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  1. Home
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  3. Textbook of Neural Repair and Rehabilitation
  • Cited by 9
Publisher:
Cambridge University Press
Online publication date:
August 2010
Print publication year:
2006
Online ISBN:
9780511545078
DOI:
https://doi.org/10.1017/CBO9780511545078
Subjects:
Neurology and Clinical Neuroscience, Medicine
Information

Book description

In two freestanding but linked volumes, Textbook of Neural Repair and Rehabilitation provides comprehensive coverage of the science and practice of neurological rehabilitation. This volume, Medical Neurorehabilitation, can stand alone as a clinical handbook for neurorehabilitation. It covers the practical applications of the basic science principles presented in volume 1, provides authoritative guidelines on the management of disabling symptoms, and describes comprehensive rehabilitation approaches for the major categories of disabling neurological disorders. Emphasizing the integration of basic and clinical knowledge, this book and its companion are edited and written by leading international authorities. Together they are an essential resource for neuroscientists and provide a foundation for the work of clinical neurorehabilitation professionals .

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Contents

Page 2 of 2

Contents
  • 20 - Balance, vestibular and oculomotor dysfunction
    pp 298-314
  • View abstract

    Summary

    Vision, somatosensory, and vestibular inputs each contribute unique information regarding body position and motion contributing to postural control. This chapter focuses on vestibular contributions to postural stability, and discusses the effect of peripheral vestibular loss on balance and postural control. A method utilized to study the role of vestibular inputs is to directly stimulate the vestibular system. The effect of vestibular loss on the amplitude of muscle response at the ankle is related to several factors, the most important being the degree of deficit. Individuals with chronic unilateral vestibular hypofunction (UVH) have the largest amplitude of muscle response, followed by those with acute UVH and individuals with bilateral vestibular hypofunction (BVH) had the smallest amplitude of responses. The chapter discusses the effect of eye movements on balance, and describes the role of vestibular rehabilitation (VR) in the remediation of imbalance and gaze instability.
  • 21 - Deconditioning and energy expenditure
    pp 315-336
  • View abstract

    Summary

    This chapter presents an overview of basic principles of exercise metabolism and reviews acute and adaptive responses to exercise. It describes the factors that limit exercise capacity and contribute to the deconditioned state of people with neurologic disability. The main factors contributing to individual differences in exercise capacity are sex, age, and level of physical activity. A major obstacle to documenting exercise capacity of individuals with neurologic impairments has been the lack of testing protocols that can accommodate motor and balance disturbances. The chapter also describes biomechanical and metabolic factors in relation to the energy expenditure of normal gait and that of individuals with neurologic conditions. Factors that help to explain differences in the economy of movement in healthy populations include age, walking environment, and walking speed. For many individuals with neurologic conditions, the co-existence of neuromuscular and cardiovascular impairments increases the complexity of the physiologic adaptations to training.
  • 22 - Rehabilitation of the comatose patient
    pp 339-355
  • View abstract

    Summary

    The main objective in the rehabilitation of the comatose patient is the regaining of consciousness. The comatose state is widely perceived as a serious clinical prognosis. The use of prognostic indicators is of fundamental importance in planning the rehabilitation treatments that are necessary after the acute phase. There is no single prognostic factor or model of prediction that allows one to make an early-on forecast for individual patients in post-traumatic vegetative state (VS). To facilitate regaining contact with the environment for patients in a coma or VS, many authors have maintained that rehabilitation programs including multisensory stimulation are useful. In clinical practice, there are patients that do not receive any benefit from pharmacological manipulation with neurotransmitter drugs. Depauperation is maintained by the condition of hypercatabolism to which the traumatized organism is subject. Finally, a couple of potential secondary causes for the primary rehabilitation prognosis becoming progressively more negative are discussed.
  • 23 - Plasticity in the neural pathways for swallowing: role in rehabilitation of dysphagia
    pp 356-367
  • View abstract

    Summary

    This chapter discusses the notion of neural plasticity in relation to dysphagia rehabilitation. It talks about the structures and neural controls on which swallowing depends, and describes the causes of dysphagia. Any abnormality of critical swallowing structures or neural controls can disrupt swallowing with the nature of the deficit being at least in part the result of the locus and type of involvement. Surgical, medical, and behavioral treatments for dysphagia are now available. The chapter discusses the rehabilitative treatments, because their influence on the person with dysphagia provides the greatest contribution to what is known about plasticity in dysphagia. Learned non-use can occur when a behavior is not performed for a period of time extending into the interval when performance is actually possible physiologically. As in all treatments, a placebo effect is anticipated in dysphagia management.
  • 24 - Autonomic dysfunction
    pp 368-399
  • View abstract

    Summary

    The etiology of autonomic dysfunction may be primary, such as pure autonomic failure (PAF), secondary, such as that due to cervical spinal cord injury (SCI) or due to drugs and chemical. An understanding of the components of the autonomic nervous system (ANS), their function and their supraspinal, spinal and peripheral organization is essential to appreciate autonomic dysfunction. Animal studies have indicated that after lesions of rostral ventrolateral medulla (RVLM), arterial pressure is maintained by the renin-angiotensin system and by arginine vasopressin (AVP). Gastrointestinal (GI) tract function is to retain nutrients and eliminate waste. These functions are accomplished by the motility, secretion, and absorption processes of the GI tract, which are regulated via exocrine, endocrine, and neural mechanisms. Neurons in the anterior hypothalamus preoptic area (POA) have intrinsic temperature sensitivity and drive many thermoregulatory effector mechanisms. Impairment of temperature regulation is a recognized hazard for persons with SCI.
  • 25 - Sexual neurorehabilitation
    pp 400-410
  • View abstract

    Summary

    This chapter provides an introduction to approaches in sexuality counseling. It presents an overview of male and female physiology. The prostate gland is a partly muscular and partly glandular male sex gland whose major function is to secrete a slightly alkaline fluid forming part of the seminal fluid. Seminal vesicles, sac-like glands that lie behind the bladder, release fluid for transport of sperm. Spermatogenesis begins with a pulsatile hypothalamic release of gonadotrophin releasing hormone (GnRH) that induces the release of pituitary luteinizing hormone (LH) and follicle stimulating hormone (FSH). Female sexual responses require transmission of somatic, afferent, parasympathetic, and sympathetic signals. The chapter describes the common neurologic disorders and their impact on sexuality and reviews treatment options for those disorder. Sexual activity for men with spinal cord injury (SCI) or multiple sclerosis (MS) is possible. The anticholinergic and sympatholytic effects of psychoactive drugs impair sexual function.
  • 26 - Rehabilitation for aphasia
    pp 413-423
  • View abstract

    Summary

    This chapter presents an overview of aphasia rehabilitation and deals only with acquired aphasia due to focal brain damage in adults. It discusses some principles explicitly or implicitly underlying the rationale of aphasia rehabilitation. The endeavour to treat language disorders has a long history, and the approaches are extremely heterogeneous. Among interventions for acquired cognitive deficits, the rehabilitation of speech and language disorders following brain damage has the longest tradition, dating back to the 19th century. A variety of approaches have been applied to the rehabilitation of aphasia. The emphasis of the behavioural approach is on the learning process, and is an application to aphasia treatment of programmed instruction based on operant conditioning. A meta-analysis of studies dealing with the effectiveness of language rehabilitation, limited to aphasia as a result of stroke, has been performed by the Cochrane collaboration.
  • 27 - Apraxia
    pp 424-443
  • View abstract

    Summary

    This chapter focuses on apraxic syndromes that are similar to those described by Liepmann: ideational (conceptual) apraxia, ideomotor apraxia either as ideomotor limb apraxia or buccofacial apraxia, and limbkinetic apraxia. Limbkinetic apraxia could reflect deficient information processing during the preparation and execution of specific movements components such as the object-related grip formation, a capability that has been shown to involve specific parieto-premotor circuits. The chapter describes the model of praxis-related processes, and outlines the neuroanatomical considerations. Various cognitive-motor aspects that are relevant for praxis are represented in different functional brain networks. Signs and symptoms of motor apraxia were described both for ideomotor and ideational apraxia by Poeck who argued that positive signs for apraxia can be observed as parapraxias, that is typical apraxic performance errors, when certain movement tasks are examined. Apraxic disorders are prevalent in different neurological patient groups, and affect motor competence in everyday life tasks and communication.
  • 28 - Unilateral neglect and anosognosia
    pp 444-460
  • View abstract

    Summary

    Unilateral hemineglect is characterised by lack or decrease of attention to stimuli and events on one side of the patient following a contralateral hemispheric lesion. It can affect visual, auditory, somatosensory and motor modalities. In the acute stage neglect phenomena have been reported after right or left hemispheric lesions. Current evidence suggests that neglect rehabilitation is associated with better outcome. The evidence comes from prospective randomised and non-randomised group studies as well as single and multiple single case studies. Psychological denial of illness, flattened affect, sensory deficits, neglect or faulty control of action has been proposed as possible mechanisms of anosognosia. Quantification of anosognosia for neglect is possible through the use of observational scales such as the Catherine Bergego Scale. The therapy of anosognosia, which often accompanies hemineglect, consists mostly of providing feedback to the patient or is based, in a more experimental fashion, on sensory manipulations.
  • 29 - Memory dysfunction
    pp 461-474
  • View abstract

    Summary

    This chapter presents a brief introduction to the different forms of memory. After brain injury there is usually a period during which cognitive functions impaired by primary and secondary damage recover. The aim of restitution-oriented therapies for memory impairment (or indeed any impairment) is, in effect, to restore the physical or the functional integrity of the memory systems of the brain. Pharmacological and some memory training interventions might be considered to be attempts to restore functional integrity of memory systems. The chapter reviews recent studies that provide the basis for future developments in biologically based memory rehabilitation, along with examples of compensatory learning methods, strategies and aids. Within the category of compensatory strategies, there is a range of possible intervention approaches, some of which have been well evaluated. Four different types of approach can be identified: enhanced learning, mnemonic strategies, external aids, and environmental modification.
  • 30 - Neurorehabilitation of executive function
    pp 475-487
  • View abstract

    Summary

    This chapter describes the cognitive deficits observed in patients with frontal lobe damage, which has resulted in the concept of the dysexecutive syndrome. Based on clinical observations, there are two major behavioral/cognitive syndromes that occur after damage to different regions of the prefrontal cortex. These syndromes reflect separable circuits of connections of the prefrontal cortex with subcortical structures. Careful characterization of the type of deficits observed in patients with frontal lesions has allowed for the development of cognitive models of executive function. The chapter reviews current cognitive and pharmacologic approaches towards treating executive function impairments. Improved understanding of the physiologic basis of executive function leads to a narrower and more useful view of prefrontal cortical function that hopefully allow the development of new therapies, both cognitive and pharmacologic, in patients with specific cognitive difficulties from damage to this critical region of the brain.
  • 31 - Rehabilitation of dementia
    pp 488-512
  • View abstract

    Summary

    Rehabilitation assessments and treatments focus on performance of mundane functions essential to negotiate through everyday life. While these activities are mundane, they can be viewed as cognitively complex for an individual with dementia. Despite loss of cognitive functions, new or alternative ways of participating in everyday life rituals can be developed during rehabilitation. Individualized assessment of cognition and behavior becomes essential to define their profiles of cognitive and behavioral weaknesses, and strengths. Rehabilitation treatments have emphasized the processes of learning/relearning of skills that may be viewed as simple motor tasks, but really are cognitively quite complex for someone with dementia. Caregivers define the interpersonal and physical environment around the individual with dementia. There is exploratory evidence from functional imaging studies of the brain that there is an adequate cerebral substrate at the tissue level in individuals with mild to moderate severity of dementia to support behaviorally based learning during rehabilitation.
  • 32 - The organization of neurorehabilitation services: the rehabilitation team and the economics of neurorehabilitation
    pp 515-526
  • View abstract

    Summary

    The World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) provides a foundation for discussing the tenets of traditional rehabilitation and its social but is limited as a descriptive tool for the broader view of neurorehabilitation, which incorporates plasticity and repair of the nervous system. The makeup of the rehabilitation team and the requirements for qualification vary from one country to another, although in most cases, the basic principles are similar. The best guideline to apply to a patient requiring neurorehabilitation is to provide the environment with the most intense therapy that the patient can tolerate. The model of stroke rehabilitation best illustrates this concept. When compared with conventional or less intensive care, stroke rehabilitation in an inpatient rehabilitation facility (IRF) with coordinated, transdisciplinary care significantly reduced the statistical risk of death or institutionalization, or death or dependency, independent of age, sex, or stroke severity.
  • 33 - Traumatic brain injury
    pp 527-541
  • View abstract

    Summary

    This chapter highlights the problems encountered after traumatic brain injury (TBI), and suggests clinical strategies and treatment methods by which many of these problems can be alleviated. Alcohol plays a significant part in the majority of TBI, particularly in road traffic accidents but also in falls and violence. In the acute stages following TBI, there could be some robust predictor of eventual outcome. This may help to focus on an appropriate rehabilitation strategy and enable accurate information to be imparted to the patient's family. All rehabilitation needs to involve an appropriate client-centred, goal setting process and outcome measures are clearly necessary to monitor those goals and determine when they have been met. Continued developments in neuroscience should steadily lead to a greater understanding of the mechanisms of neural recovery and neural plasticity which hopefully will lead to a firmer basis for the management of people following TBI.
  • 34 - Neurorehabilitation in epilepsy
    pp 542-559
  • View abstract

    Summary

    This chapter reviews the causes that limit patients with epilepsy (PWE) from reaching their full potential academically, professionally and socially, and the potential role of rehabilitation in overcoming these obstacles. The cognitive, psychiatric and psychosocial causes of impaired psychologic, professional and social achievements in PWE can be categorized as seizure related, treatment related or related to environmental/ social factors. The chapter offers suggestions on how the field of rehabilitation should be incorporated into the evaluation and management of every PWE. It focuses on patients undergoing temporal lobectomy, as this is the most frequently performed procedure. Temporal lobectomy improves cognitive functions, including verbal and visual-spatial memory. This can result from the cessation of seizure activity and the reduction in dose and number of antiepileptic drugs (AEDs). Improvements are greatest in functions subserved by the hemisphere contralateral to the resection and are seen in patients who become seizure free after surgery.
  • 35 - Parkinson's disease and other movement disorders
    pp 560-578
  • View abstract

    Summary

    Parkinson's disease (PD) is characterized neuropathologically by Lewy body type neuronal degeneration in the pars compacta of the substantia nigra resulting in dopamine deficiency in nigrostriatal projection areas. Autosomal-recessive Parkinsonism associated with the Parkin mutations is characterized by early onset with dystonia, slow progression and L-dopa responsiveness for prolonged time periods. The diagnosis of PD is made on the basis of patient history and clinical signs. Rehabilitative therapy in PD intends to provide physical and psychosocial aid that helps to secure quality of life and to reduce the characteristic complications of long-term disease. One rationale behind implementing cues in the rehabilitation of patients with PD is to substitute defective signaling between basal ganglia and supplementary motor area (SMA). Basal ganglia dysfunction in idiopathic dystonia has been confirmed by simultaneous electromyography (EMG) and deep brain recordings demonstrating disturbed basal ganglia activation related to dystonic movements.
  • 36 - Neurorehabilitation of the stroke survivor
    pp 579-592
  • View abstract

    Summary

    Comprehensive rehabilitation improves the functional abilities of the stroke survivor, despite age and neurologic deficit, and decreases long-term patient care costs. Motor recovery usually occurs in well-described patterns after stroke. A number of methods are currently used to facilitate movement in affected extremities and teach compensatory techniques to perform activities of daily living (ADL). Stroke survivors usually do not place the same degree of importance on improving upper extremity performance as that of the lower extremity. Complications involving the upper extremity may prevent the stroke survivor from reaching patient's maximal potential. Speech and language disorders may be diagnosed by both formal testing and conversational interaction. Impaired content of speech suggests aphasia or cognitive-communication impairment. Good communication between the neurorehabilitation physician, the patient, and the family will facilitate optimal care, and provide the patient with the opportunity to reach his maximal functional potential.
  • 37 - Rehabilitation in spinal cord injury
    pp 593-615
  • View abstract

    Summary

    The key to rehabilitation of the patient with acute spinal cord injury (SCI) is a strong team approach. The neurologic level of injury is determined according to the results of the motor and sensory examination. SCI may be complicated by respiratory disorders, venous thrombosis (DVT), and pulmonary embolism (PE), pressure ulcers, autonomic dysreflexia (AD), heterotopic ossification (HO), urinary tract infections (UTIs), renal calculi, gastrointestinal dysfunction, spasticity, and pain. The most accurate predictor for recovery from SCI is the standardized physical examination as endorsed by the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients(ASIA and IMSOP, 2000), that is, the neurologic (motor) level and severity. SCI with higher ASIA impairment levels have varying degrees of recovery. Research on complete tetraplegia has provided the best predictive data on functional outcomes. Functional outcome-based guidelines provide estimates of the effect of rehabilitation on functional abilities.
  • 38 - Multiple sclerosis
    pp 616-635
  • View abstract

    Summary

    Multiple sclerosis (MS) is one of the most common neurological diseases in young adults. A first evidence for an effective drug treatment for MS derived from a large randomised-controlled study published by Rose and co-workers, showing a benefit of adrenocorticotrophic hormone (ACTH) in treatment of relapses. Rehabilitation play an important role in a comprehensive management of MS in order to reduce the consequences of the disease on functional impairment, personal activities and social participation and in order to enable persons to live an independent life with the highest possible quality of life in spite of the disease. Today, there is good evidence, that rehabilitation measures are effective in MS improving disability, handicap and quality of life despite progression of disease. Timing and mode of rehabilitation measures should be selected individually depending on disease phase, functional deficits and personal needs.
  • 39 - Cerebral palsy and paediatric neurorehabilitation
    pp 636-656
  • View abstract

    Summary

    Cerebral palsy (CP) is the common diagnostic cause of the upper motor neurone (UMN) syndrome in childhood, a syndrome characterised by positive features and negative features. In CP, spasticity has both neurophysiological and musculoskeletal components. While traditional clinical evaluation of spasticity include symptoms and signs together with examination of muscle tone, range of movement (ROM), and functional impact, assessment also include validated quantitative and qualitative instruments. Oral medications affect muscles involved to varying degrees of spasticity, including both the target muscles and those for which loss of tone and/or function is undesirable. Combination treatment, such as botulinum toxin A (BoNT-A) or orthopaedic surgery, physical therapy and oral baclofen are used in clinical practice with anecdotal benefit, but the results of further scientific studies to prove the extra benefit are awaited. While selective dorsal rhizotomy (SDR) reduces spasticity, it has no effect on selective motor control (SMC), balance or fixed deformities.
  • 40 - Neuromuscular rehabilitation: diseases of the motor neuron, peripheral nerve and neuromuscular junction
    pp 657-676
  • View abstract

    Summary

    This chapter describes the current knowledge on the pathogenesis, the clinical symptoms, and deficits and current therapy concepts during the acute disease state and for rehabilitation including long-term impairment of activities of daily living. It focuses on rehabilitation of patients with diseases of the motor neuron like amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA) and polio. Rehabilitation in polio and post-polio patients is aimed at improving muscle strength, lowering muscle and joint pain, increasing physical independence and quality of life not only of the patient but also of the caregiver. The chapter also explains the rehabilitation of patients with diseases of the peripheral nervous system, especially acute and chronic inflammatory polyneuropathies Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) and other neuropathies. Finally, it also discusses diseases of the neuromuscular junction (myasthenia gravis and Lambert-Eaton myasthenic syndrome (LEMS)).
  • 41 - Muscular dystrophy and other myopathies
    pp 677-698
  • View abstract

    Summary

    Myopathy refers to any disorder that can be attributed to pathological, biochemical or electrical changes occurring in muscle fibers or in the interstitial tissue of voluntary musculature, and in which there is no evidence that such changes are due to nervous system dysfunction. Many of the dystrophies have associated features that are not a result of the muscle weakness. In rehabilitation, the best way to group myopathic diseases is by functional limitation. In order to assess function adequately, the clinician must understand the functional demands of the individual patient relative to their particular lifestyle. The myopathic patient may have a functional disability as a result of decrease in strength and endurance, orthopedic deformity, cardiopulmonary dysfunction and/or cognitive impairment. The spectrum of rehabilitation interventions for the patient with muscle disease may include exercise and assistive devices. Myogenic stem cells from bone marrow are an area with future promise.

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