International Journal of Neurorehabilitation

Summary There is an abundance of published literature discussing the treatment of single-level lumbar
spondylolysis and spondylolisthesis. However, the treatment of patients with chronic back pain and multiple levels of combined lumbar spondylolysis and spondylolisthesis are not well-described in the existing literature.
Introduction The purpose of this case report is to review the literature and describe the successful treatment of a patient who had chronic back pain and multiple levels of lumbar spondylolysis with associated spondylolisthesis.
Methods A 32 year old male soldier had 4 level lumbar spondylolysis and L4-5 spondylolisthesis. He had chronic back pain that was refractory to conservative measures over a period of 3 years. He was treated surgically with single level lumbar fusion at the level of L4-5 spondylolisthesis. The other levels of lumbar spondylolysis were not stabilized. The patient demonstrated an excellent functional outcome at 2 years postop and was able to return to unrestricted military duty. Radiographs at 2-year follow-up showed solid L4-5 fusion with no evidence of spondylolisthesis at any other lumbar level.
Conclusion Single-level lumbar fusion may be an appropriate treatment option for patients with chronic low back pain and multiple levels of spondylolysis. Functional outcome was excellent without evidence of instability at 2 year follow-up.
Significance This case report highlights the effectiveness of single-level lumbar fusion in patients who have multiple levels of preexisting spondylolysis. Further study is recommended.

This article reviews fundamental principles related to ethics and patient care, with an emphasis on neurological disorders. The respect of the principle of autonomy is essential for patients. This principle is now recognized as one of the fundamental rights of patients, not only in the legal field but also in the moral field. In ethics, other principles favour patients in their specific relationships with their physicians such as the principles of beneficence, non-maleficence and equity. Within the framework of their customary practice, doctors must also respect other ethical principles including proportionality, truthfulness and precaution. However, for patients with cerebral damage, respect for the principle of autonomy must be subordinate to effective legal competences. Otherwise, the decisions could be made by third parties such as families or doctors, at the risk of drifting from the patient’s own demands. A number of clinical situations may result in dilemmas or conflicts between the therapists or the nursing staffs and patients or their close relatives. Some specificities of Belgian law are discussed.

Serum biomarkers could indicate the pathological changes during the secondary injury process after traumatic brain injury (TBI). Furthermore, they could reflect specific pathological processes following different types of TBI. Here we analyzed time-dependent changes of select protein biomarkers in serum samples collected from a rodent model of penetrating type of injury (pen-TBI). The model is a controlled penetration of a 2 mm thick needle-shaped object, which is accelerated into the brain tissue with a bullet from an air gun. The results obtained in the current study were compared to previously reported results of levels of serum biomarker following a rotational acceleration injury that mimics mild TBI. A total of 24 animals were used, grouped in normal controls, sham-operated and injured animals. The rats were sacrificed at day 1, day 3 and day 14 post-injury and serum samples were analyzed for Tau, neurofilament heavy chain (NF-H), myelin basic protein (MBP), N-cadherin and S100B. We found that all markers but MBP showing a bi-phasic response to injury. Their serum levels significantly increased at day 1, dropped at 3 and increased again at day 14 post-injury. This was in contrast to rotational TBI model where the peak of biomarkers was found at day 3. Our study suggests that pen-TBI results in both acute axonal and neuronal damages as well as delayed changes likely part of the ongoing secondary injury process. These findings illustrate the dynamics of the injury process in pen-TBI and underline the importance of monitoring changes in serum biomarker levels for more accurate assessment of injury severity and outcome. In addition, comparison to rotational TBI model revealed distinctive temporal pattern of serum biomarker expression dependent on the type of injury.

Background: cerebral palsy is a neuro developmental disorder. It has various types. Hemiparetic cerebral palsy is a type in which the children have limitations in capacity to use the impaired upper limb on daily life activities. This study aims to find out the effects of modified Constraint induced Movement therapy (modified CIMT) to improve the upper limb functional activities and gross manual dexterity among the children with hemiparetic cerebral palsy.
Methods: 10 children with hemiparetic cerebral palsy were undergone to modified CIMT. Interventions lasted for 4weeks, 4hrs/day, Peadiatric Motor Activity Log(PMAL) to assess the children's upper limb functional activities and box and block to assess gross manual dexterity were used before and after intervention.
Results: The results showed significant improvements on functional measures of PMAL and gross manual dexterity of box and block.
Conclusion: modified CIMT is an effective therapy to improve the upper limb functional activities and gross manual dexterity on the children with hemiparetic cerebral palsy.

Backgroud: BDNF plays an important role in maintaining survival and function of neurons. Exercise may be increasing the mRNA and protein level of BDNF in hippocampus and cortex.
Objective: To investigate the impact of a long-term physical training on the mRNA and protein level of BDNF after Middle Cerebral Artery Occlusion (MCAO) in mice.
Design, Time and Seting: A randomized, controlled, animal experiment was performed at the department of rehabilitation medicine, Chinese PLA general hospital
Materials: Twenty-six male C57 BL/6J mice (20–30g, 2-3 months old) were provided by Experimental Animal Center of Institute of Medicine, Chinese PLA general hospital.
Methods: Twenty-six male C57 BL/6J mice underwent MCAO (described by Bederson JB et al) and then were divided into training group Ι (n=9), training group II (n=9) and control group (n=8). The mice of training group I were trained with voluntary running wheel for one hour daily (6 days per week) for 90 days; The mice of training group II were trained for 15 days, stopped for 30 days and retrained for 45 days after MCAO .The running wheel of control group was fixed. The mRNA level of BDNF mice brain was tested by RT-PCR method 90 days after MCAO. The design of study is completely randomized among three groups. Wilcoxon rank sum test and Kruskal-Wallis test were performed.
Main Measures: Quantitation of the expression of BDNF genes is determined by RT-PCR for mRNA level techniques and Western blotting for protein level.
Results: Both the mRNA and protein levels of BDNF mice brain are significantly higher in training group I and training group II than that in control group in 90 days after MCAOï¼ÂˆT values respectively are 5.1 and 3.9,P<0.01ï¼Â‰. There was no marked difference in the levels of BDNF mRNA or BDNF expression between training group I and in training group II, respectively (T value is 1.2,or 1.3 P>0.05).
Conclusion: The long term physical training can elevate the mRNA and protein levels of BDNF in mice brain after Middle Cerebral Artery Occlusion.

Patients with malignant brain tumors have varied degree of neurological impairments because of factors influencing activities of daily living (ADL). Those factors are related to characteristics of patients, tumor natures, and received treatment. However, factors influencing ADL of patients with malignant brain tumors are not fully elucidated. The functional independence measurement (FIM) is an ADL scoring system to determine impairment in different domains objectively. Here, we assessed ADL of 27 patients with malignant brain tumors at admission, discharge, 1 year and 2 years later using FIM scoring system, and identified factors influencing their ADL. In results, patient age and tumor pathology were identified as factors influencing ADL, while tumor site and operation type were not related to FIM scores. In conclusion, patient age and tumor pathology are identified as factors influencing ADL of patients with malignant brain tumors. Taking into account of those factors, neuro-rehabilitation program for patients with malignant brain tumors should be scheduled.

Introduction: We developed the method of the spinal cord decompression and analyzed its efficacy. The essence of the operation lies in the performance of multilevel laminectomy and mandatory durotomy of spinal cord with the local administration of Cortexin.
Purpose: To develop the most efficient tactics of the decompression laminectomy and to study efficacy of the durotomy and local administration of Cortexin in patients with spinal cord injury.
Methods: As of from January 2013 to June 2015 we performed 24 decompression operations in the thoracic spine in the patients with spinal cord injury. In 12 patients the decompression laminectomy was performed without durotomy of spinal cord. In 12 patients the durotomy of spinal cord with the local administration of Cortexin in the setting in intradural space was performed.
Results: The first group of study consisted of 12 patients submitted to the decompression laminectomy without durotomy. Efficacy in the first group of study corresponded to 50 %. In the group 2 we performed the durotomy and local administration of Cortexin in the setting in intradural space (12 patients). The efficacy in the second group corresponded to - 83 %.
Conclusion: The performance of multilevel decompression laminectomy, durotomy and local administration of cortexin is preferable for the full-scale decompression of spinal cord and prevention of the extension of edema. The method makes it possible to improve efficiency of the decompression operations.

Despite on-going technological developments, clinical assessment remains an essential tool to evaluate the effects of rehabilitation treatment and to predict functional recovery. This paper provides a review of clinical assessment for stroke patients focusing on predictive value of motor, function and participation assessment, taking into consideration some specific evaluations for upper and lower limb function, trunk control, balance and walking. In the future an increased integration between clinical assessment, neurophysiology and neuroimaging will be required, in order to apply specific evaluation pathways to reach a more accurate and customized prognostic stratification.

There has been a gradual shift in the approach towards managing the occupational and physical health of patients in last few decades. While the earlier approach was standardized and involves using time tested solutions for all patients, the new era is moving towards customized medicine in which the focus is on an individual and how the solutions can be tailor made for his maximal benefit. Clinicians and therapists worldwide are looking for technological advancements that help them realize their goal to ensure optimal outcomes that are patient specific. 3D patient optimized rehabilitation tools also known as 3D PORT is based on additive manufacturing of customized devices using 3D printers. This review describes the basics of the use of technology and also on the future trends and possible clinical applications of the same.

Constraint-induced aphasia therapy is a widely used method in the treatment after stroke. Focusing on the theoretical basis of the original conception of the constraint-induced procedure we first made a special adaptation for Hungarian aphasic patients. We have been applying this method since 2012. So far, we have accomplished the treatment of 7 groups including 22 patients. It was supposed that the intensive language therapy based on the certain language features such as phonologic, semantic, syntactic and pragmatic parameters can facilitate the abstraction of general linguistic rules. The data were measured by standard and special tests significant improvement occurred in both the expressive and receptive language by the help of patients’ intact cognitive functions. Regarding our data we assumed that the new elaborated version for Hungarian language of the constraint-induced aphasia therapy can facilitate the abstraction and generalization of linguistic rules and could improve the patients’ linguistic skills according to the original method.