Application of ERPs neuromarkers for assessment and treatment of a patient with chronic crossed aphasia after severe TBI and long-term coma - Case Report

 Objective. The study aimed to evaluate the application of ERPs neuromarkers for the assessment and treatment of a patient with chronic crossed aphasia after severe TBI and a long-term coma.

CASE REPORT

An ambidextrous female patient, aged 29, suffered from posttraumatic chronic crossed aphasia, severe TBI and a prolonged coma after a car accident. The patient took part in two differentiated rehabilitation programmes of neurotherapy included 20 sessions of relative beta training and 20 sessions of rTMS; both programmes were combined with behavioural training. The patient was tested 3 times: before the experiment, after completion of programme A, and after completion of programme B.

RESULTS

In the 1st recording, the neuromarker of aphasia was found - an excess of the P2 wave over the left temporal area. There was a cognitive control deficit - an excess of omission errors and an increase of RT variability - all indexes of sporadic ADHD. In the 2nd recording, slight improvements in cognitive control, and language functions were found. In the 3rd recording, after the rTMS sessions most of her cognitive dysfunctions had been resolved, including language functions. It should be stressed that the activation (especially the increase in the ERP potential of the right side over the frontal lobe) was found. The neuromarker of aphasia did not change, only the location had slightly moved frontally.

CONCLUSIONS

The application of ERP neuromarkers assists in the diagnosis, treatment, and academic success of an ambidextrous patient with chronic posttraumatic aphasia and sporadic ADHD. ERPs can be used to assess the functional brain changes induced by neurotherapeutical programmes.

APPLICATION OF FUNCTIONAL NEUROMARKERS FOR CONSTRUCTING PROTOCOLS OF NEUROTHERAPY AND MONITORING THE SUCCESS OF TREATMENT IN CHRONIC CROSSED TRANSCORTICAL SENSORY APHASIA: A CASE STUDY

Background. The goal of the study was threefold: 1) to evaluate QEEG/ERPs in­dexes of functional brain impairment after a stroke associated with chronic crossed transcortical sensory aphasia, 2) to construct a neu­rotherapy protocol to compensate for this functional damage, and 3) to assess the changes in the functional neuromarkers induced by the neurotherapy sessions. Case study. A 72-year-old, strongly right-handed woman with atrial fibrillation sud­denly developed cerebral embolism of the right middle cerebral artery. She was treated conservatively, and the left hemiparesis, and aphasia – in a moderate degree, consequently existed. A CT-scan showed a large infarct lesion partially parallel to Wernicke’s area. After one year of ineffective aphasia therapy we constructed an experimental neuro­therapy protocol (TMS combined with comprehensive aphasia therapy) on the basis of an assessment of the spontaneous QEEG and event-related potentials (ERPs) in the cued GO/NOGO. The patient was assessed before and after the neurotherapy sessions by the same methodology. Conclusions.It was found that before the TMS treatment the temporal area (T6) generates a strong P2 wave in response to visual stimulus indicating a hyper-sensitivity of the neurons located at temporal areas of the right hemisphere. This was connected with crossed transcortical sensory aphasia found within the aphasia profile in the Polish version of the Western Aphasia Battery (K-WAB). The TMS sessions reduced this hyper-sensitivity substantially. The patient speech returned to the norm, she was to return to social life.

Neuropsychological rehabilitation for traumatic brain injury patients

The aim of this review is to discuss the basic forms of neuropsychological rehabilitation for patients with traumatic brain injury (TBI). More broadly, we discussed cognitive rehabilitation therapy (CRT) which constitutes a fundamental component in therapeutic interaction at many centres worldwide. Equally presented is a comprehensive model of rehabilitation, the fundamental component of which is CRT. It should be noted that the principles of this approach first arose in Poland in the 1970s, in other words, several decades before their appearance in other programmemes. Taken into consideration are four factors conditioning the effectiveness of such a process: comprehensiveness, earlier interaction, universality and its individualized character. A comprehensive programmeme of rehabilitation covers: cognitive rehabilitation, individual and group rehabilitation with the application of a therapeutic environment, specialist vocational rehabilitation, as well as family psychotherapy. These training programmemes are conducted within the scope of the 'Academy of Life,' which provides support for the patients in their efforts and shows them the means by which they can overcome existing difficulties. Equally emphasized is the close cooperation of the whole team of specialists, as well as the active participation of the family as an essential condition for the effectiveness of rehabilitation and, in effect, a return of the patient to a relatively normal life. Also presented are newly developing neurothechnologies and the neuromarkers of brain injuries. This enables a correct diagnosis to be made and, as a result, the selection of appropriate methods for neuropsychological rehabilitation, including neurotherapy.

The effect of programed physical activity measured with levels of body balance maintenance

Background

The aim of the research was an evaluation of 2 training programs covering the same standard physical activity in the initial stage (warm-up) and the main (motor exercises) as well as a separate end part in Program A of stretching and in Programme B of vibration training designed to improve the level of body balance.

Material/Methods

We tested 40 randomly chosen students of the Academy of Physical Education and Sport in Gdansk, subsequently divided into two 20-person groups: C (average age 21.3±1.2), and E (average age 21.8±1.1). The training of body balance was conducted for 8 weeks: we used in Group C Program A and in group E Program B. The evaluation of body balance was done 3 times: at the beginning, at midway point, and at the end of the experiment. The stabilographic tests with posture-graphical method and the task of 1-leg balance standing with eyes closed was used.

Results

It was found that in the first examination both groups did not significantly differ in terms of the tested parameters of balance. During the training process we obtained increased time of maintaining balance on 1 leg. This difference was significant between tests 1 and 2 both for Group C (p=0.0002) and for E (p=0.0034), while between the tests 2 and 3 in Group E (p=0.0213) only.

Conclusions

The training Program B is more effective to maintain balance on 1 leg when compared to Program A.

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.

The quality of life of persons with TBI in the process of a comprehensive rehabilitation program

BACKGROUND

The aim of the research was to evaluate the effectiveness of the phased rehabilitation program in patients after traumatic brain injury, one developed by the authors and controlled by the strategic plan, pertaining to their quality of life compared to patients treated according to a standard, phased rehabilitation program.

MATERIAL/METHODS

The study included 40 patients of post traumatic brain injury treated at the Rehabilitation Clinic of the L. Rydygier Academy of Medical Sciences in Bydgoszcz and the Department of Medical Rehabilitation of the Cracow Rehabilitation Centre. An experimental group included 20 patients rehabilitated by a strategic approach and a control group consisted of 20 patients treated before the introduction of this approach. In assessing the effectiveness of rehabilitation, a structured interview was used with clinical observation and the Battery of Quality of Life Assessment. The study was conducted twice: before and after eight weeks of rehabilitation.

RESULTS

The quality of life of people after brain injury is affected by self-service difficulties, difficulties in meeting the physiological needs and loss of psychophysical comfort, decreased mobility, impaired cognitive functions and executive and social functions. There is no consistency between the stated (subjective) level of quality of life of the patient, and the depth of objectively measured disability resulting from the injury sustained.

CONCLUSIONS

A rehabilitation program controlled by a strategic plan, in collaboration with the patient treated subjectively is more effective in improving the quality of life, since the cooperating patient is more motivated to carry out individually designed goals. A rehabilitation program based on a strategic plan is worthy of recommendation for the treatment and improvement of patients after cranio-cerebral trauma.

Postural control in patients with lumbar disc herniation in the early postoperative period

Chronic spinal disc disease leads to disorders in postural movement coordination. An incorrect asymmetrical movement pattern for the lower limbs loading impairs proprioception and deteriorates postural stability, particularly when the vision is occluded. The standard surgical treatment improves biomechanical conditions in the lumbar spine, reduces pain, yet does it reduce the stability deficit in the upright position? An answer to the latter question would help work out targeted therapy to improve postural stability. We hypothesized that the standard surgical treatment would improve postural stability reflected by decreased sway variability accounting for better use of proprioceptive inputs postoperatively. Thirty-nine patients with lumbar disc herniation participated in the study. Their postural sway was recorded in anterior/posterior and medial/lateral planes with their eyes open or closed (EC) before and after surgery. The variability, range, mean velocity of the recorded time series and the area of the ellipse enclosed by the statokinesiogram were used as measures of postural stability. Preoperatively, EC condition resulted in an increased variability and mean velocity of postural sway, while postoperatively it caused an increase in sway mean velocity and sway area only with no effect on sway variability and range. The comparison of the balance before and after the surgery in the EC condition showed significant decrease in all parameters. In the early postoperative period, the patients recover the ability to control their postural sway in EC within normal limits, however, at the expense of significantly increased frequency of corrective torques. It is probably a transient short-term strategy needed to compensate for the recovery phase when the normal weighting factors for all afferents are being reestablished. We propose that this transient postoperative period may be the best timing of therapeutic intervention targeted at facilitating and reinforcing the acquisition of correct motor patterns.