Isabella Schwartz

The Effectiveness of Locomotor Therapy Using Robotic-Assisted Gait Training in Subacute Stroke Patients: A Randomized Controlled Trial

To evaluate the effectiveness of early and prolonged locomotor treatment with the use of a robotic‐assisted gait training (RAGT) device (Lokomat; Hocoma Inc., Zurich, Switzerland) on the functional outcomes of patients after subacute stroke.

Reliability and validity of the modified functional reach test at the sub-acute stage post-stroke

Objectives. The first aim of this study was to evaluate the within-session reliability of sitting balance measures by assessing forward and lateral reach while sitting in both healthy subjects and patients post- stroke. The second aim was to evaluate the ability to document change in reaching while sitting over time in patients post-stroke. The third aim was to compare sitting balance results by the modified functional reach test (MFRT) to the Balance Master (BM), motor and function assessments. Design. Data were collected on two occasions: Two to three weeks post-event and again six weeks later. On each occasion within-session reliability was tested using the intra-class correlations (ICC). The tests were performed three times; the second and third attempts were compared in order to test the within-session reliability. For assessing the concurrent validity, the MFRT results were compared with the BM results, Stroke Assessment Scale (SAS) and the Functional Independence Measure (FIM) score using Pearson correlations. Setting. In-patient rehabilitation department. Participants. Patients after a first ischemic stroke 14 – 21 days post-event were recruited from the inpatient rehabilitation department at Hadassah University Hospital, Jerusalem, Israel. Excluded were patients with brain stem lesions and/or bilateral signs or hemorrhagic events as diagnosed by Computerized Tomography, patients with Mini-Mental State Examination < 20, those who were not able to sit unsupported for 10 sec and those who could stand without support for more than 30 sec. Main Outcome Measures. The MFRT, performed while sitting in forward and sideward directions. Results. The MFRT in all directions on both occasions exhibited high reliability (intra-class correlation coefficient range, 0.90 – 0.97). The responsiveness to the paretic side was high (effect size 0.80) and moderate for the forward and non-paretic side (effect size 0.57 – 0.60). A significant moderate correlation was found between MFRT and BM on both occasions. Conclusion. The MFRT while sitting can be reliably measured and may serve as a useful outcome measure in individuals with stroke 2 – 8 weeks post-event.

Amputees “Neglect” the Space Near Their Missing Hand

The space within reach of our hands is the medium for reaching, grasping, and avoidance movements. Accordingly, visual information in this action space is organized in hand-centered coordinates (Graziano, Yap, & Gross, 1994; Makin, Holmes, Brozzoli, Rossetti, & Farne, 2009; Makin, Holmes, & Zohary, 2007), generating a common frame of reference for perception and action (Fogassi & Luppino, 2005; Graziano, 1999). We hypothesized that amputation of the hand, producing an asymmetry in action space, would cause permanent distortions in visuospatial perception. We hypothesized further that this visual distortion would be limited to near space, because hand actions are not possible in far space. We report here that amputation of a hand is indeed associated with a mild visual neglect of the amputated side: Participants with an amputated hand favored their intact side when comparing distances in a landmarkposition judgment task. Importantly, this bias was absent when the targets were placed in far space. Our results thus demonstrate that the possibility for action within near space shapes the actor’s spatial perception.

Cognitive and functional outcomes of terror victims who suffered from traumatic brain injury

Primary objective: To describe the outcomes of terror victims suffered from traumatic brain injury (TBI). Research design: Retrospective chart review of 17 terror and 39 non-terror TBI patients treated in a rehabilitation department during the same period. Methods and procedure: Variables include demographic data, Injury Severity Scale (ISS), length of stay (LOS) and imaging results. ADL was measured using the Functional Independence Measurement (FIM), cognitive and memory functions were measured using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery and the Rivermead Battery Memory Test (RBMT), respectively. Main outcome and results: Terror TBI patients were significantly younger, had higher ISS score and higher rates of intracerebral haemorrhage (ICH), brain surgery and penetrating brain injuries than the non-terror TBI group. There was no difference in mean LOS, mean FIM values, mean FIM gain and mean cognitive and memory improvement between groups. Terror victims suffered from a higher percentage of post-traumatic epilepsy (35% vs. 10%, p= 0.05), whereas the rate of PTSD and the rate of return to previous occupation were similar between groups. Conclusions: Although TBI terror victims had more severe injury, they gained most of ADL functions and their rehabilitation outcomes were similar to non-terror TBI patients. These favourable results were achieved due to a comprehensive interdisciplinary approach to terror victims and also by national support which allowed an adequate period of treatment and sufficient resources as needed.

Musculoskeletal Injury in Professional Dancers: Prevalence and Associated Factors: An International Cross-Sectional Study.

Objective: The purpose of the study was to determine the prevalence and factors associated with injury in professional ballet and modern dancers, and assess if dancers are reporting their injuries and explore reasons for not reporting injuries. Design: Cross-sectional study. Setting: Participants were recruited from nine professional ballet and modern dance companies in Canada, Denmark, Israel, and Sweden. Participants: Professional ballet and modern dancers. Independent Variables: Sociodemographic variables included age, sex, height, weight, and before-tax yearly or monthly income. Dance specific characteristics included number of years in present dance company, number of years dancing professionally, number of years dancing total, and rank in the company. Main Outcome Measures: Self-reported injury and Self-Estimated Functional Inability because of Pain. Results: A total of 260 dancers participated in the study with an overall response rate of 81%. The point prevalence of self-reported injury in professional ballet and modern dancers was 54.8% (95% CI, 47.7-62.1) and 46.3% (95% CI, 35.5-57.1), respectively. Number of years dancing professionally (OR = 4.4, 95% CI, 1.6-12.3) and rank (OR = 2.4, 95% CI, 1.2-4.8) were associated with injury in ballet dancers. More than 15% of all injured dancers had not reported their injury and their reasons for not reporting injury varied. Conclusions: The prevalence of injury is high in professional dancers with a significant percentage not reporting their injuries for a variety of reasons. Number of years dancing and rank are associated with injury in professional ballet dancers.

Spinal decompression sickness presenting as partial Brown-Sequard syndrome and treated with robotic-assisted body-weight support treadmill training.

OBJECTIVE To describe the rehabilitation outcome of a case of spinal decompression sickness presenting as partial Brown-Sequard syndrome treated with robotic-assisted body-weight support treadmill training. STUDY DESIGN Case report. BACKGROUND Type II decompression sickness patients commonly suffer from myelopathy with gait disturbances necessitating rehabilitation. Robotic-assisted body-weight support treadmill training has been shown to improve the rehabilitation outcome of incomplete spinal cord injury. Its usefulness has not been described in decompression sickness myelopathy. METHODS Robotic-assisted body-weight support treadmill training was administrated using the Lokomat. Primary outcomes were American Spinal Cord Association scale, Spinal Cord Independence Measurement, Berg Balance Test, and Walking Index for Spinal Cord Injury. RESULTS The patient was admitted 3 weeks after the diving injury, with severe paraparesis and a T11 sensory neurological level, resembling partial Brown-Sequard syndrome. After 3 months of rehabilitation including 18 Lokomat sessions, American Spinal Cord Association score improved from C to D, Spinal Cord Independence Measurement improved from 50 to 90 out of 100. Berg Balance Test improved from 35 to 43 out of 56 and Walking Index for Spinal Cord Injury improved from 1 to 15 out of 20. Upon discharge he could walk with one crutch for more than 1 km. CONCLUSION Robotic-assisted body-weight support treadmill training for spinal decompression sickness rehabilitation might be beneficial.

Correlation between time to diagnosis and rehabilitation outcomes in patients with spinal dural arteriovenous fistula

Abstract Background Spinal dural arteriovenous fistulas (SDAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy although they are under diagnosed. Surgical or embolization treatment of SDAVFs improved significantly in the last decade. However, a high percentage of patients are still left with severe disability. Objective To describe the correlation between time to diagnosis and the rehabilitation outcomes of eight patients with SDAVFs. Design Retrospective chart study of all SDAVF patients in 20 years. Setting A tertiary university rehabilitation center. Main outcome measures The lower extremities motor score (LEMS), Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM) and Walking Scale for Spinal Cord Injury (WISC II). Overall prognosis was evaluated using the Aminoff-Logue scale (ALS). Results There were seven men and one woman with mean age of 61.3 ± 15 (30–72) and mean time until the diagnosis of SDAVF of 265.5 ± 245 days (4–730). At the end of rehabilitation period, five of the eight patients remained wheelchair dependent. Strong correlation was found between LEMS, FIM, SCIM, and WISC II scores and the functional level according to the ALS scale. A significant correlation was found between time to diagnosis and the height of the SDAVF, the clinical and rehabilitation outcomes. Patients with high SDAVF which were diagnosed late had the poorest prognosis. Conclusions The potential for functional ambulation in patients with SDAVF is related to the time of intervention. This finding emphasizes the important of early diagnosis and early intervention in SDAVF.

Post-polio syndrome: impact of hope on quality of life

Purpose: To determine the effect of future-oriented coping strategies on the quality of life (QOL) of individuals with post-polio syndrome (PPS). Methods: A correlative study, in which a cohort of 61 patients was surveyed and a group of 40 healthy, age-matched individuals served as controls. Patients were surveyed as to their QOL, levels of hope and utilization of proactive coping, employment status and degree of functionality. Results: PPS patients had lower total, physical and mental QOL indices compared to controls. Future-oriented coping strategies associated with hope were positively associated with physical and mental QOL in the PPS group, but not in the controls. In a multivariate analysis, hope and employment status predicted higher QOL among those with PPS. Conclusions: Future-oriented coping strategies, particularly hope are distinctively associated with improved QOL benefits in PPS patients. Fostering future-oriented coping related to hope may improve the self-perceived mental and physical status of patients with PPS. Implications for Rehabilitation Coping styles of individuals with post-polio can be conceptualized in terms of positive-optimistic psychological constructs rather than the traditional negative frame of reference. Hope is distinctively associated with improved quality of life among post-polio patients. Enhancing hope through psychotherapy may improve mental and physical health of individuals with postpolio.

The association between reality-based beliefs and indirectly experienced traumatization

The purpose of the study was to examine the association between belief types and the magnitude of indirect traumatization. Specific types of beliefs were defined in terms of the cognitive orientation theory, which is a cognitive-motivational approach to the understanding, predicting, and changing of behaviors. Belief types that were analyzed included beliefs about self, general beliefs, beliefs about norms, and goal beliefs as they relate to personal growth. Study participants included 38 rescuers (body handlers), 37 nurses, and 31 rehabilitation workers who treated injured civilians that had been exposed to politically motivated violence. The Cognitive Orientation for Posttraumatic Growth Scale was used to assess beliefs about personal growth. The Revised Posttraumatic Stress Disorder Inventory was administered to evaluate indirect traumatization. The results indicate that three of the four belief types related to personal growth were associated with the level of indirect traumatization. Optimistic and positive beliefs about self and general beliefs were associated with a lower level of indirect traumatization symptomatology, suggesting that these types of beliefs may counteract indirect traumatization. On the other hand, stronger goal beliefs were associated with greater indirect traumatization. The negative association between positive goal beliefs and indirect trauma may be related to the gap the individual perceives between the hoped-for ideals and the trauma-stricken reality. These results indicate the importance of cognitive beliefs and their possible role in determining the response to indirect traumatization.

Rehabilitation Outcomes of Patients With Stroke: Effect of Age on Functional Outcome and Discharge Destination

Objective: To investigate the effect of age on rehabilitation outcomes of patients with acute stroke. Design: Retrospective observational cohort study. Setting: Acute inpatient rehabilitation department in general hospital. Participants: Five hundred fifty-six patients with acute stroke admitted in 5 years. Intervention: Standard interdisciplinary rehabilitation program for 3 hours per day. Main outcome measures: Onset-admission interval, length of stay (LOS), neurological impairment according to National Institutes of Health Stroke Scale, activity of daily living disability measured by the functional independence measure (FIM), degree of disability according to the modified Rankin Scale, and discharge destination. Results: Mean age of our patients was 68.4 ± 12 years, and 356 (64%) of them were above the age of 65 years. Mean FIM value at admission and at discharge was significantly higher (P = .017 and P = .01, respectively), FIM gain was similar (20.6 ± 13 vs 17.1 ± 17.8; P = not significant), and FIM efficacy (FIM gain/LOS) was significantly higher (0.6 ± 0.6 vs 0.34 ± 0.32; P = .01) in the younger group. Functional independence measure at discharge and FIM efficacy were significantly correlated with age, LOS, and FIM at admission. The rate of home discharge was similar between elderly and young patients with stroke being as high as 96.2%. Conclusions: Although functional outcomes of younger patients with stroke were better as compared to the older patients with stroke, at the end of rehabilitation most of our patients regarding age were able to return home independently.