Cristina Daia

On the feasibility of using motor imagery EEG-based brain-computer interface in chronic tetraplegics for assistive robotic arm control: a clinical test and long-term post-trial follow-up.

Study design:Survey and long-term clinical post-trial follow-up (interviews/correspondence) on nine chronic, post spinal cord injury (SCI) tetraplegics.Objective:To assess feasibility of the use of Electroencephalography-based Brain–Computer Interface (EEG–BCI) for reaching/grasping assistance in tetraplegics, through a robotic arm.Settings:Physical and (neuromuscular) Rehabilitation Medicine, Cardiology, Neurosurgery Clinic Divisions of TEHBA and UMPCD, in collaboration with ‘Brain2Robot’ (composed of the European Commission-funded Marie Curie Excellence Team by the same name, hosted by Fraunhofer Institute-FIRST), in the second part of 2008.Methods:Enrolled patients underwent EEG–BCI preliminary training and robot control sessions. Statistics entailed multiple linear regressions and cluster analysis. A follow-up—custom questionnaire based—including patients’ perception of their EEG–BCI control capacity was continued up to 14 months after initial experiments.Results:EEG–BCI performance/calibration-phase classification accuracy averaged 81.0%; feedback training sessions averaged 70.5% accuracy for 7 subjects who completed at least one feedback training session; 7 (77.7%) of 9 subjects reported having felt control of the cursor; and 3 (33.3%) subjects felt that they were also controlling the robot through their movement imagination. No significant side effects occurred. BCI performance was positively correlated with beta (13–30 Hz) EEG spectral power density (coefficient 0.432, standardized coefficient 0.745, P-value=0.025); another possible influence was sensory AIS score (range: 0 min to 224 max, coefficient −0.177, standardized coefficient −0.512, P=0.089).Conclusion:Limited but real potential for self-assistance in chronic tetraplegics by EEG–BCI-actuated mechatronic devices was found, which was mainly related to spectral density in the beta range positively (increasing therewith) and to AIS sensory score negatively.

Complex Neuro-Muscular favorable rehabilitation program of a patient with politrauma including spinal cord injury and multiple bone fractures

Materials and Methods: This paper presents the case of a 43-yearold patient (having the The Teaching Emergency Hospital “Bagdasar-Arseni”, TEHBA, Bioethics Committee approval no 9181/11.04.2018), who is hospitalized in our Neuro-muscular Clinic presenting incomplete AIS / Frankel C tetraplegia with C4 neurological level and neurogenic bladder and bowel. Also she associated multiple fractures such as: left scapular fractures, right humerus fracture (surgically stabilized), pelvic fractures, right fibular head fracture without displacement. This polytrauma was caused by a car accident (pedestrian 9.11.2017). At admission the patient had severe motor and functional impairment and was assessed functionally using the following scales: AIS / Frankel, modified Ashworth Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL / IADL), Walking Scale for Spinal Cord Injury (WISCI). Results: The patient benefited from a complex neuro-muscular rehabilitation programme, having a favourable evolution, therefore the patient reaches incomplete AIS / Frankel D tetraplegia with an increase in the evaluated scales scores and thus, with a final performance of walking for short distances with a supporting frame, as well as a sphincter re-education with the neurogenic bladder remission. Conclusions: Based on the collaboration with orthopedic and surgeon fellows the PRM physician developed a complex rehabilitation programme leading to the re-expression of locomotion function, sphincterian control recovery, selfcare ability, all of the mentioned factors improving the patient’s quality of life.

Succesful rehabilitation program – including multimodal strategies of a patient with spastic tetraparesis due to anoxic encephalopathy

Abstract Introduction: Anoxic encephalopathy is one of the hardest rehabilitation condition which can generate cognitive dysfunction and tetraparesis. The multimodal/ pleiotropic therapeutical approach by influencing endogenous defense activity, a fundamental biological processes of neurogenesis, neuroprotection, neuroplasticity and neurotrophicity and counteracting neurogenic inflammation and the secondary phenomenoms according to the “tooth paste theory” combined with a specific rehabilitation program could be a benefic therapeutical association.1-2 Matherials and methods: A 42 years old patient without any previous medical conditions was admitted in our Neural-Muscular clinic division with cognitive impairment and spastic tetraparesis after anoxic encephalopathy. The case report presentation was approved by TEHBA Bioethics Commission (No.9181/11.April.2018). The patient was clinically, para-clinically and functionally assessed according to the standardized protocols implemented in our clinic through the assessment scales (AIS, FIM, QoL-Quality of Life, Asworth, Penn, FAC, WISCI II). Results: The combined and complex rehabilitation program led in this specific case to a complete cognition remission and substancial locomotor regaining: at discharge the patients having independence of walking. Conclusions: The modern ambivalent approach of spastic tetraparesis and cognitive impairment emerging from anoxic encephalopathy could be a succeful therapeutical management leading in some cases to a complete recovery.

Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic.

The ankylosing spondylitis (AS) is a systemic, multi-factorial, chronic rheumatic disease. Patients are highly susceptible to vertebral fractures with or without spinal cord injury (AS-SCI), even after a minor trauma. The study is a retrospective descriptive survey of post-acute, traumatic AS-SCI patients, transferred from the neurosurgical department and admitted in a Romanian Neurorehabilitation Clinic, during 2010–2014. There were 11 males associating AS-SCI (0.90% of all consecutive SCI admitted cases), with an average age of 54.6 years (median 56, limits 42–73 years). The average duration between the medically diagnosed AS and the actual associated spinal fracture(-s) moment was 21.4 years (median 23; limits 10–34 years). Low-energy trauma was incriminated in 54.5% cases. The spinal level of fracture was: cervical (four cases), thoracic (three), lumbar (four), assessed at admission as: American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (four subjects), C (five) and D (two). By the time of discharge, neither patient has neurologically deteriorated; five patients (45.5%) improved of at least grade 1 (AIS). The overall complications were mainly infections: symptomatic urinary tract infections (seven patients; 63.6%), pulmonary (three subjects; 27.3%) and spondylodiscitis (one case; 9%). The average follow-up period was 15.3 months (median 12; limits 1–48 months) after discharge; three subjects gained functional improvement to AIS-E. The clinical profile (different risk factors, mechanisms, types and levels of spinal fractures, additional encephalic and/or cord lesions, co-morbidities), different post-surgical and/or general complications acquired during admission in our rehabilitation ward, served us for future prevention strategies and a better therapeutic management.

A long-term, complex, unitary appraisal regarding neurorestorative, including neurorehabilitative, outcomes in patients treated with Cerebrolysin ® , following traumatic brain injury

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Journal of Neurorestoratology 2014:2 85–93 Journal of Neurorestoratology Dovepress