Long-term results of enriched environment and erythropoietin after hypobaric hypoxia in rats.

After global cerebral hypoxia, many patients are severely disabled even after intensive neurorehabilitation. Secondary mechanisms of brain injury as a result of biochemical and physiological events occur within a period of hours to months, and provide a window of opportunity for therapeutic intervention. Erythropoietin (EPO) has been shown to be neuroprotective in the brain subjected to a variety of injuries. Fifty-nine 3-month-old male Wistar rats were randomly distributed to experimental groups with respect to the housing (enriched environment - EE, standard housing - SH), to hypoxia exposure, and to EPO treatment. An acute mountain sickness model was used as a hypobaric hypoxia simulating an altitude of 8000 m. One half of the animals received erythropoietin injections, while the others were injected saline. Spatial memory was tested in a Morris water maze (MWM). The escape latency and the path length were measured. Better spatial learning in MWM was only seen in the group that received erythropoietin together with enriched environment. EPO administration itself had no influence on spatial memory. The results were very similar for both latencies and path lengths. These results support the idea that after brain injuries, the recovery can be potentiated by EPO administration combined with neurorehabilitation.

Early use of Xeomin neurotoxin for local anti-spasticity therapy for pes equines after acquired brain injury (ABI).

PRIMARY OBJECTIVE: The acute management of spasticity following ABI is challenging. Contractures can occur during the acute phases of illness. The joints most affected are the shoulders and the ankles. RESEARCH DESIGN: A case study of a 48-year-old female patient who received local chemoneurolytic anti-spasticity therapy following a severe subarachnoid haemorrhage for pes equines deformity is presented to illustrate the role of focal neurotoxin therapy. METHODS AND PROCEDURES: The increasing spasticity in her legs was observed and could not be effectively treated with oral anti-spasticity agents or intensive physiotherapy. As spasticity increased (Modified Ashworth Scale 4), mobility of the right foot continued to deteriorate, leading to indication for local anti-spasticity treatment with Xeomin neurotoxin. The spastic pes equinus was injected with Xeomin® using a total dose of 150 U. MAIN OUTCOMES AND RESULTS: On the 6th day after injection, a gradual reduction in spasticity was observed in the injected muscle (Modified Ashworth Scale 1-2) and an increasing improvement in joint mobility. CONCLUSIONS: Early local anti-spasticity treatment with Xeomin is effective treatment. The cost of the intervention would appear to be high, but if one compares it with the costs of conservative treatment, it is not more expensive.

Rehabilitation intervention in animal model can improve neuromotor and cognitive functions after traumatic brain injury: pilot study.

The aim of the present study was to quantify the effect of multisensory rehabilitation on rats' cognition after an experimental brain trauma and to assess its possible clinical implications. The complex intermittent multisensory rehabilitation consisted of currently used major therapeutic procedures targeted at the improvement of cognitive functions; including multisensory and motor stimulation and enriched environment. We have confirmed this positive effect of early multisensory rehabilitation on the recovery of motor functions after traumatic brain injury. However, we have been able to prove a positive effect on the recovery of cognitive functions only with respect to the frequency of efficient search strategies in a Barnes maze test, while results for search time and travelled distance were not significantly different between study groups. We have concluded that the positive effects of an early treatment of functional deficits are comparable with the clinical results in early neurorehabilitation in human patients after brain trauma. It might therefore be reasonable to apply these experimental results to human medical neurorehabilitation care.

International classification of functioning, disability and health of World Health Organization (ICF).

International classification of functioning (ICF) is a "common language" to describe health and disability. It gives detailed operational definitions of different functions that constitute health. From body functions such as vision, hearing, to activities of daily living and participation in societal life, ICF has brought international consensus on definitions and provided a framework to describe health and disability.

Functional outcome at 1 vs. 2 years after severe traumatic brain injury.

PURPOSE: The aim of the study was to evaluate the outcome of patients with severe traumatic brain injury (STBI) after 12 and 24 months (Glasgow Coma Scale GCS < or = 8 points for at least 24 hours). METHODS: A total of 51 patients underwent a multidisciplinary early rehabilitation treatment until they were discharged from hospital and local ambulatory care was deemed sufficient. The follow-up examination took place 12 and 24 months after the STBI. RESULTS: Data revealed a high level of independence in activities of daily living (mean Barthel Index after 1 year 92.7 points, after 2 years 93.7 points). After 1 and 2 years, 74.5% and 80.4% of the patients, respectively, were completely independent of need for care. Nevertheless, more than half of the patients had sensorimotor, behavioural, speech, visual and/or auditory disturbances. Return to work rates improved between 1-2 years after trauma, as evidenced by the rate of patients being back to full time work at 1 year (n = 14, 28%) and 2 years (n = 20, 40%) post-STBI; although none of these changes reached statistical significance. CONCLUSION: In summary, there are still changes in both impairment and disability related areas between 1-2 years post-STBI, but the degree of improvement is variable depending on the area being considered. Clinicians should remain aware of the fact that modulation of impairment and disability appear to continue well beyond 1 year post-STBI, which may impact on decisions regarding the provision and intensity of further rehabilitation efforts.

Early rehabilitation model shows positive effects on neural degeneration and recovery from neuromotor deficits following traumatic brain injury.

This study used an experimental early rehabilitation model combining an enriched environment, multisensory (visual, acoustic and olfactory) stimulation and motor training after traumatic brain injury (via fluid-percussion model) to simulate early multisensory rehabilitation. This therapy will be used by brain injured patients to improve neural plasticity and to restore brain integration functions. Motor dysfunction was evaluated using a composite neuroscore test. Direct structural effects of traumatic brain injury were examined using Fluoro-Jade staining, which allows identification of degenerating neural cell bodies and processes. Animals in the rehabilitation model group performed significantly better when tested for neuromotor function than the animals in standard housing in the 7-day and 15-day interval after injury (7d: p=0.005; 15d: p<0.05). Statistical analysis revealed significantly lower numbers of Fluoro-Jade positive cells (degenerating neurons) in the rehabilitation model group (n=5: mean 13.4) compared to the standard housing group (n=6: mean 123.8) (p<0.005). It appears that the housing of animals in the rehabilitation model led to a clear functional increase in neuromotor functions and to reduced neural loss compared with the animal group in standard housing.

Rehabilitation care in paediatrics in the Czech Republic.

The aim of this work is to inform about the present situation in the care of disabled children in the Czech Republic. It contains the evaluation of the present situation and displays plans of care in the future.

Conceptual framework for rehabilitation in the Czech Republic: a proposal.

PURPOSE: To propose a conceptual basis for a rehabilitation system in the Czech Republic (CR) founded on the WHO International Classification on Functioning (ICF). METHODS: Surveying the present state of rehabilitation in the CR using data from The Institute for Health Information and Statistics of the CR, studying the available literature of medical rehabilitation as well as the WHO ICF. RESULTS: At present the rehabilitation system in the CR is not adequate, mainly from the qualitative point of view, and requires a legal framework that would determine the availability of appropriate rehabilitation services. CONCLUSION: The WHO ICF can serve as a conceptual basis for the framework.