abnormal length has been recognized as the most important UC feature linked to unfavorable results. However, how can the UC be accurately measured in cases in which there is an overriding need for intravenous intervention, urgent lab samples or segments for stem cell cultivation? METHODS: We performed an observational study to describe our UC length measurement method at the San Ignacio University Hospital (HUSI). RESULTS: All HUSI obstetricians and pediatricians accepted the new rapid cord measurement method; no delays were reported for either maternal or neonatal care. CONCLUSIONS: In light of the association of abnormal UC length to complications, we recommend that complete UC length data be registered. Our new and rapid method allows for any UC intervention to be performed, while at the same time, providing precise UC length data under all circumstances.
Quiescent variability of cerebral, renal, and splanchnic regional tissue oxygenation in very low birth weight neonates
Authors: Mintzer J.P. , Parvez B. , Chelala M. , Alpan G. , LaGamma E.F.
Published: December 2019

OBJECTIVE: In extremely premature neonates, data concerning the normal baseline variability of near-infrared spectroscopy (NIRS)-derived regional oxygen saturation (rSO2) are lacking. We sought to determine: 1) the quiescent variability of cerebral, renal, and splanchnic rSO2 in clinically stable, undisturbed very low birth weight neonates and 2) the effects of different data averaging epochs on site-specific variability. STUDY DESIGN: In this prospective, observational study, neonates between 500 and 1250 g underwent seven days of continuous, real-time cerebral, renal, and splanchnic NIRS monitoring starting within the first seventy-two postnatal hours. Demographic, cardiopulmonary, bedside care, and rSO2 data were collected. rSO2 variability was analyzed utilizing data from quiescent periods identified using pre-specified stability criteria. Between- and within-monitoring site comparisons of data averaging methods were made utilizing ANOVA. RESULT: Twenty-four subjects (GA 27 ± 0.3 wk, birth weight 988 ± 34 g; mean ± SEM) were monitored. Coefficients of variation (CoVar = SD/mean) were calculated for each monitoring site using varied data averaging epochs. CoVar was lowest for cerebral, intermediate for renal, and highest for splanchnic rSO2 (P < 0.01). For renal and splanchnic sites, shorter epochs (5- and 15-min) resulted in significantly smaller CoVars [P < 0.01 and P < 0.05, respectively]. Splanchnic variability was highly dependent on epoch length, ranging from 16% over 5 min to 23% over 60 min. CONCLUSION: 1) rSO2 variability differs significantly between monitoring sites and 2) shorter data sampling epochs decrease rSO2 variability. These observations may assist clinicians in operationally defining minimally significant departures to enable medical decision making utilizing this monitoring technique.
Humidified high flow nasal cannula for respiratory support in	infants
Authors: Kilani Ramzi A.
Published: December 2019

Humidified high flow nasal cannula (HHFNC) has been suggested as an alternative form of respiratory support for preterm infants with apnea, respiratory distress syndrome or chronic lung disease, they appear to be easy to apply and care for. Although, HHFNC may provide positive end-expiratory pressure (PEEP), limited evidence is available to support the specific role, efficacy, and safety of HHFNC in newborns. The evidence suggests that HHFNC provides inconsistent and relatively unpredictable positive airway pressure, but may be effective in the treatment of some neonatal respiratory conditions while being more user-friendly for caregivers than conventional nCPAP. Caution should be exercised in the use of HHFNC in neonates until further evidence is available to clearly delineate its role and support its safety and efficacy. The current controversy and the available data regarding the use of HHFNC in providing noninvasive respiratory support in newborn infants are reviewed and presented herein.
A case of placental chorioangiomatosis and frontal horn cystic	lesions. Can frontal horn cysts be symptomatic?
Authors: Devarahally Sharadashree R. , Parmar Hemant , Schumacher Robert E. , Lieberman Richard W. , Sarkar Subrata , Barks John D. E.
Published: December 2019

Chorioangioma is a benign growth of the placenta. Diffuse placental chorioangioma is termed as chorioangiomatosis. We report a case of placental chorioangiomatosis with hydrops fetalis and frontal horn cystic lesions. Frontal horn cystic lesions are considered as benign lesions. Contrary to expectations, this neonate with frontal horn cysts developed seizures at 2~months of age.
Riga-Fede disease: A case report
Authors: Mathew Philips , Austin Ravi David , Ramya K.
Published: December 2019

Riga-Fede disease is a rare condition characterized by traumatic ulceration occurring on the ventral surface of the tongue of neonates and infants. It is most often associated with natal and neonatal teeth in newborns but may also occur in older infants after eruption of primary lower incisors. It is important to diagnose the lesion early and treat it by eliminating the cause of trauma to avoid untoward complications. Here we report a case of a thirty-three day old female baby with Riga-Fede disease associated with a natal tooth. After extraction of the mobile natal tooth, the ulcerative lesion healed satisfactorily in four days.
Pasteurized donor human milk for VLBW infants: The effect on	necrotizing enterocolitis and related factors
Authors: Bishop Christine E. , Vasquez Margarita M. , Petershack Jean A. , Blanco Cynthia L.
Published: December 2019

Objective: Necrotizing enterocolitis (NEC) causes significant morbidity and mortality in very low birth weight (VLBW) infants. Our objective was to assess the influence of pasteurized donor human milk (PDHM) on the incidence of NEC.

Methods: This is a retrospective chart review of 179 VLBW (< 1500 g) infants born in the pre-PDHM era (January 2001–March 2003) vs 152 born in the post-PDHM era (April 2003–December 2004).

Results: The cohorts had similar demographic characteristics. The overall incidence of NEC was 12% in the pre-PDHM era vs 10% in the post-PDHM. Although not statistically significant, surgical NEC decreased from 7% to 3% respectively. Sepsis decreased from 10% to 6% between the pre and post-PDHM eras (p=0.04). Erythropoietin administration for anemia of prematurity was associated with a protective effect for NEC, even after adjusting for gestational age, indomethacin and mother's own milk intake (OR 0.37, 95% CI 0.16–0.85, p=0.02). The introduction of PDHM did not decrease the amount of mother's own milk use.

Conclusions: The overall incidence of NEC remained unchanged after the introduction of PDHM in a single neonatal intensive care unit, but the cases of surgical NEC had a trend to decrease. Randomized controlled clinical studies evaluating the effect of PDHM on the severity of NEC are warranted.
Electroencephalogram changes in a neonate following maternal fluoxetine use during the third trimester of pregnancy
Authors: McCall K. , Patel N.
Published: December 2019

A term infant developed seizure activity, irritability, jitteriness, hypertonia and irregular breathing after delivery, following maternal fluoxetine use during the third trimester of pregnancy. An electroencephalogram (EEG) demonstrated changes consistent with mild cerebral dysfunction. Adverse neurological signs in the newborn infant following third trimester selective serotonin reuptake inhibitor (SSRI) exposure have been previously reported. This is the first report of directly observed changes in cerebral function at EEG. This finding has implications for the treatment of depression in pregnancy and neurological follow-up of infants exposed to SSRIs in-utero.
Eosinophilic pustular folliculitis in a premature infant: Case report and literature review
Authors: Smyth D. , Al Awad E. Hamdan , Akierman A. , Remington T. , Barber D. , Vayalumkal J.
Published: December 2019

A 10 week old preterm infant was noted to have a vesiculo-pustular eruption on the face and scalp with an erythematous base. Initially the lesions were thought to be secondary to herpes simplex virus infection. However, skin biopsy confirmed the diagnosis of eosinophilic pustular folliculitis (EPF). This idiopathic skin disorder is rarely seen in neonates. To our knowledge this is the first reported case of EPF in a preterm infant.
Neonatal pertussis complicated by apnea with favorable outcome
Authors: Ooi Y.K. , Rais-Bahrami K.
Published: December 2019

Pertussis, or whooping cough, is a severe infection when affecting young children. Infants in the neonatal period are especially vulnerable, since they have not received vaccination, and have an immature immune system. We report a case of a neonate who was diagnosed with pertussis complicated by multiple episodes of apneas, bradycardia and desaturation events. The infant was critically ill and was admitted to the Neonatal Intensive Care Unit, but subsequently improved while receiving only conventional respiratory support and was discharged home with an overall good outcome.
A randomized controlled trial on early versus late minimal enteral feeding in preterm growth-restricted neonates with abnormal antenatal Doppler studies
Authors: Abdelmaaboud M. , Mohammed A.
Published: December 2019

Background: Preterm and growth-restricted babies are at high risk of milk intolerance and necrotizing enterocolitis (NEC). Currently, there is a lack of published literature on ideal feeding practices for this study population. Objective: To evaluate the effects of an “early” enteral feeding regimen at the start of day 2 after birth compared to late enteral feeding and at the start of day 6 after birth in preterm growth restricted babies with abnormal antenatal Doppler studies regarding the incidence of NEC and feeding intolerance. Patients and methods: Babies with gestational age below 37 weeks and birth weight below the 10th percentile for gestational age, were randomly allocated to an “early” or “late” enteral feeding regimen. Feeds were gradually increased using a feeding protocol used in Neonatal Intensive Care Unit, Women's Hospital, Hamad Medical Corporation. Results: Maternal demographic data as well as cases of NEC and feeding intolerance were all recorded. One hundred twenty-five infants were enrolled in the study: 62 received early feeding and 63 received delayed feeding. The incidence of NEC and feeding intolerance were not significantly different between the two groups. Birth weight was an independent risk factor for NEC in both groups. Conclusion: Early minimal enteral feeding (MEF) of preterm and small for gestational age infants with abnormal antenatal Doppler findings may not have a significant effect on the incidence of NEC or feeding intolerance. Furthermore, birth weight seems to be an independent risk factor for the development of NEC, regardless of the timing of MEF introduction.
Relationship between diffusion-tensor fractional anisotropy and long-term outcome in patients with hemiparesis after intracerebral hemorrhage
Authors: Koyama Tetsuo , Marumoto Kohei , Miyake Hiroji , Ohmura Takehisa , Domen Kazuhisa
Published: December 2019

We assessed the relationship between fractional anisotropy (FA) values of magnetic resonance–diffusion tensor imaging (DTI) and long-term outcome (3–7 months after onset) in patients with hemiparesis after intracerebral hemorrhage ( N = 12). DTI data were obtained on days 14–18. FA values within the cerebral peduncle were analyzed using a computer-automated method. Motor outcome of hemiparesis was evaluated using Brunnstrom stage (six-point scale: severe to normal) for separate shoulder/elbow/forearm, wrist/hand, and lower extremity functions when patients were discharged from a long-term rehabilitation facility 3–7 months after onset. In addition, the motor component of the functional independence measure (FIM-motor) was scored. The ratio of FA values in the affected hemisphere to those in the unaffected hemisphere (rFA) was assessed in relation to the clinical data (Spearman's rank correlation test, P < 0.05). Analysis revealed a statistically significant relationship between rFA and upper extremity function ( R = 0.863 for shoulder/elbow/forearm; 0.834 for wrist/hand). Although statistically significant, the relationship between rFA and lower extremity function was less evident ( R = 0.609). In contrast, analysis of rFA and FIM-motor scores did not reveal statistical significance. FA values within the cerebral peduncle are tightly associated with long-term outcomes of upper extremity function.
The effect of gym training on multiple outcomes in Parkinson's disease: A pilot randomised waiting-list controlled trial
Authors: Poliakoff Ellen , Galpin Adam J. , McDonald Kathryn , Kellett Mark , Dick Jeremy P.R. , Hayes Sue , Wearden Alison J.
Published: December 2019

There is accumulating evidence for the benefits of exercise in Parkinson's disease (PD), but less is known about group exercise interventions. We evaluated the effect of gym-training programme on people with PD. Thirty-two adults with mild to moderate PD, not currently exercising formally, were randomised to an immediate 20-week biweekly gym training programme at a local leisure complex, or a 10-week programme starting 10 weeks later. Assessments at baseline (T1), 10 weeks (T2) and 20 weeks (T3) included reaction time, motor performance (UPDRS), quality of life and illness perceptions. Experiences of the programme were assessed via questionnaire and a focus group. Overall UPDRS motor function score did not change over time. However, gym training was associated with significant improvements in reaction times and some timed tests in the immediate training group (T1-T2). The delayed group showed similar improvements following gym training (T2-T3). Participants reported enjoyment, obtaining social benefits, and increased confidence. However, the questionnaire measures did not show improvements in subjective health ratings or illness perceptions. Although benefits were not apparent in the questionnaire measures or overall UPDRS scores, our findings suggest that a 10-week gym training programme in a community setting can provide some benefits for people with PD.
Study of accent-based music speech protocol development for improving voice problems in stroke patients with mixed dysarthria
Authors: Kim Soo Ji , Jo Uiri
Published: December 2019

Based on the anatomical and functional commonality between singing and speech, various types of musical elements have been employed in music therapy research for speech rehabilitation. This study was to develop an accent-based music speech protocol to address voice problems of stroke patients with mixed dysarthria. Subjects were 6 stroke patients with mixed dysarthria and they received individual music therapy sessions. Each session was conducted for 30 minutes and 12 sessions including pre- and post-test were administered for each patient. For examining the protocol efficacy, the measures of maximum phonation time (MPT), fundamental frequency (F0), average intensity (dB), jitter, shimmer, noise to harmonics ratio (NHR), and diadochokinesis (DDK) were compared between pre and post-test and analyzed with a paired sample t-test. The results showed that the measures of MPT, F0, dB, and sequential motion rates (SMR) were significantly increased after administering the protocol. Also, there were statistically significant differences in the measures of shimmer, and alternating motion rates (AMR) of the syllable /Kə/ between pre- and post-test. The results indicated that the accent-based music speech protocol may improve speech motor coordination including respiration, phonation, articulation, resonance, and prosody of patients with dysarthria. This suggests the possibility of utilizing the music speech protocol to maximize immediate treatment effects in the course of a long-term treatment for patients with dysarthria.
The effect of transcranial direct current stimulation on the motor suppression in stop-signal task
Authors: Kwon Jung Won , Nam Seok Hyun , Lee Na Kyung , Son Sung Min , Choi Yong Won , Kim Chung Sun
Published: December 2019

Purpose:

This study examined whether transcranial direct current stimulation (tDCS) of the primary motor cortex alters the response time in motor suppression using the stop-signal task (SST).

Methods:

Forty healthy subjects were enrolled in this study. The subjects were assigned randomly to either the tDCS condition or sham control condition. All subjects performed a stop-signal task in three consecutive phases: without, during or after the delivery of anodal tDCS on the primary motor cortex (the pre-tDCS motor phase, on-tDCS motor phase, and after-tDCS motor phase).

Results:

The response times of the stopping process were significantly lower in each SST motor phase during or after tDCS ( p < 0.05) and shorter immediately during delivery of the tDCS, whereas there was no change after the delivery of tDCS compared to sham condition. In contrast, the response times of the going process were similar under the two conditions ( p > 0.05). No subjects complained of any adverse symptoms or signs.

Conclusion:

Anodal tDCS enhances voluntary going and stopping of movement in executive control. tDCS appears to be an effective modality to modulate motor suppression and its related dynamic behavioral changes in motor sequential learning.
Motor recovery by improvement of limb-kinetic apraxia in a chronic stroke patient
Authors: Jang Sung Ho
Published: December 2019

Objectives:

We report on a chronic stroke patient who showed motor recovery by improvement of limb-kinetic apraxia (LKA) after undergoing intensive rehabilitation for a period of one month, which was demonstrated by diffusion tensor tractography (DTT) and transcranial magnetic stimulation (TMS).

Methods:

A 50-year-old male patient presented with severe paralysis of the left extremities at the onset of thalamic hemorrhage. At thirty months after onset, the patient exhibited moderate weakness of his left upper and lower extremities. In addition, he exhibited a slow, clumsy, and mutilated movement pattern during grasp-release movements of his left hand. During a one-month period of intensive rehabilitation, which was started at thrity months after onset, the patient showed 22% motor recovery of the left extremities. The slow, clumsy, and mutilated movement pattern of the left hand almost disappeared.

Results:

DTTs of the corticospinal tract (CST) in both hemispheres originated from the cerebral cortex, including the primary motor cortex, and passed along the known CST pathway. The DTT of the right CST was located anterior to the old hemorrhagic lesion. TMS study performed at thirty and thirty-one months after onset showed normal and similar findings for motor evoked potential in terms of latency and amplitude of the left hand muscle.

Conclusions:

We think that the motor weakness of the left extremities in this patient was mainly ascribed to LKA and that most of the motor recovery during a one-month period of rehabilitation was attributed to improvement of LKA.
Visual stimulations' critical period in infants with perinatal brain damage
Authors: Alimović Sonja , Katušić Ana , Mejaški-Bošnjak Vlatka
Published: December 2019

Background:

Children with perinatal brain damage have a high prevalence of visual impairment. Stimulation of vision at a critical period can encourage brain plasticity and the recovery of impaired function.

Objective:

The aim of our study was to investigate when is the critical period for visual stimulation in children with perinatal brain damage.

Methods:

We compared 35 children within the first eight months of life (median age = 4 months) to 35 children aged between eight and thirty months (median age = 15 months), all with perinatal brain damage. All the children were attending an early intervention program at Mali dom, Zagreb, a rehabilitation centre for children with visual impairment. We compared the results from baseline and follow-up assessments of visual functions (grating acuity and contrast sensitivity). We also compared differences in change scores between the two groups.

Results:

Our results have shown that children who commence a visual stimulation program within the first eight months of life had more improvement in both visual functions. This improvement is statistically significant in visual acuity (p = 0.048).

Conclusions:

These results indicate the importance of starting a visual stimulation program within the first eight months after birth.
Using multiple views of family dynamics to predict the mental health of individuals with TBI and their caregivers in Mexico
Authors: Stevens Lillian F. , Perrin Paul B. , Hubbard Rebecca , Díaz Sosa Dulce María , Espinosa Jove Irma Guadalupe , Arango-Lasprilla Juan Carlos
Published: December 2019

Purpose:

To examine differences in ratings of family dynamics between individuals with traumatic brain injury (TBI) and their family caregivers in Mexico, as well as differences in the prediction of caregiver and patient mental health outcomes from those ratings.

Method:

Forty-two patient-caregiver dyads (n = 84) from the National Institute of Rehabilitation in México City participated in a comprehensive evaluation of their family dynamics and mental health.

Results:

Patients' and caregivers' ratings of family dynamics were significantly correlated and did not differ across five of six types of family dynamics, but caregivers rated their family's level of empathy higher than patients, p < 0.001. Additionally, all patient and caregiver ratings of family dynamics were significantly correlated. Patients', caregivers', and combined (using structural equation modeling latent constructs) ratings of family dynamics robustly predicted four times as many caregiver mental health outcomes as patient mental health outcomes.

Conclusions:

Family dynamics influence both TBI patient and caregiver mental health but much more so in caregivers. Research on families of individuals with TBI in Mexico should incorporate both patient and caregiver perspectives to more comprehensively depict the environment in which TBI rehabilitation occurs.
Selective use of low frequency stimulation in Parkinson's disease based on absence of tremor
Authors: Stegemöller Elizabeth L. , Vallabhajosula Srikant , Haq Ihtsham , Hwynn Nelson , Hass Chris J. , Okun Michael S.
Published: December 2019

Background:

High frequency stimulation (HFS) of the subthalamic nucleus is one of the most effective treatments for advanced Parkinson's disease (PD). HFS has provided beneficial improvements in the cardinal features of PD, but has not been proven as effective for addressing the axial predominant levodopa resistant symptoms, such as speech disturbances, gait disturbances, and postural instability. Recent studies have suggested that changes in stimulation parameters may influence differing PD symptoms.

Objective:

The purpose of this study was to compare the effects of low frequency stimulation (LFS) versus HFS on the Unified Parkinson's Disease Rating Scale (UPDRS), gait, balance, and verbal fluency.

Methods:

Eight tremor dominant and nine non-tremor dominant participants with bilateral deep brain stimulation of the subthalamic nucleus were tested off stimulation, during LFS, and during HFS.

Results:

Results revealed that HFS significantly reduced UPDRS tremor score in the tremor dominant group; however no differences emerged within the non-tremor dominant group. No differences between groups or stimulation conditions were found for gait, balance, and verbal fluency measures.

Conclusion:

These results may suggest that HFS is better than LFS for reducing tremor in tremor dominant patients. However, patients with mild or no tremor show no acute differences in benefit from LFS as compared to HFS.
Long-term cortical reorganization following stroke in a single subject with severe motor impairment
Authors: Chelette Kenneth C. , Carrico Cheryl , Nichols Laurie , Sawaki Lumy
Published: December 2019

Background:

Stroke continues to be a major public health concern in the United States. Motor recovery in the post-acute stages of stroke is possible due to neuroplasticity, or the capacity of the brain to reorganize.

Objective:

This case study tracks neuroplastic and motor change in a subject with severe hemiparesis following an extensive middle cerebral artery stroke. He had absence of ipsilesional motor evoked potentials in early evaluations. This report is unique in that the duration of follow-up evaluation extends nearly 2 years, with evaluations being performed at 7, 9, 10, 13, 20, and 21 months post-stroke.

Methods:

At each evaluation we used transcranial magnetic stimulation to track neuroplastic change and the Fugl-Meyer Assessment and the Wolf Motor Function Test to evaluate upper extremity motor performance.

Results:

The contralesional hemisphere showed dynamic change throughout the study period. In contrast, the ipsilesional hemisphere demonstrated notable change only between 13 and 21 months post-stroke, with the most dramatic change occurring between 20 and 21 months post-stroke. Motor performance generally improved throughout the study period.

Conclusions:

Our findings demonstrate that substantial neuroplasticity-mediated motor recovery can occur nearly 2 years after stroke in an individual with severe post-stroke motor impairment.
A hippotherapy simulator is effective to shift weight bearing toward the affected side during gait in patients with stroke
Authors: Sung Yun-Hee , Kim Chang-Ju , Yu Byong-Kyu , Kim Kyeong-Mi
Published: December 2019

Aim:

We investigated whether a hippotherapy simulator has influence on symmetric body weight bearing during gait in patients with stroke.

Method:

Stroke patients were divided into a control group (n = 10) that received conventional rehabilitation for 60 min/day, 5 times/week for 4 weeks and an experimental group (n = 10) that used a hippotherapy simulator for 15 min/day, 5 times/week for 4 weeks after conventional rehabilitation for 45 min/day. Temporospatial gait assessed using OptoGait and trunk muscles (abdominis and erector spinae on affected side) activity evaluated using surface electromyography during sit-to-stand and gait. Prior to starting the experiment, pre-testing was performed. At the end of the 4-week intervention, we performed post-testing.

Result:

Activation of the erector spinae in the experimental group was significantly increased compared to that in the control group (p < 0.01), whereas activation of the rectus abdominis decreased during sit-to-stand. Of the gait parameters, load response, single support, total double support, and pre-swing showed significant changes in the experimental group with a hippotherapy simulator compared to control group (p < 0.05). Moreover, activation of the erector spinae and rectus abdominis in gait correlate with changes of gait parameters including load response, single support, total double support, and pre-swing in experimental group.

Conclusion:

These findings suggest that use of a hippotherapy simulator to patients with stroke can improve asymmetric weight bearing by influencing trunk muscles.
Effects of Ai-Chi on balance, functional mobility, strength and fatigue in patients with multiple sclerosis: A pilot study
Authors: Bayraktar Deniz , Guclu-Gunduz Arzu , Yazici Gokhan , Lambeck Johan , Batur-Caglayan Hale Zeynep , Irkec Ceyla , Nazliel Bijen
Published: December 2019

Background:

Multiple Sclerosis (MS) patients are often referred to aquatic physical therapy, but unfortunately, researches on the effects of aquatic therapy in MS patients are limited.

Objective:

The purpose of this study was to investigate the effects of Ai-Chi on balance, functional mobility, strength and fatigue in ambulatory patients with MS.

Methods:

Twenty-three ambulatory female patients were divided into two groups as experimental (n = 15) or control (n = 8) for an 8-week treatment program. The experimental group underwent Ai-Chi exercises in a swimming pool and the control group performed active arm and leg exercises combined with abdominal breathing exercises at home. Static standing balance was measured with duration of one-leg stance, functional mobility was evaluated with Timed-up and Go test and 6 minute walk test, upper and lower muscle strength was assessed with hand-held dynamometer and fatigue was evaluated with Fatigue Severity Scale.

Results:

Improvements were observed in static standing balance, functional mobility, upper and lower extremity muscle strength and fatigue in the Ai-Chi group (p < 0.05), but no significant differences in any outcome measures were observed in the control group (p > 0.05) after the intervention.

Conclusions:

According to these findings Ai-Chi may improve balance, functional mobility, upper and lower extremity muscle strength and fatigue in patients with MS.
Evaluation of intrarater and interrater reliability of the Wisconsin Gait Scale with using the video taped stroke patients in a Turkish sample
Authors: Yaliman A. , Kesiktas N. , Ozkaya M. , Eskiyurt N. , Erkan O. , Yilmaz E.
Published: December 2019

Objective:

To establish the intrarater and interrater reliability of Wisconsin Gait Scale (WGS) in hemiplegic patients.

Design:

Repeated-measures reliability study using video data of stroke patients.

Setting:

Rehabilitation department of the university hospital.

Participitants:

Nineteen hemiplegic patients with 3–9 months stroke history and two physiatrists and two physical therapists.

Interventions:

Video recordings were assessed twice, at an interval of 2 days, by the two physiatrists and two physical therapists.

Main outcome measure:

Wisconsin Gait Scale.

Results:

Internal consistency coefficients for the WGS were excellent; Cronbach scores were 0.91 and 0.94 for the first and third days. Coefficient of Repeatability (CR) for observers' WGS assessments were ranged between 4.23–5.76 and intraclass correlation coefficients for total WGS score were indicated very high interrater reliability at the begining and end, respectively 0.91 and 0.96. Intraclass correlation coefficients for fourteen items of WGS ranged from 0.81 to 1. “Hip hiking at mid-swing”, “Circumduction at mid-swing” and “Hip extension of the affected leg” were the items with lowest correlation coefficients. Intrarater reliability for total WGS scores ranged from 0.75 to 0.90.

Conclusion:

WGS was found excellent in reliability and may provide an objective means to document the findings from observational gait analysis, which is frequently used in clinical practice by rehabilitation teams.
Feasibility study of a combined treatment of electromyography-triggered neuromuscular stimulation and mirror therapy in stroke patients: A randomized crossover trial
Authors: Kojima Kosuke , Ikuno Koki , Morii Yuta , Tokuhisa Kentaro , Morimoto Shigeru , Shomoto Koji
Published: December 2019

Background:

Mirror therapy (MT) and electromyography-triggered neuromuscular stimulation (ETMS) are both effective treatments for impaired upper limbs following stroke. A combination of these two treatments (ETMS-MT) may result in greater gain than either treatment alone.

Objectives:

The feasibility and possible effects of ETMS-MT upon upper extremity function were investigated in stroke patients.

Methods:

Thirteen post-acute stroke patients were randomly assigned to an immediate ETMS-MT group or a delayed ETMS-MT group and then underwent an 8-week training program. The immediate ETMS-MT group received ETMS-MT in addition to physical and occupational therapy (PT+OT) for 4 weeks. They then received only PT+OT for the next 4 weeks. In the delayed ETMS-MT group, interventions were provided in the reverse order. The main outcome measure was the Fugl-Meyer Assessment (FMA).

Results:

The immediate ETMS-MT group showed significantly greater gain in FMA in the first 4 weeks. The delayed ETMS-MT group showed significantly greater gain in active range of motion during the latter 4 weeks. No adverse effects were reported following ETMS-MT.

Conclusion:

ETMS-MT might be as effective as independent MT or ETMS without causing any side effects. Future research should focus upon the direct comparisons between independent and combined interventions.
Neuroimaging and the school-based assessment of traumatic brain injury
Authors: Jantz Paul B. , Bigler Erin D.
Published: December 2019

Advanced neuroimaging contributes to a greater understanding of brain pathology following a traumatic brain injury (TBI) and has the ability to guide neurorehabilitation decisions. When integrated with the school-based psychoeducational assessment of a child with a TBI, neuroimaging can provide a different perspective when interpreting educational and behavioral variables relevant to school-based neurorehabilitation. School psychologists conducting traditional psychoeducational assessments of children with TBI seldom obtain and integrate neuroimaging, despite its availability. This article presents contextual information on the medical assessment of TBI, major types of neuroimaging, and networks of the brain. A case study illustrates the value of incorporating neuroimaging into the standard school-based psychoeducational evaluations of children with traumatic brain injury.
Cognitive dysfunction and functional limitations are associated with major depression in stroke survivors attending rehabilitation in Nigeria
Authors: Ojagbemi Akin , Akinyemi Rufus , Baiyewu Olusegun
Published: December 2019

Background:

The frequency and predictors of post-stroke depression diagnosed according to codified criteria remain unknown in Nigeria.

Objectives:

We report on the predictors of post-stroke major depressive disorder (MDD) in Nigeria using standardized assessment methods.

Method:

Using a case-control design, we consecutively recruited 260 participants. Among them were 130 stroke survivors attending rehabilitation. Along with historical details, an exploration for MDD meeting criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders was carried out using a semi-structured interview. Cognition was assessed using both the Mini Mental State Examination and the modified Indiana University Token test, while disability was assessed using the modified Rankin Scale. Associations were explored using univariate and multivariate analyses.

Results:

The diagnosis of MDD was more frequently present in the stroke survivors (41.5%, p < 0.001). It was strongly associated with female gender (p < 0.001, O.R = 3.77, 95% C.I = 1.78–8.00), disability (p = 0.001, O.R = 3.27, 95% C.I = 1.57–6.83), and cognitive dysfunction (p < 0.001, O.R = 5.28, 95% C.I = 2.25–12.41). Female gender (p = 0.037, O.R = 2.65, 95% C.I = 1.06–6.62) and cognitive dysfunction (P = 0.03, O.R = 4.58, 95% C.I = 1.68–12.46) were independent predictors of post-stroke MDD.

Conclusion:

Post stroke MDD is common in Nigerian survivors attending rehabilitation. The high rates reported in this population may be the result of factors affecting the efficient management of stroke in developing countries.
Effectiveness of a novel community exercise transition program for people with moderate to severe neurological disabilities
Authors: Ploughman Michelle , Shears Jennifer , Harris Chelsea , Hogan Stephen H. , Drodge Olivia , Squires Sherry , McCarthy Jason
Published: December 2019

Purpose:

To determine the effectiveness of a community re-integration exercise initiative on function, mood, participation, and exercise adherence for persons with moderate to severe neurological conditions (stroke, multiple sclerosis, etc.).

Methods:

We recruited 29 adults (able to walk at least 3 m with assistance) discharged from an outpatient rehabilitation program for the 10 week intervention which was comprised of two components: circuit training and guided transition to a standard gym setting. We evaluated participants before and after the intervention and at four month follow up, including functional balance and mobility using the Timed Up and Go Test, walking endurance using the 6 Minute Walk Test, health related quality of life (HR QoL) using a visual analogue scale, activity and participation using the Frenchay Activities Index and mood using the Hospital Anxiety and Depression Scale.

Results:

Twenty-seven participants completed the intervention. The only significant improvement was in HR QoL. Forty-four percent of participants continued to exercise after cessation of the program. Those who continued to exercise (Exercisers n = 12) experienced more improvement in HR QoL than Non-Exercisers (n = 15).

Conclusions:

This re-integration initiative for people with neurological impairments improved HR QoL and facilitated independent exercise for 44% of participants. The novel component of the program, which facilitated transition to standard gym equipment, likely contributed to improved exercise adherence in the longer term.
Interdisciplinary rehabilitation outcomes following thrombolysis for acute ischaemic stroke: A case series
Authors: Finch Emma , Fleming Jennifer , Clark Kathy , Hayward Kathryn S.
Published: December 2019

Background:

Thrombolysis with recombinant tissue plasminogen activator (rtPA) is part of routine acute stroke clinical practice worldwide. Yet, it is unclear how rtPA influences specific rehabilitation outcomes, such as motor, cognitive and communication function.

Objective:

The present study aimed to collect pilot data about the effects of rtPA on communication and motor recovery during the first three months post-rtPA.

Methods:

Four individuals who received thrombolysis with rtPA for a single left hemisphere ischaemic stroke completed an assessment battery two weeks and three months post-stroke. Information pertaining to allied health service usage was also investigated.

Results:

Reliable changes in assessment scores were observed for lower limb function in two participants with severe functional limitations. There was no reliable change in lower limb function for the two milder participants, or for any participants in upper limb or language function. Service usage varied between participants. Two participants required extensive inpatient rehabilitation. Three participants required outpatient or community rehabilitation.

Conclusions:

Tailoring of the service delivery approach may be required for individuals who receive rtPA based on functional limitations evident post-rtPA. Future research into the impact of rtPA on motor, cognitive and communication recovery after stroke is vital to inform rehabilitation programs and optimize outcomes.
Factors influencing interest in providing MS patient care among physiatry residents
Authors: Kane Heather , Halpern Michael T. , Teixeira-Poit Stephanie , Frost Corey , Keating Michael , Olmsted Murrey , Johnson Shana
Published: December 2019

Background:

Rehabilitation care is an important part of comprehensive care for MS patients. Little is known about the number of physiatry residents who are interested in providing care to individuals with multiple sclerosis [MS].

Objective:

This study examines factors that influence physiatry residents' interest in providing care to MS patients.

Methods:

We randomly sampled half of all Accreditation Council for Graduate Medical Education-certified physical medicine and rehabilitation residency programs in the continental United States and Puerto Rico. Surveys were received from 74% of programs (Stage 1 response rate) and from 221 residents (45% Stage 2 response rate).

Results:

Residents expressing interest in providing MS care were more likely to be female, Asian, and to select statements emphasizing multidisciplinary care approaches and a community of dedicated professional colleagues as positive features of MS patient care. Residents interested in teaching and with more education debt were marginally more likely to express interest in MS care.

Conclusions:

Medical education should emphasize the need for physical medicine and rehabilitative care among individuals with MS, the ability of physiatrists to improve the functional status and quality of life for MS patients, and the team-based nature of MS care.
The role of cognitive training in the neurorehabilitation of a patient who survived a lightning strike. A case study
Authors: Tánczos Tímea , Zádori Dénes , Jakab Katalin , Hnyilicza Zsuzsanna , Klivényi Péter , Keresztes László , Engelhardt József , Németh Dezső , Vécsei László
Published: December 2019

Background:

Lightning-related injuries most often involve impairment of the functions of the central and peripheral nervous systems, usually including cognitive dysfunctions. We evaluated the cognitive deficit of a patient who had survived a lightning strike and measured the improvement after her cognitive training. This therapeutic method appears to be a powerful tool in the neurorehabilitation treatment.

Objective:

The aim of this case study was to prove the beneficial effects of cognitive training as part of the neurorehabilitation after a lightning strike.

Methods:

Six neuropsychological functions were examined in order to test the cognitive status of the patient before and after the 2-month cognitive training: phonological short-term memory (digit span test and word repetitions test), visuo-spatial short-term memory (Corsi Block Tapping Test), working memory (backward digit span test and listening span test), executive functions (letter and semantic fluencies), language functions (non-word repetition test, Pléh-Palotás-Lörik (PPL) test and sentence repetition test) and episodic memory (Rivermead Behavioral Memory Test and Mini Mental State Examination). We also utilized these tests in aged-matched healthy individuals so as to be able to characterize the domains of the observed improvements more precisely.

Results:

The patient exhibited a considerable improvement in the backward digit span, semantic fluency, non-word repetition, PPL, sentence repetition and Rivermead Behavioral Memory tests.

Conclusions:

The cognitive training played an important role in the neurorehabilitation treatment of this lightning injury patient. It considerably improved her quality of life through the functional recovery.
Assistive technology to promote leisure and constructive engagement by two boys emerged from a minimal conscious state
Authors: Stasolla Fabrizio , De Pace Claudia
Published: December 2019

Background:

Post-coma persons with multiple disabilities may represent a challenge to rehabilitation centers, due to their clinical conditions. Moreover, they can failed to engage adaptive responses aimed at the self-management of environmental stimuli.

Objectives:

To assess the impact and social rating of a new assistive technology set-up for promoting constructive engagement by two post-coma boys emerged from a minimal conscious state.

Method:

During baseline sessions, the participants were provided with a mouse to manage the computer system. During intervention phases, a new technology was implemented, allowing both participants to manage environmental stimuli with a microswitch instead of the mouse. Furthermore, a social validation assessment was carried out, involving students as raters.

Results:

Data showed an increasing of constructive engagement by both participants during intervention phases. Sixty psychology students (social raters) favoured the new technology on a six items questionnaire (i.e. enjoyment, suitability, rehabilitation, independence, daily context and support).

Conclusions:

The new technology was suitable, affordable, effective and socially preferable.