Europa medicophysica
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Europa medicophysica · Jun 2007
ReviewNuclear medicine in the rehabilitative treatment evaluation in stroke recovery. Role of diaschisis resolution and cerebral reorganization.
There has recently been a tremendous increase in imaging technology and imaging methodology enabling noninvasive exploration of brain function to such an intricate degree as to enable measurements of very small spatial and short temporal cerebral operations responsible for neurological and functional recovery after stroke. This has allowed conceptualization of rehabilitation strategies designed to maximally enhance rehabilitation protocols tailored to the individual patient's deficits. Rehabilitation strategies may now be designed and optimized by employing methods to synchronize functional training of brain regions ascribed to those areas innately undergoing neuronal plasticity change responsible for stroke recovery. ⋯ Data is presented describing the results of application of imaging methodologies as the patient undergoes rehabilitation that demonstrates the importance of blood flow and metabolic changes in the contralesional frontal lobe both during the resting state and during motor and speech activation paradigms. The results of advanced imaging technologies on cerebral damage and cerebral reorganization during rehabilitation are presented in the context of furthering designs of rehabilitation strategies. Success can be monitored to assess the optimization of rehabilitation strategy design to maximize neurological recovery from stroke by employing facilitatory methods to maximally synchronize rehabilitation techniques with recovery of functionally counterpart areas of viable brain.
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Europa medicophysica · Jun 2007
ReviewNeuroimaging experimental studies on brain plasticity in recovery from stroke.
Topographical cortical organization of sensorimotor area has been shown to be highly plastic, altering his configuration in response to training in different tasks in healthy controls and neurological patients. The term ''brain plasticity'' encompasses all possible mechanisms of neuronal reorganization: recruitment of pathways that are functionally homologous to, but anatomically distinct from, the damaged ones (eg, non-pyramidal corticospinal pathways), synaptogenesis, dendritic arborisation and reinforcement of existing but functionally silent synaptic connections (particularly at the periphery of core lesion). The study of neuroplasticity has clearly shown the ability of the developing brain--and of the adult and ageing brain--to be shaped by environmental inputs both under normal conditions (ie, learning) and after a lesion. ⋯ However, the use of objective methods that assess brain reactivity to a physical stimulus (i.e., TMS) or to a sensory input (ie, electrical stimulation to hand and fingers) can integrate information from self-paced motor tasks, because the resolution of abnormal activation over time could be secondary to recovery. Functional MRI (fMRI) and positron emission tomography (PET), on their own, have insufficient time resolution to follow the hierarchical activation of relays within a neural network; however, because of their excellent spatial resolution, they can integrate the findings of TMS and MEG. An integrated approach constitutes, at present, the best way to assess the brain plasticity both under normal conditions and after a lesion.
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Europa medicophysica · Jun 2007
Controlled Clinical TrialIncrease of the heat pain threshold during and after high-frequency transcutaneous peripheral nerve stimulation in a group of normal subjects.
Transcutaneous electrical nerve stimulation (TENS) is used worldwide for pain relief, but its mechanisms of action are not completely understood. High frequency transcutaneous peripheral nerve stimulation (HF-TPNS) is a term describing a type of TENS where a peripheral nerve is stimulated transcutaneously. The aim of the investigation was to verify the hypothesis that HF-TPNS increases the heat pain threshold in the skin territory of the stimulated nerve, during and after stimulation. ⋯ This study confirms that HF-TPNS induces an important hypoalgesic effect. The prolonged duration of poststimulation hypoalgesia (60 min) indicates that continuous stimulation is probably unnecessary. Further studies are needed to test the hypothesis that intermittent HF-TPNS is able to maintain its hypoalgesic effectiveness over time.
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Europa medicophysica · Mar 2007
ReviewThe diagnosis and treatment of nonspecific neck pain and whiplash.
Nonspecific (simple) neck pain is the commonest cause of neck symptoms and results from postural and mechanical causes. It includes pain following whiplash injury provided there is no bony injury or objective neurological deficit. The anatomy of the cervical spine is described, with the degenerative changes that are seen in patients with nonspecific neck pain, but also occur with ageing. ⋯ The epidemiology, clinical presentation, investigation, and complications of nonspecific neck pain are described with a discussion of the controversial aspects of natural history, prognosis and therapy. Chronic whiplash is very common in some countries, but nonexistent in other countries and the factors which might explain this difference are considered. There is a great need for better quality studies to explore pathogenesis, natural history and factors including therapy that influence outcome.
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Europa medicophysica · Mar 2007
Case ReportsCompressive neuropathy of long thoracic nerve and accessory nerve secondary to heavy load bearing. A case report.
Carrying heavy loads that compress the shoulders is a possible etiological factor for both accessory and long thoracic nerve entrapment. In our patient, shouldering heavy loads damaged both nerves. ⋯ An EMG confirmed entrapment of long thoracic and accessory nerves. An exercise program was instituted; 16 months after initial referral, though winged scapula was still noted, manual muscular strength had returned without functional limitation.