Effect of Citicoline on Functional and Cognitive Status Among Patients With Traumatic Brain Injury: Citicoline Brain Injury Treatment Trial (COBRIT).
Effect of citicoline on functional and cognitive status among patients with traumatic brain injury: Citicoline Brain Injury Treatment Trial (COBRIT).
Filed under: Rehab Centers
JAMA. 2012 Nov 21; 308(19): 1993-2000
Zafonte RD, Bagiella E, Ansel BM, Novack TA, Friedewald WT, Hesdorffer DC, Timmons SD, Jallo J, Eisenberg H, Hart T, Ricker JH, Diaz-Arrastia R, Merchant RE, Temkin NR, Melton S, Dikmen SS
Traumatic brain injury (TBI) is a serious public health problem in the United States, yet no treatment is currently available to improve outcome after TBI. Approved for use in TBI in 59 countries, citicoline is an endogenous substance offering potential neuroprotective properties as well as facilitated neurorepair post injury.To determine the ability of citicoline to positively affect functional and cognitive status in persons with complicated mild, moderate, and severe TBI.The Citicoline Brain Injury Treatment Trial (COBRIT), a phase 3, double-blind randomized clinical trial conducted between July 20, 2007, and February 4, 2011, among 1213 patients at 8 US level 1 trauma centers to investigate effects of citicoline vs placebo in patients with TBI classified as complicated mild, moderate, or severe.Ninety-day regimen of daily enteral or oral citicoline (2000 mg) or placebo.Functional and cognitive status, assessed at 90 days using the TBI-Clinical Trials Network Core Battery. A global statistical test was used to analyze the 9 scales of the core battery. Secondary outcomes were functional and cognitive improvement, assessed at 30, 90, and 180 days, and examination of the long-term maintenance of treatment effects.Rates of favorable improvement for the Glasgow Outcome Scale-Extended were 35.4% in the citicoline group and 35.6% in the placebo group. For all other scales the rate of improvement ranged from 37.3% to 86.5% in the citicoline group and from 42.7% to 84.0% in the placebo group. The citicoline and placebo groups did not differ significantly at the 90-day evaluation (global odds ratio [OR], 0.98 [95% CI, 0.83-1.15]); in addition, there was no significant treatment effect in the 2 severity subgroups (global OR, 1.14 [95% CI, 0.88-1.49] and 0.89 [95% CI, 0.72-1.49] for moderate/severe and complicated mild TBI, respectively). At the 180-day evaluation, the citicoline and placebo groups did not differ significantly with respect to the primary outcome (global OR, 0.87 [95% CI, 0.72-1.04]).Among patients with traumatic brain injury, the use of citicoline compared with placebo for 90 days did not result in improvement in functional and cognitive status.clinicaltrials.gov Identifier: NCT00545662.
HubMed – rehab
A piece of my mind. No more apologies.
Filed under: Rehab Centers
JAMA. 2012 Nov 21; 308(19): 1983-4
Clark ME
Instrumental methods in the diagnostics of locked-in syndrome.
Filed under: Rehab Centers
Restor Neurol Neurosci. 2012 Nov 19;
Kotchoubey B, Lotze M
The locked-in syndrome (LiS) is typically characterized by a paralysis of almost all body muscles combined with intact cognitive functions. In practice, there are often additional brain damages besides the one directly causing LiS. These damages can lead to cognitive impairment, which substantially complicates the diagnosis of LiS. At the level of behavior, therefore, the disease can be confused with akinetic mutism, vegetative state (syn. unresponsive wakefulness state) and some other conditions. Using instrumental methods in addition to behavioral diagnostics helps to avoid diagnostic errors and to improve prognosis of rehabilitation of such patients. These methods, which include measurements of brain electric or magnetic fields, electrical potential of muscles, blood flow and oxygen consumption in the brain, are reviewed in this paper.
HubMed – rehab
Reducing Robotic Guidance during Robot-Assisted Gait Training Improves Gait Function: A Case Report on a Stroke Survivor.
Filed under: Rehab Centers
Arch Phys Med Rehabil. 2012 Nov 17;
Krishnan C, Kotsapouikis D, Dhaher YY, Rymer WZ
OBJECTIVE: To test the feasibility of patient-cooperative robotic gait training for improving locomotor function of a chronic stroke survivor with severe lower extremity motor impairments. DESIGN: Single-subject crossover design SETTING: The study was performed in a controlled Laboratory Setting PARTICIPANT: A 62-year-old male with right temporal lobe ischemic stroke was recruited for this study. The baseline lower-extremity Fugl-Meyer score of the subject was 10 on a scale of 34, which represented severe impairment in the paretic leg. However, the subject had good ambulation level (community walker with the aid of a stick cane and ankle foot orthosis) and showed no signs of sensory or cognitive impairments. INTERVENTIONS: The subject underwent 12 sessions (3 x per week for 4 weeks) of conventional robotic training with the Lokomat, where the robot provided full assistance to leg movements while walking, followed by 12 sessions (3 x per week for 4 weeks) of patient-cooperative robotic control training, where the robot provided minimal guidance to leg movements during walking. MAIN OUTCOME MEASURES: Clinical outcomes were evaluated before the start of the intervention, immediately after 4-weeks of conventional robotic training, and immediately after 4-weeks of cooperative control robotic training. These included: (1) Self-selected and fast walking speed, (2) 6-minute walk test, (3) Timed Up and Go test, and (4) Lower extremity Fugl-Meyer score RESULTS: Results showed that clinical outcomes changed minimally after full guidance robotic training, but improved considerably after 4-weeks of reduced guidance robotic training. CONCLUSIONS: The findings from this case study suggest that cooperative control robotic training is superior to conventional robotic training and is a feasible option to restoring locomotor function in ambulatory stroke survivors with severe motor impairments. A larger trial is needed to verify the efficacy of this advanced robotic control strategy in facilitating gait recovery after stroke.
HubMed – rehab
Impact of an exercise program on muscular and functional performance and plasma levels of IL-6 and sTNFr1 in pre-frail community-dwelling older women: A randomized clinical trial.
Filed under: Rehab Centers
Arch Phys Med Rehabil. 2012 Nov 17;
Lustosa LP, Máximo Pereira LS, Coelho FM, Pereira DS, Silva JP, Parentoni AN, Dias RC, Domingues Dias JM
OBJECTIVE: s: To examine the impact of the muscle resistance program (MRP) on muscular and functional performance and on IL-6 and soluble TNF receptor-1 (sTNFr1) plasma levels in pre-frail community-dwelling women. DESIGN: Randomized clinical trial-Cross over design with a post intervention and short term follow-up. SETTING: university hospital. PARTICIPANTS: Thirty-two pre-frail community-dwelling women (?65 years) INTERVENTION: The muscle resistance program was designed based on the exercise at 75% of each participant’s maximum load (10 week, 3 times/week). MAIN OUTCOME MEASURES: Plasma concentrations of IL-6 and sTNFr1 (high sensitivity ELISA kits); muscle strength of the knee extensors (Isokinetic); functional performance (Timed up and go [TUG]; 10-m walk test [10MWT]). RESULTS: There were significant differences in functional and muscular performance between the pre–muscle resistance program (pre-MRP), post-muscle resistance program (post-MRP), and a 10-week follow-up period. After the muscle resistance program, both functional (TUG, pre-MRP = 11.1 seconds vs. post-MRP = 10.4 seconds, P = 0.00; 10MWT, pre-MRP = 4.9 seconds vs. post-MRP = 4.4 seconds, P = 0.00) and muscular performances (pre-MRP = 77.8% and post-MRP = 83.1%, P = 0.02) improved. After cessation of muscle resistance program (follow-up period), the sTNFr1 plasma levels increased by 21.4% at the 10-week follow up (post-MRP, 406.4 pg/ml; 10 week follow up, 517.0 pg/ml; p = 0.03). There was significant differences in sTNFr1 (P = 0.01). CONCLUSION: The muscle resistance program was effective in improving functional and muscular performances, although alterations in plasma levels of IL-6 and sTNFr1 could not be identified after muscle resistance program. Cessation of the muscle resistance program during 10-week resulted in increased plasma levels of the sTNFr1.
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