RehabWire Volume 1 Number 4, May 1999

Welcome to the fourth edition of RehabWire. May’s issue centers on stroke and neurological disabilities. In this issue of RehabWire we’re highlighting the work of NIDRR projects who focus on these issues.

NIDRR Projects: Research in the New Millennium

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NIDRR's Field Initiated Projects produce valuable research in many aspects of disability and rehabilitation. Current projects in stroke and neurorehabilitation include:

Functional and Rehabilitation Outcomes of Patients Who Have Developed Guillain-Barre Syndrome, University of Alabama/Birmingham (H133G70032) led by Jay M. Meythaler.
This study provides the data necessary to describe the significance to rehabilitation of Guillain-Barre Syndrome (GBS). GBS is the most common cause of acute neuromuscular paralysis in developed countries, afflicting about 5,000 people annually in the United States. However, the extent and duration of physically disabling secondary results of GBS, including the incidence of secondary medical complications, have never been described. In this project results of pilot studies and a database-building data collection effort are used to develop new and refined research questions and hypotheses, and build appropriate mechanisms into the database to address those questions. The database is built upon the collective experience of an investigative team that has successfully developed and maintained the National Spinal Cord Injury Statistical Center (NSCISC).

Development of a Rehabilitator for Arm Therapy After Brain Injury, Rehabilitation Institute Research Corporation (H133G80052) led by David Reinkensmeyer, PhD.
This project develops a self-therapy rehabilitator for the arm after hemiplegic stroke and other types of brain injury to correct the current lack of appropriate technology. The device, called the "Assisted Rehabilitation and Measurement (ARM) Guide," implements a common manual therapy technique, active assistance for reaching movements. In addition, the ARM Guide is designed to provide visual feedback of guidance forces to the user during assisted reaching.
Find out more at: http://www.eng.uci.edu/~dreinken/djr.htm.

Enhancement of Upper Limb Functional Recovery in Stroke Using a Computer-Assisted Training Paradigm, Rehabilitation Institute Research Corporation (H133G80063) led by Julius Dewald.
This study investigates use of a novel computer-assisted isometric training regime to overcome abnormal movement synergies following hemiparetic stroke. The effect of two training regimes on functional movement are being investigated in 40 hemiparetic stroke subjects. The first training regime uses a general, classical strengthening protocol to increase torque production in specific directions. The second, novel regime strengthens subjects using torque combinations that require the subject to deviate progressively from their abnormal torque synergies. Assessment of the effectiveness of these two regimes is based on quantitative comparisons of voluntary upper limb movements performed pre- and post-training.
Find out more at: http://nuinfo.nwu.edu/nuin/blurbs/Dewald.html.

Effect of Motor Learning Procedures on Brain Reorganization in Subjects with Stroke, University of Minnesota (H133G80041) led by James Carey.
This project determines whether elements of motor learning can promote brain reorganization and recovery of function in individuals with stroke. Two interventions have been shown to be effective in helping people recover from stroke, "forced use" of the weak side and electrical stimulation. The project involves two experiments: (1) subjects with stroke receive 20 training sessions at a finger movement tracking task in which they are forced to process the perceptual motor information mentally and learn to respond accurately, and (2) different subjects with stroke receive 20 days of electrical stimulation to the weak forearm muscles. For both experiments, changes in finger function are measured with tracking and manual dexterity tests. Neuroplastic changes in the brain are measured with functional magnetic resonance imaging. This project may show for the first time that physical rehabilitation procedures may stimulate beneficial reorganization of the brain following stroke and invite further experiments to optimize treatments.

Learn more about these and other projects from the NIDRR Program Directory available at NARIC's Instant Disability Information Center http://www.naric.com

NIDRR also funds three Rehabilitation Research and Training Centers whose focus includes stroke and neurorehabilitation:

  • Rehabilitation Research and Training Center in Neuromuscular Diseases, University of California/Davis (H133B980008) lead by Craig McDonald, MD, can be found at: http://www.rehabinfo.net.
  • Multiple Sclerosis Rehabilitation Research and Training Center, University of Washington (H133B980017) led by George H. Kraft, MD, MS, can be visited at: http://weber.u.washington.edu/~rehab/ms-grant.
  • Rehabilitation Research and Training Center on Stroke Rehabilitation, Rehabilitation Institute Research Corporation (H133B980021) led by Elliot J. Roth, MD. is not available online. Information is available at http://www.naric.com.

 

picture of a computer NARIC’s Search Page features topic pages for stroke and neurological and neuromuscular disabilities. Take a moment and browse through articles, organizations, and Internet resources on these and other topics at http://www.naric.com/public.

New Research: From the NIDRR Projects

Roth, E. J., Heinemann, A. W., Lovell, L. L., Harvey, R. L., McGuire, J. R., Diaz, S. (1998). Impairment and Disability: Their Relation During Stroke Rehabilitation. Archives of Physical Medicine and Rehabilitation, 79(3), 329-335. RTC on Enhancing Quality of Life of Stroke Survivors. Accession Number: J34829.
Abstract: Article describing the association between impairment and disability during stroke rehabilitation. The authors conclude that although stroke-related impairment and disability are significantly correlated, reduced impairment level alone does not fully explain the reduced disability that occurs during rehabilitation. Even patients without substantial impairment reduction demonstrate disability reduction during rehabilitation, suggesting that rehabilitation has an independent role in improving function beyond that explained by neurologic recovery alone.

Fowler Jr, W. M., Abresch, R. T., Koch, T. R., Brewer, M. L., Bowden, R. K., Wanlass, R. L. (1998). Employment Profiles in Neuromuscular Diseases. American Journal of Physical Medicine and Rehabilitation, 76, 26-37. RRTC in Neuromuscular Diseases, University of California/Davis. Accession Number: J35761
Abstract: Study investigating consumer and rehabilitation provider factors that might limit employment opportunities for persons with neuromuscular diseases (NMD). Data are from a questionnaire survey of 154 individuals with slowly progressing NMD, and physician reviews of medical files. Factors examined included education, functional status, type of occupation, intellectual capacity, psychosocial adjustment, beliefs regarding barriers to employment, rates of physician referral to state rehabilitation programs and rates of acceptance by such programs, and interest in obtaining a job.

Harvey, R. L., Roth, E. J., Heinemann, A. W., Lovell, L. L., McGuire, J. R., Diaz, S. (1998). Stroke Rehabilitation: Clinical Predictors of Resource Utilization. Archives of Physical Medicine and Rehabilitation, 79(11), 1349-1355. RRTC on Enhancing Quality of Life of Stroke Survivors, Rehabilitation Institute Research Corporation. Accession Number: J35953
Abstract: Study aimed at identifying time-of-admission predictors of resource utilization by persons admitted to a rehabilitation facility for acute inpatient rehabilitation. Demographic, medical, and functional information were collected at admission for 945 consecutive stroke patients admitted to the facility, and related to rehabilitation length of stay (LOS) and charge per day (CPD). It was found that severe impairment and motor disability were the main predictors of longer LOS, while motor disability and medical comorbidities predicted higher CPD.

Abresch, R. T., Seyden, N. K., Wineinger, M. A. (1998). Quality of Life: Issues For Persons with Neuromuscular Disorders. Physical Medicine and Rehabilitation Clinics of North America, 9(1), 233-248. RRTC in Neuromuscular Diseases, University of California/Davis. Accession Number: J36050.
Abstract: Article discussing the literature on quality of life for persons with neuromuscular disorders (NMD), including subjective assessment of life satisfaction/quality of life by health care providers and persons with NMD, and the effects of health care providers' assessment of patients' quality of life on the health care they provide. Includes results from in-depth interviews with 36 persons with NMD concerning quality of life issues.

Huang, M. E., Cifu, D. X., Keyser-Marcus, L. (1998). Functional Outcome After Brain Tumor and Acute Stroke: A Comparative Analysis. Archives of Physical Medicine and Rehabilitation, 79(11), p1386-1390. RRTC on Improving Supported Employment Outcomes for Individuals with Developmental and Other Severe Disabilities, Virginia Commonwealth University. Accession Number: J35954.
Abstract: Study comparing functional outcome, length of stay (LOS), and discharge disposition of persons admitted to an inpatient rehabilitation unit with brain tumors and with acute stroke. The authors found that brain tumor patients can achieve comparable functional outcome and rates of discharge to community and have a shorter rehabilitation LOS than stroke patients.

Defining Disability: Updating the REHABDATA Thesaurus

The REHABDATA Thesaurus is a key instrument in indexing the materials in the NARIC collection. The Thesaurus is a constantly evolving document which is modified and updated on a regular basis. Each month we look at a term, how it’s defined, and how it’s used in indexing rehabilitation and disability literature.

Stroke is the fifth most common medical condition causing difficulty or need for assistance with activities of daily living, according to statistics generated from the Survey of Income and Program Participation. Alzheimer's disease, Parkinson's disease, Amyotrophic Lateral Sclerosis, and Multiple Sclerosis are the most prevalent chronic neurological conditions causing activity limitations, according to statistics generated by the National Health Interview Survey of 1992.

DAILY LIVING
Scope Notes: Evaluation of, and training in, the ability to perform essential self help skills: dressing, use of public transportation, and other functional skills.
Related Terms: Clothing; Communication devices; Community living; Devices; Feeding; Grooming; Habilitation; Homemakers; Independent living; Mobility; Self care; Self help; Sensory aids; Social skills.
Use For: Activities of daily living (ADL); Housekeeping; Hygiene; Life skills training; Toileting.