Publications by authors named "Karin Diserens"

41 Publications

Disentangling the percepts of illusory movement and sensory stimulation during tendon vibration in the EEG.

Neuroimage 2021 Nov 28;241:118431. Epub 2021 Jul 28.

Acute Neurorehabilitation Unit (LRNA), Division of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. Electronic address:

Mechanical vibration of muscle tendons in specific frequencies - termed functional proprioceptive stimulation (FPS) - has the ability to induce the illusion of a movement which is congruent with a lengthening of the vibrated tendon and muscle. The majority of previous reports of the brain correlates of this illusion are based on functional neuroimaging. Contrary to the electroencephalogram (EEG) however, such technologies are not suitable for bedside or ambulant use. While a handful of studies have shown EEG changes during FPS, it remains underinvestigated whether these changes were due to the perceived illusion or the perceived vibration. Here, we aimed at disentangling the neural correlates of the illusory movement from those produced by the vibration sensation by comparing the neural responses to two vibration types, one that did and one that did not elicit an illusion. We recruited 40 naïve participants, 20 for the EEG experiment and 20 for a supporting behavioral study, who received functional tendon co-vibration on the biceps and triceps tendon at their left elbow, pseudo-randomly switching between the illusion and non-illusion trials. Time-frequency decomposition uncovered a strong and lasting event-related desynchronization (ERD) in the mu and beta band in both conditions, suggesting a strong somatosensory response to the vibration. Additionally, the analysis of the evoked potentials revealed a significant difference between the two experimental conditions from 310 to 990ms post stimulus onset. Training classifiers on the frequency-based and voltage-based correlates of illusion perception yielded above chance accuracies for 17 and 13 out of the 20 subjects respectively. Our findings show that FPS-induced illusions produce EEG correlates that are distinct from a vibration-based control and which can be classified reliably in a large number of participants. These results encourage pursuing EEG-based detection of kinesthetic illusions as a tool for clinical use, e.g., to uncover aspects of cognitive perception in unresponsive patients.
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http://dx.doi.org/10.1016/j.neuroimage.2021.118431DOI Listing
November 2021

Movement-Related Cortical Potentials in Embodied Virtual Mirror Visual Feedback.

Front Neurol 2021 15;12:646886. Epub 2021 Jun 15.

Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Mirror therapy is thought to drive interhemispheric communication, resulting in a balanced activation. We hypothesized that embodied virtual mirror visual feedback (VR-MVF) presented on a computer screen may produce a similar activation. In this proof-of-concept study, we investigated differences in movement-related cortical potentials (MRCPs) in the electroencephalogram (EEG) from different visual feedback of user movements in 1 stroke patient and 13 age-matched adults. A 60-year-old right-handed (Edinburgh score >95) male ischemic stroke [left paramedian pontine, National Institutes of Health Stroke Scale (NIHSS) = 6] patient and 13 age-matched right-handed (Edinburgh score >80) healthy adults (58 ± 9 years; six female) participated in the study. We recorded 16-electrode electroencephalogram (EEG), while participants performed planar center-out movements in two embodied visual feedback conditions: (i) direct (movements translated to the avatar's ipsilateral side) and (ii) mirror (movements translated to the avatar's contralateral side) with left (/) or right () arms. As hypothesized, we observed more balanced MRCP hemispheric negativity in the compared to the condition [statistically significant at the FC4 electrode; 99.9% CI, (0.81, 13)]. MRCPs in the stroke participant showed reduced lateralized negativity in the (non-paretic) situation compared to healthy participants. Interestingly, the potentials were stronger in the (non-paretic) compared to case, with significantly more bilateral negativity at FC3 [95% CI (0.758 13.2)] and C2 [95% CI (0.04 9.52)]. Embodied mirror visual feedback is likely to influence bilateral sensorimotor cortical subthreshold activity during movement preparation and execution observed in MRCPs in both healthy participants and a stroke patient.
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http://dx.doi.org/10.3389/fneur.2021.646886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8239222PMC
June 2021

European Academy of Neurology and European Federation of Neurorehabilitation Societies guideline on pharmacological support in early motor rehabilitation after acute ischaemic stroke.

Eur J Neurol 2021 Sep 21;28(9):2831-2845. Epub 2021 Jun 21.

RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania.

Background And Purpose: Early pharmacological support for post-stroke neurorehabilitation has seen an abundance of mixed results from clinical trials, leaving practitioners at a loss regarding the best options to improve patient outcomes. The objective of this evidence-based guideline is to support clinical decision-making of healthcare professionals involved in the recovery of stroke survivors.

Methods: This guideline was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. PubMed, Cochrane Library and Embase were searched (from database inception to June 2018, inclusive) to identify studies on pharmacological interventions for stroke rehabilitation initiated in the first 7 days (inclusive) after stroke, which were delivered together with neurorehabilitation. A sensitivity analysis was conducted on identified interventions to address results from breaking studies (from end of search to February 2020).

Results: Upon manually screening 17,969 unique database entries (of 57,001 original query results), interventions underwent meta-analysis. Cerebrolysin (30 ml/day, intravenous, minimum 10 days) and citalopram (20 mg/day, oral) are recommended for clinical use for early neurorehabilitation after acute ischaemic stroke. The remaining interventions identified by our systematic search are not recommended for clinical use: amphetamine (5, 10 mg/day, oral), citalopram (10 mg/day, oral), dextroamphetamine (10 mg/day, oral), Di-Huang-Yi-Zhi (2 × 18 g/day, oral), fluoxetine (20 mg/day, oral), lithium (2 × 300 mg/day, oral), MLC601(3 × 400 mg/day, oral), phosphodiesterase-5 inhibitor PF-03049423 (6 mg/day, oral). No recommendation 'for' or 'against' is provided for selegiline (5 mg/day, oral). Issues with safety and tolerability were identified for amphetamine, dextroamphetamine, fluoxetine and lithium.

Conclusions: This guideline provides information for clinicians regarding existing pharmacological support in interventions for neurorecovery after acute ischaemic stroke. Updates to this material will potentially elucidate existing conundrums, improve current recommendations, and hopefully expand therapeutic options for stroke survivors.
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http://dx.doi.org/10.1111/ene.14936DOI Listing
September 2021

Case Report: Behavioral Unresponsiveness in Acute COVID-19 Patients: The Utility of the Motor Behavior Tool-Revised and F-FDG PET/CT.

Front Neurol 2021 30;12:644848. Epub 2021 Apr 30.

Unit of Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland.

Along with the propagation of COVID-19, emerging evidence reveals significant neurological manifestations in severely infected COVID-19 patients. Among these patients admitted to the intensive care unit (ICU), behavioral unresponsiveness may occur frequently, yet, there are still only a few cases reported and with rare descriptions of their motor behavior after pathological awakening. Several hypotheses regarding central lesions in these patients are conceivable. Here, we describe two acute SARS-CoV-2- infected patients who developed neurological symptoms evoking the condition of clinical cognitive motor dissociation (CMD). This diagnosis could be confirmed first by clinical observation of a dissociation between preserved cognitive abilities and lack of initial motor interaction and second, by performing F- FDG PET imaging. Accurate diagnosis led to an appropriate neuro-rehabilitation regimen with long-term neuro-rehabilitation leading to an improved outcome for both patients.
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http://dx.doi.org/10.3389/fneur.2021.644848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119781PMC
April 2021

[Neurorehabilitation in the acute and post-acute phase: what did we learn from the first wave of COVID-19?]

Rev Med Suisse 2021 Apr;17(736):835-840

Unité de neurorééducation aiguë, Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne.

The majority of patients with Coronavirus disease 2019 (COVID-19) present mild to moderate illness and recover without hospitalization. Nevertheless, 5 % of cases require hospitalization in the intensive care unit, with 15 % of them showing severe central and peripheral nervous system manifestations. These patients should be considered high risk patients and their management must include prevention of a potential accompanying cascade of negative factors. In order to optimize care, it is essential that signs of neurological damage are searched for as early as in intensive care so that appropriate neurorehabilitation can be started immediately and continued in a specific unit for patients with neurological sequelae at post-acute and outpatient phases.
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April 2021

Discriminating cognitive motor dissociation from disorders of consciousness using structural MRI.

Neuroimage Clin 2021 29;30:102651. Epub 2021 Mar 29.

Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address:

An accurate evaluation and detection of awareness after a severe brain injury is crucial to a patient's diagnosis, therapy, and end-of-life decisions. Misdiagnosis is frequent as behavior-based assessments often overlook subtle signs of consciousness. This study aimed to identify brain MRI characteristics of patients with residual consciousness after a severe brain injury and to develop a simple MRI-based scoring system according to the findings. We retrieved data from 128 patients and split them into a development or validation set. Structural brain MRIs were qualitatively assessed for lesions in 18 brain regions. We used logistic regression and support vector machine algorithms to first identify the most relevant brain regions predicting a patient's outcome in the development set. We next built a diagnostic MRI-based score and estimated its optimal diagnostic cut-off point. The classifiers were then tested on the validation set and their performance compared using the receiver operating characteristic curve. Relevant brain regions predicting negative outcome highly overlapped between both classifiers and included the left mesencephalon, right basal ganglia, right thalamus, right parietal cortex, and left frontal cortex. The support vector machine classifier showed higher accuracy (0.93, 95% CI: 0.81-0.96) and specificity (0.97, 95% CI: 0.85-1) than logistic regression (accuracy: 0.87, 95% CI: 0.73 - 0.95; specificity: 0.90, 95% CI: 0.75-0.97), but equal sensitivity (0.67, 95% CI: 0.24-0.94 and 0.22-0.96, respectively) for distinguishing patients with and without residual consciousness. The novel MRI-based score assessing brain lesions in patients with disorders of consciousness accurately detects patients with residual consciousness. It could complement valuably behavioral evaluation as it is time-efficient and requires only conventional MRI.
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http://dx.doi.org/10.1016/j.nicl.2021.102651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056460PMC
July 2021

Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19?

Front Neurol 2020 25;11:880. Epub 2020 Aug 25.

Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland.

Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties.
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http://dx.doi.org/10.3389/fneur.2020.00880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477378PMC
August 2020

Early discrimination of cognitive motor dissociation from disorders of consciousness: pitfalls and clues.

J Neurol 2021 Jan 4;268(1):178-188. Epub 2020 Aug 4.

Acute Neuro-rehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Bâtiment Champ de l'Air, Rue du Bugnon 21, 1011, Lausanne, Switzerland.

Bedside assessment of consciousness and awareness after a severe brain injury might be hampered by confounding clinical factors (i.e., pitfalls) interfering with the production of behavioral or motor responses to external stimuli. Despite the use of validated clinical scales, a high misdiagnosis rate is indeed observed. We retrospectively analyzed a cohort of 49 patients with severe brain injury admitted to an acute neuro-rehabilitation program. Patients' behavior was assessed using the Motor Behavior Tool and Coma Recovery Scale Revised. All patients underwent systematic assessment for pitfalls including polyneuropathy and/or myopathy and/or myelopathy, major cranial nerve palsies, non-convulsive status epilepticus, aphasia (expressive or comprehensive), cortical blindness, thalamic involvement and frontal akinetic syndrome. A high prevalence (75%) of pitfalls potentially interfering with sensory afference (polyneuropathy, myopathy, myelopathy, and sensory aphasia), motor efference (polyneuropathy, myopathy, motor aphasia, and frontal akinetic syndrome), and intrinsic brain activity (thalamic involvement and epilepsy) was found. Nonetheless, the motor behavior tool identified residual cognition (i.e. a cognitive motor dissociation condition) regardless of the presence of these pitfalls in 70% of the patients diagnosed as unresponsive using the Coma Recovery Scale Revised. On one hand, pitfalls might contribute to misdiagnosis. On the other, it could be argued that they are clues for diagnosing cognitive motor dissociation rather than true disorders of consciousness given their prominent effect on the sensory-motor input-output balance.
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http://dx.doi.org/10.1007/s00415-020-10125-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815538PMC
January 2021

[How to improve social and professional reinsertion of patients with neurodiabilities ? Practical indications for the general practitioner].

Rev Med Suisse 2020 May;16(692):911-914

Service de neurorééducation aiguë, Département des neurosciences cliniques, CHUV, 1011 Lausanne.

One part of the population of neurolesioned patients is the transition of young patients with neurodisabilities to adult life. To guarantee favourable social and professional reinsertion is a major challenge, requiring inter-professional care. For this reason, in 2006 the CHUV, Lausanne created a transition-consultation framework with neuro-paediatricians and adult neurologists specialised in neuro-rehabilitation linked to a Swiss pilot social and professional reinsertion project collaborating with the invalidity insurance. As a model of the follow up of neurolesioned patients, this article reports the results of the reinsertion project that aims to bring awareness to the general practitioner of an inter-disciplinary care method adaptable to individuals. The holistic service saves time and improves the rate of successful reinsertion of young adults into social and professional life.
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May 2020

[Spasticity management: an interprofessional evaluation].

Rev Med Suisse 2020 May;16(692):904-906

Unité de neurorééducation aiguë, Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne.

Spasticity is a common sign of central nervous system lesions and its management is difficult because it is usually associated with other symptoms of upper motoneuron syndrome (paresis, spastic dystonia, contractures, …). We propose an interprofessional evaluation, which demonstrates that a standardized evaluation, a common approach and a gait analysis improve the therapeutic decision.
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May 2020

[Brain function in complex regional pain syndrome : implications for pain management].

Rev Med Suisse 2020 May;16(692):885-889

Service de neurologie, Hôpital du Valais - Sion, Avenue du Grand-Champsec 80, 1950, Sion.

The International Association for the Study of Pain (IASP) proposed the current diagnostic description of complex regional pain syndrome (CRPS) for the distinct and complex chronic pain condition in 1994. Since this classification, studies on the syndrome have led to a better understanding of the underlying pathophysiological mechanisms, epidemiology and therapeutic approaches. F. Luthi of SUVA Care reviewed CRPS in detail in 2014 and 2019 issues of the Revue médicale suisse. The purpose of this article is to provide an update of results on the neural mechanisms involved in this syndrome and how this helps management of CRPS, in particular bringing awareness to physicians of all specialties of the first symptoms with practical advice for investigations and treatment.
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May 2020

Neurorééducation : quelques outils pour le médecin traitant.

Rev Med Suisse 2020 05;16(692):883

Médecin-chef, Service de neurorééducation, HUG, Genève.

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May 2020

Recovery in cognitive motor dissociation after severe brain injury: A cohort study.

PLoS One 2020 5;15(2):e0228474. Epub 2020 Feb 5.

Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland.

Objective: To investigate the functional and cognitive outcomes during early intensive neurorehabilitation and to compare the recovery patterns of patients presenting with cognitive motor dissociation (CMD), disorders of consciousness (DOC) and non-DOC.

Methods: We conducted a single center observational cohort study of 141 patients with severe acquired brain injury, consecutively admitted to an acute neurorehabilitation unit. We divided patients into three groups according to initial neurobehavioral diagnosis at admission using the Coma Recovery Scale-Revised (CRS-R) and the Motor Behavior Tool (MBT): potential clinical CMD, [N = 105]; DOC [N = 19]; non-DOC [N = 17]). Functional and cognitive outcomes were assessed at admission and discharge using the Glasgow Outcome Scale, the Early Rehabilitation Barthel Index, the Disability Rating Scale, the Rancho Los Amigos Levels of Cognitive Functioning, the Functional Ambulation Classification Scale and the modified Rankin Scale. Confirmed recovery of conscious awareness was based on CRS-R criteria.

Results: CMD patients were significantly associated with better functional outcomes and potential for improvement than DOC. Furthermore, outcomes of CMD patients did not differ significantly from those of non-DOC. Using the CRS-R scale only; approximatively 30% of CMD patients did not recover consciousness at discharge.

Interpretation: Our findings support the fact that patients presenting with CMD condition constitute a separate category, with different potential for improvement and functional outcomes than patients suffering from DOC. This reinforces the need for CMD to be urgently recognized, as it may directly affect patient care, influencing life-or-death decisions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228474PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001945PMC
April 2020

[Neurology 2019].

Rev Med Suisse 2020 Jan;16(676-7):68-71

Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne.

New studies confirm the possibility of late thrombolysis. Meta-analyses have confirmed that CGRP inhibitors are efficacious for migraines. Cladribine is a new oral treatment for relapsing-remitting multiple sclerosis. Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a new clinical entity accounting for cognitive decline in old patients. The timing of levodopa introduction has no effect on the long-term course of idiopathic Parkinson's disease. Hypophosphatemia helps distinguish between seizures and syncopes in the emergency department. A second course of intravenous immunoglobulins provides no benefit for severe Guillain Barre syndrome. Outdoor therapy improves clinical scales in patients with disorder of consciousness. Ultrasound guided lumbar puncture improves the yield of the procedure.
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January 2020

Peri-personal space encoding in patients with disorders of consciousness and cognitive-motor dissociation.

Neuroimage Clin 2019 23;24:101940. Epub 2019 Jul 23.

MySpace Lab, Department of Clinical Neurosciences, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland. Electronic address:

Behavioral assessments of consciousness based on overt command following cannot differentiate patients with disorders of consciousness (DOC) from those who demonstrate a dissociation between intent/awareness and motor capacity: cognitive motor dissociation (CMD). We argue that delineation of peri-personal space (PPS) - the multisensory-motor space immediately surrounding the body - may differentiate these patients due to its central role in mediating human-environment interactions, and putatively in scaffolding a minimal form of selfhood. In Experiment 1, we determined a normative physiological index of PPS by recording electrophysiological (EEG) responses to tactile, auditory, or audio-tactile stimulation at different distances (5 vs. 75 cm) in healthy volunteers (N = 19). Contrasts between paired (AT) and summed (A + T) responses demonstrated multisensory supra-additivity when AT stimuli were presented near, i.e., within the PPS, and highlighted somatosensory-motor sensors as electrodes of interest. In Experiment 2, we recorded EEG in patients behaviorally diagnosed as DOC or putative CMD (N = 17, 30 sessions). The PPS-measure developed in Experiment 1 was analyzed in relation with both standard clinical diagnosis (i.e., Coma Recovery Scale; CRS-R) and a measure of neural complexity associated with consciousness. Results demonstrated a significant correlation between the PPS measure and neural complexity, but not with the CRS-R, highlighting the added value of the physiological recordings. Further, multisensory processing in PPS was preserved in putative CMD but not in DOC patients. Together, the findings suggest that indexing PPS allows differentiating between groups of patients whom both show overt motor impairments (DOC and CMD) but putatively distinct levels of awareness or motor intent.
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http://dx.doi.org/10.1016/j.nicl.2019.101940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664240PMC
September 2020

Neurosensory stimulation outdoors enhances cognition recovery in cognitive motor dissociation: A prospective crossover study.

NeuroRehabilitation 2019 ;44(4):545-554

Department of Clinical Neurosciences, Neurology, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Vaud, Switzerland.

Background: Neurosensory stimulation is effective in enhancing the recovery process of severely brain-injured patients with disorders of consciousness. Multisensory environments are found in nature, recognized as beneficial to many medical conditions. Recent advances detected covert cognition in patients behaviorally categorized as un- or minimally responsive; a state described as cognitive motor dissociation (CMD).

Objective: To determine effectiveness of a neurosensory stimulation approach enhanced by outdoor therapy, in the early phases of recovery in patients presenting with CMD.

Methods: A prospective non-randomized crossover study was performed. A two-phase neurosensory procedure combined identical individually goal assessed indoor and outdoor protocols. All sessions were video-recorded and observations rated offline. The frequency of volitional behavior was measured using a behavioral grid.

Results: Fifteen patients participated in this study. The outdoor group patients had statistically significant higher number of intentional behaviors than the indoor group on seven features of the grid. Additionally, for all items assessed, total amount of behaviors in the outdoor condition where higher than those in the indoor condition.

Conclusions: Although preliminary, this study provides robust evidence supporting the effectiveness and appropriateness of an outdoor neurosensory intervention in patients with covert cognition, to improve adaptive goal-oriented behavior. This may be a step towards helping to restore functional interactive communication.
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http://dx.doi.org/10.3233/NRE-192692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700645PMC
October 2019

Predictive Factors of Swallowing Disorders and Bronchopneumonia in Acute Ischemic Stroke.

J Stroke Cerebrovasc Dis 2019 Aug 22;28(8):2148-2154. Epub 2019 May 22.

Acute Neurorehabilitation Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne, Switzerland.

Background: In stroke patients, early complications such as swallowing disorders (SD) and bronchopneumonia (BP) are frequent and may worsen outcome. The aim of this study was to evaluate the prevalence of SD in acute ischemic stroke (AIS) and the risk of BP, as well as to identify factors associated with these conditions.

Methods: We retrospectively studied all AISs over a 12-month period in a single-center registry. We determined the frequency of SD in the first 7 days and of BP over the entire hospital stay. Associations of SD and BP with patient characteristics, stroke features, dental status, and presence of a feeding tube were analyzed in multivariate analyses.

Results: In the 340 consecutive patients, the overall frequency of SD and BP was 23.8% and 11.5%, respectively. The multivariate analyses showed significant associations of SD with NIHSS scores >4, involvement of the medulla oblongata and wearing a dental prosthesis (area under the receiver-operator curve (AUC) of 76%). BP was significantly associated with NIHSS scores >4, male sex, bilateral cerebral lesions, the presence of SD, and the use of an enteral feeding tube (AUC 84%). In unadjusted analysis, unfavorable 12-month outcome and mortality were increased in the presence of SD.

Conclusion: In AIS, SD and BP are associated with stroke severity and localization and wearing a dental prosthesis increases the risk of SD. Given that patients with SD have an increased risk of poor outcome and mortality, high-risk patients warrant early interventions, including more randomized trials.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.04.025DOI Listing
August 2019

Motor behavior unmasks residual cognition in disorders of consciousness.

Ann Neurol 2019 03 10;85(3):443-447. Epub 2019 Feb 10.

Department of Clinical Neurosciences, University Hospital CHUV, Lausanne, Switzerland.

Disorders of consciousness (DOC) are a common consequence of severe brain injuries, and clinical evaluation is critical to provide a correct diagnosis and prognosis. The revised Motor Behavior Tool (MBT-r) is a clinical complementary tool aiming to identify subtle motor behaviors that might reflect residual cognition in DOC. In this prospective study including 30 DOC patients in the early stage after brain injury, we show that the revised MBT-r has an excellent inter-rater agreement and has the ability to identify a subgroup of patients, underestimated by the Coma Recovery Scale-Revised, showing residual cognition and a subsequent recovery of consciousness. ANN NEUROL 2019;85:443-447.
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http://dx.doi.org/10.1002/ana.25417DOI Listing
March 2019

Motor Attempt EEG Paradigm as a Diagnostic Tool for Disorders of Consciousness.

Annu Int Conf IEEE Eng Med Biol Soc 2018 Jul;2018:4681-4684

To investigate whether a motor attempt EEG paradigm coupled with functional electrical stimulation can detect command following and, therefore, signs of conscious awareness in patients with disorders of consciousness, we recorded nine patients admitted to acute rehabilitation after a brain lesion. We extracted peak classification accuracy and peak session discriminant power (PSDP) and we assessed their correlation to the established coma recovery scale revised (CRS-R) and the agreement with diagnosis based on the novel motor behavior tool (MBT). Only PSDP correlated significantly with CRS-R and it also outperformed peak accuracy regarding the MBT. We conclude that PSDP might be more suitable than accuracy to complement CRS-R and MBT in evaluating ambiguous cases and in detecting cognitive motor dissociation.
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http://dx.doi.org/10.1109/EMBC.2018.8513217DOI Listing
July 2018

Families' Needs of Patients With Acquired Brain Injury: Acute Phase and Rehabilitation.

Rehabil Nurs 2019 Nov/Dec;44(6):319-327

Lausanne University Hospital, Lausanne, Switzerland.

Purpose: The aim of this study was to identify and compare the needs of families of patients with acquired brain injury (ABI) in acute care and rehabilitation settings.

Design: A descriptive exploratory study was conducted.

Methods: Data were collected in the acute care setting and in the rehabilitation setting during meetings with families (n = 54) of patients with ABI using the Family Needs Questionnaire.

Findings: In both settings, families identified obtaining information about ABI or the patients' health as the most important need, followed by support from health professionals.

Conclusion: For families, accessing information about the disease situation was important regardless of patients being in the acute care or rehabilitation phase. To provide tailored care for these families, it is important to assess information needs systematically early in the acute phase of hospitalization.

Clinical Relevance: A paradigm shift is desirable to include families in care, identify their needs, and support them in a more tailored way.
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http://dx.doi.org/10.1097/rnj.0000000000000122DOI Listing
April 2020

[Process for implementing a pain assessment scale for patients with brain injuries: description of a project methodology based on the Integrated Model of Consultation].

Rech Soins Infirm 2017 Mar(128):79-91

Background : in a neurosurgery unit, nurses selected the Critical Pain Observation Tool (CPOT) based on evidence to assess pain in brain-injured patients. However, months after implementation, nursing managers have observed an underutilization.Objectives : support a care team to overcome the pitfalls encountered during the implementation of the CPOT scale for brain-injured patients in neurosurgery unit.Methods : the Lescarbeau, Payette and St-Arnaud's Integrated Model of Consultation was selected. In addition to a scientific literature review, self-administered questionnaire and three interview guides were developed to gather the views of caregivers.Results : the process allowed to identify pitfalls at level of interprofessional collaboration CPOT scale and implementation processes. Improving interprofessional collaboration and adaptation of CPOT scale for brain-injured patients were withholding action priorities.Discussion : a rigorous methodology, the mutual recognition of clinical skills and the development of relationship of trust are prerequisites for the success of clinical innovation.Conclusion : the Integrated Intervention Model is a methodology of choice allowing to take into consideration both evidence and preferences of all actors at every step of the process led to informed choices and priorities setting for a successful implementation.
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http://dx.doi.org/10.3917/rsi.128.0079DOI Listing
March 2017

European core curriculum in neurorehabilitation.

Funct Neurol 2017 Apr/Jun;32(2):63-68

To date, medical education lacks Europe-wide standards on neurorehabilitation. To address this, the European Federation of NeuroRehabilitation Societies (EFNR) here proposes a postgraduate neurorehabilitation training scheme. In particular, the European medical core curriculum in neurorehabilitation should include a two-year residency in a neurorehabilitation setting where trainees can gain practical experience. Furthermore, it should comprise six modules of classroom training organized as weekend seminars or summer/winter schools. In conclusion, after defining the European medical core curriculum in neurorehabilitation, the next activities of the EFNR will be to try and reach the largest possible consensus on its content among all national societies across Europe in order to further validate it and try to extend it to the other, non-medical, professionals on the neurorehabilitation team in line with their core curricula defined by each professional association.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507154PMC
http://dx.doi.org/10.11138/fneur/2017.32.2.063DOI Listing
January 2018

Sinking flap syndrome with abdominal pain: an atypical presentation.

BMJ Case Rep 2016 Sep 6;2016. Epub 2016 Sep 6.

Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.

Unlabelled: A 53-year-old man developed significant mass effect secondary to an ischaemic stroke and was treated with decompressive craniectomy. During the first few days postsurgery he developed orthostatic vertigo with nausea. After a month, with increasing mobilisation and rehabilitation, he started reporting of severe abdominal pain. No aetiology could be found despite extensive local work up and the symptoms were resistant to any symptomatic treatment. Within days postcranioplasty there was a complete resolution of all the symptoms.

Conclusion: the sinking flap syndrome can cause abdominal pain and orthostatic vertigo.
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http://dx.doi.org/10.1136/bcr-2016-215946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020764PMC
September 2016

Outcome Prediction of Consciousness Disorders in the Acute Stage Based on a Complementary Motor Behavioural Tool.

PLoS One 2016 30;11(6):e0156882. Epub 2016 Jun 30.

Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland.

Introduction: Attaining an accurate diagnosis in the acute phase for severely brain-damaged patients presenting Disorders of Consciousness (DOC) is crucial for prognostic validity; such a diagnosis determines further medical management, in terms of therapeutic choices and end-of-life decisions. However, DOC evaluation based on validated scales, such as the Revised Coma Recovery Scale (CRS-R), can lead to an underestimation of consciousness and to frequent misdiagnoses particularly in cases of cognitive motor dissociation due to other aetiologies. The purpose of this study is to determine the clinical signs that lead to a more accurate consciousness assessment allowing more reliable outcome prediction.

Methods: From the Unit of Acute Neurorehabilitation (University Hospital, Lausanne, Switzerland) between 2011 and 2014, we enrolled 33 DOC patients with a DOC diagnosis according to the CRS-R that had been established within 28 days of brain damage. The first CRS-R assessment established the initial diagnosis of Unresponsive Wakefulness Syndrome (UWS) in 20 patients and a Minimally Consciousness State (MCS) in the remaining13 patients. We clinically evaluated the patients over time using the CRS-R scale and concurrently from the beginning with complementary clinical items of a new observational Motor Behaviour Tool (MBT). Primary endpoint was outcome at unit discharge distinguishing two main classes of patients (DOC patients having emerged from DOC and those remaining in DOC) and 6 subclasses detailing the outcome of UWS and MCS patients, respectively. Based on CRS-R and MBT scores assessed separately and jointly, statistical testing was performed in the acute phase using a non-parametric Mann-Whitney U test; longitudinal CRS-R data were modelled with a Generalized Linear Model.

Results: Fifty-five per cent of the UWS patients and 77% of the MCS patients had emerged from DOC. First, statistical prediction of the first CRS-R scores did not permit outcome differentiation between classes; longitudinal regression modelling of the CRS-R data identified distinct outcome evolution, but not earlier than 19 days. Second, the MBT yielded a significant outcome predictability in the acute phase (p<0.02, sensitivity>0.81). Third, a statistical comparison of the CRS-R subscales weighted by MBT became significantly predictive for DOC outcome (p<0.02).

Discussion: The association of MBT and CRS-R scoring improves significantly the evaluation of consciousness and the predictability of outcome in the acute phase. Subtle motor behaviour assessment provides accurate insight into the amount and the content of consciousness even in the case of cognitive motor dissociation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156882PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928790PMC
July 2017

[Acute neurorehabilitation in neurooncology: Swiss Pilot Project and review of the litterature].

Rev Med Suisse 2016 Apr;12(516):848, 850-2

New treatment modalities in oncology, radiation oncology and surgery have led to a significant improvement in life expectancy for cancer patients. Some will however develop severe neurologic deficits that will impact their quality of life. To limit this impact, it is essential to offer optimal neurorehabilitation. In this context, a pilot project of early and intensive neurorehabilitation for brain tumor patients has been set up. A collaboration between the teams of neurooncology, acute neurorehabilitation and neurosurgery from the CHUV and the Clinique La Lignière allows an intensive and direct neurorehabilitation following neurosurgery. This neuroreeducation has allowed 75% of the patients included in this program to return home.
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April 2016

From disorders of consciousness to early neurorehabilitation using assistive technologies in patients with severe brain damage.

Curr Opin Neurol 2015 Dec;28(6):587-94

aAcute Neurorehabilitation Unit bDepartment of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland.

Purpose Of Review: The purpose of this review is to provide an update on the latest challenges addressed by neurorehabilitation initiated very early after the brain damage, such as dealing with disorders of consciousness in terms of diagnosis, prognosis and rehabilitative treatment, or determining best timing for first rehabilitative intervention, best therapeutic approaches and best modalities.

Recent Findings: Early management of patients with severe brain damage requires a multidisciplinary rehabilitative approach that encompasses clinical skills in various fields, standard therapies, and assistive technologies.Despite a high rate of misdiagnosis and poor outcome prediction in disorders of consciousness, the observation of subtle motor signs may be a promising way to reach accurate diagnosis and better outcome prediction. Neurosensory stimulation remains the current treatment to promote emergence from disorders of consciousness.Early timing of neurological rehabilitation is definitively efficient, but a safety period should be respected. Some standard therapies and assistive technologies have demonstrated explicit evidence in neurological recovery and high treatment dose is needed to emphasize the therapeutic effect, but several controversies persist in treatment evidence.

Summary: Current advancements have provided growing evidence for early neurorehabilitation, which should be definitively applied, but further studies are explicitly needed to diminish persistent controversies in the field.
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http://dx.doi.org/10.1097/WCO.0000000000000264DOI Listing
December 2015

Bilateral ptosis: Lesion in the oculomotor nuclei or supranuclear lesion?

NeuroRehabilitation 2015 ;36(3):323-7

Département des Neurosciences cliniques, Unité de Neuro-Réhabilitation Aigüe, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Background: Bilateral ptosis is a very interesting clinical challenge for doctors because of the multiple possible localizations of a lesion which can lead to this neurological sign.

Objectives: Through this case report, we aim to determine the difference between an apraxia of lid opening (ALO) with difficulty in initiating the act of lid elevation, in spite of adequate understanding, motor control and cranial nerve pathways, and a bilateral ptosis with a lesion in the oculomotor nucleus or blepharospasm.

Methods: The case report of a 50-year-old patient presenting bilateral ptosis and multiple ischemic lesions in the brainstem and bilateral frontal lobe lesions after the emergency removal of a large frontal tumor.

Results: Our patient had an ALO according to the neurological follow-up and showed the ability, after a few weeks, of initiating the act of opening her eyes with her hand. The ophthalmic evaluation confirmed that in her case the ALO was associated with a nuclear lesion of the oculomotor nerve secondary to a midbrain lesion.

Conclusion: Our case report confirms multiple differential diagnoses in bilateral ptosis and the importance of clinical examination in spite of good neurological imaging.
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http://dx.doi.org/10.3233/NRE-151220DOI Listing
May 2016

Reliability of maximal grip strength measurements and grip strength recovery following a stroke.

J Hand Ther 2015 Oct-Dec;28(4):356-62; quiz 363. Epub 2015 May 9.

Acute Neurological Rehabilitation Unit, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland.

Study Design: Clinical measurement.

Purpose: The test-retest reliability of maximal grip strength measurements (MGSM) is examined in subjects for 12 weeks post-stroke together with maximal grip strength recovery and the maximal-grip and upper-extremity strength measurements' relationship with capacity and performance test scores.

Methods: A Jamar dynamometer and the Motricity Index (MI) were used for strength measurements. The Chedoke Arm and Hand Activity Inventory and ABILHAND questionnaire for evaluating capacities and performances.

Results: MGSM were reliable (Intraclass Correlation Coefficients = 0.97-0.99, Minimal Detectable Differences = 2.73-4.68 kg). Among the 34 participants, 47% did not have a measurable grip strength one week post-stroke but 50% of these recovered some strength within the first eight weeks. The MGSM and MI scores were correlated with scores of tests of capacity and performance (Spearman's Rank Correlation Coefficients = 0.69-0.94).

Conclusions: MGSM are reliable in the first weeks after a stroke.

Level Of Evidence: N/A.
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http://dx.doi.org/10.1016/j.jht.2015.04.004DOI Listing
August 2016

Diagnostic dyspraxia by disrupted fiber connections of the posterior corpus callosum after distal anterior cerebral artery aneurysm rupture.

Acta Neurochir (Wien) 2014 Jul 6;156(7):1327-8. Epub 2014 May 6.

Département des Neurosciences Cliniques, Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois, Université de Médecine et Biologie de Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland,

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http://dx.doi.org/10.1007/s00701-014-2102-0DOI Listing
July 2014
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