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Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):156-167, March/April 2006
The authors propose a theory-based model for the treatment of post-traumatic brain injury executive dysfunction that integrates (1) theories of cerebral function and organization, (2) cognitive-behavioral theory of problem solving, and (3) learning theory. The model delineates appropriate targets of and methods for the treatment of executive dysfunction. A practical application of the theoretical model is described in the form of a comprehensive day treatment program, Executive Plus. A test of the model is also discussed, focused on the comparison of Executive Plus and a standard day treatment program along parameters dictated by the model.
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):131-141, March/April 2006
Within a theoretical framework for rehabilitation that distinguishes between automatic and controlled processes, this article reviews basic science research and addresses the following issues: What cognitive abilities remain relatively intact after severe traumatic brain injury, and how can we incorporate intact skills into rehabilitative techniques? The reviewed research indicates that individuals with severe traumatic brain injury (a) generally perform similar to controls on cognitive tasks (or task components) that require automatic and implicit processes as opposed to consciously controlled processes; (b) can learn through implicit learning mechanisms; and (c) can acquire and use automatic processes in complex, cognitive task performance.
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):179-193, March/April 2006
This is a descriptive article outlining issues in the development and implementation of a multisite randomized rehabilitation trial for brain injury treatment. The goal of this article is to present practical and theoretical considerations in designing and conducting multicenter rehabilitation trials. Practical issues discussed include (a) treatment setting, (b) patient accessibility in determining the research question of interest, as well as inclusion and exclusion criteria, (c) research protocol development in the context of rehabilitation standard of care, and (d) protocol treatments in the context of realistic cost-benefits analysis.
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):142-155, March/April 2006
Goal planning is a central concept in the clinical practice of rehabilitation. Several disciplines within psychology and medicine have elaborated theories related to goal attainment and self-regulation, the process of managing one's own goal-directed behavior. These theories may be highly relevant to brain injury rehabilitation both to help address characteristic deficits in executive function and to teach clients how to manage life tasks outside of formal rehabilitation. In this article, we describe testable, theoretically motivated interventions at 2 levels: the goal level focused on attaining or enhancing performance on individual tasks and the self-regulation level of metacognitive processes involved in planning and managing one's own goal-directed behavior.
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):194-197, March/April 2006
The challenge to presenters at the Galveston Brain Injury Conference held in April 2005 was to discuss examples of the use of theory to motivate the design of treatments for cognitive deficits resulting from traumatic brain injury. This article considers the role of theoretical rationales as well as the new optimism embracing neurorehabilitation today. However, caution to respect the maturational process needed to adequately prepare treatment evidence for clinical application is affected.
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):119-130, March/April 2006
This article proposes that constraint-induced therapy represents a theoretical model of rehabilitation emerging from basic research with implications for cognitive remediation attempts. It provides an overview of current work on constraint-induced therapies with a focus on the most widely used of these techniques, constraint-induced movement therapy (CIMT). An example from recent research in the cognitive sciences demonstrates how underlying principles of the CIMT could be used to guide rehabilitative efforts for cognitive dysfunction. Limitations and obstacles of applying such an approach are discussed.
European Journal of Neurology, Volume 13, Number 6, June 2006, pp. 611-615(5)
Computerized tomography and magnetic resonance imaging allow the accurate diagnosis in stroke and distinction of ischemic from hemorrhagic lesions. However, clinical diagnosis is still critical where neuroimaging techniques are not available, especially to establish first-aid measures in a stroke patient. In this prospective study of 300 patients with stroke, the diagnosis of ischemic and hemorrhagic strokes was made as an informal bedside diagnosis prior to neuroimaging.
European Journal of Neurology, Volume 13, Number 6, June 2006, pp. 632-638(7)
Assessment of initial disease severity after subarachnoid haemorrhage (SAH) remains difficult. The objective of the study is to identify biochemical markers of brain damage in peripheral blood after SAH. Hospital admission S100ß, glial fibrillary acidic protein (GFAP) and neuron-specific enolase (NSE) serum levels were analysed in 67 patients with SAH. Disease severity was determined by using the World Federation of Neurological Surgeons (WFNS) scale and the Fisher CT (computerized tomography) grading scale.
Congenital vertebral artery (VA) hypoplasia is an uncommon embryonic variation of posterior circulation. The frequency of this congenital variation was reported to be 2-6% from autopsy and angiograms. The aim of our study was to elucidate the role of VA hypoplasia in acute ischemic stroke.
The authors derived a clinical score to predict mortality in status epilepticus (SE) from analysis of a retrospective SE cohort, using four variables available at presentation: history of seizures, age, seizure type, and consciousness impairment. Validation on a small prospective SE series (34 patients) resulted in sensitivity, 1.000; specificity, 0.643; negative predictive value, 1.000; and unweighted accuracy, 0.822. This simple clinical score may reliably identify patients surviving after SE.
Clinical Pediatric Emergency Medicine Volume 7, Issue 2 , June 2006, Pages 94-104
Prehospital providers are often the first line of response for the triage and treatment of children with traumatic brain injury (TBI). New advances in diagnosis and management in the prehospital setting have led to a dramatic improvement in the care of patients with TBI.
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):168-178, March/April 2006
3-stage model of intervention is used to contrast the philosophy and treatment practices of 2 behavioral approaches to behavior disorder following traumatic brain injury. The first referred to here as the Operant Neurobehavioral Approach developed from neuropsychology and learning theory.
Acta Radiologica, Volume 47, Number 1, February 2006, pp. 85-90(6)
To evaluate FDG-PET in post-radiotherapy differentiation of tumor recurrence/malignant degeneration and radiation reaction, and to assess the role of PET in terms of survival. Material and Methods: 117 consecutive patients with a total of 156 FDG-PET examinations with positive but non-diagnostic MRI and/or CT were included.
Survivors of brain injury or stroke can improve movement ability with intensive, supervised practice. Since the hours of supervised therapy with a physical or occupational therapist are limited, telerehabilitation will enable patients to greatly expand the hours that they practice therapeutic exercises.
Journal of Trauma-Injury Infection & Critical Care. 60(6):1250-1256, June 2006
Prehospital management of traumatic brain injury (TBI) and trauma system development and organization are aspects of TBI care that have the potential to significantly impact patient outcome. This multi-center study was conducted to explore the effect of prehospital management decisions on early mortality after severe TBI.
The authors describe diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) changes in the hippocampus within 48 hours of acute symptomatic seizures or status epilepticus in 12 patients.
The authors performed a retrospective cohort comparison using the Nationwide Inpatient Sample for 1999 through 2002 of acute ischemic stroke admissions. Mortality was compared based on the use of thrombolysis.
Recent data suggest that women obtain greater benefit than men from IV fibrinolysis for acute ischemic stroke. It is unknown whether this gender–thrombolysis advantage extends to those treated with intra-arterial (IA)
thrombolysis. The authors evaluated the independent effect of gender among ischemic stroke patients treated with IA fibrinolysis and found no differences in short-term clinical and angiographic outcomes between men and women who received IA thrombolysis for acute ischemic stroke.
opean Journal of Neurology, Volume 13, Number 6, June 2006, pp. 581-598(18)
Reliable data on stroke incidence and prevalence are essential for calculating the burden of stroke and the planning of prevention and treatment of stroke patients. In the current study we have reviewed the published data from EU countries, Iceland, Norway, and Switzerland, and provide WHO estimates for stroke incidence and prevalence in these countries.
Preclinical animal models can help guide the development of clinical pediatric and newborn stroke trials. Data obtained using currently available models of hypoxia-ischemia and focal stroke have demonstrated the need for age-appropriate models.
Clinical Neurology and Neurosurgery Volume 108, Issue 5 , July 2006, Pages 507-510
Cheiro-oral-pedal syndrome is characterized by specific sensory disturbance around the corner of the mouth, in the hand and in the foot on the same side. Lesions responsible for causing this syndrome vary.
European Journal of Neurology, Volume 13, Number 6, June 2006, pp. 599-603(5)
The consequences of brain abscess (BA) on cognition and behaviour have never been examined in detail. The aim of this study was to determine the long-term cognitive deficits of patients who suffered a BA and to estimate its effect on the quality of life.
Lung Cancer Volume 53, Issue 1 , July 2006, Pages 51-58
Lung cancer accounts for about 50% of brain metastases, of which nearly 25% are eligible for neurosurgery, providing a neurological control rate of up to 70% when followed by whole brain radiation therapy. How to manage the primary lung carcinoma remains elusive.
To develop standardized definitions for classification of partial seizure symptoms for use in genetic research on the epilepsies, and evaluate inter-rater reliability of classifications based on these definitions.
Disability & Rehabilitation Volume 28, Number 13-14 / July 2006 815 - 821
‘Plateau’ is an expression frequently used in relation to decisions to discharge patients from physiotherapy following stroke. This paper critically considers the concept of recovery plateau in stroke, exploring
(i) the evidence for plateau, (ii) potential contributing factors, and (iii) the consequences for patients, therapists and services.
Disability & Rehabilitation Volume 28, Number 13-14 / July 2006 823 - 830
The present debate paper addresses four relevant issues related to the impact of intensity of practice after stroke. First, the best way to define intensity of practice is discussed. Second, the paper describes the evidence that exists for a dose-response relationship in stroke rehabilitation. Third, the relevance of an appropriate patient selection for a meaningful intensive practice is explored. Finally, the paper raises the question of what it is that patients actually learn when they improve their functional skills.
Disability & Rehabilitation Volume 28, Number 13-14 / July 2006 831 - 840
There is little guidance on using extrinsic feedback to enhance motor learning after stroke. This narrative review synthesises research findings and identifies questions remaining to be answered.
Disability & Rehabilitation Volume 28, Number 13-14 / July 2006 841 - 847
Social Cognition Theory and the cognitive construct of self-efficacy often form the theoretical basis for many chronic disease self-management programmes. Self-efficacy can be influenced through these programmes and has been shown to be predictive of greater levels of functioning and psychological well-being. Stroke is regarded as a complex chronic disability, and individuals may share many of the same concerns as those living with other chronic diseases such as arthritis and chronic pulmonary disease. However there has been minimal reported research on the utility of self-management programmes following stroke.
Disability & Rehabilitation Volume 28, Number 13-14 / July 2006 849 - 856
To explore differences in cognitive-motor interference between people with stroke and controls when performing functional tasks and to compare dual task performance of stroke fallers and non-fallers.
Disability & Rehabilitation Volume 28, Number 13-14 / July 2006 857 - 864
The syndrome of unilateral neglect following stroke is associated with poor outcome and presents significant challenges to those providing therapy for affected individuals. In contrast to a number of reviews which have recently appeared in therapy and rehabilitation journals relating to sensory aspects of neglect, this review focuses on ‘motor neglect’.
Disability & Rehabilitation Volume 28, Number 13-14 / July 2006 865 - 872
The lack of information about the content of therapy packages is a frequent criticism in stroke rehabilitation research. This study aimed to describe, in detail, the content of one aspect of physiotherapy; the rehabilitation of postural control.
Disability & Rehabilitation Taylor & Francis Volume 28, Number 13-14 / July 2006 873 - 881
The purpose of this study was to characterize the gait cycle of patients with hemiplegia before and after a period of outpatient physiotherapy based on the Bobath concept.
Disability & Rehabilitation Volume 28, Number 13-14 / July 2006 891 - 897
Understanding the relationship between the motor impairments and their impact on physical activity will allow rehabilitation after stroke to be based on scientific principles. The aims of this study were to determine: (i) the relative contribution of weakness and spasticity to contracture, and (ii) the relative contribution of all three impairments to limitations in physical activity during the first 12 months after stroke.
Clinical Neurology and Neurosurgery Volume 108, Issue 5 , July 2006, Pages 433-439
Post-traumatic epilepsy (PTE) is a recurrent seizure disorder secondary to brain injury following head trauma. PTE is not a homogeneous condition and can appear several years after the head injury. The mechanism by which trauma to the brain tissue leads to recurrent seizures is unknown. Cortical lesions seem important in the genesis of the epileptic activity, and early seizures are likely to have a different pathogenesis than late seizures.
American Journal of Surgical Pathology. 30(5):635-642, May 2006
Amplification of MYCN in neuroblastoma is associated with a poor prognosis. However, methods for estimating the number of MYCN genes based on pooled cells do not address copy number heterogeneity at the cell level and can underestimate or even miss amplification. MYCN copy number can be directly assessed by fluorescence in situ hybridization, but evaluation of tissue histology is next to impossible.
Neurobiology of Disease Volume 22, Issue 2 , May 2006, Pages 312-322
Chemokine receptors represent promising targets to attenuate inflammatory responses and subsequent secondary damage after brain injury. We studied the response of the chemokines CXCL1/CINC-1 and CXCL2/MIP-2 and their receptors CXCR1 and CXCR2 after controlled cortical impact injury in adult rats. Rapid upregulation of CXCL1/CINC-1 and CXCL2/MIP-2, followed by CXCR2 (but not CXCR1), was observed after injury. Constitutive neuronal CXCR2 immunoreactivity was detected in several brain areas, which rapidly but transiently downregulated upon trauma.
Neurobiology of Disease Volume 22, Issue 2 , May 2006, Pages 374-387
The biology underlying epileptic brain activity in humans is not well understood and likely depends on changes in gene expression. We performed a microarray transcriptome profiling of 12 anterolateral temporal cortical samples originating from five individuals who suffered with temporal lobe epilepsy for at least 10 years.
There have been few published reports of successful surgical treatment of focal status epilepticus. Surgical intervention is considered a last resort after medical strategies have been exhausted.
Our group has developed a relatively low-cost virtual reality (VR) system for rehabilitation of the upper limb following stroke. Our system is immersive in that the participant views a representation of their arm and hand, reaching and retrieving objects in the virtual environment
(VE), through a head-mounted display (HMD). This is thought to increase the participant’s sense of presence in the VE and may lead to improved rehabilitation outcomes. However, use of immersion, particularly with our low-cost system, may increase the incidence of side effects reported.
Cerebrovascular disorders are increasingly recognized as important causes of mortality and morbidity in the pediatric population. However, there have been no clinical trials performed to assess the safety and tolerability of acute interventions or secondary preventative treatments.
Stroke is an important complication after cardiac catheterization procedures, resulting in death and disability for thousands of patients each year. Common risk factors include advanced age, vascular comorbidities, and more complicated and invasive procedures. Several lines of evidence suggest that these strokes are embolic, from either dislodgement of a clot or atheromatous debris off the aortic arch or from thrombus formation on the tip of a guide catheter. These strokes are likely amenable to thrombolysis, although the current literature regarding the use of thrombolysis in this setting is limited to case reports and series. Whether thrombolysis is safe and efficacious remains to be determined, but the existing evidence seems favorable for individual circumstances.
Before designing epidemiologic, genetic, or treatment trials in pediatric stroke, we should learn from adult trials which preceded. Adult trialists state that there is a need for improved animal models to mimic human disease.
Journal of Trauma-Injury Infection & Critical Care. 60(6):1245-1249, June 2006
Crushing head injuries (CHI) are caused by static loading. This static force slowly deforms a cranium and damages some intracranial components. Severe CHI is usually fetal but substantial brain damage may not be recognized in some patients. In this article, we report seven patients who sustained CHI and analyzed clinical and radiological findings.
American Society of Clinical Oncology
(ASCO) annual meeting, Atlanta, June 3, 2006.
The addition of the drug motexafin gadolinium to whole-brain radiation therapy for patients with brain metastases from non-small cell lung cancer significantly delayed the progression of brain damage. The amount of time between the diagnosis of metastases and the start of therapy correlated with the benefit of the treatment—delayed therapy was less effective.
The Remote Console (ReCon) is a telerehabilitation application that allows therapists to remotely communicate with patients while monitoring and controlling their virtual rehabilitation exercises. It provides therapists visual feedback of patients' movements, their exercise simulations replicated in real time and with tools to conduct training without a face-to-face session.
Disability and Rehabilitation: Assistive Technology Volume 1, Number 3 / June 2006 175 - 182
The aim of this study was to investigate how adults with spinal cord injury assess their satisfaction regarding various aspects and use of their manual wheelchair.
Cerebral ischaemia is implicated in poor outcome after brain injury, and is a very common post-mortem finding. The inability of the brain to store metabolic substrates, in the face of high oxygen and glucose requirements, makes it very susceptible to ischaemic damage.
Journal of Infection Volume 52, Issue 6 , June 2006, Pages e177-e180
Reports linking alterations in blood glucose concentrations with fluoroquinolones, mostly gatifloxacin and ciprofloxacin, have been published. We describe an elderly, non-diabetic patient with steroid-induced hyperglycemia prescribed glyburide who later developed severe hypoglycemia resulting in anoxic brain injury soon after initiating therapy with levofloxacin.
The external validity of a noninvasive language mapping protocol with magnetoencephalography (MEG) has been established through direct comparisons with invasive functional mapping techniques. This study examines the test–retest and interrater reliability of this protocol under realistic testing conditions in 21 epilepsy surgery candidates.
To replicate an investigation of the effects of a multi-component cognitive-behavioural intervention on the challenging behaviour of two young children with growing behavioural concerns after TBI.
Among the recent advances in neuroimaging and clinical neurophysiology, simultaneous electroencephalography (EEG) and functional magnetic resonance imaging
(fMRI), that is SEM, stands apart as a challenging integration of techniques with great potential to provide unique information. The benefit of this integration is the utilization of each technique’s strengths: the high temporal resolution and sensitivity to epileptic abnormalities of EEG and the high spatial resolution and noninvasive localization of cerebral metabolic change of
fMRI.
Up to one-third of children with epilepsy are diagnosed with cryptogenic localization-related epilepsy (CLRE). CLRE is a large nonspecific category within the ILAE classification. For this population no unequivocal prognosis exists.
Longitudinal cognitive outcome with respect to general cognitive status and memory at the group and individual levels was studied 10 years after temporal lobe resection for epilepsy. Twenty-five patients who had undergone a medium-term follow-up (T2, median = 2.7 years) also underwent a long-term follow-up (T3, median = 9.8 years). At the group level, there was a significant increment across time, partly due to practice, in IQ (P value from 0.049 to <0.0001) but not in memory variables.
It has been suggested that there exists a close relationship between seizure discharges and functional recovery from brain injury, and that paroxysmal bombardment in late seizures may herald functional recovery or may “kick-start” recovery.
The long-term effects of tiagabine monotherapy on cognition and mood were evaluated in adult patients with chronic partial epilepsy in a 48-week, open-label extension period that followed an 8-week, double-blind, titration study.
The present study was conducted to evaluate the long-term effects of low-dose topiramate (TPM) monotherapy on the cognitive function of epilepsy patients.
Craniopharyngiomas are rare, mainly sellar/parasellar, epithelial tumors diagnosed during childhood or adult life. Histologically, two primary subtypes have been recognized (adamantinomatous and papillary) with an as yet, unclarified pathogenesis. They may present with a variety of manifestations (neurological, visual, and hypothalamo-pituitary). Despite their benign histological appearance, they often show an unpredictable growth pattern, which, combined with the lack of randomized studies, poses significant difficulties in the establishment of an optimal therapeutic protocol. This should focus on the prevention of recurrence(s), improvement of survival, reduction of the significant disease and treatment-related morbidity (endocrine, visual, hypothalamic, neurobehavioral, and cognitive), and preservation of the quality of life.
This study compared thought disorder (i.e., impaired use of language to formulate and organize thoughts) in 93 children with complex partial seizures (CPSs) and 56 children with primary generalized epilepsy with absence (PGE) and its relationship to age, seizure, cognitive, and linguistic variables. By the use of psychopathology, social competence, academic achievement, and school problem measures, the functional implications of thought disorder in these two groups were compared.
The use of rapid infusion of large-volume cold saline (CS) as an adjunctive therapy for treating refractory fever in nine patients is reported. A decline in temperature (39.2 ± 0.3 vs 37.1 ± 1.2 °C, p = 0.006) at 2 hours and fever burden (97.3 ± 343.8 vs 734.3 ± 422.3 °C*min, p = 0.02) at 12 hours was noted after CS bolus. Rapid infusion of large-volume CS may be used as an adjunct for inducing normothermia in refractory febrile patients.
Pathologic findings, including cerebellar changes and brainstem Lewy bodies, distinguished 10 essential tremor (ET) cases from 12 controls. Numbers of torpedoes (p = 0.009) and Bergmann glia (p = 0.046) were increased in cases. Six cases (60%) had Lewy bodies vs 2 controls (16.7%) (odds ratio 7.5, 95% CI 1.04 to 54.1; p = 0.035). Four of these six had an atypical distribution of brainstem Lewy bodies. ET may be pathologically heterogeneous.
Recent data suggest that women obtain greater benefit than men from IV fibrinolysis for acute ischemic stroke. It is unknown whether this gender–thrombolysis advantage extends to those treated with intra-arterial (IA)
thrombolysis. The authors evaluated the independent effect of gender among ischemic stroke patients treated with IA fibrinolysis and found no differences in short-term clinical and angiographic outcomes between men and women who received IA thrombolysis for acute ischemic stroke.
The authors performed a retrospective cohort comparison using the Nationwide Inpatient Sample for 1999 through 2002 of acute ischemic stroke admissions. Mortality was compared based on the use of thrombolysis. Hospital mortality was significantly greater for the thrombolysis cohort (10.1% vs 5.8%) as was the rate of secondary intracranial hemorrhage (4.2% vs 0.4%). US community experience in the use of thrombolysis has higher rates of complications and mortality than in controlled clinical trials.
The authors derived a clinical score to predict mortality in status epilepticus (SE) from analysis of a retrospective SE cohort, using four variables available at presentation: history of seizures, age, seizure type, and consciousness impairment. Validation on a small prospective SE series (34 patients) resulted in sensitivity, 1.000; specificity, 0.643; negative predictive value, 1.000; and unweighted accuracy, 0.822. This simple clinical score may reliably identify patients surviving after SE.
The authors describe diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) changes in the hippocampus within 48 hours of acute symptomatic seizures or status epilepticus in 12 patients. DWI showed increased signal and a decreased apparent diffusion coefficient (ADC) in all patients, with corresponding lactate detected on MRS in six patients and EEG seizure activity in nine patients. On follow-up, the atrophic hippocampus had an increased ADC in six patients. DWI and MRS may predict development of hippocampal sclerosis.
To examine the potential validity of performance measures and examination-based scales in Friedreich ataxia (FA) by examining their correlation with disease characteristics.
Caudal midbrain lesions involving the entire decussation of the superior cerebellar peduncles have a distinctive clinical picture: bilateral cerebellar ataxia, eye-movement disorders, and palatal myoclonus. Occasionally, unilateral lesions may produce a similar neurologic picture.
The –1p/–19q genotype has been associated with prolonged survival and chemosensitivity in oligodendroglial
neoplasms, but the predictive and prognostic significance of genotype in the routine clinic is not established.
To evaluate the efficacy and tolerability of levetiracetam (LEV) as adjunctive therapy in children (4 to 16 years) with treatment-resistant partial-onset seizures.
To develop standardized definitions for classification of partial seizure symptoms for use in genetic research on the epilepsies, and evaluate inter-rater reliability of classifications based on these definitions.
The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 6 2105-2111
The aim of this study was to determine 1) the prevalence of anterior pituitary hormone deficiencies in the acute phase of TBI and after 12 months, 2) whether severity of trauma correlated with basal hormone levels, and 3) whether initial hormone deficiencies predicted medium-term hormonal status.
Acute hamstring rupture is an uncommon event often occurring during high impact sports. Such events have not been previously reported during neurological rehabilitation. This case report describes a 30 year-old Chinese male presenting in a minimally responsive state 5 years after a severe traumatic brain injury.
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 2119-2125
Sturge-Weber syndrome is characterized by leptomeningeal angiomatosis and a facial naevus that is usually unilateral. Magnetic resonance imaging is the cornerstone of confirming the disease and judging the extent of the abnormalities. It has been shown, however, that brain perfusion abnormalities on nuclear medicine imaging often are more extensive than the abnormal leptomeningeal enhancement on magnetic resonance. In this article, we assess the utility of magnetic resonance perfusion in demonstrating perfusion abnormalities in pediatric cases of Sturge-Weber syndrome.
To explore pre-injury variables related to post-discharge psychosocial status and identify factors related to work and driving outcomes. Methods and procedures : Ninety-three brain-injured patients attended a holistic milieu-oriented neurorehabilitation program and were contacted 1-7 years post-discharge.
This study reports two patients with tumours arising from the splenium of the corpus callosum that caused a memory disturbance consistent with retrosplenial amnesia as well as a variety of cognitive deficits including agraphia, acalculia, constructional apraxia and ideomotor and ideational apraxia involving both hands, but not aphasia.
We examined anticipatory mechanisms of reward-motivated memory formation using event-related FMRI. In a monetary incentive encoding task, cues signaled high- or low-value reward for memorizing an upcoming scene. When tested 24 hr postscan, subjects were significantly more likely to remember scenes that followed cues for high-value rather than low-value reward.
Therapeutic Apheresis and Dialysis, Volume 10, Number 1, February 2006, pp. 90-93(4)
A 53-year-old-male patient was admitted to the Hiroshima University Hospital in August 2001, with a history of progressive cerebellar ataxia, notable by standing and gait disturbances. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed no signs of ischemic damage. Two weeks later, left axillary lymphadenopathy developed. The pathological finding was Hodgkin's disease (HD; a classical malignant lymphoma in an early stage). Serum antibodies against Purkinje's cells (anti-Tr antibody) were detected by immunohistochemical study. Thus, we diagnosed this as paraneoplastic cerebellar degeneration (PCD) associated HD.
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 2111-2118
Early diagnosis of periventricular hemorrhagic infarction in premature infants is based on bedside neonatal cranial ultrasonography. Currently, evaluation of its morphology and evolution by cranial ultrasound relies largely on data predating major advances in perinatal care and lacks a consistent classification system for determining severity of injury. The objective of this study was to examine the ultrasonographic morphology and evolution of periventricular hemorrhagic infarction in the modern NICU and to determine the value of a cranial ultrasonography-based severity score for predicting outcome.
International Journal of Rehabilitation Research. 29(2):137-143, June 2006
The aim of this study was to examine the predictive factors, and their relative strengths, for predicting length of rehabilitation stay using the path model. One hundred and seventeen stroke patients were recruited from two rehabilitation units in university-affiliated hospitals in northern Taiwan.
International Journal of Rehabilitation Research. 29(2):131-136, June 2006
Volunteers play an important role in many organisations that deliver services for the public good. Many people within the community choose to volunteer and there is a rich literature on the reasons why people do so, as well as the benefits that accrue to individuals, organisations and the community. However, there are few reports of people with long-standing disability becoming volunteers.
International Journal of Rehabilitation Research. 29(2):123-129, June 2006
The educational group has been proposed as an effective way to deliver a program based on structured stroke knowledge to enhance emotional support among people with stroke and their caregivers. The aim of this study was to explore whether the stroke educational group could increase stroke-related knowledge, and improve perceived health status, in persons with stroke and their caregivers, and thus reduce the stress induced during the care-giving process.
International Journal of Rehabilitation Research. 29(2):117-121, June 2006
The Community Integration Program Questionnaire was developed to measure various quantifiable characteristics of community integration programs for people with brain injury. There are three versions: one for outpatient facility-based, one for residential and one for home programs. In this study questionnaires were administered to directors and associate directors of seven programs. A research assistant then went on-site to collect corresponding data using patient records, planning books and schedules, annual and quarterly reports, employee lists, staff curricula vitae, census data, insurance payment data, team meeting notes, incident reports, and staff logs.
International Journal of Rehabilitation Research. 29(2):105-111, June 2006
The objectives of this study were to examine the demographic and clinical characteristics of stroke patients admitted for inpatient rehabilitation, to study the occurrence of medical problems/complications, and to document functional outcome and possible factors influencing outcome.
Primary objective : The objective was to learn what the family members of individuals with acquired brain injury (ABI) perceived as important needs and to what extent these needs are being met. Methods and procedures : Sixty-six individuals who care for someone with an ABI and who receive service from the Saskatchewan South ABI Outreach Team completed the Family Needs Questionnaire (FNQ).
A virtual reality (VR)–based locomotor training system has been developed for gait rehabilitation post-stroke. The system consists of a self-paced treadmill mounted onto a 6-degree-offreedom motion platform. Virtual environments
(VEs) that are synchronized with the speed of the treadmill and the motions of the platform are rear-projected onto a screen in front of the walking subject. A feasibility study was conducted to test the capability of two stroke patients and one healthy control to be trained with the system.
To determine if WBRT combined with SRS results in improvements in survival, brain tumor control, functional preservation rate, and frequency of neurologic death.
The ethical and scientific literature reflects a certain amount of controversy and confusion surrounding the concept of death by neurological criteria, or brain death. The issues surrounding brain death occur with limited frequency for those working in acute critical care settings. Even so, the literature and our own experiences evidence the discomfort of caregivers and policymakers when dealing with brain-dead patients and their family and loved ones. One particular area in which there seems to be significant diversity of opinion is what should occur when death by neurological criteria is pronounced. At some hospitals, when the patient is pronounced dead by neurological criteria, the support equipment is removed from the body immediately and the body is prepared for visitation by family or is transported to the morgue. In other hospitals, support equipment is maintained for a certain limited period to allow the family to be present when the equipment is ultimately removed. In general, however, it appears that institutional guidelines and policy are vague, at best, or often silent about the issue of when, how, and, to some extent, who decides what is done with the body. This policy paper discusses the confusion of care providers as well as lay persons related to the general concepts of death by neurological criteria. In addition, alternative approaches to the withdrawal of support equipment are examined. This article may also allow nursing administrators to better understand the importance of establishing specific clinical guidelines for their staff related to patients declared dead by neurological criteria.
Journal of Manipulative and Physiological Therapeutics Volume 29, Issue 4 , May 2006, Pages 330-335
To discuss the case of a patient with chronic headache. Although not in severe pain at time of consultation, signs and symptoms raised concern. The patient later had a cerebrovascular accident.
Journal of Infection Volume 52, Issue 6 , June 2006, Pages 443-450
We evaluated the efficacy of cefotaxime in the management of brain abscesses caused by Streptococcus milleri. Twenty two patients with a S. milleri brain abscess were treated with metronidazole and cefotaxime, in accordance with recent recommendations by the British Society Of Antimicrobial Chemotherapy (BSAC). Seven patients who had Glasgow Coma Scales =11 also received rifampicin and high dose cefotaxime. The clinical response of the patients was determined.
Sleep Medicine Volume 7, Issue 4 , June 2006, Pages 380-381
We present a case of episodic stupor associated with a myriad of neuropyschiatric manifestations that baffled doctors until they were recognized as sleep attacks. Continuous monitoring and recognition of a cyclical pattern of symptoms and signs helped to uncover the underlying cause of a rapidly cycling bipolar disorder. The symptoms abated quickly and persistently when treated by olanzapine and lithium.
The long-term outcome with respect to seizure relapse after planned discontinuation of antiepileptic drugs (AEDs) in seizure-free patients is not well known. Relapse and its treatment outcome were evaluated in a longitudinal population-based study of 148 patients from the onset of their epilepsy to an average follow-up of 37 years.
The Journal of Neuroscience, May 24, 2006, 26(21):5665-5672
Slow-wave sleep is characterized by alternating periods of activity and silence in corticothalamic networks. Both activity and silence are stable network states, but the mechanisms of their alternation remain unknown. We show, using simultaneous multisite intracellular recordings in cats, that slow rhythm involves all neocortical neurons and that both activity and silence started almost synchronously in cells located up to 12 mm apart.
Variability has been reported in the practices to determine death by neurological criteria for adults and children. The objective of this study was to determine if this variability exists in the Canadian context.
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):107-118, March/April 2006
Functions of the prefrontal cortex (PFC) are fundamental to learning and rehabilitation after brain injuries, but the PFC is particularly vulnerable to trauma. We propose approaches to cognitive training that are hypothesized to specifically enhance PFC function. We present a theoretical framework that generates hypotheses regarding the effects of training on the functional integration of processes across distributed networks of brain regions. Specific outcome measurements that may be used to test these hypotheses in clinical trials are proposed. This neural network-level approach may guide cognitive rehabilitation and facilitate development of adjunctive biologic treatments to enhance the effects of training.
Intracerebral hemorrhage (ICH) is the most serious and potentially fatal complication of oral anticoagulant therapy (OAT). Still, there are no universally accepted treatment regimens for patients with OAT-ICH, and randomized controlled trials do not exist. The aim of the present study was to compare the acute treatment strategies of OAT-associated ICH using vitamin K (VAK), fresh frozen plasma (FFP), and prothrombin complex concentrates (PCCs) with regard to hematoma growth and outcome.
The British Journal of Psychiatry (2006) 188: 574-580
To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial.
Higher proportions of hemorrhagic stroke and lacunar infarction were reported in rural Japan compared with those in Western countries. We examined the relative proportions of stroke subtypes in an urban Japanese city where westernized lifestyles are more common than in rural areas.
Impaired glucose tolerance, an intermediate metabolic state between normal glucose and diabetes characterized by nonfasting glucose levels between 7.8 to 11.0 mmol/L, is associated with an increased stroke risk in patients with coronary heart disease. Whether impaired glucose tolerance increases the risk of stroke in patients with transient ischemic attack (TIA) or minor ischemic stroke is unknown.
Although there is some early evidence showing the value of repetitive transcranial magnetic stimulation (rTMS) in stroke rehabilitation, the therapeutic effect of high-frequency rTMS, along with the physiology of rTMS-induced corticomotor excitability supporting motor learning in stroke, has not been established. This study investigated high-frequency rTMS-induced cortical excitability and the associated motor skill acquisition in chronic stroke patients.
Readmission rate within 6 months after a stroke is 40% to 50%. The purpose of the project was to evaluate whether an interdisciplinary stroke team could reduce length of hospital stay, readmission rate, increase patient satisfaction and reduce dependency of help.
To assess whether poststroke rehabilitation outcomes and reimbursement for Medicare beneficiaries differ across inpatient rehabilitation facilities (IRFs) and skilled nursing facility (SNF) subacute rehabilitation programs.
A recent study showed a dramatic increase in cerebral hemorrhage comprising atypical locations with low-frequency ultrasound–mediated recombinant tissue plasminogen activator–thrombolysis in humans. Here, we provide a possible explanation for this phenomenon by a side effect observed in a study using the similar ultrasound device.
Classification of outcome events is essential in clinical research. The Executive Committee of the European/Australasian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT), a secondary prevention trial in patients with cerebral ischemia, repeatedly encountered problems in classifying the cause of death after a stroke if the interval between these events was relatively long. We aimed to develop guidelines for classifying such events.
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