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1.
Dev Neurorehabil ; 23(1): 50-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30668211

RESUMO

Aim: To determine the feasibility and acceptability of parent-delivered elastic taping to the thumb and wrist in infants with cerebral palsy (CP).Design: Randomized cross-over feasibility trial.Participants: 20 infants (11 male; mean age 22 months) with CP.Intervention: Groups A and B received taping for 4 and 2 weeks, respectively.Outcomes: Primary: Recruitment and retention rates; adherence to protocol; Parent Satisfaction Questionnaire. Secondary: House Thumb score; Zancolli classification; Assisting Hand Assessment (AHA)/mini AHA. Exploratory: Duration of hand regard, thumb in palm, and open hand contact with toys during AHA/mini AHA.Results: Recruitment was feasible (95.2% uptake). Completion rates were 80% and 60% in Groups A and B. Questionnaire feedback was generally positive. Some parents reported increased awareness of the taped hand. Objective improvements were rare though one participant showed consistent improvement in thumb position.Conclusion: Taping proved feasible and acceptable; individual case benefit suggests further research is required.Trial registration: ISRCTN41918400.


Assuntos
Paralisia Cerebral/reabilitação , Reabilitação Neurológica/métodos , Polegar/patologia , Atividades Cotidianas , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Pais
2.
Dev Neurorehabil ; 23(1): 59-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31342814

RESUMO

Children with autism spectrum disorder (ASD) are at increased risk for being overweight/obese and face a variety of challenges with achieving the recommended levels of physical activity. Physical activity level has additionally been linked to motor skills, sleep, cognitive function and academic performance, and mental health in children with ASD. We pilot tested the feasibility and preliminary efficacy of walking routes as a novel approach to increasing physical activity among children with ASD. Physical activity was measured by accelerometry in 21 children ages 6-10 years. Participants received feedback on their physical activity and were counseled on using their surrounding neighborhoods to increase their physical activity. Non-completion (n = 9) reasons included equipment discomfort, family challenges, and diagnosis misattribution. While small changes in physical activity level and sedentary time were observed, neither was statistically significant. Further controlled studies on walking route interventions should continue to explore the potential benefits among this high-risk population.


Assuntos
Transtorno do Espectro Autista/reabilitação , Condicionamento Físico Humano/métodos , Caminhada , Transtorno do Espectro Autista/fisiopatologia , Criança , Feminino , Humanos , Masculino , Reabilitação Neurológica/métodos , Sobrepeso/prevenção & controle , Condicionamento Físico Humano/psicologia , Condicionamento Físico Humano/normas
3.
Dev Neurorehabil ; 23(1): 64-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31411516

RESUMO

Objective: To explore the effects of a web platform, aiming to support parents of children 5-12 years old with suspected or diagnosed developmental coordination disorder (DCD), on parental knowledge and skills.Method: A randomized pilot trial was undertaken (Clinical trial NCT03141333). Parents of the intervention group (n = 15) had access to a web platform (including resources, forum and virtual interactions) for three months. The control group (n = 13) only had access to resources. The primary outcome was measured pre- and post-intervention with the Parent Knowledge and Skills Questionnaire. Pre- post-questionnaires evaluated secondary outcomes (parents' sense of competence, children's strenghts and difficulties, and occupational performance).Results and discussion: All outcome measures improved over time for the intervention group. However, those improvements were not clinically or statistically significant (p 0.08-0.41).Conclusion: Web platforms supporting parents of children with DCD need further evaluation. Especially, usability of web platforms and new outcome measures should be explored.


Assuntos
Transtornos das Habilidades Motoras/reabilitação , Reabilitação Neurológica/métodos , Pais/psicologia , Apoio Social , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Inquéritos e Questionários
4.
Handb Clin Neurol ; 163: 435-456, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31590745

RESUMO

Acute trauma to the brain can lead to chronic changes in an individual's neurologic functioning, with some of the most debilitating and far-reaching consequences leading to compromised goal-directed functioning. Underlying sources of dysfunction can be dynamic, complex, and challenging to effectively address. This chapter delineates key principles that can be valuable for improving goal-directed functioning. The chapter is grounded in neuroscience and theoretical underpinnings while emphasizing practical approaches to maximizing functional improvements in an individual's personal life. Rehabilitation efforts can be maximized by taking into account multiple levels and facets of goal-directed functioning in cohesive, individualized treatments. Core functions subserved by prefrontal cortical networks may be targeted and strengthened through specific approaches to training. Optimization of functioning may require unraveling and addressing some of the many factors that can modulate brain processes. We dedicate special emphasis to considering the regulation of cognitive-emotional functioning during goal pursuit, especially pertinent to treatment of combined physical and experiential trauma that is a hallmark of military service injuries. These foundations point to frontiers for innovation in strengthening goal-directed functioning after brain injury.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Cognição/fisiologia , Metas , Reabilitação Neurológica/métodos , Lesões Encefálicas Traumáticas/fisiopatologia , Humanos , Recuperação de Função Fisiológica/fisiologia
5.
Rehabilitation (Stuttg) ; 58(5): 339-350, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31645080

RESUMO

Multiple sclerosis is the most common cause of non-traumatic disability in young adults. The following article addresses special features of multiple sclerosis in the context of neurological rehabilitation. The rehabilitative and symptomatic therapy of frequent symptoms and functional deficits are presented independently of the course of the disease. Rehabilitation in MS focuses on functional deficits in mobility, paresis, spasticity, ataxia, bladder dysfunction, fatigue, cognitive symptoms, depression and pain. The multimodal inpatient rehabilitation comprises aerobic training in MS-specific groups and interventions targeting individual deficits. Neuropsychological training, individual and group session on coping and adherence to therapy as well as advice on social issues and the evaluation of the work place situation complement the therapy options. The early age of onset of the disease often causes an early restriction of participation in working life. The restoration and maintenance of work ability is therefore an essential goal of neurological rehabilitation, as well as the organization of aftercare and the introduction of vocational rehabilitation services.


Assuntos
Fadiga/complicações , Esclerose Múltipla/psicologia , Esclerose Múltipla/reabilitação , Reabilitação Neurológica/métodos , Atividades Cotidianas , Depressão/reabilitação , Alemanha , Humanos , Qualidade de Vida , Centros de Reabilitação , Resultado do Tratamento
6.
Tumori ; 105(6): NP75-NP78, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31600120

RESUMO

This study reports a case series of patients with upper limb neuromotor deficits following pediatric central nervous system tumor and treated with rehabilitative therapy according to action observation therapy (AOT). AOT is based on the "mirror neurons" system and had positive results in various non-oncologic neurologic pathologies. This study is the first experience in the oncology field, and included 6 patients, 4 of whom were fully evaluated at 6-month follow-up. In all patients, therapy showed improvement in all assessment tests. These promising results lead to further studies to confirm their effectiveness.


Assuntos
Neoplasias do Sistema Nervoso Central/complicações , Reabilitação Neurológica , Doenças Neuromusculares/etiologia , Doenças Neuromusculares/reabilitação , Extremidade Superior/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Reabilitação Neurológica/métodos , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/terapia , Resultado do Tratamento , Adulto Jovem
7.
Funct Neurol ; 34(2): 99-105, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31556390

RESUMO

The influence of intensive multifunctional neurorehabilitation on post-stroke changes at the level of the paretic leg quadriceps muscle was examined in elderly subacute stroke patients. We assessed paretic leg muscle mass thickness and muscle fatty infiltration thickness, as well as clinical outcome measures (National Institutes of Health Stroke Scale, modified Ranking Scale, and Barthel Index) both before and after neurorehabilitation. Improved outcome measures (p ≤ 0.01) and increased muscle mass thickness (p = 0.005) with decreased muscle fatty infiltration thickness (p = 0.005) were observed after neurorehabilitation. No correlations were found between clinical outcome measures and muscle parameters either before or after neurorehabilitation. The findings of this study suggest that neurorehabilitation has a positive influence on global functional recovery and on remodelling of the quadriceps muscle, even in elderly stroke patients, but they do not support the hypothesis that post-stroke muscle changes might have prognostic significance in terms of the severity of neurological deficit and disability, nor do they suggest that these changes can be regarded as a determinant of stroke severity.


Assuntos
Reabilitação Neurológica/métodos , Paresia/complicações , Músculo Quadríceps/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Músculo Quadríceps/patologia , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
8.
NeuroRehabilitation ; 45(2): 247-254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498137

RESUMO

BACKGROUND: There are few evidences on safety of Constraint-Induced Movement Therapy (CIMT), as well as its effects in neurological conditions, including multiple sclerosis (MS). OBJECTIVE: To evaluate safety and effectiveness of a 2-week CIMT protocol on upper limb activity of progressive MS patients through a three-dimensional (3D) kinematic analysis. METHODS: In this randomized single-blind pilot study, we randomly allocated patients affected by progressive MS reporting a reduced use of one upper limb into two different groups: CIMT group (less affected limb blocked by a splint) and control group (undergoing bi-manual treatment). Primary outcome was CIMT safety. Furthermore, we assessed CIMT effects through clinical outcomes (hand grip strength, HGS, and 9 Hole Peg Test, 9HPT) and 3D kinematic analysis (normalized jerk, number of movement units, going phase duration, mean velocity, endpoint error). All evaluations were performed at baseline (T0) and after 2 weeks of treatment (T1) for both arms in both groups. RESULTS: Ten MS patients, mean aged 51.0±7.7 years, were randomly allocated in the 2 groups. After treatment, no differences were found in the blocked arm. Furthermore, CIMT group showed significant improvements in clinical and kinematic parameters. CONCLUSIONS: CIMT might be considered a safe and effective technique in MS patients.


Assuntos
Técnicas de Exercício e de Movimento/métodos , Terapia por Exercício/métodos , Esclerose Múltipla/reabilitação , Reabilitação Neurológica/métodos , Extremidade Superior/fisiopatologia , Adulto , Fenômenos Biomecânicos , Técnicas de Exercício e de Movimento/efeitos adversos , Terapia por Exercício/efeitos adversos , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Projetos Piloto , Método Simples-Cego
9.
NeuroRehabilitation ; 45(2): 255-263, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498138

RESUMO

BACKGROUND: Studies have demonstrated that the combination of Nintendo Wii (NW) with Conventional Exercises (CE) was effective in the rehabilitation of patients with Parkinson's Disease (PD), but there are no studies comparing the effects of this combination on both techniques isolated. OBJECTIVE: To investigate if the effects of the combination of NW to CE are superior to isolated techniques in the rehabilitation of balance, gait, functional mobility and improvement of the quality of life of individuals with PD. METHODS: 45 patients with PD were divided into three groups, NW alone, CE alone and NW plus EC. The sessions occurred for 50 minutes, twice a week and evaluations administered before and after the 2-month intervention. RESULTS: Significant differences were found in the pre and post intervention analyzes of all the outcomes in the three groups, but there was no difference between the groups. The effect size was evaluated, in which the NW plus CE group had a greater magnitude of the therapeutic effect. CONCLUSION: The NW plus CE was statistically as effective as each intervention alone in the rehabilitation of patients with PD, however, the use of this combination provided a magnitude of the therapeutic effect superior to the other groups.


Assuntos
Terapia por Exercício/métodos , Reabilitação Neurológica/métodos , Doença de Parkinson/reabilitação , Ludoterapia/métodos , Jogos de Vídeo , Idoso , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Qualidade de Vida , Método Simples-Cego
10.
NeuroRehabilitation ; 45(2): 285-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498141

RESUMO

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease due to dopamine deficiency in the basal ganglia, leading to motor symptoms such as bradykinesia, tremor, stiffness, and postural instability. This disease may also be associated with a broad spectrum of non-motor symptoms. More than 24% of patients with PD have one or more cognitive symptoms. OBJECTIVE: To evaluate the effects of computer-assisted cognitive rehabilitation (CACR) in Parkinson's disease (PD). METHODS: Sixty patients with PD were enrolled in this study and were randomly divided into control group (CG) and experimental group (EG). Each participant was evaluated at the beginning (T0) and at the end of training (T1). The CG underwent standard cognitive training (SCT) while EG performed CACR using the ERICA platform, aimed at improving several cognitive domains. In both the group, each training consisted of 3 sessions a week, each of these lasting sixty minutes, for eight weeks. RESULTS: Although both the groups had significant improvement after CR, we observed more significant changes in the EG, especially concerning attention, orientation and visual-spatial domains. CONCLUSIONS: Our data demonstrate that CACR is more effective than SCT in improving visual-spatial and executive deficits, in patients affected by PD.


Assuntos
Cognição , Função Executiva , Reabilitação Neurológica/métodos , Doença de Parkinson/reabilitação , Comportamento Espacial , Terapia Assistida por Computador/métodos , Atenção , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/instrumentação , Terapia Assistida por Computador/instrumentação
11.
Behav Neurol ; 2019: 9894571, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31428210

RESUMO

Communication in humans activates almost every part of the brain. Of course, the use of language predominates, but other cognitive functions such as attention, memory, emotion, and executive processes are also involved. However, in order to explain how our brain "understands," "speaks," and "writes," and in order to rehabilitate aphasic disorders, neuroscience has faced the challenge for years to reveal the responsible neural networks. Broca and Wernicke (and Lichtheim and many others), during the 19th century, when brain research was mainly observational and autopsy driven, offered fundamental knowledge about the brain and language, so the Wernicke-Geschwind model appeared and aphasiology during the 20th century was based on it. This model is still useful for a first approach into the classical categorization of aphasic syndromes, but it is outdated, because it does not adequately describe the neural networks relevant for language, and it offers a modular perspective, focusing mainly on cortical structures. During the last three decades, neuroscience conquered new imaging, recording, and manipulation techniques for brain research, and a new model of the functional neuroanatomy of language was developed, the dual stream model, consisting of two interacting networks ("streams"), one ventral, bilaterally organized, for language comprehension, and one dorsal, left hemisphere dominant, for production. This new model also has its limitations but helps us to understand, among others, why patients with different brain lesions can have similar language impairments. Furthermore, interesting aspects arise from studying language functions in aging brains (and also in young, developing brains) and in cognitively impaired patients and neuromodulation effects on reorganization of brain networks subserving language. In this selective review, we discuss methods for coupling new knowledge regarding the functional reorganization of the brain with sophisticated techniques capable of activating the available supportive networks in order to provide improved neurorehabilitation strategies for people suffering from neurogenic communication disorders.


Assuntos
Afasia/fisiopatologia , Transtornos da Linguagem/fisiopatologia , Reabilitação Neurológica/métodos , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Compreensão , Humanos , Linguagem , Rede Nervosa/fisiologia
12.
NeuroRehabilitation ; 45(1): 1-9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31450519

RESUMO

BACKGROUND: Research into the evolution of the functional performance of children and adolescents with DS enables parents and professionals involved in their follow-up to promote their development. OBJECTIVE: To evaluate the functional abilities of children and adolescents with Down syndrome and the assistance offered by their parents/caregivers. METHOD: A cross-sectional study, with 100 children and adolescents with DS whom parents or caregivers were interviewed to complete the Paediatric Evaluation of Disability Inventory (PEDI). Linear regression analyses were performed with the software MedCalc version 16.8.4 and GraphPad Prism version 6.07. RESULTS: Children and adolescents with DS need more time to acquire skills of self-care, mobility and social function. Their parents were able to better identify the difficulties before the children reached 8-years of age. CONCLUSION: Parents can identify the difficulties of their children when they are younger and offer more assistance, but this does not happen when the children are of elementary school age. This suggests that they need professional support that is not restricted to the guidelines and the schools.


Assuntos
Atividades Cotidianas , Cuidadores , Síndrome de Down/reabilitação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Reabilitação Neurológica/métodos , Pais , Autocuidado
13.
Handb Clin Neurol ; 161: 187-194, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307600

RESUMO

Clinical neurophysiologic testing provides valuable support in predicting outcome in the setting of disorders of consciousness (DOC), including coma and traumatic brain injury (TBI). Electroencephalography (EEG) and evoked potentials (EP) are simple to apply, inexpensive, safe, and available in most rehabilitation facilities. This chapter reviews the use of EEG and EP in postanoxic coma and TBI. Bilateral absence of cortical somatosensory evoked potentials (SSEP) may be regarded as a predictor of poor outcome in hypoxic brain damage. Flash VEP may be useful to differentiate between good and poor outcome. In addition, low EEG frequencies, burst suppression, and isoelectric EEG patterns prognosticate poor outcomes in hypoxic brain damage. While a loss of cortical SSEP is generally regarded as a negative prognostic sign in the acute phase of hypoxic brain damage, absence of cortical SSEP responses is not necessarily associated with poor outcome in TBI. Event-related potentials (ERPs) can provide support in outcome prediction. In particular, the N100, mismatch negativity, P300, and N400 may improve accuracy of outcome prediction DOC of different etiologies. Some evidence suggests that ERPs may be superior to SSEP in predicting functional and DOC outcomes (Lew et al., 2003). ERPs are measured brain responses resulting from specific cognitive tasks, sensory stimulation, or planned motor activity.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/reabilitação , Coma/fisiopatologia , Coma/reabilitação , Reabilitação Neurológica/métodos , Eletroencefalografia/métodos , Potenciais Somatossensoriais Evocados/fisiologia , Humanos
14.
Int J Neurosci ; 129(11): 1066-1075, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31220973

RESUMO

Aim: The present study describes the training effects of a novel motorized bicycle-like device for individuals with incomplete spinal cord injury. Methods: Participants were five individuals with motor incomplete spinal cord injury (56 ± 7 years). Four of five participants received two 30-min sessions of training: one with, and one without, mechanical stimulation on the plantar surface of the foot; soleus paired H-reflex depression was examined before and after each session. Three of five participants received 24 sessions of 30-min of training (long-training). Following the long-training, balance, walking and spasticity improvements were assessed using validated clinical outcome measures, in addition to the H-reflex assessment. Results: One cycling session with mechanical stimulation yielded 14% and 32% more reflex depression in participants with moderate spasticity (n = 2/4). The same trend was not observed in non-spastic participants (n = 2/4). All participants who participated in the long-training had spasticity and showed reduced spasticity, improved walking speed, endurance and balance. Conclusions: Overall, participants with spasticity showed increased soleus H-reflex suppression after one training session with mechanical stimulation and reduced spasticity scores after long training. We interpret this as evidence that the training influenced both presynaptic and postsynaptic inhibitory mechanisms acting on soleus motoneurons. Therefore, this training has the potential to be a non-invasive complementary therapy to reduce spasticity after incomplete spinal cord injury.


Assuntos
Terapia por Exercício/instrumentação , Espasticidade Muscular/reabilitação , Músculo Esquelético , Reabilitação Neurológica , Paralisia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Idoso , Ciclismo , Desenho de Equipamento , Terapia por Exercício/métodos , Feminino , Reflexo H/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Paralisia/etiologia , Estimulação Física , Estudo de Prova de Conceito , Traumatismos da Medula Espinal/complicações
15.
BMC Neurol ; 19(1): 119, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31179920

RESUMO

BACKGROUND: The use of vestibular rehabilitation principles in the management of gaze and postural stability impairments in people with multiple sclerosis (PwMS) has shown promise in pilot work completed in our lab and in a recently published randomized clinical trial (RCT). However, further work is needed to fully quantify the gaze and postural impairments present in people with multiple sclerosis and how they respond to rehabilitation. METHODS/DESIGN: The study is a single blind RCT designed to examine the benefit of a gaze and postural stability (GPS) intervention program compared to a standard of care (SOC) rehabilitation program in dizzy and balance impaired PwMS. Outcomes will be collected across the domains of body structure and function, activity, and participation as classified by the World Health Organization International Classification of Functioning, Disability, and Health (ICF). Our primary outcomes are the Dizziness Handicap Inventory (DHI) and the Functional Gait Assessment (FGA). Secondary outcomes include other measures of gaze and postural stability, fatigue, and functional mobility. Participants who are interested and eligible for enrollment will be consented prior to completing a baseline assessment. Following the baseline assessment each participant will be randomized to either the GPS or SOC intervention group and will complete a 6 week treatment period. During the treatment period, both groups will participate in guided exercise 3x/week. Following the treatment period participants will be asked to return for a post-treatment evaluation and again for a follow-up assessment 1 month later. We anticipate enrolling 50 participants. DISCUSSION: This study will be an innovative RCT that will utilize gaze and postural stability metrics to assess the efficacy of vestibular rehabilitation in PwMS. It will build on previous work by examining measures across the ICF and improve the current evidence base for treating PwMS. TRIAL REGISTRATION: ClinicalTrials.gov, May 29th 2018, NCT03521557 .


Assuntos
Fixação Ocular/fisiologia , Esclerose Múltipla/reabilitação , Reabilitação Neurológica/métodos , Equilíbrio Postural/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia
16.
Eur Arch Otorhinolaryngol ; 276(10): 2681-2689, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31187238

RESUMO

PURPOSE: Vestibular schwannoma removal causes unilateral vestibular deafferentation, which results in dizziness and postural unsteadiness. Vertigo and balance problems together are among the most important aspects affecting quality of life. Intensive vestibular rehabilitation, which starts before surgery, with following postsurgical supervised rehabilitation, using visual biofeedback propose an instrument to accelerate a recovery process. Another option how to accelerate the vestibular compensation, is employment of presurgical gentamicin ablation together with vestibular rehabilitation (prehabilitation) of vestibular function. Purpose of present study was to examine the dynamics of vestibular compensation process using supervised intensive vestibular rehabilitation with visual biofeedback in the short-term postsurgical period. The second aim was to compare both studied groups mainly to evaluate if prehabilitation has potential to accelerate the compensation process in the early postoperative course. METHODS: The study included 52 patients who underwent the retrosigmoid vestibular schwannoma removal. They were divided into two groups. The first group was prehabilitated with intratympanic application of gentamicin before surgery to cause unilateral vestibular loss (14 patients), the second group (38 patients) was treated in standard protocol without prehabilitation. All patients underwent at home vestibular training before surgery to learn new movement patterns. Following the surgery supervised intensive vestibular rehabilitation including visual biofeedback was employed daily in both groups between the 5th and 14th postoperative day. Outcome measurements included an evaluation of subjective visual vertical (SVV), posturography and the Activities-Specific Balance Confidence Scale (ABC). ANOVA for repeated measurements was used for statistical analysis. RESULTS: We observed significant improvement in SVV (p < 0.05), posturography parameters (p < 0.05) and ABC scores (p < 0.05) with postoperative rehabilitation program following surgery in both groups. There was no statistically significant difference between group treated by prehabilitation and group without prehabilitation. CONCLUSIONS: Results of this study showed that intensive postsurgical rehabilitation represents key factor in compensation process following retrosigmoid vestibular schwannoma surgery. Prehabilitation did not speed up recovery process.


Assuntos
Tontura , Reabilitação Neurológica/métodos , Neuroma Acústico/cirurgia , Procedimentos Cirúrgicos Otológicos/reabilitação , Complicações Pós-Operatórias , Qualidade de Vida , Vertigem , Tontura/etiologia , Tontura/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Procedimentos Cirúrgicos Otológicos/métodos , Complicações Pós-Operatórias/psicologia , Complicações Pós-Operatórias/reabilitação , Pré-Medicação/métodos , Resultado do Tratamento , Vertigem/etiologia , Vertigem/reabilitação
17.
Funct Neurol ; 34(1): 45-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31172939

RESUMO

The relationship between abdominal subcutaneous adipose tissue thickness (aSAT), body fat percentage (BFP), waist-to-hip ratio (WHR) and body mass index (BMI) and outcome measures of neurological deficit and functional recovery was evaluated in obese subacute stroke patients before and after neurorehabilitation. Decreased National Institutes of Health Stroke Scale (p = 0.0001) and modified Rankin Scale (mRS) (p= 0.002) scores, as well as increased Barthel Index (p= 0.0001) scores were detected after neurorehabilitation. Decreased BMI, aSAT, BFP and WHR observed after neurorehabilitation did not penalize the overall functional recovery as shown by correlations between the clinical measure scores and fat mass indices. The correlation observed after neurorehabilitation between BMI and mRS (rho = 0.4526, p < 0.05) suggests that a high BMI may compromise functional recovery. Monitoring of body fat mass indices may provide information aimed at improving the disability of obese stroke patients.


Assuntos
Reabilitação Neurológica/métodos , Obesidade/epidemiologia , Obesidade/reabilitação , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Reabilitação Neurológica/tendências , Obesidade/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento
18.
G Ital Med Lav Ergon ; 41(2): 156-161, 2019 05.
Artigo em Italiano | MEDLINE | ID: mdl-31170347

RESUMO

SUMMARY: We present the clinical case of a 17-year-old boy who, after an auto-motorbike collision, suffered of bilateral condylar atlo-occipital dislocation with blood in the medullary canal and contusion of the C1-C3 spinal cord, hemothorax and pneumothorax, multiple costal fractures, fractures processes transverse L1 and right iliac wing and displaced fracture of the middle third of the right femur. In the emergency phase the patient, who was in a coma GCS: 3/15, was immediately intubated and taken to the Emergency Department and subsequently to Intensive Care Unit. He was also immediately subjected to chest drainage, reduction of femoral fracture and placement of external fixator and tracheostomy. Upon stabilization of the clinical picture, the patient was subjected to occipital-cervical stabilization with plates and screws and reduction of the fracture of the right femur with an intramedullary rod. Then the patient in hemodynamically stable and in alert condition, in spontaneous breath, was discharged and transferred to our Operative Unit of Intensive Neurorehabilitation. At the entrance, the doctor's evaluation, with the whole multidisciplinary team, enabled to identify the ICD-9 and ICF codes that best described the severity of the clinical picture: the patient showed tetraplegia, dysphonia and dysphagia, bearing a tracheal cannula in breath spontaneous with O2 supplementation, sequelae of multiple costal fractures and right femur, totally dependent on ADL. The rehabilitation intervention was aimed at promoting motor recovery in the 4 limbs, recovery of standing and walking, acquisition of ability to control daily life activities (ADL), recovery of physiological swallowing and removal of the tracheostomy tube. After long and slow physiotherapeutic training, the patient recovered the active motility at the crural and brachial level mainly at the proximal level, which however is not effective for ADL recovery. On the other hand, speech therapy allowed the passage to oral feeding and removal of the tracheostomy tube. Upon discharge, the re-evaluation of the ICF codes identified at the entrance indicated an improvement in the strength of the trunk muscles (b7305) with the possibility of performing transfers with assistance (d420), of dysphonia (b320) and of swallowing (b510) which led to the removal of the PEG and the tracheostomy tube; unfortunately severe deficiency of the muscular force at the distal brachial and crural level (b730, b7304) persists with severe disability in the activities of daily life (d455, d4551, d465, d429, d230).


Assuntos
Doenças do Sistema Nervoso/reabilitação , Reabilitação Neurológica/métodos , Traumatismos da Medula Espinal/reabilitação , Acidentes de Trânsito , Atividades Cotidianas , Adolescente , Avaliação da Deficiência , Humanos , Classificação Internacional de Doenças , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Masculino , Doenças do Sistema Nervoso/fisiopatologia , Equipe de Assistência ao Paciente/organização & administração
19.
Dev Neurorehabil ; 22(8): 527-541, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31169045

RESUMO

Background: The use of assistive technology, specifically microswitches, with children with RTT has been shown to effectively moderate the impact of their disability on their quality of life- by facilitating access to meaningful leisure and other activities. Objectives: This study aimed to evaluate the effectiveness of a microswitch intervention on increased choice making, engagement in a targeted sorting activity, and indices of happiness, and decreased stereotypic behaviors for six girls with Rett syndrome. Targeted dependent variables were also assessed at six months post-intervention. Following the intervention study, 90 external raters completed a social validation procedure. Method: An ABABAB experimental sequence was implemented for each participant with a cross-over effect. A social validation assessment involving 90 external raters was carried out. Results: Data emphasized an improved performance for each participants involved (i.e., adaptive responses). Five participants showed a capacity of independent choice. One participant seemed to be closely linked to the position of the container. Social raters favorably endorsed the use of the program since they positively evaluated the use of the technology on all the dimensions investigated. Conclusion: A microswitch intervention may improve choice making and activity engagement for children with Rett syndrome. Further research is needed on the development of more sophisticated forms of individualized technological options to improve opportunities for enhanced engagement and choice-making for individuals with RTT.


Assuntos
Comportamento de Escolha , Síndrome de Rett/reabilitação , Equipamentos de Autoajuda , Criança , Feminino , Felicidade , Humanos , Atividades de Lazer , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Comportamento Estereotipado
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