Brain Injury Professional – Volume 12, Issue 4: Evolving Topics in Neurorehabilitation

Brain Injury Professional – Volume 12, Issue 4:
Evolving Topics in Neurorehabilitation

Featured open access content
Use of Robotic Tools in Neurorehabilitation
By Alex Nastaskin, MS, ORT/L, Katherine Scheponik, MS, ORT/L, Joe Padova, MS, ORT/L, Mike Tobin BS. 

Content currently available in print only
A Review of the Behaviorial and Neural Correlates of Theory of Mind Following a Pediatric Traumatic Brain Injury
By Cherylynn Marino, PhD, Ekaterina Dobryakova, PhD, Helen Genova, PhD, John DeLuca, PhD

Does Tele-Health Training Stack Up to On-site Executive Control Training for Youth and Adults with TBI?  
By Asha Vas, PhD, Lori Cook, PhD, Molly Keebler, MS, Sandra Chapman, PhD

Non-Invasive Brain Stimulation in the Management of Traumatic Brain Injury
By Yelena Bogdanova, PhD, Megan K. Yee, MA, Karina S. Gilbert, PhD, Sarah M. Kark, MA, Vivian T. Ho, BS, Margaret A. Naeser, PhD

Upper extremity recovery following gamified Constraint-Induced Movement therapy:  A Case Study in Dense Amnestic TBI
By Lynne V. Gauthier, PhD, Alexandra Borstad, PT, PhD, Emerly Luong, Kala Phillips, BA, Linda Lowes, PT, PhD, Kevin Stahr, MOT, Lise Worthen-Chaudhari MS-MFA, Roger Crawfis, PhD, David Maug, BS

Message from the Guest Editor

Jacobs Headshots-1
Guest Editor:  Harvey E. Jacobs, PhD

NeuroRehabilitation is broadly based across many neurological impairments and relies on a wide range of clinical and research based processes.  As defined by the World Federation for Neuro Rehabilitation (WFNR):

“Neurorehabilitation is a complex medical process of diagnosis, assessment, acute and long-term management of people with complex neurological disabilities – physical, psychological and/or cognitive. It aims to aid recovery from an injury to the nervous system and to minimise and/or compensate for any functional alterations resulting from it. The individual is supported to achieve their maximum potential for physical, cognitive, social and psychological function, participation in society and quality of living. It is a patient-centered, iterative, goal-focused learning process to optimise functional recovery, disability management and adaptation to loss and change.

Neurorehabilitation requires an interdisciplinary team of experts comprising clinicians trained in rehabilitation medicine, nurses, physiotherapists, speech and language therapists, occupational therapists and clinical psychologists.”

In this issue we focus on a limited area of NeuroRehabilitation that involves technological applications in clinical practice following acquired brain injury.

Marino, Dobryakova, Genova and DeLuca open the issue with a seminal review of neural bases of Theory of Mind as it relates to social cognition and functioning following pediatric traumatic brain injury.  The authors note relationships between critical periods of social competency and emotional growth for children and how cerebral insult at different points in a child’s chronological history can adversely affect the trajectory of such development.  Subsequent recovery is often an incomplete process that can further be affected by and affect the increasingly complex environments that a child faces as he or she ages.

Cognitive rehabilitation of executive functions offers significant promise, but many people do not have reasonable geographic access to such services.  Vas, Cook, Keebler and Chapman explore the efficacy of providing such services remotely via tele-health training as compared to more traditional within clinic service delivery.  Results note a similar results between these venues, as well as possibly greater adaptability and “environmental salience” when such training in provided in an individual’s natural environment.  Continuing research is articulating these findings and identifying other potential tele-health advantages.

Although non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have been used in research laboratories for decades, both techniques are in the early stages of clinical implementation. Sanchez and Massie review the primary technology involved in each of these techniques as well as guidelines for their future use.  The authors also cite important considerations in how to train clinicians and other technicians in these application relative to potential safety concerns.

The clinical application of transcranial magnetic stimulation (TMS) as well as photobiomodulation for TBI related sleep disorders is presented by Bogdanova, Yee, Gilbert, Kark, Ho and Naeser.  Citing limitations with pharmacological and cognitive-behavioral approaches to this issue, the authors note promising findings in early studies in addressing both insomnia and neuropsychiatric symptoms.  Additional research will help to further validate these findings, thereby providing another important tool for this pervasive clinical challenge.

Nastaskin, Scheponik, Padova and Tobin review primary advantages of robotic therapy in improving motor control, especially when combined with mental imaging techniques.  The ability to program this treatment relative to individual capacities and impairments is key to noted functional gains.  Perspectives for in-home and autonomous training are suggested.

Gauthier, Borstad, Luong, Phillips, Lowes, Stahr, Worthen-Chaudhari, Crawfis and Maung address this proposition with a novel video game system, using readily available consumer electronics.  The developed software provides home-based constraint induced movement therapy that was found efficacious for a 27 year old male with asymmetric spastic tetraparesis following severe TBI and severe cognitive dysfunction.  Therapist time was also significantly reduced through the use of the system.

Compiling this issue of Brain Injury Professional proved to be an intriguing and engaging task.  I am forever indebted to the authors of each article who graciously redirected precious time from their ongoing research and clinical responsibilities to produce their respective manuscripts.  The combined articles reflect conceptual, technical and empirical perspectives on this topical issue.

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