Remarkable Recovery After Severe Gunshot Brain Injury: A Comprehensive Case Study of Functional Rehabilitation.

BACKGROUND Penetrating traumatic brain injury (TBI) caused by gunshots is a rare type of TBI that leads to poor outcomes and high mortality rates. Conducting a formal neuropsychological evaluation concerning a patient's neurologic status during the chronic recovery phase can be challenging. Furthermore, the clinical assessment of survivors of penetrating TBI has not been adequately documented in the available literature. Severe TBI in patients can provide valuable information about the functional significance of the damaged brain regions. This information can help inform our understanding of the brain's intricate neural network. CASE REPORT We present a case of a 29-year-old right-handed man who sustained a left-hemisphere TBI after a gunshot, causing extensive diffuse damage to the left cerebral and cerebellar hemispheres, mainly sparing the right hemisphere. The patient survived. The patient experienced spastic right-sided hemiplegia, facial hemiparesis, left hemiparesis, and right hemianopsia. Additionally, he had severe global aphasia, which caused difficulty comprehending verbal commands and recognizing printed letters or words within his visual field. However, his spontaneous facial expressions indicating emotions were preserved. The patient received a thorough neuropsychological assessment to evaluate his functional progress following a severe TBI and is deemed to have had a favorable outcome. CONCLUSIONS Research on cognitive function recovery following loss of the right cerebral hemisphere typically focuses on pediatric populations undergoing elective surgery to treat severe neurological disorders. In this rare instance of a favorable outcome, we assessed the capacity of the fully developed right hemisphere to sustain cognitive and emotional abilities, such as language.

Constraint-Induced Movement Therapy Promotes Myelin Remodeling and Motor Function by Mediating Sox2/Fyn Signals in Rats With Hemiplegic Cerebral Palsy.

OBJECTIVE: Hypoxic-ischemic brain injury in infants often leads to hemiplegic motor dysfunction. The mechanism of their motor dysfunction has been attributed to deficiencies of the transcription factor sex-determining region (SRY) box 2 (Sox2) or the non-receptor-type tyrosine kinase Fyn (involved in neuronal signal transduction), which causes a defect in myelin formation. Constraint-induced movement therapy (CIMT) following cerebral hypoxia-ischemia may stimulate myelin growth by regulating Sox2/Fyn, Ras homolog protein family A (RhoA), and rho-associated kinase 2 (ROCK2) expression levels. This study investigated how Sox2/Fyn regulates myelin remodeling following CIMT to improve motor function in rats with hemiplegic cerebral palsy (HCP). METHODS: To investigate the mechanism of Sox2 involvement in myelin growth and neural function in rats with HCP, Lentivirus (Lenti)-Sox2 adeno-associated virus and negative control-Lenti-Sox2 (LS) adeno-associated virus were injected into the lateral ventricle. The rats were divided into a control group and an HCP group with different interventions (CIMT, LS, or negative control-LS [NS] treatment), yielding the HCP, HCP plus CIMT (HCP + CIMT), HCP + LS, HCP + LS + CIMT, HCP + NS, and HCP + NS + CIMT groups. Front-limb suspension and RotaRod tests, Golgi-Cox staining, transmission electron microscopy, immunofluorescence staining, western blotting, and quantitative polymerase chain reaction experiments were used to analyze the motor function, dendrite/axon area, myelin ultrastructure, and levels of expression of oligodendrocytes and Sox2/Fyn/RhoA/ROCK2 in the motor cortex. RESULTS: The rats in the HCP + LS + CIMT group had better values for motor function, dendrite/axon area, myelin ultrastructure, oligodendrocytes, and Sox2/Fyn/RhoA/ROCK2 expression in the motor cortex than rats in the HCP and HCP + NS groups. The improvement of motor function and myelin remodeling, the expression of oligodendrocytes, and the expression of Sox2/Fyn/RhoA/ROCK2 in the HCP + LS group were similar to those in the HCP + CIMT group. CONCLUSION: CIMT might overcome RhoA/ROCK2 signaling by upregulating the transcription of Sox2 to Fyn in the brain to induce the maturation and differentiation of oligodendrocytes, thereby promoting myelin remodeling and improving motor function in rats with HCP. IMPACT: The pathway mediated by Sox2/Fyn could be a promising therapeutic target for HCP.

Evaluation of finger strength and spasticity in hemiplegic patients using hand-finger robotic device: A validity and reliability study.

We aimed to investigate the validity, reliability, and clinical relevance of Amadeo hand-finger robotic rehabilitation system measurements for evaluating spasticity and strength in hemiplegic patients. In total, 161 participants (107 hemiplegic patients and 54 sex- and age-matched healthy controls) were included in this study. Spasticity was evaluated using the Modified Ashworth Scale, hand motor functions were evaluated using the Fugl-Meyer Assessment Hand Subscale, and hand grip and pinch strength were evaluated using the Jamar hand grip and pinch dynamometer. The Amadeo (Tyromotion) hand-finger robotic rehabilitation system was used to evaluate finger spasticity and strength of the participants. A statistically significant difference was found between the median values of the Modified Ashworth Scale (both clinical and robotic evaluation results) and the mean values of hand flexor and extensor strength measured with the robotic device in patients compared to healthy subjects (P < .01). Statistically, excellent agreement was obtained between the clinical and robotic test-retest results of the scale (P < .01) (intra-class correlation coefficient, ICC = .98-.99; ICC = .98-.99, respectively). There was a statistically significant positive correlation between the clinical and robotic device results of the Modified Ashworth Scale (r = .72; P < .01). There was a statistically significant positive correlation between the hand strength values measured with the robotic device, Jamar grip, pinch, and Fugl-Meyer Assessment Hand Subscale scores (P < .01) in the patient group. Hand finger spasticity and strength measurements of the Amadeo hand-finger robotic rehabilitation system were valid, reliable, and clinically correlated in stroke patients.

Effectiveness of physical exercise on the recovery of limb function in stroke patients / Eficácia do exercício físico na recuperação da função dos membros em pacientes com avc / Efectividad del ejercicio físico en la recuperación de la función de las extremidades en pacientes con acv

ABSTRACT Introduction Patients with cerebrovascular accident and hemiplegia need to perform physical exercise and aerobic training, but physical dysfunction restricts the performance of these activities. Objective The article aims to develop physical strength sports for stroke patients with hemiplegia to explore the efficacy of sports to regain limb function in these patients. Methods We randomly selected 30 patients with stroke sequelae and divided them into control and exercise groups. While undergoing rehab, the exercise group performed a certain amount of aerobic exercise. During this period, we compared the relevant physiological indicators of the patients, and, at the same time, we used the Fugle-Meyer motor function scoring method to assess limb function. Results The two groups of patients are significantly different regarding the recovery of physical function and the capacity for daily life. Physiological indicators of patients are also different. Conclusion Low-intensity aerobic exercise can help stroke and hemiplegia patients regain their basic ability to live and exercise. Level of evidence II; Therapeutic studies: investigation of treatment results.

RESUMO Introdução É muito importante que pacientes com acidente vascular encefálico e hemiplegia realizem exercícios físicos e treinamento aeróbio, mas a disfunção física restringe a realização dessas atividades. Objetivo o artigo tem como objetivo desenvolver esportes de força física para pacientes com AVC com hemiplegia para explorar a eficácia dos esportes para recuperar a função dos membros nesses pacientes. Métodos Selecionamos aleatoriamente 30 pacientes com sequela de AVC e os dividimos em grupos controle e exercício. Durante a reabilitação, o grupo de exercícios realmente executou uma certa quantidade de exercícios aeróbicos. Durante esse período, comparamos os indicadores fisiológicos relevantes dos pacientes e, ao mesmo tempo, usamos o método de pontuação da função motora de Fugle-Meyer para avaliar a função dos membros. Resultados Os dois grupos de pacientes são significativamente diferentes em termos de recuperação da função física e capacidade para a vida diária. Os indicadores fisiológicos dos pacientes também são diferentes. Conclusão O exercício aeróbico de baixa intensidade pode ajudar os pacientes com derrame e hemiplegia a recuperar sua capacidade básica de viver e se exercitar. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción Es muy importante para los pacientes con accidente cerebrovascular y hemiplejía realizar ejercicio físico y entrenamiento aeróbico, pero la disfunción física restringe la realización estas actividades.Objeto: El artículo tiene como objetivo desarrollar deportes de fuerza física para pacientes con accidente cerebrovascular con hemiplejía para explorar la eficacia de los deportes para recuperar la función de las extremidades de estos pacientes. Métodos Seleccionamos aleatoriamente a 30 pacientes con secuelas por accidente cerebrovascular y los dividimos en grupos de control y de ejercicio. Mientras se sometía a rehabilitación, el grupo de ejercicio llegó a realizar una cierta cantidad de ejercicio aeróbico. Durante este período, comparamos los indicadores fisiológicos relevantes de los pacientes y, al mismo tiempo, utilizamos el método de puntuación de la función motora de Fugle-Meyer para evaluar la función de las extremidades. Resultados Los dos grupos de pacientes son significativamente diferentes en cuanto a la recuperación de la función física y la capacidad para la vida diaria. Los indicadores fisiológicos de los pacientes también son diferentes. Conclusión El ejercicio aeróbico de baja intensidad puede ayudar a los pacientes con accidente cerebrovascular y hemiplejía a recuperar su capacidad básica de vida y ejercicio. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Risk factors for long-term care after hemiplegia from cancer-related brain surgery: a pilot study for new prediction model.

BACKGROUND: Hemiplegia is a worldwide-represented neurological condition leading to long-term disability. The most common cause of hemiplegia is stroke; 25% to 50% of stroke survivors require some assistance after hospital discharge; approximately half of them become dependent, while only 14% achieve full recovery of activities of daily living (ADL). Cancer and cancer-related surgery are other causes of hemiplegia and rehabilitation in cancer patients has been recognized as important factor in order to help maintaining quality of life as long as possible. Many studies have been done in order to assess a reliable prediction about outcome of hemiplegia from stroke, but outcome prediction for cancer-related hemiplegia still remains a challenge and no clinical prediction tool has been developed being better than physician's informal prediction. AIM: Aim of this pilot study was: a) to detect risk factors associated with need for long-term care for patients suffering from hemiplegia due to cancer-related brain surgery, b) to build an algorithm-based model from detected risk factors in order to predict the need for long-term care after rehabilitation 3) to assess the feasibility of a subsequent study on a larger sample of subjects, in order to validate of the model. The subsequent study will be considered feasible if the model developed by the pilot study will be able to correctly predict more than 85% of patients needing or not long-term care after rehabilitation. DESIGN: Observational retrospective study. SETTING: Neurorehabilitation Unit. POPULATION: Inpatients affected by hemiplegia due to cancer-related surgery. METHODS: The observational retrospective study involved 158 subjects affected by hemiplegia due to cancer-related brain surgery. All of the subjects underwent rehabilitation therapy, while radio /chemotherapy was administered if needed. Stroke prognostic factors and other clinical variables were recorded for all subjects. The endpoint variable was Functional Independence Measure (FIM®) Score at discharge after rehabilitation. Variables were then associated with patient's FIM Score <61 at discharge after rehabilitation, as predictor of long-term care at home. RESULTS: After statistical evaluation, age, comorbidity Charlson Index >3, complete absence of motricity of the affected limbs, hypoesthesia, trunk-control deficit, dysphagia, language disorder, urinary or fecal incontinence were found to be risk factors for FIM Score <61 at discharge. From detected factors an algorithm-based model was built in order to estimate patient's overall probability to need or not an intensive long-term care after rehabilitation. CONCLUSIONS: The model developed by the pilot study allowed correct positive or negative prediction for long-term care need after rehabilitation for 90.6% of the patients suffering from cancer-related hemiplegia. A subsequent study on a larger sample of subjects resulted therefore feasible because overall correct prediction was higher than 85%. CLINICAL REHABILITATION IMPACT: Risk factors for intensive care at home (complete absence of motricity of affected limbs, trunk control deficit, fecal incontinence, dysphagia and comorbidity Charlson Index >3) can be useful to evaluate patients suffering from hemiplegia due to cancer-related brain surgery, at admission into Rehabilitation Unit. The algorithm-based model seems to be a promising tool to estimate the probability of intensive home care for that type of hemiplegic patients.

Long-term effects on body functions, activity and participation of hemiplegic patients in equino varus foot deformity surgical correction followed by immediate rehabilitation. A prospective observational study.

Background: Functional surgery is an effective approach in the treatment of the rigid equinovarus foot deformity (EVFD). This must be associated with early rehabilitation treatments (ERTs) to prevent muscle rearrangements due to immobilization. Objectives: To assess the effects of EVFD surgical correction in adult stroke patients, when assessed according to the ICF domains. Methods: Variables from 24 adult chronic stroke survivors with EVFD surgical correction followed by ERT, age 55 ± 13 years, affected side 12L/12R, time from lesion 5 ± 4 years were analyzed. Body function domain: pain (NPRS), walking speed, clinical global impression of change (cGIC). Activity domain: Rivermead Mobility Index (RMI), FAC, and 6 min walking test (6MWT). Participation domain: Walking Handicap Scale (WHS). Patients were assessed before (T0), one (T1), three (T2) and twelve (T3) months after surgery by a single assessor. Results: All variables but the 6MWT significantly improved (Wilcoxon test, p < .05) at T1 or T2 and this remained until the 12-months mark. Since T1, all patients reached and maintained a supervised independent walking (FAC≥3) and all those wearing an AFO stopped using it. The median cGCI was "much improved" at T1, with a "further minimal improvement" at T3. This was not associated with the improvement measured by both FAC, and WHS (Chi-square test, p = .20 and p = .36, respectively). Conclusions: Functional surgery combined with ERT is effective in improving the patients' condition according to all ICF domains. Both subjective and objective assessments have to be used when assessing these patients.

Feasibility and effectiveness of a newly modified protocol-guided selective dorsal rhizotomy via single-level approach to treat spastic hemiplegia in pediatric cases with cerebral palsy.

PURPOSE: It still remains challenging to treat CP cases with spastic hemiplegia using SDR via a single-level approach when guided by the traditional EMG response grading system. Our aim was to assess the feasibility and effectiveness of a newly modified protocol-guided single-level laminectomy SDR to treat such pediatric patients. METHODS: A retrospective cohort review was conducted in the CP cases with spastic hemiplegia undergone our newly modified protocol-guided single-level approach SDR since May 2016 to October 2017, and followed by intensive rehabilitation program for at least 12 months in both Shanghai Children's Hospital and Shanghai Rehabilitation and Vocational Training Center for the Disabled. Inclusion and exclusion criteria were set for the selection of patients in the current study. Our study focused on the setup, EMG recording interpretation, and outcome measures for this newly modified rhizotomy scheme. RESULTS: Eleven cases were included in the current study. Based on our new rhizotomy protocol, a total of 34 rootlets over our 11 cases were cut (2 in 4, 3 in 4, 4 in 1, and 5 rootlets in 2 cases, respectively). After SDR and the following rehabilitation program at a mean duration of 19 months, muscle tone of those "target muscles" in affected lower extremities which identified during pre-op assessment decreased by a mean of 1.4 degrees (Modified Ashworth Scale) in our cases. Strength of those target muscles and ROM of joints involved in their lower limbs were reported to have improved significantly as well. All cases showed major progress with regard to their motor function. A mean of about 10-point increase of GMFM-66 score was reported, and five of six cases who were with GMFCS level II preoperatively improved their GMFCS level at the last assessment. Kinematics of joints of hip, knee, and ankle on the affected side in our cases demonstrated a major correction, along with improvement of their foot pressure patterns to the ground during their gait cycles. Surgery-related complications, such as cerebral-spinal fluid leak/infection, long-term hypoesthesia, or urinary/bowel incontinence were not recorded in the current study. CONCLUSION: Single-level SDR when guided by our simplified rhizotomy protocol is feasible and effective to treat pediatric CP cases with spastic hemiplegia.

Asymmetry Index in Muscle Activations.

Gait asymmetry is typically evaluated using spatio-temporal or joint kinematics parameters. Only a few studies addressed the problem of defining an asymmetry index directly based on muscle activity, extracting parameters from surface electromyography (sEMG) signals. Moreover, no studies used the extraction of the muscle principal activations (activations that are necessary for accomplishing a specific motor task) as the base to construct an asymmetry index, less affected by the variability of sEMG patterns. The aim of this paper is to define a robust index to quantitatively assess the asymmetry of muscle activations during locomotion, based on the extraction of the principal activations. SEMG signals were analyzed combining statistical gait analysis (SGA) and a clustering algorithm that allows for obtaining the muscle principal activations. We evaluated the asymmetry levels of four lower limb muscles in: (1) healthy subjects of different ages (children, adults, and elderly); (2) different populations of orthopedic patients (adults with megaprosthesis of the knee after bone tumor resection, elderly subjects after total knee arthroplasty, and elderly subjects after total hip arthroplasty); and (3) neurological patients (children with hemiplegic cerebral palsy and elderly subjects affected by idiopathic normal pressure hydrocephalus). The asymmetry index obtained for each pathological population was then compared to that of age-matched controls. We found asymmetry levels consistent with the expected impact of the different pathologies on muscle activation during gait. This suggests that the proposed index can be successfully used in clinics for an objective assessment of the muscle activation asymmetry during locomotion.

Safety and long-term effects on gait of hemiplegic patients in equinovarus foot deformity surgical correction followed by immediate rehabilitation: a prospective observational study.

BACKGROUND: Equinovarus foot deformity (EVFD) is the most common lower limb deformity in stroke patients. Immobilization following EVFD surgical correction is known to have a negative impact on muscle rearrangement with possible loss of walking ability in stroke patients. In a previous study, safe and positive effects at one-month follow-up after surgery were obtained with an early rehabilitation treatment (ERT) characterized by immediate walking and training. AIM: To determine long-term safety and efficacy of functional surgery followed by early rehabilitation (FSER). DESIGN: A 12 months prospective observational study. SETTING: Outpatients clinic, Gait and Motion Laboratory, Sol et Salus Hospital, Rimini, Italy. POPULATION: Twenty-four adult chronic stroke survivors with EVFD surgical correction followed by ERT, age 55±13 years, affected side 12L/12R, time from lesion 5±4 years. METHODS: Patients received clinical and instrumental evaluation by gait analysis (GA) before (T0), one, three and twelve months after surgery. Safety was defined as the absence of any complication consequent to FSER. Efficacy was assessed by the recovery in ankle kinematics, walking speed and space-time parameters. RESULTS: No clinical complication (thrombosis, surgical wound infection, muscle or tendon injury, muscle hematoma) arose in the sample during the follow-up year. Variables relating to ankle kinematics improved towards their normal values at one month after surgery. These were maintained at 3 and 12 months, with a significant difference between follow-ups and pre-surgical values (Durbin-Conover Test, P<0.01). Gait speed, cadence, anterior step length and stride length of the affected side showed a statistical improvement at 3 and 12 months (Wilcoxon test, P=0.012 and P=0.001, respectively). Stride width decreased at 1 month after surgery and showed a further stable reduction at 3 months (P=0.008). CONCLUSIONS: The ERT protocol with immediate rehabilitation starting on the first day after surgical correction was safe and effective in providing a long-term correction of EVFD. Ankle dorsiflexion improved both in stance and swing, allowing for a significative improvement in walking speed. CLINICAL REHABILITATION IMPACT: FSER can be considered an encouraging approach in the management of EVFD, with durable results.

Trial of Contralateral Seventh Cervical Nerve Transfer for Spastic Arm Paralysis.

BACKGROUND: Spastic limb paralysis due to injury to a cerebral hemisphere can cause long-term disability. We investigated the effect of grafting the contralateral C7 nerve from the nonparalyzed side to the paralyzed side in patients with spastic arm paralysis due to chronic cerebral injury. METHODS: We randomly assigned 36 patients who had had unilateral arm paralysis for more than 5 years to undergo C7 nerve transfer plus rehabilitation (18 patients) or to undergo rehabilitation alone (18 patients). The primary outcome was the change from baseline to month 12 in the total score on the Fugl-Meyer upper-extremity scale (scores range from 0 to 66, with higher scores indicating better function). Results The mean increase in Fugl-Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft. RESULTS: The mean increase in Fugl-Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft. CONCLUSIONS: In this single-center trial involving patients who had had unilateral arm paralysis due to chronic cerebral injury for more than 5 years, transfer of the C7 nerve from the nonparalyzed side to the side of the arm that was paralyzed was associated with a greater improvement in function and reduction of spasticity than rehabilitation alone over a period of 12 months. Physiological connectivity developed between the ipsilateral cerebral hemisphere and the paralyzed hand. (Funded by the National Natural Science Foundation of China and others; Chinese Clinical Trial Registry number, 13004466 .).

Rehabilitación cognitiva de pacientes con alteraciones perceptivas sobrevivientes a ictus isquémico / Cognitive rehabilitation of patients with perceptive disorders surviving to ischemic ictus

Se realizó una intervención terapéutica en 30 pacientes con déficit motor (hemiplejía/ hemiparesia), sobrevivientes a ictus isquémico, irrigado por la arteria cerebral media con alteraciones perceptivas (negligencia sensorial, atencional o anosognosia), atendidos en el Departamento de Rehabilitación del Hospital General Docente Dr Juan Bruno Zayas Alfonso, de Santiago de Cuba, desde enero hasta noviembre del 2016, con vistas a evaluar la efectividad del tratamiento rehabilitador. La muestra fue dividida en 2 grupos de 15 integrantes cada uno: los del grupo control recibieron tratamiento convencional; los del grupo de estudio, tratamiento convencional y terapia ocupacional asociada a rehabilitación cognitiva. Se consideraron parámetros sociodemográficos, de valoración clínica y funcional, así como de recuperación funcional global. La heminegligencia resultó ser la alteración perceptiva más frecuente (63,4 por ciento) y al finalizar el tratamiento el grupo de estudio mostró una mejor recuperación funcional (93,3 por ciento), por lo cual quedó demostrada la eficacia de la rehabilitación convencional integrada a técnicas cognitivas y terapia ocupacional

A therapeutic intervention in 30 patients with motor deficit (hemiplegia/hemiparesis), surviving to ischemic ictus, irrigated by the mean cerebral artery with perceptive disorders (sensorial or atentional negligence or anosognosia), assisted in the Rehabilitation Department of Dr Juan Bruno Zayas Alfonso Teaching General Hospital, was carried out in Santiago de Cuba, from January to November, 2016, aimed at evaluating the effectiveness of the rehabilitative treatment. The sample was divided in 2 groups of 15 members each: those of the control group received conventional treatment; those of the study group, conventional treatment and occupational therapy associated with cognitive rehabilitation. They were considered sociodemographic parameters, of clinical and functional valuation, as well as of global functional recovery. Heminegligence was the most frequent perceptive disorder (63.4 percent) and the study group showed a better functional recovery (93.3 percent) when concluding the treatment, reason why the effectiveness of the conventional rehabilitation integrated to cognitive techniques and occupational therapy was demonstrated

Electrophysiological evidence for pre-attention information processing improvement in patients with central hemiplegic after peripheral nerve rewiring: a pilot study.

Central neurologic injury (CNI) causes dysfunctions not only in limbs but also in cognitive ability. We applied a novel peripheral nerve rewiring (PNR) surgical procedure to restore limb function. Here, we conducted a prospective study to develop estimates for the extent of preattentive processes to cognitive function changes in CNI patients after PNR. Auditory mismatch negativity (MMN) was measured in CNI patients who received the PNR surgery plus conventional rehabilitation treatment. During the 2-year follow-up, the MMN was enhanced with increased amplitude in the PNR plus rehabilitation group compared to the rehabilitation-only group as the experiment progressed, and progressive improvement in behavioural examination tests was also observed. Furthermore, we found a significant correlation between the changes in Fugl-Meyer assessment scale scores and in MMN amplitudes. These results suggested that PNR could affect the efficiency of pre-attention information processing synchronously with the recovery of motor function in the paralyzed arm of the in chronic CNI patients. Such electroencephalographic measures might provide a biological approach with which to distinguish patient subgroups after surgery, and the change in MMN may serve as an objective auxiliary index, indicating the degree of motor recovery and brain cognitive function.

Características das pessoas com acidente vascular encefálico atendidas em um centro de referência estadual / Características de las personas con accidente cerebrovascular atendidas em um centro de rehabilitación / Characteristics of encephalic vascular accident patients treated at a state reference center

Encephalic Vascular Accident is a clinical sign of brain dysfunction and it might result in permanent and irreversible lesions. Objective: defined the characteristics such as age, sex and date of the first treatment at a Santa Catarina State’s Rehabilitation Center. Methods: This is a quantitative cross-sectional descriptive study.The Ethnics in Human Research (CEPSH), the Pro Rector for Research and Extension Federal University of Santa Catarina, number 1024 reviewed this study. Results: Stroke affected 25,11% of women between 71-80 years old and 34,09% of the men aged between 61-70 years old. The most common consequence due to stroke was hemiplegia and the study observed that many patients only looked for proper treatment after several years post stroke. Conclusions: The physical therapy is important, so patients can relearn daily tasks and furthermore reintegrate their social life.

Acidente Vascular Encefálico (AVE) é uma disfunção cerebral que causa lesões permanentes e irreversíveis. Objetivo: Avaliar as idades, os sexos e a data do primeiro atendimento das pessoas com AVE atendidas no centro de reabilitação do Estado de Santa Catarina. Métodos: É um estudo quantitativo, descritivo e transversal, sendo a coleta de dados realizada com base documental nos prontuários. O presente estudo foi avaliado pelo Comitê de Ética em Pesquisa com Seres Humanos (CEPSH), Reitoria de Pesquisa e Extensão da Universidade Federal de Santa Catarina de número 1024. Resultados: O AVE afeta 25,11% de mulheres entre 71-80 anos e 34,09% de homens entre 61-70 anos. Observou-se que a sequela mais comum é a hemiplegia e que muitos somente procuravam tratamento após muitos anos de sequelas. Conclusão: Os dados encontrados mostram a importância da terapia física para que os pacientes reaprendam tarefas diárias e auxilia na reintegração social.

El Accidente Cerebrovascular (ACV) es un signo clínico de disfunción cerebral e ocasiona lesiones cerebrales permanentes e irreversibles. Objetivo: Evaluar las edades, sexos y la fecha del tratamiento inicial de los pacientes con accidente cerebrovascular tratados en el centro de rehabilitación en el estado de Santa Catarina. Métodos: El estudio cuantitativo, descriptivo y transversal. Este estudio fue revisado por el Pro Rector de Investigación y Extensión de la Universidad Federal de Santa Catarina para la Investigación Humana (CESPH). La recolección de datos se basó en registros documentales de las personas atendidas en el Centro de Rehabilitación del Estado de Santa Catarina, entre 2000-2009. Resultados: El AVC afecta 25.11% de las mujeres de 71-80 años y el 34,09% de los varones de 61-70 años. La hemiplejia es secuela más común. El estudio destaca que muchos pacientes buscan tratamiento sólo después de muchos años de secuela. Conclusión: Nuestros datos muestran la importancia de la terapia física, ya que permite que los pacientes pueden volver a aprender las tareas cotidianas.

Does unilateral single-event multilevel surgery improve gait in children with spastic hemiplegia? A retrospective analysis of a long-term follow-up.

Single event multilevel surgery (SEMLS) has become a standard intervention for children with cerebral palsy (CP). SEMLS proved to improve the gait in bilateral spastic cerebral palsy and those improvements can be maintained in the long term. However there is no evidence on the long-term outcome of unilateral SEMLS in children with unilateral spastic cerebral palsy. The gait analyses and clinical data of 14 children (9 male/5 female, mean age 12.1) with unilateral CP (6 children Gross Motor Function Classification System Scale level I and 8 children level II) were retrospectively reviewed at four time-points: preoperatively, 1year, 3-5 years and approximately 10 years after unilateral SEMLS. The Gait Profile Score (GPS) of the affected leg was used as a main and the number of fine tuning procedures as well as complications rate (Clavien-Dindo classification) as secondary outcome measures. The gait improved postoperatively and the GPS of the affected leg significantly declined by 3.73° which is well above the minimal clinical important difference of 1.6°. No deterioration of GPS occurred throughout the follow-up period. Therefore the postoperative improvement was maintained long-term. However, additional fine-tuning procedures had to be performed during the follow-up in 5 children and three complications occurred (one level II and two level III). The results indicate that children with unilateral cerebral palsy benefit from unilateral SEMLS and maintain gait improvements long-term.

Constraint-Induced Movement Therapy for Children With Brain Tumors.

PURPOSE: The purpose of this pilot study was to investigate the feasibility of a 3-week constraint-induced movement therapy program in children with brain tumors and upper extremity hemiplegia and to describe resultant change in extremity use. METHODS: Affected arm use, health-related quality of life, and parent-reported feasibility of program participation were measured before and after the intervention and at a 3-month follow-up visit. RESULTS: All 9 participants completed the entire study. The quality and amount of affected arm use improved significantly; gains were maintained at the 3-month follow-up evaluation. Some parents (44%) reported that program participation was difficult; however, all reported satisfaction with the program. Participants did not experience negative changes in health-related quality of life during the intervention, indicating that they tolerated the program well. CONCLUSIONS: Findings suggest that a child with hemiplegia as a result of a brain tumor can adhere to and benefit from a constraint-induced movement therapy program.

Efeito da Realidade Virtual no deslocamento do COP de indivíduos com hemiplegia / Effect of Virtual Reality on the COP displacement of individuals with hemiplegia

Introdução: O Traumatismo Cranioencefálico (TCE) é uma das principais causas de incapacidade funcional e alteração motora na população adulta. Objetivo: Avaliar o efeito da terapia com Wii no deslocamento do COP de hemiplégicos devido à sequela TCE. Métodos: Foram realizadas 10 sessões de treinamento com o Nintendo Wii Fit® em 10 indivíduos hemiplégicos pós TCE, do sexo masculino, com média de 31,3 ± 2,9 anos de idade. Os participantes foram avaliados antes, após e 3 meses após o protocolo de treinamento, nas quais mediu-se os dados cinéticos. Resultados: Não foram encontradas diferenças na RMS e velocidade do deslocamento do COP nos sentidos ântero-posterior e médio-lateral dos sujeitos hemiplégicos após as 10 sessões de treinamento com o console Wii. Esses valores se mantiveram após 3 meses. Conclusão: A terapia com o console Wii não alterou o deslocamento do COP nos sentidos ântero-posterior e médio-lateral de indiví-duos com hemiplegia.

Introducion: The Traumatic brain injury (TBI) is a major cause of disability and motor disorders in adults. Objective: To evaluate the effects of Wii rehabilitation therapy on COP displacement of hemiplegic individuals due to traumatic brain injury. Methods: 10 hemiplegic individuals after TBI were recruited for this study. Mean age, height and weight were 31.3 ± 2.9 years, 1.72 ± 0.03 m and 74.5 ± 5.1 kg, respectively. The individuals were evaluated before and after the training protocol and after 3 months again, in which kinetic data of the ground reaction force were measured. Results: There were no significant differences in the anterior-posterior and medio-lateral displacement of hemiplegic subjects after the 10 training sessions with the Wii console and these values remained the same after 3 months. Conclusion: The therapy with the Wii console was unable to alter the COP displacement of individuals with hemiplegia.

Relação entre o equilíbrio e a capacidade funcional em hemiparéticos / Relationship between the balance and functional capacity in hemiparetics

INTRODUÇÃO: O Acidente Vascular Encefálico (AVE) é responsável por incapacidades na vida do sujeito e pode muitas vezes provocar o seu óbito. Nos indivíduos acometidos, o equilíbrio é um dos principais componentes prejudicados, resultando em incapacidade. A Escala de Berg (EB) é um instrumento validado para avaliação do equilíbrio nessa população e a Escala de Avaliação de Fugl-Meyer (EFM) é também utilizada para avaliação do comprometimento sensório-motor e capacidade funcional nos pacientes vítimas de AVE. OBJETIVO: analisar a relação entre o equilíbrio e a capacidade funcional de pacientes hemiparéticos vítimas de AVE do Centro Universitário Jorge Amado. METODOLOGIA: Trata-se de um estudo observacional de corte transversal, realizado no ano de 2014, composto por 11 indivíduos, utilizando para coleta dos dados as EB e EFM como instrumento de avaliação. RESULTADOS: Correlacionando a EB com a EFM, encontrou-se uma correlação estatisticamente significante (r=0,680; p=0,021). Com a pontuação total da EB, foram correlacionados com os domínios "Sensibilidade" e "Função Motora do Membro Inferior - FMI" da EFM, além da idade e tempo de AVE, obtendo a maior relevância a relação tempo de AVE com EB (p=0,009), FMI (p=0,012) e sensibilidade (p=0,008). Os gêneros foram correlacionados com o equilíbrio e capacidade funcional, sendo as mulheres com menor pontuação na EB (p=0,425) e maior na EFM (p=0,767). Os indivíduos que realizam tratamento fisioterapêutico obtiveram melhor pontuação nas escalas (p=0,082 e p=0,166 para EB e EFM). CONCLUSÃO: Através dos resultados, é possível inferir que pacientes com melhor equilíbrio possuem melhor capacidade funcional.

INTRODUCTION: Stroke is responsible for disabilities in the life of the life of the subject and often cause his/her death. In affected individuals, the balance is one of the damaged components, resulting in disability. The Berg Balance Scale (BBS) is an instrument for the assessment of the balance in this population and the Fugl-Meyer Assessment (FMA) is also used to evaluate the sensory-motor impairment and functional capacity in patients suffering from stroke. OBJECTIVE: Analyze the relation between the balance and the functional capabilities in of hemiparetic patients victims of a Stroke on the Universitary Center Jorge Amado. METHODOLOGY: This study is a cross-sectional ob-servational study, carried out in 2014, compound of 11 individuals, using for data collection the BBS and FMA as evaluation instruments. RESULTS: Correlating the BBS with the FMA, was found a statistically significant correlation (r=0,680; p=0,021). The total score of BBS was correlated with "sensibility" and "the lower limb section" at FMA, moreover the age and time since Stroke, obtaining the bigger rel-evance in relation to the time since Stroke with BBS (p=0,009), FMI (p=0,012) and sensibility (p=0,008). The gender was correlated with the balance and functional capability, having the women the lower score at BBS (p=0,425) and the bigger in FMA (p=0,767). The individuals how have performed physiotherapeutic treatment had the best score in the scales (p=0,082 at BBS and p=0,166 at FMA). CONCLUSION: Through the results, it is possible infer that the patients with the best balance have best functional capability.

Early rehabilitation treatment combined with equinovarus foot deformity surgical correction in stroke patients: safety and changes in gait parameters.

BACKGROUND: Equinovarus foot deformity (EVFD) compromises several prerequisites of walking and increases the risk of falling. Guidelines on rehabilitation following EVFD surgery are missing in current literature. AIM: The aim of this study was to analyze safety and adherence to an early rehabilitation treatment characterized by immediate weight bearing with an ankle-foot orthosis (AFO) in hemiplegic patients after EVFD surgery and to describe gait changes after EVFD surgical correction combined with early rehabilitation treatment. DESIGN: Retrospective observational cohort study. SETTING: Inpatient rehabilitation clinic. POPULATION: Forty-seven adult patients with hemiplegia consequent to ischemic or haemorrhagic stroke (L/R 20/27, age 56±15 years, time from lesion 6±5 years). METHODS: A specific rehabilitation protocol with a non-articulated AFO, used to allow for immediate gait training, started one day after EVFD surgery. Gait analysis (GA) data before and one month after surgery were analyzed. The presence of differences in GA space-time parameters, in ankle dorsiflexion (DF) values and peaks at initial contact (DF at IC), during stance (DF at St) and swing (DF at Sw) were assessed by the Wilcoxon Test while the presence of correlations between pre- and post-operative values by Spearman's correlation coefficient. RESULTS: All patients completed the rehabilitation protocol and no clinical complications occurred in the sample. Ankle DF increased one month after surgery at all investigated gait phases (Wilcoxon Test, P<0.0001), becoming neutral at IC. Significant (P<0.05) variations were found for stride length, stride width, anterior step length of the affected side and for the duration of the double support phase of the contralateral side. The postsurgery ankle DF at St was found to be correlated (R=0.81, P<0.0001) with its pre-surgery value, thus being predictable. Weaker significant correlations were found for DF at Sw and DF at IC, where contribution from the dorsiflexor muscles is required in addition to calf muscle passive lengthening. CONCLUSIONS: An orthosis-assisted immediate rehabilitation associated with surgical procedure is safe and may be suitable to correct EVFD by restoring both the neutral heel foot-ground contact and the ankle DF peaks during stance and swing at one month from surgery. CLINICAL REHABILITATION IMPACT: The proposed protocol is a safe and potentially useful rehabilitative approach after EVFD surgical correction in stroke patients.