Neurobehavioral function during coma, stroke rehabilitation effective for elderly

March 14, 2005

The current issue of the Journal of Rehabilitation Research and Development (JRRD) includes articles that focus on health management of patients during coma, development of a comprehensive stroke database, and effectiveness of rehabilitation following stroke in elderly populations. Full-text articles are available, free, online at

Disorders of Consciousness Scale© reliably predicts recovery of consciousness from coma, pg 1
This study, the first of a two-part series, examines the development of and psychometric properties of the Disorders of Consciousness Scale© (DOCS), which measures neurobehavioral functioning during coma. Veterans and civilians over age 18 unconscious after a severe brain injury were evaluated with the DOCS weekly. Investigators found that the DOCS is a sensitive, reliable, and valid measure of changes in neurobehavioral functioning in unconscious people. Improvements, declines, and plateaus in neurobehavioral functioning were reliably and accurately detected. Physicians can use the DOCS to tell families the likelihood of recovering consciousness within the first year of injury. Preliminary findings indicate that this prognosis can be provided with up to 86% certainty.

Systematic tracking of recovery from coma improves medical and rehabilitation strategies, pg 19
This study, the second of a two-part series, illustrates how repeated measures of neurobehavioral functioning derived from the Disorders of Consciousness Scale© (DOCS) improves medical and rehabilitation management during coma recovery. Investigators found that medical decision-making regarding short-term effects of pharmacological interventions was improved. Previously undetected secondary medical complications were detected and successfully treated. Development and refinement of individualized rehabilitation programs was facilitated and enhanced. An investigation of treatment effectiveness during coma recovery and how to examine the relationship between behavioral changes and neural adaptation are illustrated. Data suggest that tracking individual neurobehavioral recovery patterns during coma recovery is useful for medical and rehabilitation management.

Brain wave abnormalities may help explain interpersonal challenges faced by people with TBI, pg 29
This study uses visually evoked brain waves to identify emotion recognition deficits in people with traumatic brain injury (TBI). Investigators measured the ability of 13 patients with moderate to severe TBI and 13 controls to identify pictures of angry faces randomly distributed among neutral faces. Patients with TBI showed significantly impaired responses while attempting to detect facial cues. Individuals with TBI were also much slower and less accurate in recognizing the angry faces. The finding of impaired facial emotion processing may be one of the reasons why patients with TBI are at risk for crossing social boundaries in interpersonal interactions.

Vocational and cognitive behavior therapy effective in treating schizophrenia, pg 35
This study describes for the first time the use of a vocational and cognitive behavior therapy (CBT) program to help people with schizophrenia disorders overcome negative beliefs and hold paid employment. The program, the Indianapolis Vocational Intervention Program (IVIP), requires participants to work up to 20 hours per week at a paid work placement while attending weekly group and individual CBT sessions. The IVIP manual helps people with schizophrenia to think more positively about themselves and work and differs from other CBT programs in that it seeks to enhance social and work function.

Stroke patients over 75 receive health benefits from rehabilitation therapy, pg 47
This study assesses the length and efficacy of rehabilitation for stroke patients over 75 years old. Investigators compared prestroke, admission, and discharge functional status of 305 patients age 75 and older who were hospitalized for rehabilitation following stroke. A patient's age did not affect the length of stroke rehabilitation. Fifty-three percent of patients between the ages of 75-84 and 40 percent of patients age 85 and older were successfully rehabilitated. Investigators conclude that although the success rate for rehabilitation following stroke is lower in patients over age 85, treatment is beneficial.

New test identifies osteoporosis risk in people with spinal cord injury, pg 55
This study evaluates the influence of osteoporosis risk factors on bending of the tibia (shin) bone and discusses a method to identify at-risk groups for osteopenia following spinal cord injury (SCI). Investigators measured the tibia- bending stiffness in 175 able bodied men without known orthopaedic or neurological impairment(s) and in 33 men with SCI. Data suggest a direct relationship between health status, tibia length, age, and shin-bending stiffness. Volunteers with chronic SCI had significantly lower shin-bending stiffness than able bodied volunteers. Also, there were significant differences between SCI groups divided into individuals with and without pathologic fracture history.

No difference found in the recovery of upper and lower limbs post stroke, pg 65
This study quantifies recovery of upper-limb function post stroke and compares the recovery of upper-limb function to lower-limb function. Fifty-five volunteers were evaluated within 10 days post stroke and reevaluated at five weeks post stroke for upper-limb impairment and activity limitation. Over the first five weeks following stroke, volunteers showed significant improvement in upper- and lower-limb function. Upper-limb impairment measured at one week post stroke was the most important predictor of function five weeks post stroke. There was no evidence to suggest that recovery of the lower limb is very different from recovery of the upper limb within five weeks post stroke.

Stroke outcomes database joins patient information from several sources, pg 77
This study describes the creation of a stroke database that pulls challenging to assemble patient information that is potentially very useful for improving care to veterans. The Integrated Stroke Outcomes Database (ISOD) is a national-level resource that contains clinical, functional, psychosocial, cost, and long-term outcomes in a single package, providing a valuable tool for stroke outcomes research. This database provides a means to conduct large-scale national-level studies at rela¬tively low cost. ISOD strengths include the centralization of information on inpatient and outpatient services, as well as cost data. Further, the ISOD is created annually, allowing for trend analysis of cohorts of people.

Affective aprosodia responsive to behavioral treatments, pg 93
This study investigates the effects of two treatments for affective aprosodia, or the inability to express or understand emotional intent in spoken communication. Three participants with affective aprosodia were asked to complete emotional communication batteries. Measures of sentence production using treated and nontreated emotions were completed during baseline and treatment phases. Sentences were scored for accuracy by a trained rater blind to time of testing and analyzed visually and statistically. Data confirmed modest to substantial effects for both treatments in all three participants. This study is among the first to suggest that aprosodia may be responsive to behavioral treatments.

12-minute Walk Test most sensitive in detecting walking changes in patients with stroke, pg 103
This study assesses the reliability of the 2-, 6-, and 12-minute walk tests to assess walking speed and endurance following stroke. This is the first study to compare all three tests. Patients enrolled in an inpatient stroke rehabilitation program were asked to walk with their primary therapist on the first and third day, and weekly thereafter, until discharge. A second therapist walked with the patient on the second day. Each test showed acceptable reliability and high inter-test correlations in assessing walking fitness following stroke. The 12-minute walk test was the most responsive to change in walking and most useful in predicting gait outcomes.

Rat study may aid in testing medications and other treatments for urinary incontinence, pg 109
This study tests the short-term effects and functional changes in the urethra in female rats after nerve injury. Fifty-four female rats underwent a pudendal nerve crush and 13 rats were used as controls. Leak point and abdominal pressures were measured after injury and compared to controls. Leak point pressure and abdominal pressure decreased after nerve injury compared to controls. Data suggest that nerve function may begin recovering by two weeks after injury, or that compensatory events might occur in the urethra. This animal model may be useful for preclinical testing of medications and other protocols aimed at rehabilitation or prevention of stress urinary incontinence.

Education, social ties linked to quality of life in tracheoesophageal speakers, pg 115
This study investigates quality of life in adult men who received a total laryngectomy as treatment for laryngeal cancer and who use a tracheoesophageal (TE) prosthesis to speak. Thirty men who use TE speech as their primary mode of communication completed a general information form and a quality of life (QOL) instrument. Volunteers reported a high level of QOL in the areas of communication, eating, pain, and emotion, challenging data from previous studies. Identification of factors such as education and social support that fostered a high QOL in the present group may provide the focus for rehabilitative changes for others who undergo laryngectomy.
About the Journal
JRRD has been a leading research journal in the field of rehabilitation medicine and technology for 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines. JRRD's mission is to responsibly evaluate and disseminate scientific research findings impacting the rehabilitative healthcare community. For more information about JRRD, visit

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