Gelu Onose

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.

Psycho-cognitive syndrome, blindness and tetraplegia after severe traumatic brain injury in polytraumatic context (road acc.) with favorable recovery of cognitive and motor deficits

Introduction: We live in a multisensory environment and the interaction between our genes and the environment shapes our brains. Cortical blindness as a result of head trauma (to the brains occipital cortex) is a rare phenomenon and can be a total or partial loss of vision in a normal-appearing eye. How patients will adjust to the loss of vision and its consequences might be a challenge let along if they have mobility impairment (tetraplegia) as well. Adaptation and reintegration of patients into society after motor recovery in the context of visual sensory deficit is mandatory. Cognitive and behavioral changes, difficulties maintaining personal relationships and coping with school and work are reported by survivors as more disabling than any residual physical deficits. As with all rehabilitation, the goal is to help the person achieve the maximum degree of return to their previous level of functioning. Material and method: Having the patient and TEHBA Bioethics Committee approval No.9181/11.04.2018, we will present the evolution of a case with posttraumatic spastic tetraplegia post severe traumatic brain injury, blindness post traumatic bilateral occipital lesions and psycho-cognitive syndrome. Clinical and paraclinical aspects will be discussed (patient history and clinical examination, results of imaging and laboratory tests, the nerve, muscles, joint and kinesiology exams, specific rating scales, both medical and kinesio-therapeutic treatments). Results: We will address the case in terms of particularities and treatment approach (neurorehabilitation of a motor deficit in the context of a major sensory deficiency) and evolution during hospitalization. Conclusions: Trauma has been known to result in cortical blindness but the exact pathophysiology remains unknown and remains a matter of continued debate. Cortical blindness may occur after trauma, however, most cases regardless of etiology, are reversible and have no long-term sequelae. While TBI can cause long-term physical disability, it is the complex neurobehavioral sequelae that produce the greatest disruption to quality of life. As with all rehabilitation, the goal is to help the person achieve the maximum degree of return to their previous level of functioning. In the setting of polytrauma, a careful ophthalmologic and neurologic examination of the trauma patient, together with a high index of suspicion, is necessary for the diagnosis of this condition. Heightened awareness of the causes should be followed with appropriate imaging and management. PSYCHO-COGNITIVE SYNDROME, BLINDNESS AND TETRAPLEGIA AFTER SEVERE TRAUMATIC BRAIN INJURY IN POLYTRAUMATIC CONTEXT (ROAD ACCIDENT) WITH FAVORABLE RECOVERY OF COGNITIVE AND MOTOR DEFICITS

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.

Iontophoresis with Potassium Iodide, Inedited Palliative Physiatric Method for Hemifacial Spasm-Case Report and Literature Review

Background: Hemifacial spasm (HFS) is a rare entity, characterized by alternating involuntary twitching (clonic or tonic contractions) of the facial muscles on one side of the face. In most cases the pathophysiological mechanism is represented by a neurovascular conflict. Methods and findings: The actual case refers to a 62 years old Caucasian woman, with a typical progressive left side HFS, manifested at the age of 55. She was admitted twice (in November 2015 and February 2016) in the rehabilitation department, and investigated for an optimal therapeutic approach. Magnetic resonance angiography (MRA) revealed a mechanical neurovascular conflict, inflicted by an ipsilateral dolichoectatic, compressive vertebral artery. The patient categorically refused the conventional standard therapies (the functional neurolysis with botulinum toxin injections, or the microvascular surgical decompression alternative). She was treated in a conservative manner, using iontophoresis with potassium iodide (KI) applied to the twitched hemiface, for 10 days, in two therapeutic sequences. After the second treatment session, the patient noticed a 47% global reduction of her disturbances, reflected by the self-assessment questionnaires scores. Conclusion: Iontophoresis with KI is an inedited, conservative treatment applied in a typical form of HFS (with vascular compressive etiology), indicated as a therapeutic palliative alternative, to a patient who refused the conventional treatment methodology. It is a cheap procedure, painless, without adverse reactions, repeatable, controllable. The patient had a good compliance and therapeutic satisfactions, although symptoms alleviation was partial and temporary (as long as the trigger persisted).

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

EARLY POST-ACUTE CLINICAL and EVOLUTIVE PARTICULARITIES of CERVICAL SPINAL CORD INJURY (CSCI) at ELDERLY SUBJECTS

Study design: Retrospective analysis, focused on the early post acute evolution of 291 elderly ( >65 years) patients with CSCI, first time admitted in the Rehabilitation Clinic, during 2004-2013. Methods: analysis of the medical files. Results: There were 205 males and 86 females (ratio 2,4). Most of the patients (215 74%) were from rural regions, and 57% of the CSCI happened during agricultural activity; the etiology was dominated (79 %) by accidental falls from the same level (22%), falls from height (from chariot 48%, from trees 5,5%), but also traffic accidents (21%). Vertebral lesions consisted in facet dislocation (bilateral in 32%, unilateral in 11% cases) or/and (associated) disk hernia (54%); about 37% patients had no radiological evidence of bone injury. Conservative management was indicated in 106 subjects (36,4%) vs. operated (63,6%), with significant improvement of the neurological status in the surgical approached group, versus the non-operated (Fisher test, p < 0.01). Early admission in our department and specialized treatment favored a better neurological outcome, from totally paralisis (AIS type A+B) to incomplete lesions (AIS type C+D) (p=0.006). Most of the patients 175 (60%) were discharged at home, whereas 63 (21,6%) were admitted in nursing home, aspect significantly correlated with the marital status vs. single (widow or divorced) ( p<0,01). A low mortality rate (2%) and miscellaneous medical complications were noticed, mainly transient postural hypotension 192 subjects (65,9%), asymptomatic urinary tract infections 259 (89%), haematuria (42 14,4%), bronchopneumonia (11,3%), depression (58,7%), central pain (44%), mild decubitus ulcer 7 patients (2,4%). Conclusions: CSCI at elderly has etiological and physiopathological particularities. Geriatric associated pathology and poor social conditions favored the incidence of CSCI. Comprehensive inter/ multidisciplinary therapeutic approach, early admission in the rehabilitation department after surgical stabilization, favored a better outcome and a low mortality rate.