Posts Tagged therapy

[Abstract] Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial.

Abstract

BACKGROUND/AIM:

Task-specific repetitive training, a usual care in occupational therapy practice, and robotic-aided rehabilitation with bilateral practice are used to improve upper limb motor and task performance. The difference in effects of two strategies requires exploration. This study compared the impact of robotic-assisted therapy with bilateral practice (RTBP) and usual task-specific training facilitated by therapists on task and motor performance for stroke survivors.

METHODS:

Forty-three community-dwelling stroke survivors (20 males; 23 females; 53.3 ± 13.1 years; post-stroke duration 14.2 ± 10.9 months) were randomised into RTBP and usual care. All participants received a 10-minute per-protocol sensorimotor stimulation session prior to interventions as part of usual care. Primary outcome was different in the amount of use (AOU) and quality of movement (QOM) on the Motor Activity Log (MAL) scale at endpoint. Secondary outcomes were AOU and QOM scores at follow-up, and pre-post and follow-up score differences on the Fugl-Meyer Assessment (FMA) and surface electromyography (sEMG). Friedman and Mann-Whitney U tests were used to calculate difference.

RESULTS:

There were no baseline differences between groups. Both conditions demonstrated significant within-group improvements in AOU-MAL and FMA scores following treatment (P < 0.05) and improvements in FMA scores at follow-up (P < 0.05). The training-induced improvement in AOU (30.0%) following treatment was greater than the minimal detectable change (16.8%) in the RTBP group. RTBP demonstrated better outcomes in FMA wrist score (P = 0.003) and sEMG of wrist extensor (P = 0.043) following treatment and in AOU (P < 0.001), FMA total score (P = 0.006), FMA wrist score (P < 0.001) and sEMG of wrist extensor (P = 0.017) at follow-up compared to the control group. Control group boost more beneficial effects on FMA hand score (P = 0.049) following treatment.

CONCLUSIONS:

RTBP demonstrated superior upper limb motor and task performance outcomes compared to therapists-facilitated task training when both were preceded by a 10-minute sensorimotor stimulation session.

 

via Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomi… – PubMed – NCBI

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[Review] Ketogenic Diet and Epilepsy – Full Text PDF

Abstract

Currently available pharmacological treatment of epilepsy has limited effectiveness.
In epileptic patients, pharmacological treatment with available anticonvulsants leads to seizure control in <70% of cases. Surgical intervention can lead to control in a selected subset of patients, but still leaves a significant number of patients with uncontrolled seizures. Therefore, in drug-resistant epilepsy, the ketogenic diet proves to be useful. The purpose of this review was to provide a comprehensive overview of what was published about the benefits of ketogenic diet treatment in patients with epilepsy. Clinical data on the benefits of ketogenic diet treatment in terms of clinical symptoms and adverse reactions in patients with epilepsy have been reviewed. Variables that could have influenced the interpretation of the data were also discussed (e.g., gut microbiota). The data in this review contributes to a better understanding of the potential benefits of a ketogenic diet in the treatment of epilepsy and informs scientists, clinicians, and patients—as well as their families and caregivers—about the possibilities of such treatment. Since 1990, the number of publications on attempts to treat drug-resistant epilepsy with a ketogenic diet has grown so rapidly that it has become a challenge to see the overall trajectory and major milestones achieved in this field. In this review, we hope to provide the latest data from randomized clinical trials, practice guidelines, and new research areas over the past 2 years.

[…]

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[Abstract] Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology

Highlights

  • Virtual reality technology improves cognitive function post-traumatic brain injury.
  • Optimal treatment protocol is; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week.
  • There was weak evidence for positive effect of virtual reality on attention.

Abstract

Background

Traumatic brain injury (TBI) can causes numerous cognitive impairments usually in the aspects of problem-solving, executive function, memory, and attention. Several studies has suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of brain injury. Virtual reality (VR) technology potential as a useful tool for the assessment and rehabilitation of cognitive processes.

Objectives

The aims of present systematic review are to examine effects of VR training intervention on cognitive function, and to identify effective VR treatment protocol in patients with TBI.

Methods

PubMed, Scopus, PEDro, REHABDATA, EMBASE, web of science, and MEDLINE were searched for studies investigated effect of VR on cognitive functions post TBI. The methodological quality were evaluated using PEDro scale. The results of selected studies were summarized.

Results

Nine studies were included in present study. Four were randomized clinical trials, case studies (n = 3), prospective study (n = 1), and pilot study (n = 1). The scores on the PEDro ranged from 0 to 7 with a mean score of 3. The results showed improvement in various cognitive function aspects such as; memory, executive function, and attention in patients with TBI after VR training.

Conclusion

Using different VR tools with following treatment protocol; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week may improves cognitive function in patients with TBI. There was weak evidence for effects of VR training on attention post TBI.

via Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology – Journal of Clinical Neuroscience

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[Abstract] Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients with Traumatic Brain Injury

Abstract

Objective

To explore the patterns of cognitive and motor recovery at four time points from admission to nine months post-discharge from IR and to investigate the association of therapeutic factors and pre- and post-discharge conditions with long-term outcomes.

Design

Secondary analysis of traumatic brain injury-practice based evidence (TBI-PBE) dataset.

Settings

Inpatient rehabilitation (IR) in Ontario, Canada.

Participants

A total of 85 patients with TBI consecutively admitted for IR between 2008 and 2011 and had data available from admission to nine months follow-up.

Interventions

Not applicable.

Main outcome measure

Functional Independence Measure-Rasch cognitive and motor scores at admission, discharge, three, and nine months post-discharge.

Results

Cognitive and motor recovery showed similar patterns of improvement with recovery up to three months but no significant change from three to nine months. Having fewer post-discharge health conditions was associated with better long-term cognitive scores (95% CI -13.06, -1.2) and added 9.9 % to the explanatory power of the model. More therapy time in complex occupational therapy activities (95% CI .02, .09) and fewer post-discharge health conditions (95% CI -19.5, -3.8) were significant predictors of better long-term motor function and added 14.3% and 7.2% to the explanatory power of the model, respectively.

Conclusion

Results of this study inform health care providers about the influence of the timing of IR on cognitive and motor recovery. In addition, it underlines the importance of making patients and families aware of residual health conditions following discharge from IR.

via Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients with Traumatic Brain Injury – Archives of Physical Medicine and Rehabilitation

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[Abstract] Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results

Abstract

Background

Facilitating neural activity using non-invasive brain stimulation may improve extinction-based treatments for posttraumatic stress disorder (PTSD).

Objective/hypothesis

Here, we examined the feasibility of simultaneous transcranial direct current stimulation (tDCS) application during virtual reality (VR) to reduce psychophysiological arousal and symptoms in Veterans with PTSD.

Methods

Twelve Veterans with PTSD received six combat-related VR exposure sessions during sham-controlled tDCS targeting ventromedial prefrontal cortex. Primary outcome measures were changes in skin conductance-based arousal and self-reported PTSD symptom severity.

Results

tDCS + VR components were combined without technical difficulty. We observed a significant interaction between reduction in arousal across sessions and tDCS group (p = .03), indicating that the decrease in physiological arousal was greater in the tDCS + VR versus sham group. We additionally observed a clinically meaningful reduction in PTSD symptom severity.

Conclusions

This study demonstrates feasibility of applying tDCS during VR. Preliminary data suggest a reduction in psychophysiological arousal and PTSD symptomatology, supporting future studies.

via Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[ARTICLE] Pilot testing of the spring operated wearable enhancer for arm rehabilitation (SpringWear) – Full Text

Abstract

Background

Robotic devices for neurorehabilitation of movement impairments in persons with stroke have been studied extensively. However, the vast majority of these devices only allow practice of stereotyped components of simulated functional tasks in the clinic. Previously we developed SpringWear, a wearable, spring operated, upper extremity exoskeleton capable of assisting movements during real-life functional activities, potentially in the home. SpringWear assists shoulder flexion, elbow extension and forearm supination/pronation. The assistance profiles were designed to approximate the torque required to move the joint passively through its range. These three assisted DOF are combined with two passive shoulder DOF, allowing complex multi-joint movement patterns.

Methods

We performed a cross-sectional study to assess changes in movement patterns when assisted by SpringWear. Thirteen persons with chronic stroke performed range of motion (ROM) and functional tasks, including pick and place tasks with various objects. Sensors on the device measured rotation at all 5 DOF and a kinematic model calculated position of the wrist relative to the shoulder. Within subject t-tests were used to determine changes with assistance from SpringWear.

Results

Maximum shoulder flexion, elbow extension and forearm pronation/supination angles increased significantly during both ROM and functional tasks (p < 0.002). Elbow flexion/extension ROM also increased significantly (p < 0.001). When the subjects volitionally held up the arm against gravity, extension at the index finger proximal interphalangeal joint increased significantly (p = 0.033) when assisted by SpringWear. The forward reach workspace increased 19% (p = 0.002). Nine subjects could not complete the functional tasks unassisted and only one showed improvement on task completion with SpringWear.

Conclusions

SpringWear increased the usable workspace during reaching movements, but there was no consistent improvement in the ability to complete functional tasks. Assistance levels at the shoulder were increased only until the shoulder could be voluntarily held at 90 degrees of flexion. A higher level of assistance may have yielded better results. Also combining SpringWear with HandSOME, an exoskeleton for assisting hand opening, may yield the most dramatic improvements in functional task performance. These low-cost devices can potentially reduce effort and improve performance during task practice, increasing adherence to home training programs for rehabilitation.

Background

There are 800,000 new strokes in the United States each year [1]. Many survivors experience debilitating motor impairments in the upper extremity that negatively affect functional capacity and quality of life. Impairments can include weakness [2] and lack of coordination between different muscle groups [3]. Fifty percent of stroke survivors older than 64 have persistent hemiparesis at six months post-stroke and 26% are dependent in activities of daily living (ADL) [1]. Unfortunately, a very high level of upper extremity motor control may be needed before the impaired limb is actually incorporated into ADL. Stroke patients often appear to have adequate movement ability when observed in the laboratory, but don’t use the limb with the expected regularity [4].

Neurorehabilitation of these impairments is possible with task-specific repetitive movement practice that incorporates high repetition, volitional effort, and successful completion of tasks to prevent frustration and maintain motivation [5]. Robotics has been studied extensively as a means of assisting movements with forces applied to the limb, allowing completion of movements that would otherwise be impossible to complete unassisted. A recent meta-analysis of 34 studies including 1160 subjects found that robotic devices produced larger gains in arm function, strength and ADL ability than comparison interventions [6]. However, authors concluded the advantages of robotic therapy may not be clinically relevant. The vast majority of these studies involved patients traveling to the clinic on a regimented schedule to practice components of tasks. Home-based approaches may be more effective in increasing the amount of limb use, in particular devices that can assist movements while subjects perform real-world ADL.

Many robotic treatments involve providing partial support of the arm against gravity to enable practice of reaching within a larger workspace [78]. This approach is motivated by research that has shown that many stroke patients have an abnormal synergy whereby elevation of the shoulder against gravity impairs the ability to extend the elbow [91011]. More recently, work has shown an abnormal coupling of proximal and distal arm muscles, such that activation level of proximal muscles and level of arm support can affect control of hand and wrist muscles [1213]. However current robotic approaches that provide gravity compensation do not allow practice of tasks in real-world environments, such as in the home, while standing or when performing bimanual tasks. Also, the provision of gravity support may not completely overcome distal weakness in elbow extension and forearm supination [14]. Additionally, many robotic paradigms rely on repetitive performance of components of functional tasks, for example, planar reaching movements. This contradicts motor learning studies that suggest retention and generalization of skills requires task variability [151617].

In previous work we developed a wearable passively actuated hand exoskeleton (HandSOME) that increases finger ROM and function [1819]. However, some subjects were found to be inappropriate for HandSOME because of proximal weakness, and while the HandSOME enabled adequate range of motion at the fingers, some subjects had difficulty supinating the forearm enough to properly grasp certain objects. Furthermore, finger extension ability would degrade as the arm was lifted against gravity. This motivated the development of a wearable arm exoskeleton called the spring-operated wearable enhancer (SpringWear). Springs apply an angle-dependent torque to the joints, with the goal of increasing ROM, repertoire of possible movements, task variability and success in completing tasks.

Overall, the goal was to enable effective use of the impaired limb in the home environment, thereby allowing patients a highly variable, but meaningful task practice. SpringWear can also reduce effort in task completion promoting greater adherence to home practice schedules. At the shoulder, SpringWear provides partial gravity compensation, which reduces the muscle forces at the shoulder needed to lift the arm. With proper selection of assistance level, the initiation and control of movements are still under patient control but less effort is needed and a larger ROM can be achieved. At the elbow, patients often can flex the joint, but have limited extension, so extension torques are applied to increase elbow extension range. A similar strategy is used to assist forearm supination/pronation. In order to benefit from SpringWear, patients should have some active movement at the joints, but for profoundly weak patients, this approach will not be effective. In these patients, powered exoskeletons may be needed, since they can move the limb throughout a larger workspace than spring powered devices. However, powered devices are much more expensive and complicated to integrate into a wearable device and compact designs are often high impedance, requiring sensors to infer the patient’s intended movement trajectory, which may be difficult in very low level patients.

In this study, chronic stroke patients performed a number of tasks with and without assistance from the SpringWear, and the kinematics of the movements were compared. If successful, SpringWear combined with HandSOME, may provide an inexpensive home-based intervention for a wide range of severe to moderately impaired stroke patients.

Methods

SpringWear design

An upper limb exoskeleton, in general, needs to be adaptable to different segment lengths and have a high number of DOFs in order to allow realistic movement practice with many anatomical joint axes involved [20]. With five DOFs, SpringWear was designed to provide assistance to forearm supination/pronation, elbow extension, shoulder flexion, while providing passive joints for shoulder horizontal abduction/adduction and internal/external rotation to allow realistic upper limb movements (Fig. 1). The design uses rubber bands or bungee cords as springs to provide the assistance. These profiles can be customized for each subject by adjusting the stiffness of the springs, which is dependent on impairment level.

 

Fig. 1 Full Assembly of SpringWear with back splint. Double-headed arrows represents five degrees of freedom. Assistance was applied at shoulder FE, elbow FE, and supination/pronation

[…]

Continue —> Pilot testing of the spring operated wearable enhancer for arm rehabilitation (SpringWear) | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] Classification of Traumatic Brain Injury for Targeted Therapies – Full Text

Abstract

The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials.

Introduction

Traumatic brain injury (TBI) remains a major cause of death and disability. Although much has been learned about the molecular and cellular mechanisms of TBI in the past 20 years, these advances have failed to translate into a successful clinical trial, and thus there has been no significant improvement in treatment. Among the numerous barriers to finding effective interventions to improve outcomes after TBI, the heterogeneity of the injury and identification and classification of patients most likely to benefit from the treatment are considered some of the most significant challenges (Doppenberg et al., 2004; Marshall, 2000; Narayan et al., 2002).

The type of classification one develops depends on the available data and the purpose of the classification system. An etiological classification describes the factors to change in order to prevent the condition. A symptom classificationdescribes the clinical manifestation of the problem to be solved. A prognostic classification describes the factors associated with outcome, and a pathoanatomic classification describes the abnormality to be targeted by the treatment. Most diseases were originally classified on the basis of the clinical picture using a symptom-based classification system. Beginning in the 18th century, autopsies became more routine, and an increasing number of disease conditions were classified by their pathoanatomic lesions. With improvement of diagnostic tools, modern disease classification in most fields of medicine uses a mixture of anatomically, physiologically, metabolically, immunologically, and genetically defined parameters.

Currently, the primary selection criterion for inclusion in a TBI clinical trial is the Glasgow Coma Scale (GCS), a clinical scale that assesses the level of consciousness after TBI. Patients are typically divided into the broad categories of mild, moderate, and severe injury. While the GCS has proved to be extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms responsible for the neurological deficits. This is clearly demonstrated in Figure 1, in which all six patients are classified as having a severe TBI. Given the heterogeneity of the pathoanatomic features depicted in these computed tomography (CT) scans, it is difficult to see how a therapy targeted simply for severe TBI could effectively treat all of these different types of injury. Many tools such as CT scans and magnetic resonance imaging (MRI) already exist to help differentiate the multiple types of brain injury and variety of host factors and other confounders that might influence the yield of clinical trials. In addition, newer advances in neuroimaging, biomarkers, and bioinformatics may increase the effectiveness of clinical trials by helping to classify patients into groups most likely to benefit from specific treatments.

 

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Heterogeneity of severe traumatic brain injury (TBI). Computed tomography (CT) scans of six different patients with severe TBI, defined as a Glasgow Coma Scale score of <8, highlighting the significant heterogeneity of pathological findings. CT scans represent patients with epidural hematomas (EDH), contusions and parenchymal hematomas (Contusion/Hematoma), diffuse axonal injury (DAI), subdural hematoma (SDH), subarachnoid hemorrhage and intraventricular hemorrhage (SAH/IVH), and diffuse brain swelling (Diffuse Swelling).

Continue —>  Classification of Traumatic Brain Injury for Targeted Therapies

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[Abstract] Interventions for Improving Upper Limb Function after Stroke – Cochrane Database Syst Rev.

Abstract

Impairment of the upper limbs is quite frequent after stroke, making rehabilitation an essential step towards clinical recovery and patient empowerment. This review aimed to synthetize existing evidence regarding interventions for upper limb function improvement after Stroke and to assess which would bring some benefit. The Cochrane Database of Systematic Reviews, the Database of Reviews of Effects and PROSPERO databases were searched until June 2013 and 40 reviews have been included, covering 503 studies, 18 078 participants and 18 interventions, as well asdifferent doses and settings of interventions. The main results were:

  1. Information currently available is insufficient to assess effectiveness of each intervention and to enable comparison of interventions;
  2. Transcranial direct current stimulation brings no benefit for outcomes of activities of daily living;
  3. Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy, mental practice, mirror therapy, interventions for sensory impairment, virtual reality and repetitive task practice;
  4. Unilateral arm training may be more effective than bilateral arm training;
  5. Moderate-quality evidence showed a beneficial effect of robotics on measures of impairment and ADLs;
  6. There is no evidence of benefit or harm for technics such as repetitive transcranial magnetic stimulation, music therapy, pharmacological interventions, electrical stimulation and other therapies.

Currently available evidence is insufficient and of low quality, not supporting clear clinical decisions. High-quality studies are still needed.

 

via [Analysis of the Cochrane Review: Interventions for Improving Upper Limb Function after Stroke. Cochrane Database Syst Rev. 2014,11:CD010820]. – PubMed – NCBI

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[ARTICLE] Classification of Traumatic Brain Injury for Targeted Therapies. Journal of Neurotrauma – Full Text

Abstract

The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials.

Introduction

Traumatic brain injury (TBI) remains a major cause of death and disability. Although much has been learned about the molecular and cellular mechanisms of TBI in the past 20 years, these advances have failed to translate into a successful clinical trial, and thus there has been no significant improvement in treatment. Among the numerous barriers to finding effective interventions to improve outcomes after TBI, the heterogeneity of the injury and identification and classification of patients most likely to benefit from the treatment are considered some of the most significant challenges (Doppenberg et al., 2004; Marshall, 2000; Narayan et al., 2002).

The type of classification one develops depends on the available data and the purpose of the classification system. An etiological classification describes the factors to change in order to prevent the condition. A symptom classificationdescribes the clinical manifestation of the problem to be solved. A prognostic classification describes the factors associated with outcome, and a pathoanatomic classification describes the abnormality to be targeted by the treatment. Most diseases were originally classified on the basis of the clinical picture using a symptom-based classification system. Beginning in the 18th century, autopsies became more routine, and an increasing number of disease conditions were classified by their pathoanatomic lesions. With improvement of diagnostic tools, modern disease classification in most fields of medicine uses a mixture of anatomically, physiologically, metabolically, immunologically, and genetically defined parameters.

Currently, the primary selection criterion for inclusion in a TBI clinical trial is the Glasgow Coma Scale (GCS), a clinical scale that assesses the level of consciousness after TBI. Patients are typically divided into the broad categories of mild, moderate, and severe injury. While the GCS has proved to be extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms responsible for the neurological deficits. This is clearly demonstrated in Figure 1, in which all six patients are classified as having a severe TBI. Given the heterogeneity of the pathoanatomic features depicted in these computed tomography (CT) scans, it is difficult to see how a therapy targeted simply for severe TBI could effectively treat all of these different types of injury. Many tools such as CT scans and magnetic resonance imaging (MRI) already exist to help differentiate the multiple types of brain injury and variety of host factors and other confounders that might influence the yield of clinical trials. In addition, newer advances in neuroimaging, biomarkers, and bioinformatics may increase the effectiveness of clinical trials by helping to classify patients into groups most likely to benefit from specific treatments. […]

 

Continue —> Classification of Traumatic Brain Injury for Targeted Therapies

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[Poster] Collaboration of Music and Physical Therapy: Case Study for Treatment of Patient with Chronic Stroke

To evaluate the change in gait speed pre- and post-treatment. To evaluate the change in quality of life pre- and post-treatment. To evaluate the change in outcome measures pre- and post-treatment.

First page of article

via Collaboration of Music and Physical Therapy: Case Study for Treatment of Patient with Chronic Stroke – Archives of Physical Medicine and Rehabilitation

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