American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Mar 2012
ReviewRepetitive transcranial magnetic stimulation of motor cortex after stroke: a focused review.
Repetitive Transcranial Magnetic Stimulation (rTMS) is known to modulate cortical excitability and has thus been suggested to be a therapeutic approach for improving the efficacy of rehabilitation for motor recovery after stroke. In addition to producing effects on cortical excitability, stroke may affect the balance of transcallosal inhibitory pathways between motor primary areas in both hemispheres: the affected hemisphere (AH) may be disrupted not only by the infarct itself but also by the resulting asymmetric inhibition from the unaffected hemisphere, further reducing the excitability of the AH. Conceptually, therefore, rTMS could be used therapeutically to restore the balance of interhemispheric inhibition after stroke. rTMS has been used in two ways: low-frequency stimulation (≤1 Hz) to the motor cortex of the unaffected hemisphere to reduce the excitability of the contralesional hemisphere or high-frequency stimulation (>1 Hz) to the motor cortex of the AH to increase excitability of the ipsilesional hemisphere. ⋯ The studies included investigated the concurrent effects of rTMS on the excitability of corticospinal pathways and upper-limb motor function in adults after stroke. This review suggests that rTMS applied to the AH is a safe technique and could be considered an effective approach for modulating brain function and contributing to motor recovery after stroke. Although the studies included in this review provide important information, double-blinded, sham-controlled Phase II and Phase III clinical trials with larger sample sizes are needed to validate this novel therapeutic approach.
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Am J Phys Med Rehabil · Mar 2012
Case ReportsTerson syndrome: an underrecognized cause of reversible vision loss in patients with subarachnoid hemorrhage.
Terson syndrome is a known complication of subarachnoid hemorrhage (SAH) that causes potentially reversible vision loss. It develops after SAH because of vitreous hemorrhage caused by retinal capillary disruption. Case series report an incidence of Terson syndrome in approximately 8%-15% of patients with SAH. ⋯ Physiatrists must be aware of this clinical presentation to coordinate the care of patients with SAH who develop vision loss and develop a rehabilitation plan that addresses the co-morbid motor, sensory, and cognitive impairments. Physiatrists may be the first to identify visual loss, are well equipped to emphasize compensatory strategies, and are well positioned to coordinate surgical treatment for visual recovery in appropriate cases. In this report, we describe the case of a young woman with SAH and Terson syndrome through her acute hospital admission, rehabilitation treatment, ophthalmologic management, and outcome, describing the salient epidemiology, pathophysiology, diagnostic workup, and treatment options.
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Am J Phys Med Rehabil · Mar 2012
Case ReportsUltrasound-guided intra-articular knee injection in an obese patient.
A 35-yr-old woman was referred to our outpatient clinic for a right intra-articular knee aspiration and injection. She had a medical history notable for lymphedema and morbid obesity (Fig. 1). ⋯ On physical examination, it was difficult to localize common knee joint bony landmarks, including the medial and lateral borders of the patella (Fig. 2). Consequently we opted to utilize ultrasound guidance for the knee joint injection via the technique described herein.