Imaging cerebral activity in recovery from chronic traumatic brain injury: a preliminary report.
People in chronic phase of traumatic brain injury (TBI) are often told that there will be no further recovery in brain function, that they are in a "static phase." Holistic Approach to NeuroDevelopment and Learning Efficiency (HANDLE), an alternative therapy, aims to improve function by teaching a series of physical and mental activities that clients perform and encouraging changes in lifestyle. Five subjects (3 males) with chronic TBI (at least 3 years since ictus) completed the HANDLE Institute's program and were prospectively evaluated. Each had six regional cerebral blood flow (rCBF) single-photon emission computed tomography (SPECT) scans over 7 months (scans n= 30). Paired scans were performed with injection of Tc-99m ECD to image rCBF at rest and during the HANDLE "Crossed Arm Bounce" (CAB) exercise before the program, at 3-4 months into the program, and at 6-7 months, after the program had ended. SPECT images were analyzed statistically using Neurostat in which image sets were coregistered and warped into Talaraich atlas for pairwise subtraction between conditions. Group analysis of SPECT showed that CAB activated (increased rCBF) vermis and cerebellar hemispheres in first two paired scans and anterior cingulate and vermis on the final pair. Increased rCBF at rest occurred in cerebellar hemispheres, vermis, and right dorsomedial frontal cortex. These preliminary observations suggest that there may be a role of the hindbrain (vermis and cerebellum) with HANDLE treatment of chronic TBI.
Lewis
David H
DH
Harborview Medical Center, Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA. lewis@u.washington.edu
Bluestone
Judith P
JP
Savina
Maryann
M
Zoller
William H
WH
Meshberg
Emily B
EB
Minoshima
Satoshi
S
D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000534:rehabilitation; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D015899:Tomography, Emission-Computed, Single-Photon