Gait characteristics, range of motion, and spasticity changes in response to massage in a person with incomplete spinal cord injury: case report.

Purpose: Our study set out to measure the effect of a specific routine of massage on gait characteristics, range of motion, and spasticity in a person with incomplete spinal cord injury.

Methods: This descriptive, pre-post case study, conducted at the outpatient program of a rehabilitation facility, used neuromuscular techniques in massage for a 42-year-old man with incomplete chronic C5 spinal cord injury. The massage was applied to the iliopsoas, triceps surae, and hamstring muscle groups for 3 consecutive days.

Technologies and strategies for people with communication problems following brain injury or stroke.

Communication problems experienced following a brain injury or stroke not only impact a person's ability to participate in their desired social and vocational roles but may also impact their ability to participate in decision-making about their care, participate in therapy and receive counseling and education. Many technologies exist, including Augmentative and Alternative Communication (AAC), which can help increase communication and life participation following a brain injury or stroke. This article will define and describe a variety of AAC technologies and interventions for people with communication problems following acquired brain injury as well as discuss assessment, training and funding issues.

Peripheral nerve repair through multi-luminal biosynthetic implants.

Peripheral nerve damage is routinely repaired by autogenic nerve grafting, often leading to less than optimal functional recovery at the expense of healthy donor nerves. Alternative repair strategies use tubular scaffolds to guide the regeneration of damaged nerves, but despite the progress made on improved structural materials for the nerve tubes, functional recovery remains incomplete. We developed a biosynthetic nerve implant (BNI) consisting of a hydrogel-based transparent multichannel scaffold with luminar collagen matrix as a 3-D substrate for nerve repair.

Exploring the potential for neural recovery after incomplete tetraplegia through nonsurgical interventions.

Persons with tetraplegia resulting from a cervical spinal cord injury believe that increasing upper limb (UL) function will improve their quality of life. Various lines of evidence demonstrate that persons with incomplete tetraplegia have the potential for improvements in both neural plasticity and function of the arms and hands. Therefore treatment to improve UL function in persons with incomplete tetraplegia should focus on improving motor control, not just compensation for the paralysis and sensory loss that follows a spinal cord injury.

Neural plasticity and locomotor recovery after spinal cord injury.

The discussion of neural plasticity and locomotor recovery after spinal cord injury (SCI) focuses on 2 main themes, the issues associated with detecting neural plasticity in human beings and the issue of how to translate information from animal models, in which neural plasticity can be more readily studied, to human clinical research and application. This article discusses the importance of studying neural plasticity to better understand the effects of current rehabilitation interventions and to devise the next generation of therapies. It reviews the current spectrum of clinical, functional, anatomical, and neurophysiological assessments of patients that can be made in neurorehabilitation and the relationship between those measures and the study of neural plasticity.

Translating research into clinical practice: integrating robotics into neurorehabilitation for stroke survivors.

Technological advances continue to infuse the field of neurorehabilitation with both excitement and apprehension. A challenge for clinicians is to determine which of the growing number of devices or interventions available should be incorporated into their clinical practice, and when and with whom they should be offered, in order to best assist their patients in attaining the highest level of function and quality of life. Robotics is one area of technology that has seen robust growth in rehabilitation applications, so much so that the presence of robotic devices in rehabilitation centers has become an expectation among patients, their caregivers, and therapists.

A verbal cuing device for persons with brain injury: development and proof-of-concept case study.

The ability to successfully return to driving following neurologic injury is one of the most critical factors in re-establishing independence and the most notable safety concern of health providers and family members. This assistive technology study describes the development of a verbal cuing device called the Electronic Driving Coach used as an adjunct to driver training following brain injury. We review literature on rates of return to driving following brain injury and factors associated with predicting return to driving and driving ability.

Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research.

Objectives: To conduct a systematic review of behavioral assessment scales for disorders of consciousness (DOC); provide evidence-based recommendations for clinical use based on their content validity, reliability, diagnostic validity, and ability to predict functional outcomes; and provide research recommendations on DOC scale development and validation.

Data Sources: Articles published through March 31, 2009, using MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Biomedical Reference Collection, and PsycINFO. Thirteen primary terms that defined DOC were paired with 30 secondary terms that defined aspects of measurement.

A report of paraparesis following spinal cord stimulator trial, implantation and revision.

Background: Spinal cord injury has been reported as a rare complication of spinal cord stimulation (SCS). A review of the literature shows a very low incidence of neurological injury after spinal cord stimulation trial, implantation and revision. The most common reported complication is equipment failure without neurologic injury.

Using the Spinal Cord Independence Measure III to measure functional recovery in a post-acute spinal cord injury program.

Study Design: A prospective design was conducted using admission and discharge Spinal Cord Independence Measure III (SCIM-III) data for persons discharged from a post-acute rehabilitation program.

Objective: The purpose of this study is to analyze the functional gains as measured by the SCIM-III that occur during a post-acute rehabilitation program.

Setting: Shepherd Center, Atlanta, GA, USA.

Challenges of diffuse axonal injury diagnosis.

"This can't be right. Jay is in a vegetative state following a severe traumatic brain injury (TBI), but his computed tomography scan is essentially normal. How am I going to explain this to his mom?" This is a conversation I overhear among my rehabilitation nurse colleagues from time to time.

Validation of the seating and mobility script concordance test.

The purpose of this study was to develop the scoring system for the Seating and Mobility Script Concordance Test (SMSCT), obtain and appraise internal and external structure evidence, and assess the validity of the SMSCT. The SMSCT purpose is to provide a method for testing knowledge of seating and mobility prescription. A sample of 106 therapists and 15 spinal cord injury experts contributed to the development of the scoring system.

A sip-and-puff wireless remote control for the Apple iPod.

This brief technical note describes the authors' efforts to modify an existing wireless remote control for the Apple iPod so it could be operated using sip-and-puff switches by individuals with limited upper extremity dexterity due to cervical level spinal cord injury. The authors were able to successfully interface the wireless controller with sip-and-puff switches so that users could play, pause, and fast forward through a song list on the iPod. Details of the interface are described, and limitations of the current system are discussed.

Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence.

Objectives: To examine prospectively the incidence and severity of co-occurring traumatic brain injury (TBI) in persons with traumatic spinal cord injury (SCI) and to describe a TBI assessment process for SCI rehabilitation professionals.

Design: A prospective, cohort design to collect and analyze clinical variables relevant for diagnosing co-occurring TBI.

Setting: An urban, single-center National Institute of Disability and Rehabilitation Research Model Spinal Cord Injury System in the Southeastern United States.

Effects of intrathecal baclofen on perceived sexual functioning in men with spinal cord injury.

Background/objective: Reports in the literature suggest that administration of intrathecal baclofen to control spasticity may have deleterious effects on erectile function in men with spinal cord injury (SCI). A prospective study was conducted to document any changes in perceived sexual function after implant of a baclofen pump.

Methods: Seven adult men with SCI (ASIA A or B) who received intrathecal baclofen through an implantable pump for treatment of severe spasticity were followed for an average of 670 days (22.

The utility of the FIM+FAM for assessing traumatic brain injury day program outcomes.

Objective: To evaluate the effectiveness of the FIM+FAM as a primary outcome measure for traumatic brain injury (TBI) comprehensive day programs.

Design: Retrospective data analysis.

Setting: Single center, TBI comprehensive day program facility.

Locomotor training: is translating evidence into practice financially feasible?

Purpose: Several lines of evidence suggest that locomotor training (LT) modalities, such as body weight-supported treadmill training (BWSTT), improves gait in individuals with incomplete spinal cord injury (SCI). Yet, manual BWSTT has been criticized for being cost prohibitive due to the number of staff required to perform this treatment. This study examined the financial viability of a LT program using manual BWSTT.

Research priorities: wheeled mobility.

Purpose: To bring together an interdisciplinary group of leaders in the field of seating and wheeled mobility to discuss and exchange information about the methodological challenges of studying health, activity and participation of wheelchair users. This article summarizes the discussions from the Wheeled Mobility breakout groups.

Methods: Conference attendees were provided with wheeled mobility priority topics determined by consensus.

Time to rehabilitation admission and associated outcomes for patients with traumatic brain injury.

Objective: To examine the association between time from injury to rehabilitation admission and outcomes for patients with traumatic brain injuries (TBIs).

Design: Retrospective chart review.

Setting: One hundred-bed inpatient rehabilitation facility with a 20-bed brain injury unit.

Victoria Symptom Validity Test performance in acute severe traumatic brain injury: implications for test interpretation.

Effort testing has become commonplace in clinical practice. Recent research has shown that performance on effort tests is highly correlated with performance on neuropsychological measures. Clinical application of effort testing is highly dependent on research derived interpretive guidelines.