An evaluation of the strategic approach to the rehabilitation of traumatic brain injury (TBI) patients

Cerebrovascular Protective Effect of Boldine Against Neural Apoptosis via Inhibition of Mitochondrial Bax Translocation and Cytochrome C Release

BACKGROUND In the present study, we explored the protective effect and mechanism of action of boldine (BOL) against neural apoptosis, which is a mediator of TBI. MATERIAL AND METHODS The effect of BOL on mitochondrial and cytosol proteins of extracted from cerebral cortical tissue of mice was evaluated. The grip test was used to assess the neurological deficit and brain water content of the subjects after administration of BOL to assess its effect on SOD, GSH, and MDA activity in brain ischemic tissues. To further confirm the effect of the BOL, the histopathological analysis and morphology of neurons were studied by Nissl staining. The effect of BOL against TBI-induced neural apoptosis by immuno-histochemistry and Western blotting assay were also studied. RESULTS BOL showed significant improvement against TBI in a dose-dependent manner. In the BOL-treated group, the apoptotic index was significantly reduced, but the level of caspase-3 was greatly diminished. Additionally, the level of the Bax in mitochondria (mit) and cytosol was elevated in the TBI-treated group as compared to the sham group. Further BOL at the test dose causes significant reduction in the level of mitochondrial MDA together with increase in SOD activity as compared to the TBI alone group. CONCLUSIONS BOL showed a cerebroprotective effect against TBI by attenuating the oxidative stress and the mitochondrial apoptotic pathway. It also inhibited mitochondrial Bax translocation and cytochrome c release.

The effectiveness of selected Tai Chi exercises in a program of strategic rehabilitation aimed at improving the self-care skills of patients aroused from prolonged coma after severe TBI

Background

Difficulties in self-care constitute a very common problem for patients recovering from prolonged coma after a severe TBI, and a major factor reducing their quality of life. Effective new rehabilitation programs that would help solve this problem are urgently needed. The purpose of our experiment was to evaluate improvement in this respect in a group of patients aroused from prolonged coma who participated in a goal-oriented rehabilitation program (Rehab-3), enhanced with selected elements of Tai-Chi.

Material/Methods

We examined 40 patients aroused from prolonged coma after a severe TBI, undergoing long-term rehabilitation according to a standard phased rehabilitation program. These patients were divided into two numerically even groups: a control group treated according to the standard program, and an experimental group, who received an additional goal oriented program enhanced with selected Tai-Chi exercises. The research methods included analysis of documentation (MRI, CT), a structured clinical interview, and the Standard Self-Care Scale.

Results

The experimental group achieved significant improvement of self-care skills, whereas in the control group the improvement was slight and not statistically significant. The value of co-efficient j (0.64) indicates a very strong association between the rehabilitation procedure and improved self-care in the experimental group, but not in the control group.

Conclusions

Our results confirmed that a goal-oriented rehabilitation program enhanced with elements of Tai-Chi was more effective than the standard program in improving the performance of activities of daily living.

Functional recovery after injury of motor cortex in rats: effects of rehabilitation and stem cell transplantation in a traumatic brain injury model of cortical resection

PURPOSE

Experimental studies and clinical trials designed to help patients recover from various brain injuries, such as stroke or trauma, have been attempted. Rehabilitation has shown reliable, positive clinical outcome in patients with various brain injuries. Transplantation of exogenous neural stem cells (NSCs) to repair the injured brain is a potential tool to help patient recovery.

METHODS

This study aimed to evaluate the therapeutic efficacy of a combination therapy consisting of rehabilitation and NSC transplantation compared to using only one modality. A model of motor cortex resection in rats was used to create brain injury in order to obtain consistent and prolonged functional deficits. The therapeutic results were evaluated using three methods during an 8-week period with a behavioral test, motor-evoked potential (MEP) measurement, and measurement of the degree of endogenous NSC production.

RESULTS

All three treatment groups showed the effects of treatment in the behavioral test, although the NSC transplantation alone group (CN) exhibited slightly worse results than the rehabilitation alone group (CR) or the combination therapy group (CNR). The latency on MEP was shortened to a similar extent in all three groups compared to the untreated group (CO). However, the enhancement of endogenous NSC proliferation was dramatically reduced in the CN group compared not only to the CR and CNR groups but also to the CO group. The CR and CNR groups seemed to prolong the duration of endogenous NSC proliferation compared to the untreated group.

CONCLUSIONS

A combination of rehabilitation and NSC transplantation appears to induce treatment outcomes that are similar to rehabilitation alone. Further studies are needed to evaluate the electrophysiological outcome of recovery and the possible effect of prolonging endogenous NSC proliferation in response to NSC transplantation and rehabilitation.

Radiological and biomechanical analysis of humeral fractures occurring during arm wrestling

Background

Arm wrestling has recently become one of the most popular sports among young people, mainly due to its simplicity and spectacularity. Yet, unfortunately it is also injury prone. The aim of the study was to perform a biomechanical analysis of the forces which act during arm wrestling, as well as to explain the mechanism of the occurrence of humeral fractures of a similar topology as observed on X-rays.

Material/Methods

During the period 2001 to 2008 nine cases of humeral fractures resulting from arm wrestling were consulted and treated at the Clinic. The assessment of the limb condition included an interview and the examination of the fractured extremity. All the patients underwent surgical treatment, using the method of open reduction and internal fixation. The virtual dynamic model of the upper limb was established on the basis of a series of computer tomography scans of the bone, and literature data. The biomechanical analysis was carried out using the Finite Elements Method (FEM).

Results

There were five cases of the 12-B1 type in the AO Classification with butterfly fragments in five cases, and four of the 12-A1 type without the butterfly fragment. The maximum bone stress resulting from torsional loading which occurs during arm wrestling amounted to 60 MPa and was located 115 mm above the elbow on the medial - posterior side of the humeral.

Conclusions

The strength analysis carried out during arm wrestling revealed that the forces of the acting muscles significantly exert stresses within the distal third of the humeral.