Study Protocol: Multimodal Longitudinal Assessment of Infant Brain Organization and Recovery in Perinatal Brain Injury.

PURPOSE: Perinatal brain injury is a primary cause of cerebral palsy, a condition resulting in lifelong motor impairment. Infancy is an important period of motor system development, including development of the corticospinal tract (CST), the primary pathway for cortical movement control. The interaction between perinatal stroke recovery, CST organization, and resultant motor outcome in infants is not well understood. METHODS: Here, we present a protocol for multimodal longitudinal assessment of brain development and motor function following perinatal brain injury using transcranial magnetic stimulation and magnetic resonance imaging to noninvasively measure CST functional and structural integrity across multiple time points in infants 3 to 24 months of age. We will further assess the association between cortical excitability, integrity, and motor function. DISCUSSION: This protocol will identify bioindicators of motor outcome and neuroplasticity and subsequently inform early detection, diagnosis, and intervention strategies for infants with perinatal stroke, brain bleeds, and related diagnoses.

Electronic reminding technology following traumatic brain injury: effects on timely task completion.

OBJECTIVE: To determine whether automated reminders from 2 contemporary personal digital assistant (PDA) devices produce higher rates of timely task completion in people with traumatic brain injury (TBI). SETTING: Outpatient and community rehabilitation settings. PARTICIPANTS: Thirty-six adults aged 18 to 66 years with TBI and self-determined complaints of memory impairment. MEASURES: Timely completion rates for assigned memory tasks under 4 randomly assigned memory aid conditions. RESULTS: Significantly, higher completion rates were found when using either PDA device when compared with a combined baseline and paper memory aid condition (for Palm OS device, Incidence Rate Ratio [IRR] = 2.14, P < .0005, CI [confidence interval] = 1.77-2.59; for Microsoft Pocket PC OS device, IRR = 1.47, P < .001, CI = 1.18-1.82). A significant difference in completion rates was also found between the 2 PDA devices (IRR = 1.46, P < .0005, CI = 1.26-1.70), with the Palm version producing the better scores. CONCLUSIONS: Substantially higher rates of task completion (more than double in some cases) when using either PDA device suggest that rehabilitation clinicians can make productive use of PDA-based memory aids in their TBI patient populations. The strength of the effects of PDA device usage argues for further investigation of the impact of device usage on quality-of-life and costs of care, and of personal and caregiver factors predictive of successful and sustained device usage.

Practical applications for use of PDAs and smartphones with children and adolescents who have traumatic brain injury.

It is often recommended that individuals with memory and organizational problems after a traumatic brain injury (TBI) use some type of memory device such as a paper calendar. Recently the use of electronic devices has been suggested. This article outlines data obtained from in vivo trials using personal data assistants (PDAs) and follow up in depth studies with PDAs and smartphones. These trials were conducted with individuals who had memory and organizational problems as a result of cognitive disorders of traumatic brain injury (TBI) or intellectual disability (ID) Results indicate that the use of electronic devices can enhance independent behavior. Factors influencing success include: student motivation, audible beep of the device; support for programming and troubleshooting, alterations of functions; and selection of features to motivate. Based on the result of the studies, an intervention plan for use of PDAs was developed for use by clinicians.

Effect of a hip flexor-stretching program on gait in the elderly.

OBJECTIVES: To test whether a reduction in peak hip extension during the terminal stance phase of walking in elderly compared with young adult subjects represents a hip flexor contracture impairment rather than some dynamic consequence and to test the hypothesis that stretching the hip flexors improves both static and dynamic peak hip extension, as well as other age-related gait changes about the ankle. DESIGN: A double-blinded, randomized, controlled trial. SETTING: Stretching exercises were performed in the subjects' homes. Pre- and postassessments were performed in a gait laboratory. PARTICIPANTS: Ninety-six healthy elderly individuals in 2 groups: treatment (n=47) and control (n=49). INTERVENTION: The treatment group received a 1-time instruction in hip flexor stretching, whereas the control group received a 1-time instruction in shoulder abductor stretching. Participants in each group were asked to perform stretching exercises on their own twice daily for 10 weeks. MAIN OUTCOME MEASURES: Static and dynamic peak hip extension, peak anterior pelvic tilt, and other peak kinematic and kinetic variables during the gait cycle. RESULTS: There was a modest improvement in static peak hip extension as measured by a goniometer within the treatment group (mean +/- standard deviation, 6.1 degrees +/-2.5 degrees to 7.7 degrees +/-3.6 degrees, P=.032) compared with no change in the control group. At comfortable walking speed, dynamic hip extension tended to increase in the treatment group (5.1 degrees +/-9.7 degrees to 7.1 degrees +/-8.0 degrees, P=.103) compared with no real change in the control group (5.3 degrees +/-8.9 degrees to 5.4 degrees +/-7.5 degrees, P=.928). Similarly, at fast walking speed, dynamic hip extension tended to increase in the treatment group (6.4 degrees +/-9.8 degrees to 8.4 degrees +/-8.0 degrees, P=.093) compared with no change in the control group. Changes in ankle kinematics and kinetics included a significant improvement in peak ankle plantarflexion and a tendency to improved ankle power generation. CONCLUSION: The static and dynamic trends to improvement in peak hip extension were of similar magnitude, suggesting that age-related reduction in peak hip extension during gait is the result of a static hip flexion contracture rather than a dynamic consequence. Additionally, age-related changes in ankle kinematics and kinetics may be secondarily related to hip flexion contracture impairment rather than impairment at the ankle per se. This study was limited by the exercises being unsupervised and relying on 1-time instruction. A more rigorous and supervised hip flexor-stretching exercise program may yield more substantial improvements in gait parameters.