Recent study in our centre and also Multicentre studies in Germany demonstrated the
Mechanical Gait trainer could achieve similar results as the PWSTT. There are also
other modalities of training can enhance the functional recovery. Functional electrical
stimulation has been used for a long period of time but previous studies were of relatively
low quality that the systematic review could not be conclusive. However, a recent published
double-blind randomized controlled study from our centre showed that a programmed 4-leads FES
can enhance functional recovery of ambulation in recent stroke patients.
Another interesting approach in recent research is to use mental imagery in training
of post-stroke patients. Application of this training is not complex and will be
cost-effective if further research confirms its effectiveness. During functional
recovery of an upper motor neurone lesion, spasticity can sometimes be the culprit.
Proper management of the spasticity can assist functional recovery in the selected
patients. Alternative treatment such as acupuncture has not been evidence-based for
its effectiveness. However, it has been a commonly used modality in the Eastern Culture
for over a thousand years and further well-designed research is needed to evaluate its
effectiveness. As a whole, we are nowadays having many more evidence-based modalities in
addition to the traditional rehabilitation training to achieve a better functional
recovery after neurological damage. Justification use of these new modalities in single
or combination should be tailored according to the individual's condition and progress so
that functional recovery can be maximized.
10:00 – 10:30
Evidence For Traumatic Brain Injury Rehabilitation Across The Ages: What Do We Know?
NLB 3rd Floor, Function Room 3
Traumatic brain injury can lead to significant impairments and disabilities in
multiple domains, including the physical, cognitive, emotional, behavioural and
psychosocial. Rehabilitation is usually recommended to optimize function and aid in
the recovery process. However, the goals of rehabilitation and the needs of the
individual patient can vary greatly. In addition, the rehabilitation process is
often labour intensive and costly. It is therefore important to evaluate the efficacy
of various programmes in order to be able to provide the most appropriate, efficacious
and cost-effective service to the patients.
In this talk, we provide an overview of the rehabilitation services and programmes
available to brain-injured patients and review the evidence regarding their benefits
and effectiveness. Parameters to be discussed include the organization of rehabilitation,
the onset, setting and intensity of therapies, as well as specific therapeutic interventions.
Although a significant amount of the available literature is focused on working-age adults,
patients at both ends of the age continuum often have special issues and needs which differ
from this group. We describe these differences and recommend evidence-based methods of
meeting the needs of the very young as well as the elderly with brain injury.
10:50 – 11:20
Assessing the Minimally Responsive Patient – Can We Do Better?
NLB 3rd Floor, Function Room 3
"Coma"."Consciousness"."Wakefulness"."Awareness".
"Arousal"."Vegetative". These are just some of the terms
commonly used to describe the condition of persons in varying states of impaired
consciousness. Understanding the different states of impaired consciousness and the
key differences between them allows the rehabilitation team to plan appropriate
management strategies. How then do we assess persons with such conditions? What
are the more commonly available tools currently being used to assess and how different
are they? Is there a better approach from another and is there a best method?
In this presentation, we shall define the various states of impaired consciousness,
in particular that of the minimally responsive state, and explore the issues raised
above with reference to assessment.
With advancement of medical technology and skill, more are surviving severe brain
injuries. Management of persons with such conditions often involves high costs and
labour-intensive measures. As such monitoring (small) changes in recovery has an
impact on decisions with regards to medical management including rehabilitation.
11:20 – 11:50
Dizziness and Balance Disorders after Traumatic Brain Injury
NLB 3rd Floor, Function Room 3
Dizziness is a common complaint after a traumatic brain injury (TBI). It has been
reported to occur in 25% to 90% of TBI cases.Common vestibular disorders after TBI
include benign paroxysmal positional vertigo (BPPV), vestibular hypofunction and
central vestibular dysfunction. These disorders can affect eye-head coordination,
balance abilities, gait and activities of daily living of TBI patients, thus affecting
quality of life. Vestibular rehabilitation adopts an exercise-based approach in the
management of dizziness and balance disorders associated with vestibular pathology.
This presentation will discuss common vestibular pathology after TBI and various
treatment techniques used to manage those conditions. Outcomes of vestibular
rehabilitation for TBI patients and prognosis will also be addressed.
11:50 – 12:20
Emerging Therapies in the Rehabilitation of Traumatic Brain Injury (TBI): What Can We Learn?
NLB 3rd Floor, Function Room 3
Recent advances in TBI rehabilitation have centered on the remediation of cognitive
disorders and new scales to measure arousal and attentional deficits.The time-honoured
neurorehabilitation principles of task specific training and progression of difficulty
have shown benefit in TBI-targeted therapies to improve attention. Memory retraining
using implicit (procedural) learning including errorless learning techniques for
patients in post-traumatic amnesia or those with chronic memory deficits show promise.
Visual scanning techniques for treatment of visual-spatial deficits using the useful
field of view (UFOV) are increasingly being used for assessment and training. The use
of robotic devices such as the Lokomat for body weight supported training for ambulation
and MIT manus for the upper limb may promote recovery through increased repetitions of
training with more objective and reproducible treatment.
Computer systems can be used as supplements to traditional pen and paper neuropsychiatric
assessments due to their ease in documentation, unobtrusiveness and telerehabilitation
possibilities. Virtual reality technology may offer a more naturalistic, controlled and
interactive environment for cognitive remediation or training for independent living,
vocational assessment or navigation. The efficacy of holinergic or nootropic augmentation
for TBI memory deficits continues to be debated in the light of conflicting efficacy
from small trials in chronic TBI survivors.
12:20 – 13:00
Questions & Answers
NLB 3rd Floor, Function Room 3
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TECHNICAL PROGRAMME
Neurorehab Workshop 2A
Coping With Disability and Psychosocial Issues after Acquired Brain Injury (ABI)
25th April, 14:00 – 17:30
NLB, 3rd Floor, Function Room 3
Facing the impact of an acquired brain injury is a challenging experiences for
both patients and their significant others. There will be issues associated with
the loss of functions, job and income, studies and aspirations, as well as financial
and care issues. These are stresses on both the patients and their significant others,
and they often require long-term support to help manage them. The presenters and
facilitators of the workshop hope to discuss two models of intervention by the
psychologist and medical social worker in facilitating the patient’s and family’s
adjustment and coping. The role of the psychologist will be illustrated in the
Neuropsychological model, which highlights the importance of assessing premorbid
factors and current abilities, so as to facilitate achievement of realistic goals.
The Case Management Model is used in social work assessment/intervention – and promotes
provision of holistic support to patients and families, with the ultimate aim of
community re-integration.
Neurorehab Workshop 2B
Practical Approach to Spasticity in Acquired Brain Injury
25th April, 14:00 – 17:30
NLB, 3rd Floor, Function Room 2
Spasticity is a common consequence of stroke, head injury, multiple sclerosis,
cerebral palsy or spinal cord injury. Management of spasticity includes medication,
botulinum injection, alcohol neurolysis, range of motion exercise, splinting and
electrical stimulation. However, these interventions may be inadequate for maintaining
muscle length and joint range among patients with severe spasticity and contracture.
The application of serial and inhibitory casting can be a useful adjunct in the overall
management of patients with severe spasticity and contracture. In addition, toe spreader
can also assist in reducing toe clawing spasticity and hence alter patients' gait pattern.
Dynamic Lycra orthosis is also increasing used to achieve tone inhibition through
biomechanical alignment of muscles and joints.
Neurorehab Workshop 2C
Management of Dysphagia In Neurorehabilitation
25th April, 14:00 – 17:30
NLB, 3rd Floor, Function Room 1
Dysphagia, or swallowing problem, occurs in about 50% of the stroke patients.
People with dysphagia may be at risk of developing aspiration pneumonia if the
management of their swallowing impairment is not adequate. Thus, it is important
to increase the awareness on the risks of aspiration, and the importance of aspiration
prevention. The workshop is targeted for nurses and aims to improve the participants’
ability in managing dysphagic patients, especially those who are on transitional feeding
and modified diets, or those who require safe feeding strategies for aspiration precaution.
The workshop will address the following: risk factors for aspiration, swallowing tests,
signs of aspiration, safe feeding strategies and simple compensatory strategies which may
be recommended by the speech therapists. There will also be time allocated for discussion
and role plays to ensure that the participants are able to apply their knowledge and learnt
strategies into practice.
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TECHNICAL PROGRAMME
