Neurological Rehabilitation

To determine whether the multi-modal web-based rehabilitation 'Move it to improve it' (Mitii) is more effective than wait list control (usual care) to improve occupational performance, upper limb function, and visual perception in children with acquired brain injury (ABI). Fifty-eight randomly allocated children (53% males; mean age 11y 11mo, SD 2y 6mo; Manual Abilities Classification Scale equivalent I=32, II=24, III=2; mean Full-scale IQ 75.8, SD 16.2) received either 20 weeks of Mitii (n=29) or usual care (n=29). Mitii comprised upper limb, cognitive, visual perception, and gross motor tasks, recommended for 30 minutes per day, 6 days per week, over 20 weeks. Outcomes were the Assessment of Motor and Process Skills (AMPS), Melbourne Assessment of Unilateral Upper Limb Function, Jebsen-Taylor Test of Hand Function, Test of Visual Perceptual Skills, Assisting Hand Assessment (AHA), and Canadian Occupational Performance Measure. The primary comparison at 20 weeks between gro...

Summary

Background and purpose: Stroke as a social disease is the most common complication of cardiovascular disease and untreated heart disease. The first part describes the symptoms, factors, the types of stroke. Next are described the types of treatment in the case of stroke, treatment, risks of disease and complications. In the following paper presents rehabilitation after strokes, taking into account the function of nurse in the neurology and stroke prevention.
The aim of this work was to study the awareness of young people with knowledge about the prevention of stroke, must be sent in the event of a stroke and the wider prevention. A very important factor in the study was also to know how the information reaches the public and the ways that information will be most effective, especially in young people who had no contact with patients with a history of strokes and do not know what complications and risks may have been encountered with stroke.
Material and methods: The study included 30 people have been diagnosed with a stroke in the past three years, and in a control group of young people who have so far had no contact with the concept of żadenj stroke or disease. The study included patients residing in the neurology department of subdivision shock and post-traumatic rehabilitation ward and neurological in one of the Lubusz hospitals. The control group was selected from the environment outside the hospital.
Results: The study showed that the majority of respondents first met with the notion of the relationship of stroke friends-as much as 45% answered yes, while 44% of television. A small group of 12% received the information from your GP. Majority of respondents indicated that they do not know what are the causes of stroke, however, a fairly large group defined as the risk of stroke, life-threatening, and would report to the emergency department, ambulance-89% answered yes. With further research shows that the respondents were largely limited access to rehabilitation or significantly hindered.
Conclusions: The study has also confirmed that public knowledge of stroke, especially of young people is insufficient and there is quite a huge interest in the prevention of these diseases in the community.
Keywords: stroke, prophylaxis and treatment of stroke patients, rehabilitation of cerebral stroke patients.

Special issue of "Culture Unbound". Through an introduction and six original articles, the issue investigates a variety of cultural and scientific discourses and practices that in different ways are related to neuroscience and the brain.

The special issue was edited by guest editors Peter Bengtsen and Kristofer Hansson.

Somatosensory rehabilitation is presented by means of its paradigm which is: Look for hypoesthesia, because, by decreasing hypoesthesia neuropathic pain decreases. Occupational therapists are going to observe cutaneous sense disorders if, and only if they know beforehand that they can offer a new treatment to the patients they are taking care of.
Somatosensory rehabilitation and it’s effects are presented: by means of the Mc Gill pain questionnaire which allows the assessment of the patients pain symptoms and by means of the pharmacological treatment indicator: The number needed to treat (NNT). The important and strong correlation (Cov=15.7) between the decrease of hypoesthesia and the decrease of neuropathic pain is demonstrated. The rehabilitation of hyposensitivity based on the neuroplasticity of the somatosensory system is described. The second part of the article tells about the assessment of patients with chronic neuropathic pain: Clinical reasoning of a beginning reeducator, the mapping of the zones of hypoesthesia or when it occurs, that are hypertensive to touch and especially the therapeutic strategy which will be chosen according to the status of the skin. As a conclusion, the ways to learn more about it are enumerated.

Objectives: The study was conducted to determine the effects of MCIT on the affected upper extremity among Mild Moderate Spastic Hemiplegic children. Study Design: Randomized Control Trial (RCT) Study Settings & Participants: An experimental study was conducted on 30 participants at a renowned CP Centre in Karachi. Procedure: The participants were randomly divided into Group A that received MCITwhereas group Bwas given conventional therapy.Group Aparticipants restraint non-affected arm and involve in different activities by using the affected arm while the other group performed different selected activities using both the arms.Data was recorded in a treatment sheet where PAFTwas used as a measurement tool.Data was analyzedusing SPSS version 20 Results: Results revealed significant improvements on affected hand in both the groups but MCIT isfound to be more effective than conventional therapy. Results were independent of children age and genderbut were dependent on degree of spastici...

Report about the Maui-Molokai Adult Drug Court, which I created and which achieved over 12 years an 84% success rate for graduates, measured by whether a graduate committed another felony crime.  The program has  many innovative features, not utilized by other drug courts.  So far as I know, this is the only article that describes evolution of a drug court.

School personnel and others involved with students with head injury, brain damage and concussion have difficulty monitoring
recovery and progress of therapeutic intervention in cases of children and adolescents who have suffered a head trauma. The
recently revised Bender Gestalt II is a quick, and reliable dependable test that will at least provide some information as to recovery
from head injury or concussion and will provide a way in which clinicians can monitor progress and recovery. This article will provide
preliminary information about the revised Bender Gestalt II and outline some ways in which this instrument can be employed to
provide feedback as to growth and recovery regarding head injury.

Background: Fatigue is prevalent in neurological disorders and is associated with increased disability and mortality rates.  Currently, clinical assessment and management of fatigue is difficult as underlying mechanisms remain poorly understood. Purpose: This narrative review integrates models of pathological fatigue with the concepts of self-regulation and mindfulness.  Findings from clinical trials testing the efficacy of mindfulness-based interventions (MBI) for fatigue in neurological disorders are also reviewed.  Methods: A search of Medline and PsycINFO databases was conducted using “fatigue”, “neurological disorders”, “exercise”, “self-regulation” and “mindfulness” search terms to identify articles published from 1980 to present. Only articles reporting on fatigue relevant clinical outcomes were included in the review of trials testing MBI.  Results: Recent definitions and models of pathological fatigue suggest that neurological disorders might instigate maladaptive changes in self-regulation leading to difficulties in sustaining movement and disproportionate levels of perceived effort.  MBI might be effective in the management of fatigue since mindfulness training is thought to promote self-regulation by developing attention control and cognitive and emotional flexibility. Findings from a small number of clinical trials provide limited support for the efficacy of mindfulness-based interventions for fatigue in neurological disorders.  Conclusion: Given the prevalence and debilitating effect of fatigue in neurological conditions, further research is needed to investigate the potential role of maladaptive self-regulation in the aetiology of this condition.  Further research is also needed to test the efficacy of MBI including large randomised controlled trials with active control conditions and which directly assess changes in mindfulness along with fatigue.

Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite-and perhaps because of-their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb's residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchro...

Patients who are suffering from shoulder Orthopedic disorder Like Shoulder impingement syndrome, Rotator cuff tear , Rc Tendinitis etc. The research is about the Examination of the Rotator Cuff Disorders and treatment of patients with proper advanced Physical Rehabilitation

New research developments in the recovery of function following neurological trauma as well as basic and applied research relevant to music perception and production, seem to point to the
suggestion that specific music therapy interventions that directly address the restoration of function as opposed to developing compensatory mechanisms, in certain circumstances, may now
be a more appropriate treatment approach. We will address the issue of appropriate timing for the introduction of each strategy and discuss potential outcomes of each approach. As one might
imagine, much of this research is published in the neurological journals, which music therapists may not regularly consult. It seems challenging enough just to keep abreast of new music therapy literature. Further, there is so much neurological research that the music therapy clinician often finds it difficult to know where to begin. This text provides an overview of a growing concept related to recovery known as neuroplasticity, and how specific training models in music therapy utilize this relatively recently identified phenomenon. Also, a framework will be provided to help guide the practicing clinician when attempting to build a lineage of systematic thought relevant to the use of music in neurorehabilitation, as well as discuss the frequently employed concept of behavioural compensation. Some music therapy literature that relates to these different concepts is outlined. Discussions surrounding the decision to use either of these two approaches are presented in relation to stages of recovery and the clinical presentation of the client.

Abstract
Background
The prevalence of multimorbidity (the presence of two or more long-term conditions) is
rising internationally. Multimorbidity affects patients by increasing their burden of
symptoms, but is also likely to increase the self-care demands, or treatment burden, that they
experience. Treatment burden refers to the effort expended in operationalising treatments,
navigating healthcare systems and managing relations with healthcare providers. This is an
important problem for people with chronic illness such as stroke. Polypharmacy is an
important marker of both multimorbidity and burden of treatment. In this study, we examined
the prevalence of multimorbidity and polypharmacy in a large, nationally representative
population of primary care patients with and without stroke, adjusting for age, sex and
deprivation.
Methods
A cross-sectional study of 1,424,378 participants aged 18 years and over, from 314 primary
care practices in Scotland that were known to be demographically representative of the
Scottish adult population. Data included information on the presence of stroke and another 39
long-term conditions, plus prescriptions for regular medications.
Results
In total, 35,690 people (2.5%) had a diagnosis of stroke. Of the 39 comorbidities examined,
35 were significantly more common in people with stroke. Of the people with a stroke, the
proportion that had one or more additional morbidities present (94.2%) was almost twice that
in the control group (48%) (odds ratio (OR) adjusted for age, sex and socioeconomic
deprivation 5.18; 95% confidence interval (CI) 4.95 to 5.43). In the stroke group, 12.6% had
a record of 11 or more repeat prescriptions compared with only 1.5% of the control group
(OR adjusted for age, sex, deprivation and morbidity count 15.84; 95% CI 14.86 to 16.88).
Limitations include the use of data collected for clinical rather than research purposes, a lack
of consensus in the literature on the definition of certain long-term conditions, and the
absence of statistical weighting in the measurement of multimorbidity, although the latter was
deemed suitable for descriptive analyses.
Conclusions
Multimorbidity and polypharmacy were strikingly more common in those with a diagnosis of
stroke compared with those without. This has important implications for clinical guidelines
and the design of health services.

Through an enveloping enriched environment and interaction within a cohesive group dynamic, the modularity of Cognitive Neuroeducation (CNE) builds both a neuroprotective shield and core cognitive resources. This brochure introduces the basic scientific principles that underlie  the CNE curriculum in the prevention of and recovery from mild behavioral disorganization to more severe cognitive and neurodegenerative disorders such as dementia.

Injection-induced sciatic nerve injury is a well-known complication of intra-muscular gluteus muscle injections.
Affected individuals usually present with foot drop and this results in varying degrees of motor disability
depending on the timing, quality and duration of the remedial measures instituted. This study was carried out
to evaluate the pattern of cases of injection-induced sciatic nerve injury among children referred to the
Outpatient Physiotherapy Clinic of the Federal Medical Centre, Ido-Ekiti, Nigeria.
A retrospective review of the case notes of all paediatric patients referred to the physiotherapy clinic on
account of injection-induced sciatic nerve injury from November 2005 to October 2010 was done. Information
obtained included age, gender, side affected, personnel/place where injection was administered, the mode of
physiotherapy intervention, number of sessions, impairment variables at presentation and underlying indication
for injection administration.
A total of 33 (19.64%) cases of sciatic nerve palsy out of 168 paediatric patients managed at the
physiotherapy clinic within this 5-year period were reviewed. The ages of the participants ranged from 0-14
years. Sixteen (48.5%) of the patients were male while 17 (51.6%) were female. The side affected in 17 (51.6%)
of the patients was the right while the left was affected in 16 (48.5%) patients. The right side was more affected
in the females (12) while the left side was more affected in the males (11). Most incidences of injection-induced
sciatic nerve palsy occurred in private hospitals (45.5%). A majority of the patients (69.7%), as reported by
their carers and relatives, had the injections administered by nurses.
The results revealed that a lot of effort should be made by the relevant authorities to ensure that medical
and health professionals who administer injections adhere strictly to safe ethical practices and that unqualified
personnel are not allowed to operate.

Introduction :
CVA is the most common and debilitating Neurologic disorder in Adults. More than 50% of patients who are survived injury suffer long-term disabilities . Movement, balance and Speech disorders, Cardiopulmonary  involvements  due to inactivity or sedentary life style , urine and bowel incontinency in various levels occur in these patients. The main problem of these patients is Uncoordinated movement patterns Associated with unnatural postural tone. Spasticity  is the most restrictive issue  in natural movement function in Rehabilitation . Reduction in Severity of Spasticity can help to improve ability in using involved limbs . So the aim of this study is Comparison the effect of  two methods of baclofen phonophoresis on Flexor compartment of Forearm and Faradic functional Stimulation on Antagonist Muscles group of Spastic muscles in CVA patients.

Methods and materials:
In this Study 8 men with CVA ,52-64 years old were randomized in two Groups .The first Group were treated by  Baclofen 1%  Phonophoresis ,pulse 20% mode for 10 min daily for one month and the second group with assistive functional faradic stimulation on Antagonist muscles group of the wrist for 10 min daily for one month so that with every contraction were asked patients to do assistive extension with FES function . Ashworth scale was used before and after intervention for spasticity evaluation.
Results:
After 4 weeks  treatment first group members were going to decrease the severity in Spasticity after 10 to 15 min of baclofen phonophoresis .One of four patients in first group experienced inhibited spasticity for one week and 3 others  during one week after the end of one month  treatment showed 30-50% better function and by evaluation of Ashworth Scale pre treatment the all 4 patients took the point 4 but after treatment 2 patients took the point 2 ,one patient  point 3 and one patient point 1 while in second group after ending the treatment sessions ,the spasticity was controlled and longed for 10 min and after this duration the controlled spasticity was returned again .in second group Ashworth scale didn’t showed any significant Changes before and after treatment from the point 4 and only one patient experienced point 3 after treatment.


Conclusion :
This Study demonstrated that  Baclofen phonophoresis  could  achieve better results  compared with  assistive  Antagonist  FES in reduction  the load of spasticity in flexor compartment of forearm. 
Key words:
Phonophoresis , Baclofen , Function Faradic Stimulation ,Spasticity, CVA

The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings.

Despite progress in using computational approaches to inform medicine and neuroscience in the last 30 years, there have been few attempts to model the mechanisms underlying sensorimotor rehabilitation. We argue that a fundamental understanding of neurologic recovery, and as a result accurate predictions at the individual level, will be facilitated by developing computational models of the salient neural processes, including plasticity and learning systems of the brain, and integrating them into a context specific to rehabilitation. Here, we therefore discuss Computational Neurorehabilitation, a newly emerging field aimed at modeling plasticity and motor learning to understand and improve movement recovery of individuals with neurologic impairment. We first explain how the emergence of robotics and wearable sensors for rehabilitation is providing data that make development and testing of such models increasingly feasible. We then review key aspects of plasticity and motor learning th...

Does adding video/computer-based interactive exercises to inpatient geriatric and neurological rehabilitation improve mobility outcomes? Is it feasible and safe? Randomised trial. Fifty-eight rehabilitation inpatients. Physiotherapist-prescribed, tailored, video/computer-based interactive exercises for 1 hour on weekdays, mainly involving stepping and weight-shifting exercises. The primary outcome was the Short Physical Performance Battery (0 to 3) at 2 weeks. Secondary outcomes were: Maximal Balance Range (mm); Step Test (step count); Rivermead Mobility Index (0 to 15); activity levels; Activity Measure for Post Acute Care Basic Mobility (18 to 72) and Daily Activity (15 to 60); Falls Efficacy Scale (10 to 40), ED5D utility score (0 to 1); Reintegration to Normal Living Index (0 to 100); System Usability Scale (0 to 100) and Physical Activity Enjoyment Scale (0 to 126). Safety was determined from adverse events during intervention. At 2 weeks the between-group difference in the pri...

Background
Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders.
Methods
We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach.
Findings
Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable).
Interpretation
Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies.

Objective: Current oral health assessment has a compre-hensive view of the relationship between hard and soft tissues of the mouth as seen by orthodontics and prosthodontics in a healthy population. Despite knowing the influence this relationship has on functional outcomes such as swallowing and mastication, motor evaluation of soft tissue such as the tongue is still scarce. This lack of knowledge is even greater in individuals with a neurological condition. In this sense, the measurement of lingual strength has been addressed by some research as a key element accompanying oral rehabilitation in healthy populations. Acknowledging the importance of tongue strength in oral biomechanics, the Iowa Oral Performance Instrument (IOPI) has become a gold standard instrument. The purpose of this article was to search for scientific studies on tongue strength using the IOPI as a research tool in populations with neurological conditions, to know about its inclusion in the clinical practice and ...

La Nature humaine à la lumière de la psychopathologie (Human Nature in the Light of Psychopathology) réunit un ensemble de conférences (« The William James Lectures ») prononcées par Kurt Goldstein à l’Université Harvard, en 1938-1939 et publiées pour la première fois en 1940 par Harvard University Press. Premier ouvrage de Goldstein paru aux États-Unis où il commence une nouvelle vie, tant personnelle que professionnelle, après avoir été chassé d’Allemagne par le gouvernement nazi.
Formé à la médecine, spécialiste de psychiatrie, mais également féru de philosophie, il est confronté dans ses premières années de pratique aux cérébrolésions des soldats de la Première Guerre mondiale, sources de séquelles irréversibles.
C’est le point de départ d’une réflexion qui transcende les découpages disciplinaires entre biologie et philosophie, anthropologie et neurologie, théorie médicale et pratique clinique.
Goldstein propose en effet une conception de la clinique qui engage le rapport de l’être humain à lui-même, aux autres et au monde, et fait de la biologie une science qui doit être autant capable d’appréhender de façon « atomistique » les phénomènes qu’elle analyse que de développer une compréhension de l’organisme tout entier, malade ou en bonne santé.