Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Dec 2006
ReviewNoninvasive cortical stimulation in neurorehabilitation: a review.
The purpose of this special communication is to provide an overview of noninvasive cortical stimulation techniques, the types of mechanistic information they can provide, and the ways their use is contributing to our understanding of current models of neurorehabilitation. The focus is primarily on studies using noninvasive cortical stimulation techniques in the human motor system. Noninvasive cortical stimulation techniques are useful tools in the field of neurorehabilitation that are being actively used to test proposed models of functional recovery after neurologic injury. They can provide insight into the physiologic mechanisms of functional recovery and are under investigation as a possible auxiliary intervention to modulate cortical excitability and enhance training effects.
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Arch Phys Med Rehabil · Dec 2006
ReviewSusceptibility-weighted imaging and proton magnetic resonance spectroscopy in assessment of outcome after pediatric traumatic brain injury.
To assess the role of magnetic resonance imaging, specifically magnetic resonance spectroscopy (MRS) and susceptibility-weighted imaging (SWI), in the evaluation of children with traumatic brain injury (TBI). ⋯ The data suggest that more sensitive imaging techniques that provide early evidence of injury and that are better predictors of outcome are needed to identify children at risk for such deficits. Specifically, the number and volume of hemorrhagic DAI lesions as well as changes in spectral metabolites such as reduced N-acetylaspartate or elevations in choline-related compounds correlate with neurologic disability and impairments of global intelligence, memory, and attention.
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Arch Phys Med Rehabil · Dec 2006
Randomized Controlled TrialMental practice with motor imagery: evidence for motor recovery and cortical reorganization after stroke.
To measure the efficacy of a program combining mental and physical practice with the efficacy of a program composed of only constraint-induced movement therapy (CIMT) or only mental practice on stroke patients' levels of upper-extremity impairment and upper-extremity functional outcomes and to establish the relationship between changes in blood-oxygen-level dependent (BOLD) functional magnetic resonance imaging response during a specific motor or imagery task and improvement in motor function between intervention groups. ⋯ The case series indicates that for these patients with chronic, moderate upper-extremity impairment after stroke, a 2-week regimen of CIMT or CIMT plus mental practice only (in 1 case) resulted in modest changes occurring as a decrease in impairment, with functional improvement. Mental practice alone did not result in a clinically meaningful improvement in upper-limb impairment. We describe how these interventions may elicit "plastic" changes in the brain. Further investigations to determine the appropriate delivery and dosing of both physical and mental practice, as well as to determine whether mental practice-induced changes positively correlate with distinct patterns of cortical activation, should be undertaken before the efficacy of their use can be ascertained among patients with limitations comparable with these participants.
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Arch Phys Med Rehabil · Dec 2006
ReviewAssessing and inducing neuroplasticity with transcranial magnetic stimulation and robotics for motor function.
To describe 2 new ways of assessing and inducing neuroplasticity in the human brain--transcranial magnetic stimulation (TMS) and robotics--and to investigate and promote the recovery of motor function after brain damage. ⋯ As refinements in technology and advances in our knowledge continue, TMS and robotics should play an increasing role in assessing and promoting the recovery of function. Ongoing and future studies combining TMS and robotics within the same populations may prove fruitful for a more detailed and comprehensive assessment of the central and peripheral changes in the nervous system during precisely induced recovery.
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Arch Phys Med Rehabil · Dec 2006
Randomized Controlled TrialRespiratory muscle training in restrictive thoracic disease: a randomized controlled trial.
To investigate the effects of respiratory muscle training (RMT) in patients with restrictive thoracic disorders and intermittent noninvasive positive-pressure ventilation (NPPV). ⋯ In patients with restrictive thoracic disorders and NPPV, RMT improved inspiratory muscle strength. Exercise performance and HRQOL were improved when the 2 groups were compared. RMT was practicable and safe despite severe respiratory impairment. Further evaluation, including different training intensities and modalities, seems warranted.