Brain Tumor Rehabilitation: Symptoms, Complications, and Treatment Strategy

Brain tumors are receiving increasing attention in cancer rehabilitation due to their high rate of neurological deterioration. Motor dysfunction, cognitive deterioration, and emotional problems are commonly present in patients with brain tumors. Other medical complications, such as seizures, headache, and dysphagia are also common. An individualized multidisciplinary rehabilitation intervention is necessary to treat functional impairment due to the tumor itself and/or treatment-related dysfunction. Herein, we discuss rehabilitation treatment strategies in relation to the neurological and functional complications that commonly occur in patients with brain tumors.ope

The Effects of Rehabilitative Training in the Treatment of Patellofemoral Pain Syndrome

Objective Inappropriate neural control of the quadriceps femoris muscle group has been implicated in patellofemoral pain syndrome (PFPS) and the methods of biomechanical assessment of PFPS has been developed recently. The aims of the present investigation were to evaluate the effects of therapeutic exercise in the alleviation of PFPS and to develope objective clinical test for PFPS. Method We investigated the onset time of the isometric contraction of vastus medialis oblique muscle (VMO) and the vastus lateralis muscle (VL) under four different conditions: knee flexion and extension in weight bearing (standing) and non-weight bearing (sitting on chair) situations. For each condition, onset times of EMG activities and onset times for VMO and VL were determined from five trials of isometric contraction. In addition, we compared knee flexor and extensor torques in control group and subjects with PFPS. To evaluate the effects of the exercise we compared the onset time difference (onset time of VL-onset time of VM) and quadriceps muscle torque at pre- and post- exercise in PFPS groups. Results In PFPS group, onset time of VMO during knee extension was significantly longer than the onset time of VL and the knee extensor torque was considerably weaker in comparison with normal group. Although onset time difference was not changed after exercise program, there were significant increase in knee extensor torque in subjects with PFPS. Conclusion The role of exercise in the rehabilitation of quadriceps functions is to reduce the pain, to strengthen the knee extensor, and further accurate diagnostic tools and methods for the result of therapeutic exercise in PFPS are needed.ope

Dysphgia in Parkinson’s Disease

Dysphagia is a frequent symptom in Parkinson’s disease (PD) and the main cause of aspiration pneumonia and death of patients with PD. It is also associated with nutritional problems, pulmonary complications and quality of life of PD patients. The prevalence is very high in PD patients, varying from 77% to 95%, but exact pathophysiology and mechanism remains obscure. Dysphagia associated with PD has been reported to affect all stages of swallowing including oral, pharyngeal, esophageal phase, but oral and pharyngeal phases are more often abnormal than esophageal phase. There are several treatment strategies for dysphagia of PD patients such as rehabilitative treatment including speech therapy, respiratory muscle strengthening, pharmacologic treatment, deep brain stimulation and surgical treatment. But, the effects of these treatments are still limited, thus individualized and interdisciplinary approach is recommended.ope

Motor Recovery after Seizure Induced by Repetitive Transcranial Magnetic Stimulation

Despite the low incidence, seizures induced by repetitive transcranial magnetic stimulation (rTMS) have been studied as they may cause neurological and functional regression. Seizures may predict poor outcomes in stroke patients, with no reports of improved neurological status after seizures. This is the first Korean report of a seizure induced by rTMS, and the first report in the literature of prompt motor recovery following a seizure induced by highfrequency rTMS of the primary motor cortex in a stroke patient. A 43-year-old man with left hemiplegia due to infarction in the right basal ganglia was enrolled 10 sessions of rTMS (each session consisted of 15 trains, with each train consisting of 5 seconds of stimulation at 20 Hz and 90% of resting motor threshold for each session followed by 55 seconds of rest). The self-limited seizure occurred within 5 seconds after the 10th session. It lasted for 60 seconds, with generalized tonic features in all four extremities and the trunk and loss of consciousness followed by prompt improvement in left hand muscle strength and coordination. Though the seizure is known to usually cause neurologic regression, this case showed neurologic improvement after rTMS even after the rTMS-induced seizure.ope

KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease

Clinical consensus statements (CCSs) aim to improve care for patients with Parkinson's disease (PD) and reduce the variability of rehabilitation methods in clinical practice. A literature search was conducted to find available evidence on the rehabilitation of patients with PD and to determine the scope of CCSs. The selection of PD rehabilitation domains and key questions was done using the modified Delphi method in 43 expert panels. These panels achieved a consensus on 11 key questions regarding rehabilitation assessment and goal setting, gait and balance, activities of daily living, and swallowing and communication disorders. After the completion of an agreement procedure, 11 key consensus statements were developed by the consensus panel. These statements addressed the needs of rehabilitation as a continuum in patients with PD. They included the appropriate rehabilitation initiation time, assessment items, rehabilitation contents, and complication management. This agreement can be used by physiatrists, rehabilitation therapists, and other practitioners who take care of patients with PD. The consensus panel also highlighted areas where a consensus could not be reached. The development of more focused CCS or clinical practice guidelines that target specific rehabilitation approaches is considered the next needed step.ope

Evaluation of Trigeminal Nerve Involvement Using Blink Reflex Test in Bell’s Palsy

Background and Objectives: Facial nerve dysfunction in Bell's palsy is evaluated using various parameters including physical examination and electrophysiological studies. Associated symptoms of facial numbness or paresthesia are reported by some patients with Bell's palsy. The aim of this study was to investigate trigeminal nerve involvement in Bell's palsy using blink reflex test. Subjects and Methods: Facial nerve and trigeminal nerve functions were assessed using House-Brackmann (HB) grading system, electroneuronography (ENoG) and blink reflex tests in 28 patients diagnosed as Bell's palsy. Results: HB grades correlated with degeneration ratio from ENoG (p=0.002, chi-square test). The ipsilateral R1 reponse of the blink reflex was absent or abnormal in 27/28 patients (96.4%), and ipsilateral R2 response was absent or abnormal in 26/28 patients (92.8%). Contralateral R2 was abnormal in 5/28 patients (17.8%), suggesting involvement of trigeminal nerve in a portion of patients. The results of blink reflex test showed no significant correlation to the outcome of facial nerve function (HB grade) in Bell's palsy patients. Conclusions: Blink reflex test provides information about trigeminal and facial nerve functions in addition to ENoG results. Our study suggests that subclinical involvement of trigeminal nerve may accompany facial nerve dysfunction in Bell's palsy.ope

Intraoperative Neurophysiological Monitoring

Intraoperative neurophysiological monitoring (IONM) is a valuable tool to prevent damage by detecting dysfunction before reaching an irreversible stage in brain, spine and other surgical procedures. This article focuses on the intraoperative application and clinical utility of somatosensory evoked potentials (SEP), motor evoked potentials (tcMEP) and triggered and spontaneous EMG. Somatosensory evoked potential (SEP) monitoring used in several decades helped to prevent neurologic deficits. However, motor compromise can occur without SEP warning and SEP deterioration can occur without motor deficit. Intraoperative MEP monitoring in patients with spinal and cranial lesions is thought to be a valuable tool for prevention of postoperative motor deficits. In recent years, motor evoked potential recording following transcranial electrical stimulation has emerged as a reliable technique to intraoperatively assess the functional integrity of the motor pathways.Spontaneous and triggered EMG is getting widely used as a means of monitoring nerve root function during spine surgery. Although IONM is a valuable technique that provides sensitive and specific indications of neurologic injury, it does have limitations that must be understood. The monitoring team must be well trained, be able to provide the surgeon feedback in real time, and coordinate activities with those of the surgical and anesthesia teams.ope

distal myopathy

Although muscle disease classically presents with proximal extremity weakness, some myopathic disorders, including several types of muscular dystrophy, result in predominantly, or exclusively, distal muscle involvement. Accurate diagnosis of these relatively uncommon conditions can be challenging for the clinician, because of unusual phenotype and significant overlap in the clinical features of theses entities. The clinical characteristics of this patient were slowly progressive symmetrical muscle weakness and wasting of all 4 extremities in distal part. Serum muscle enzymes were slightly increased. The prominent EMG findings were myopathic changes, but reduced recruitment was occasionally found in some distal muscles. The muscle biopsy finding of right gastrocnemius showed the non-specific finding of myopathy. Among various perviously described distal myopathies, several diseases have been established as clinically and genetically distinct entities. The most representative diseases are dominantly inherited Welander distal myopathy and tibial muscular dystrophy, and the recessively inherited distal myopathy with rimmed vacuoles (Nonaka myopathy) and distal muscular dystrophy (Miyoshi myopathy). In this case clinical characteristic was compatible with Welander distal myopathy, but genetically not consistent with autosomal dominant inherited disease. Because this case showed overlap in the clinical feature of these disease entity we concluded this case was nontypical early adult onset distal myopathy.ope

Rehabilitation Dysphagia Therapy for Individuals with Dysphagia

Introduction: Specialists in a variety of field should make dysphagia patients who are damaged by CNS(Central nerve system) impairment or various factors intake foods and water safely through the most appropriate dyshpagia rehabilitation approach and a multi-faced approach. Body: Swallow maneuver is a kind of dyshpagia rehabilitation approach for dysphagia patients which is via Thermal tactile oral stimulation (TTOS) stimulating anterior faucial arch, Electrical stimulation using a surface electrode on the neck and induces physiological change, the flow of the bolus through viscosity and the size of the bolus, the active movement through tongue & lip exercise, Head-lifting exercise, a Postural technique which includes head rotation, head tilt, lying down, chin tuck to compensate a structural and physiological defect and supraglottic swallow, supersupraglottic swallow, effortful swallow, Mendelson maneuver which induce patients to swallow safely and effectively when eating the foods directly. Conclusion: We should verify the existing treatment approach afresh for the dysphagia patients and the systemic study according to symptom and disease would be necessary by establishing evidence respectively. (JKDS 2011;1:31-38)ope

diagnostic criteria of conduction block and abnormal temporal dispersion

Objective : Conduction block and abnormal temporal dispersion are important electrophysiological parameters for demyelination. Many people have reported different criteria of the conduction block in amplitude, duration, area and insisted that the criteria should be different between each nerves of human race. The aims of the present investigation were to evaluate the amplitude, duration, and area ratio of compound muscle action potentials (CMAP) in the proximal to distal parts of the limbs, so to stand firm the diagnostic criteria between conduction block and abnormal temporal dispersion. Methods : Measurements were made from median nerve, ulnar nerve, deep peroneal nerve, tibial nerve of 44 upper extremities and 38 lower extremities with Excel® electromyographic equipment in normal adults who don’t have any history and signs of peripheral neuropathies, and compared the CMAP ratios (proximal CMAP/distal CMAP) of peak to peak amplitude, negative duration area. Results : Our study showed that the reduction of CMAP amplitude with proximal stimulation ranges from 18.4% to 22.2% in upper extremities and from 28.1% to 28.9% in lower extremities. The change of negative-peak duration ranged from 11.0% to 13.9% in upper extremities and from 17.9% to 25.0% in lower extremities. It was also showed that higher amplitude decay and the change of negative-peak duration in peroneal nerve are prominent. Conclusion : This study can provide useful and reliable informations on diagnostic criteria of conduction block by more than 25% drop of peak-to-peak amplitude with less than a 15% change of the negative-peak duration in upper extremities and by more than 30% drop of peak-to-peak amplitude with less than a 25% change of the negative-peak duration in lower extremities.ope