Responses to stimuli in the 'snoezelen' room in unresponsive wakefulness or in minimally responsive state.

BACKGROUND: Sensory stimulation in Snoezelen room increased responsiveness after brain injury and dementia. OBJECTIVE: To explore the physiological and clinical effects of Snoezelen stimulation in persons with unresponsive wakefulness syndrome or minimally conscious state (UWS or MCS). DESIGN: A comparative prospective observational cohort study. METHODS: Ten patients with UWS and 25 in MCS were exposed to consecutive stimuli involving the 5 senses in a Snoezelen room. Heart rate (HR) and cerebral blood flow velocity (CBFV), and scores of the Loewenstein communication scale (LCS) were obtained before and during or after the stimuli. RESULTS: The stimuli increased HR values and decreased left hemisphere CBFV values in patients with MCS (p < 0.05). Stimulation increased LCS scores (from 28.48 ± 6.55 to 31.13 ± 7.14; p < 0.001) in patients with MCS, but not in the UWS group. LCS gain correlated with HR and right hemisphere CBFV gains in patients with MCS (r = 0.439 and 0.636 respectively, p < 0.05). CONCLUSIONS: Snoezelen stimulation induced immediate improvement in communication and physiological changes in patients with MSC, and had a minor physiological effect in patients with UWS. If additional studies support these findings, it will be possible to suggest that Snoezelen stimulation can affect arousal, and possibly improve functioning.

Modified constraint-induced movement therapy improved upper limb function in subacute poststroke patients: a small-scale clinical trial.

BACKGROUND: Constraint-induced movement therapy (CIMT) has been advocated as a means of facilitating motor function in poststroke patients; however, the evidence for its efficacy is controversial. OBJECTIVE: To evaluate the effect of modified CIMT on improving paretic arm function in poststroke patients during a subacute rehabilitation period. METHODS: A single-blinded randomized controlled trial was conducted at the Loewenstein Rehabilitation Hospital, Israel. Twenty-eight subacute stroke patients with arm paresis after a first ischemic stroke in the middle cerebral artery area were randomized into a modified CIMT or control group by a 1:2 ratio. The modified CIMT group received 1-hour daily physical rehabilitation sessions for 2 weeks. The unaffected arm was restrained during the sessions. Subjects were encouraged to wear a restrictive mitten up to 4 hours a day. The control group received similar intensive regular rehabilitation. Three upper limb function tests, developed for this study, were used as outcome measures. The subjects were asked to perform the following tasks, with the affected hand for 30 seconds: (1) transfer pegs from a saucer to a pegboard; (2) grasp, carry, and release a hard rubber ball; and (3) "eating," using a spoon to remove the jelly from the plate, bring it towards the mouth, and then place it on another plate. The number of repetitions in each test was recorded as an outcome. RESULTS: The modified CIMT group showed significantly higher changes in all 3 tests compared to the standard rehabilitation group. CONCLUSION: Our study provides additional support for the use of modified CIMT during a subacute rehabilitation period of poststroke patients. CIMT may facilitate functional improvement of a plegic hand.

Constraint-induced movement therapy alters cerebral blood flow in subacute post-stroke patients.

We attempted to evaluate patterns of hemispheric activation, according to cerebral blood flow changes, in post-stroke patients during motor tasks with and without arm restriction. Bilateral continuous middle cerebral artery monitoring of 6 healthy subjects (control group) and 28 post-stroke patients by transcranial Doppler sonography was executed while performing three simple motor tasks using the paretic or nondominant (in controls) hand: ball grasping, pegs insertion, and "eating" with a spoon. The nonaffected or dominant (in controls) arm was free and thereafter restricted. Mean blood flow velocity and flow velocity changes during the tests were estimated. No significant mean blood flow velocity changes were found in the healthy subjects. Significant elevation of mean blood flow velocity in damaged middle cerebral artery was recorded in post-stroke patients after restricting the undamaged hand. This may explain the positive effect of constraint-induced movement therapy on upper limb function.