Lancet neurology
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Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. ⋯ Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.
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Biography Historical Article
Todd, Faraday, and the electrical basis of brain activity.
Robert Bentley Todd (1809-60) was the UK's first eminent neurologist and neuroscientist. An anatomist, physiologist, and clinical scientist with an interest in the nervous system, he was the first to confirm the electrical basis of brain activity in the 1840s. He was influenced by his contemporary, Michael Faraday at the Royal Institution, and by two colleagues at King's College, John Daniell and Charles Wheatstone, who were also working at the cutting edge of electrical science. ⋯ He brilliantly foresaw each nerve vesicle (cell) and its related fibres (ie, neuron) as a distinct apparatus for the development and transmission of nervous polarity. Epilepsy was the result of periodic unnatural development of nervous force leading to the "disruptive discharge" described by Faraday. Faraday, who studied animal electricity in the Gymnotus (electric eel), and Todd saw nervous polarity as a higher form of interchangeable energy.
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We review the nosological criteria and functional neuroanatomical basis for brain death, coma, vegetative state, minimally conscious state, and the locked-in state. Functional neuroimaging is providing new insights into cerebral activity in patients with severe brain damage. Measurements of cerebral metabolism and brain activations in response to sensory stimuli with PET, fMRI, and electrophysiological methods can provide information on the presence, degree, and location of any residual brain function. ⋯ In addition, ethical frameworks to guide research in these patients must be further developed. At present, clinical examinations identify nosological distinctions needed for accurate diagnosis and prognosis. Neuroimaging techniques remain important tools for clinical research that will extend our understanding of the underlying mechanisms of these disorders.