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Nathani HR, Deodhe NP, Zade RJ, Ratnani GR. Implementation of Multimodal Stimulation and Physical Therapy in Improving the Level of Consciousness and Recovery in Acute Disseminated Encephalomyelitis. Cureus 2023; 15:e51217. [PMID: 38288205 PMCID: PMC10823210 DOI: 10.7759/cureus.51217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
This case report aims to explore the use of multimodal sensory stimulation and physical therapy in rehabilitating a 30-year-old female patient with severe acute disseminated encephalomyelitis (ADEM). ADEM, characterized by autoimmune demyelination in the central nervous system, presents challenges in clinical management, particularly in cases with severe motor deficits and coordination issues. The patient's progress was measured using the Glasgow Coma Scale (GCS), Extended Glasgow Outcome Scale (GOS-E), and Coma Recovery Scale-Revised (CRS-R). The patient showed significant improvement in consciousness levels, functional status, and cognitive and neurological function. The study concludes that a collaborative approach involving both therapeutic modalities and active family participation contributed positively to the patient's recovery.
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Affiliation(s)
- Harsh R Nathani
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishigandha P Deodhe
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ruchika J Zade
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Grisha R Ratnani
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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De Luca R, Lauria P, Bonanno M, Corallo F, Rifici C, Castorina MV, Trifirò S, Gangemi A, Lombardo C, Quartarone A, De Cola MC, Calabrò RS. Neurophysiological and Psychometric Outcomes in Minimal Consciousness State after Advanced Audio-Video Emotional Stimulation: A Retrospective Study. Brain Sci 2023; 13:1619. [PMID: 38137067 PMCID: PMC10741433 DOI: 10.3390/brainsci13121619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
In the last ten years, technological innovations have led to the development of new, advanced sensory stimulation (SS) tools, such as PC-based rehabilitative programs or virtual reality training. These are meant to stimulate residual cognitive abilities and, at the same time, assess cognition and awareness, also in patients with a minimally conscious state (MCS). Our purpose was to evaluate the clinical and neurophysiological effects of multi-sensory and emotional stimulation provided by Neurowave in patients with MCS, as compared to a conventional SS treatment. The psychological status of their caregivers was also monitored. In this retrospective study, we have included forty-two MCS patients and their caregivers. Each MCS subject was included in either the control group (CG), receiving a conventional SS, or the experimental group (EG), who was submitted to the experimental training with the Neurowave. They were assessed before (T0) and after the training (T1) through a specific clinical battery, including both motor and cognitive outcomes. Moreover, in the EG, we also monitored the brain electrophysiological activity (EEG and P300). In both study groups (EG and CG), the psychological caregiver's aspects, including anxiety levels, were measured using the Zung Self-Rating Anxiety Scale (SAS). The intra-group analysis (T0-T1) of the EG showed statistical significances in all patients' outcome measures, while in the CG, we found statistical significances in consciousness and awareness outcomes. The inter-group analysis between the EG and the CG showed no statistical differences, except for global communication skills. In conclusion, the multi-sensory stimulation approach through Neurowave was found to be an innovative rehabilitation treatment, also allowing the registration of brain activity during treatment.
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Affiliation(s)
| | | | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (R.D.L.); (P.L.); (F.C.); (C.R.); (M.V.C.); (S.T.); (A.G.); (C.L.); (A.Q.); (M.C.D.C.); (R.S.C.)
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Mahajan C, Prabhakar H, Rass V, McNett M, Kapoor I, Helbok R, Zirpe K. A National Survey on Coma Epidemiology, Evaluation, and Therapy in India: Revisiting the Curing Coma Campaign Come Together Survey. Neurocrit Care 2023:10.1007/s12028-023-01852-9. [PMID: 37821721 DOI: 10.1007/s12028-023-01852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The limited representation from developing countries in the original COME TOGETHER survey gave us an impetus to conduct this survey in the Indian subcontinent. METHODS This cross-sectional online survey was conducted from August through September 2022. Participants were health care physicians caring for patients with coma and disorders of consciousness. Fischer's exact test or the Mann-Whitney U-test was used to compare respondents who agreed or disagreed with the preestablished coma definition. Fleiss κ values were calculated to assess agreement among respondents. A p value less than 0.05 was considered statistically significant. RESULTS The survey was completed by 130 physicians. We found substantial interrater agreement on absence of wakefulness (71.54%; κ = 0.71), Glasgow Coma Score ≤ 8 (78.46%; κ = 0.78), and failure to respond purposefully to visual, verbal, or tactile stimuli (66.15%; κ = 0.66). Reported common etiologies of coma included traumatic brain injury (50.76%), ischemic stroke (30%), and intracerebral hemorrhage (29.23%). The most common clinical assessment tools used for coma included the Glasgow Coma Score (92.3%) and neurological examination (60.8%). Neurological examination was the most common diagnostic tool used (100%), followed by magnetic resonance imaging (89.2%), basic laboratory studies (88.5%), and head computed tomography/angiography (86.9%). Pharmacological interventions used to stimulate arousal in patients with coma were sedation vacation (91.5%), electrolyte/endocrine correction (65.4%), osmotic therapy with mannitol (60%), hypertonic saline (54.6%), modafinil (46.9%), and antidote for drugs (45.4%). Among the nonpharmacological interventions, sensory stimulation (57.7%) was the most commonly used modality. The most common discharge disposition for comatose patients who survived hospitalization were home with or without services (70.0%). CONCLUSIONS Differences from the global survey were noted regarding the following: traumatic brain injury being the most common etiology of coma in India, more frequent practice of sedation interruption, less frequent use of electroencephalography in India, rare use of pharmacological neurostimulants, and home being the most common discharge disposition in India.
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Affiliation(s)
- Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Verena Rass
- Neuro-Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
| | - Kapil Zirpe
- Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
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Li M, Chen J, He B, He G, Zhao CG, Yuan H, Xie J, Xu G, Li J. Stimulation enhancement effect of the combination of exoskeleton-assisted hand rehabilitation and fingertip haptic stimulation. Front Neurosci 2023; 17:1149265. [PMID: 37287795 PMCID: PMC10242052 DOI: 10.3389/fnins.2023.1149265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Providing stimulation enhancements to existing hand rehabilitation training methods may help stroke survivors achieve better treatment outcomes. This paper presents a comparison study to explore the stimulation enhancement effects of the combination of exoskeleton-assisted hand rehabilitation and fingertip haptic stimulation by analyzing behavioral data and event-related potentials. Methods The stimulation effects of the touch sensations created by a water bottle and that created by cutaneous fingertip stimulation with pneumatic actuators are also investigated. Fingertip haptic stimulation was combined with exoskeleton-assisted hand rehabilitation while the haptic stimulation was synchronized with the motion of our hand exoskeleton. In the experiments, three experimental modes, including exoskeleton-assisted grasping motion without haptic stimulation (Mode 1), exoskeleton-assisted grasping motion with haptic stimulation (Mode 2), and exoskeleton-assisted grasping motion with a water bottle (Mode 3), were compared. Results The behavioral analysis results showed that the change of experimental modes had no significant effect on the recognition accuracy of stimulation levels (p = 0.658), while regarding the response time, exoskeleton-assisted grasping motion with haptic stimulation was the same as grasping a water bottle (p = 0.441) but significantly different from that without haptic stimulation (p = 0.006). The analysis of event-related potentials showed that the primary motor cortex, premotor cortex, and primary somatosensory areas of the brain were more activated when both the hand motion assistance and fingertip haptic feedback were provided using our proposed method (P300 amplitude 9.46 μV). Compared to only applying exoskeleton-assisted hand motion, the P300 amplitude was significantly improved by providing both exoskeleton-assisted hand motion and fingertip haptic stimulation (p = 0.006), but no significant differences were found between any other two modes (Mode 2 vs. Mode 3: p = 0.227, Mode 1 vs. Mode 3: p = 0.918). Different modes did not significantly affect the P300 latency (p = 0.102). Stimulation intensity had no effect on the P300 amplitude (p = 0.295, 0.414, 0.867) and latency (p = 0.417, 0.197, 0.607). Discussion Thus, we conclude that combining exoskeleton-assisted hand motion and fingertip haptic stimulation provided stronger stimulation on the motor cortex and somatosensory cortex of the brain simultaneously; the stimulation effects of the touch sensations created by a water bottle and that created by cutaneous fingertip stimulation with pneumatic actuators are similar.
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Affiliation(s)
- Min Li
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jing Chen
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Bo He
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Guoying He
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Chen-Guang Zhao
- Department of Rehabilitation, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Hua Yuan
- Department of Rehabilitation, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jun Xie
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Guanghua Xu
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jichun Li
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
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Xu C, Wu W, Zheng X, Liang Q, Huang X, Zhong H, Xiao Q, Lan Y, Bai Y, Xie Q. Repetitive transcranial magnetic stimulation over the posterior parietal cortex improves functional recovery in nonresponsive patients: A crossover, randomized, double-blind, sham-controlled study. Front Neurol 2023; 14:1059789. [PMID: 36873436 PMCID: PMC9978157 DOI: 10.3389/fneur.2023.1059789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/18/2023] [Indexed: 02/19/2023] Open
Abstract
Background Recent studies have shown that patients with disorders of consciousness (DoC) can benefit from repetitive transcranial magnetic stimulation (rTMS) therapy. The posterior parietal cortex (PPC) is becoming increasingly important in neuroscience research and clinical treatment for DoC as it plays a crucial role in the formation of human consciousness. However, the effect of rTMS on the PPC in improving consciousness recovery remains to be studied. Method We conducted a crossover, randomized, double-blind, sham-controlled clinical study to assess the efficacy and safety of 10 Hz rTMS over the left PPC in unresponsive patients. Twenty patients with unresponsive wakefulness syndrome were recruited. The participants were randomly divided into two groups: one group received active rTMS treatment for 10 consecutive days (n = 10) and the other group received sham treatment for the same period (n = 10). After a 10-day washout period, the groups crossed over and received the opposite treatment. The rTMS protocol involved the delivery of 2000 pulses/day at a frequency of 10 Hz, targeting the left PPC (P3 electrode sites) at 90% of the resting motor threshold. The primary outcome measure was the JFK Coma Recovery Scele-Revised (CRS-R), and evaluations were conducted blindly. EEG power spectrum assessments were also conducted simultaneously before and after each stage of the intervention. Result rTMS-active treatment resulted in a significant improvement in the CRS-R total score (F = 8.443, p = 0.009) and the relative alpha power (F = 11.166, p = 0.004) compared to sham treatment. Furthermore, 8 out of 20 patients classified as rTMS responders showed improvement and evolved to a minimally conscious state (MCS) as a result of active rTMS. The relative alpha power also significantly improved in responders (F = 26.372, p = 0.002) but not in non-responders (F = 0.704, p = 0.421). No adverse effects related to rTMS were reported in the study. Conclusions This study suggests that 10 Hz rTMS over the left PPC can significantly improve functional recovery in unresponsive patients with DoC, with no reported side effects. Clinical trial registration www.ClinicalTrials.gov, identifier: NCT05187000.
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Affiliation(s)
- Chengwei Xu
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Wanchun Wu
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiaochun Zheng
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Qimei Liang
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiyan Huang
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Haili Zhong
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Qiuyi Xiao
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Yang Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.,School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China
| | - Qiuyou Xie
- Department of Rehabilitation Medicine, Joint Research Centre for Disorders of Consciousness, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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