Международный журнал нейрореабилитации

Background: Diabetes mellitus predisposes to ischemic stroke, a major cause of death in this population, and worsens the post-stroke prognosis. Monitoring glycemic control is useful not only in the primary prevention of stroke in diabetics, but also in the rehabilitation from and secondary prevention of stroke. In an often functionally and neurocognitively impaired population, however, poor compliance to treatment regimens is a major problem. Digital, wireless telemonitoring glucometers offer a solution to the compliance issue—not only do they give patients a dynamic experience of their own glycemic control via digital monitors, but many also have an integrated alert system with healthcare providers and more real-time feedback than traditional self-monitoring methods.
Objective: To evaluate effectiveness of telemonitoring technologies in improving long-term glycemic control.
Methods: A search on www.clinicaltrials.gov on November 2013, using keywords “telemonitoring” (n=103), “selfcare device” (n=50), and “self management device” (n=210), revealed trials investigating a range of chronic disease including heart disease, diabetes, COPD, asthma, and hypertension. Some of the cardiac-oriented trials utilized varying outcome measurements. Therefore, we only selected published diabetes trials comparing HbA1c levels of a group receiving standard of care to a group receiving a telemonitoring intervention. Using a random effects model of mean difference, a meta-analysis was conducted on five trials that measured differences in HbA1c levels between the two groups at six months follow-up.
Results: Five clinical trials were identified. Four of the five studies showed a greater reduction in HbA1c in the intervention group compared to controls at 6 months, although only one was statistically significant. There was considerable heterogeneity between studies (I2= 69.5%, p=0.02). The random effects model estimated the aggregate effect size for mean difference in reduction of HbA1c levels in the treatment group vs. control to be 0.08% [-0.12- 0.28%], which was not statistically significant (p=0.42). Conclusions: The varying results may be due to specific factors in the trials that contributed to their large heterogeneity. Although there is great potential to use telemonitoring in stroke patients, further trials are needed to support its role in improving diabetes management in this population. Nonetheless, in the future telemonitoring may substantially help patients at risk of ischemic stroke and those who require close glucose monitoring.

Although the main stay of epileptic therapy is pharmacological certain forms of epilepsy such as temporal lobe epilepsy and epilepsy associated with benign diseases of the brain can also be successfully managed surgically. A neurosurgical procedure has the advantage of an immediate therapeutic result. When surgery is not possible, therapeutic irradiation is an option, but there is always a latent time between the radiation and the improvement in the epilepsy. This radiation is under the form of photon radiation produced by Cobalt sources in a Gamma knife® or by Linear accelerators. Special beam collimation techniques produce a sharp beam allowing for a high dose to be delivered to the target without side effects on the normal surrounding brain. The desired therapeutic effect comes from the late radiation effects, and hence is not immediate. The absorption in tissue of photon radiation is such that there is always an exit dose, and this contributes to radiation side effects on normal tissue. Particle radiation beams such as a proton beam have a dose absorption advantage over photons because there is a lower entry dose and no exit dose. This has the potential to treat the brain with a lower risk of side effects, and a lower integral dose. Presently radiation dose selection is aimed at causing tissue destruction in the target volume. Dose schedules that do not cause tissue necrosis but have a neurophysiologic therapeutic effect are presently under investigation. New irradiation technologies such as micro photon beams using synchrotron radiation and mini proton beams are been studied especially for their potential in epilepsy therapy. These technologies could greatly improve the therapeutic ratio as they cause no damage to brain tissue. If proven to have a therapeutic effect these new developments would expand the role of radiation in managing epilepsy.

More than half of all epilepsies have some genetic basis and single gene defects in ion channels or neurotransmitter receptors are associated with some inherited forms of epilepsy. Genetic research even in the field of epilepsy disorders is increasing in term of testing platform for the investigation of sequence and structural variation. Next generation sequencing (NGS), i.e., high-throughput sequencing technologies now allow analyses that were previously prohibitive. Targeted resequencing methods by diagnostic panels enable to sequence all the genes associated with a certain disease simultaneously within a few weeks. In this review, we will discuss the overall helpfulness and convenience of simultaneous genotyping of multiple epilepsy genes by NGS in a pharmacogenetics perspective.

Posttraumatic epilepsy (PTE) is a significant and debilitating issue further complicating recovery after brain injury. This review is meant to be an overview of PTE following traumatic brain injury (TBI). Beginning with an introduction into the epidemiology of PTE following TBI, the paper goes on to explain the classifications of seizures and what defines posttraumatic epilepsy as well as the risks associated with the development of PTE after TBI. The biological basis of PTE is explained using both past and current research, assisting in understanding the past and current treatment options. This review concludes with a discussion of future research directions in order to improve upon the dearth of knowledge in this area and further build and establish well utilized treatment options.

Given the continued use of decompressive craniectomy in the management of neurological emergencies recognition of complications is important in order for patients to gain maximal benefit during rehabilitation. One complication that has received relatively little attention is the neurological dysfunction that can occur due to distortion of the brain under the scalp as cerebral oedema subsides. The neurological deterioration that can occur can take many forms and this is probably due to a multifactorial pathophysiology. Recognition of this condition is important if delays in the rehabilitation process are to be avoided. This review discusses the historical background, possible pathophysiological mechanisms, clinical incidence and implications for healthcare workers involved in neurorehabilitation.

Background: Visuomotor performance can be improved by repetitive training on consecutive days. The aim of this study was to assess the training effect of visuomotor tracking in healthy subjects and hemiparetic patients with stroke and in moderately impaired patients with Parkinson’s disease.

Methods: 39 healthy right-handed subjects, 15 patients after acute cerebral artery stroke, and 15 patients with mid-stage Parkinson’s disease were trained with the commercially available, multifunctional PABLOR-device. This handhold device is equipped with force and acceleration sensors and connected to a personal computer for on-line data display and data storage. On three consecutive days the subjects were trained to navigate a target through obstacles in a virtual reality environment. Performance was assessed by modulation of force production and rotation of the hand in a visuomotor tracking paradigm using the PABLOR-device.

Results: The main findings were that training of the right dominant hand improved visuomotor coordination of hand rotation movements in both hands in the healthy subjects (p=0.0015). Training of the right affected hand improved visuomotor coordination of hand rotation movements in either patient group (p=0.026). In contrast, training improved the visuomotor coordination of force tracking of the dominant hand only in the healthy subjects (p<0.01).

Conclusions: The visuomotor training scenario was effective to improve visually guided hand coordination within three days in the healthy controls and both patient groups. The improvement of hand rotation generalized to the nontrained hand in healthy subjects.

The present study examines the role of cognitive coping in task switching abilities of patients with frontal lobe epilepsy (FLE). Participants (25 patients with FLE & 25 healthy controls) performed switching task and reported the use of cognitive coping strategies. Results showed that patients with FLE had sustained attention for emotion which lead to the unbalanced switch cost between tasks. This pattern of results did not appear in controls. Relative to controls, patients with FLE reported more frequent use of maladaptive cognitive coping strategies such as self-blame, other blame, rumination, and catastrophizing and less frequent use of putting into perspective, positive refocusing, positive reappraisal, acceptance and planning. Cognitive coping strategies were associated with switch costs. Greater use of maladaptive strategies was positively correlated with weaker task switching abilities. This study for the first time highlighted the role of cognitive coping in frontal lobe epilepsy during switching conditions. Implications of results were discussed.

Background: The aim of the study was to clarify the developmental and aging changes of Protein gene product 9.5 (PGP9.5) expression in granular and pyramidal neurons of the cerebral cortex comparing patients with Down syndrome (DS) and subjects without it.

Subjects and Methods: Fifty-four human brains were obtained from post-mortem samples of 24 subjects with DS (19 weeks gestation (GW) to 63 years of age) and 30 subjects without it (20 GW to 75 years of age). PGP9.5 expression in the frontal cerebri was qualitatively assessed in specific cortical layers and compared among 4 age groups (fetus, infant, child, and adult), and between the brains with and without DS.

Results: In subjects without DS, the expression of PGP9.5 in the cerebral cortex was highest from 30 to 39 GW, and then decreased with increasing age. In patients with DS, cortical PGP9.5 expression did not decrease with aging. Compared with samples from subjects without DS, those from patients with DS showed weaker PGP9.5 expression in layers 3 and 5 (pyramidal cell layers) of the infant group, but stronger expression in layer 4 (granule cell layer) of the child group, and in layers 2, 3, 4, and 6 of the adult group.

Conclusion: An increase of PGP9.5 expression in cortical granule neurons from children to adults with DS was found and suggests the existence of an important therapeutic window during which compensatory and plastic processes may influence the progression of cognitive impairment in individuals with DS.

Background: One of the primary concerns in rehabilitation of stroke patients is to restore motor function in upper limb to perform the myriad of tasks in daily life. Stroke patients begin to compensate for difficult activities by using the unaffected arm, delaying recovery of function in affected arm.

Purpose of the study: The purpose of this study is to find the effectiveness of Constraint Induced Movement Therapy - CIMT in improvement of upper limb function in stroke subjects.

Methods and Design: Experimental Design.

Participants: 30 sub-acute stroke subjects with dominant hand hemiplegia were selected in the study by convenient sampling method. Subjects were randomly assigned into group A and B receiving CIMT & strengthening exercises respectively for a period of 8 weeks. Prior to the study, all the subjects were assessed using a general assessment Performa and pre treatment ARAT and SS-QOL scores were measured.

Results: There is significant difference between the effectiveness of CIMT and strengthening exercises in improving upper limb function and quality of life in stroke subjects. CIMT is found to be more effective in improving upper limb function than strengthening exercises whereas conventional exercises are more effective in improving the quality of life in stroke subjects.

Conclusion: The clinical findings and the results shows that CIMT was more effective treatment than strengthening exercise in functional outcome and strengthening exercise was more effective than CIMT treatment in Quality of life domain.

Background: After stroke the unaffected hemisphere is dis-inhibited, due to reduction in trans-callosal inhibition from the damaged hemisphere this in turn may increase inhibition of the affected hemisphere and could impair functional recovery.

Objective: Low rate rTMS assumed to help gait rehabilitation as well as EEG synchronization after stroke. Are these two variables correlated?

Methods: Thirty stroke patients were treated by conventional physical therapy program as well as rTMS at 1 Hz three sessions per week. The following parameters including quantitative electroencephalogram (QEEG), timed up and go test (TUG), Fugl- Meyer scale (FMS), Cadence and gait Speed were measured before and after six weeks of the treatment program. Compared to 15 stroke patients received physiotherapy program only.

Results: All gait evaluation tests were improved after treatment in both groups, however the study group showed significant improvement than the control one. In the study group; there was significant improvement of the relative alpha band power spectrum over the treated as well as the untreated hemisphere. The relative theta/beta ratio over the central regions shows significant improvement as well. There were no significant correlations between the EEG power spectrum and the improvement of the gait evaluation tests.

Conclusion: Although rTMS for the unaffected hemisphere after stroke improves the gait ability of the patient as well as the fast frequency band of the EEG yet they are not correlated to each other.

Motion analysis processes are commonly used in the field of motion neurosciences, both with healthy and pathological subjects. Actually, the most used and validated system is the Vicon® (Oxford Metrics Group). This very accurate motion analysis system fits perfectly with laboratory contexts, but its usefulness in a clinical environment is more critical. Indeed, this device is very cumbersome, not wearable and not easy to use for clinicians. To counteract these difficulties in motion clinical analysis, some new innovative devices were proposed in the last years, more wearable, user-friendliness, low-cost, and able to record some interesting kinematic parameters. To test the accuracy of one of these systems, we compared the FX-Move® analysis with that of the Vicon®. To do this we asked three subjects to do slow and fast upper-limb reaching movements, and plotted both FX-Move® and Vicon® velocity measurements to calculate the concordance of their results. This analysis revealed a high accuracy between systems, but only until a maximal velocity threshold of 4 ms-1. Spearman coefficients were higher for data recorded for slow movements, under to the 4 ms-1 threshold (Mean r2 was 0.992 for the 3 subjects) than for data recorded for rapid arm raising movements, up to the 4 ms-1 threshold (Mean r2 was 0.715 for S1 and S2). According the well-documented motor slowing-down of impaired patients, we suggest that this motion analysis device could be used in a clinical context.