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Neurorehabilitation and Neural Repair

Brian M Sandroff, Robert W Motl, William R Reed, Aron K Barbey, Ralph H B Benedict, John DeLuca
There is a proliferation of research examining the effects of exercise on mobility and cognition in the general population and those with neurological disorders as well as focal research examining possible neural mechanisms of such effects. However, there is seemingly a lack of focus on what it is about exercise, in particular, that drives adaptive central nervous system neuroplasticity. We propose a novel conceptual framework (ie, PRIMERS) that describes such adaptations as occurring via activity-dependent neuroplasticity based on the integrative processing of multisensory input and associated complex motor output that is required for the regulation of physiological systems during exercise behavior...
September 12, 2018: Neurorehabilitation and Neural Repair
Daniel S Peterson, Keith R Lohse, Martina Mancini
BACKGROUND: Effective protective steps are critical for fall prevention, and anticipatory postural adjustments (APAs) after a perturbation but prior to protective steps affect step performance. Although APAs prior to protective steps are altered in people with Parkinson's disease (PD), whether these changes affect subsequent step performance is poorly understood. OBJECTIVE: Characterize the relationship between mediolateral APA size and protective step outcomes in response to anteroposterior balance perturbations in people with PD...
September 10, 2018: Neurorehabilitation and Neural Repair
Adriana Bastos Conforto, Sarah Monteiro Dos Anjos, Wanderley Marques Bernardo, Arnaldo Alves da Silva, Juliana Conti, André G Machado, Leonardo G Cohen
BACKGROUND: Enhancement of sensory input in the form of repetitive peripheral sensory stimulation (RPSS) can enhance excitability of the motor cortex and upper limb performance. OBJECTIVE: To perform a systematic review and meta-analysis of effects of RPSS compared with control stimulation on improvement of motor outcomes in the upper limb of subjects with stroke. METHODS: We searched studies published between 1948 and December 2017 and selected 5 studies that provided individual data and applied a specific paradigm of stimulation (trains of 1-ms pulses at 10 Hz, delivered at 1 Hz)...
September 10, 2018: Neurorehabilitation and Neural Repair
Daan P J Verberne, Marcel W M Post, Sebastian Köhler, Leeanne M Carey, Johanna M A Visser-Meily, Caroline M van Heugten
BACKGROUND: Many persons with stroke experience physical, cognitive, and emotional problems that contribute to restrictions in social participation. There is, however, a lack of knowledge on the long-term course of participation over time post-stroke. OBJECTIVE: To describe the time course of participation up to 2 years post-stroke and to identify which demographic and stroke-related factors are associated with this time course. METHODS: This was a multicenter, prospective cohort study following 390 persons with stroke from hospital admission up to 2 years (at 2, 6, 12, and 24 months)...
September 2018: Neurorehabilitation and Neural Repair
Hongchae Baek, Ki Joo Pahk, Min-Ju Kim, Inchan Youn, Hyungmin Kim
BACKGROUND: Stroke affects widespread brain regions through interhemispheric connections by influencing bilateral motor activity. Several noninvasive brain stimulation techniques have proved their capacity to compensate the functional loss by manipulating the neural activity of alternative pathways. Over the past few decades, brain stimulation therapies have been tailored within the theoretical framework of modulation of cortical excitability to enhance adaptive plasticity after stroke...
September 2018: Neurorehabilitation and Neural Repair
Christa M Nelson, Wendy M Murray, Julius P A Dewald
Poststroke deficits in upper extremity function occur during activities of daily living due to motor impairments of the paretic arm, including weakness and abnormal synergies, both of which result in altered use of the paretic arm. Over time, chronic disuse and a resultant flexed elbow posture may result in secondary changes in the musculoskeletal system that may limit use of the arm and impact functional mobility. This study utilized extended field-of-view ultrasound to measure fascicle lengths of the biceps (long head) and triceps (distal portion of the lateral head) brachii in order to investigate secondary alterations in muscles of the paretic elbow...
September 2018: Neurorehabilitation and Neural Repair
Brad Manor, Junhong Zhou, Rachel Harrison, On-Yee Lo, Thomas G Travison, Jeffrey M Hausdorff, Alvaro Pascual-Leone, Lewis Lipsitz
OBJECTIVE: To determine the effects of a transcranial direct current stimulation (tDCS) intervention with the anode placed over the left dorsolateral prefrontal cortex (dlPFC) and cathode over the right supraorbital region, on cognition, mobility, and "dual-task" standing and walking in older adults with mild-to-moderate motor and cognitive impairments. METHODS: A double-blinded, block-randomized, sham-controlled trial was conducted in 18 nondemented, ambulatory adults aged ⩾65 years with slow walking speed (⩽1...
September 2018: Neurorehabilitation and Neural Repair
Elaine H Morrato
Implementation is the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns. In their article, "Implementation-the missing link in the research translation pipeline," Lynch et al1 report that only a small fraction of published stroke rehabilitation research in leading clinical journals evaluates the implementation of evidence-based interventions into health care practice. Their findings are a wake-up call. If we are to achieve the end goals of our research investment and improve population health, then we need to also ensure that the evidence we generate is translated into real-world use...
September 2018: Neurorehabilitation and Neural Repair
Kendra M Cherry-Allen, Matthew A Statton, Pablo A Celnik, Amy J Bastian
BACKGROUND: Gait impairments after stroke arise from dysfunction of one or several features of the walking pattern. Traditional rehabilitation practice focuses on improving one component at a time, which may leave certain features unaddressed or prolong rehabilitation time. Recent work shows that neurologically intact adults can learn multiple movement components simultaneously. OBJECTIVE: To determine whether a dual-learning paradigm, incorporating 2 distinct motor tasks, can simultaneously improve 2 impaired components of the gait pattern in people posttroke...
September 2018: Neurorehabilitation and Neural Repair
Colin K Franz, Alyssa Puritz, Lewis A Jordan, Jeffrey Chow, J Alberto Ortega, Evangelos Kiskinis, Charles J Heckman
BACKGROUND: Peripheral axon regeneration is improved when the nerve lesion under consideration has recently been preceded by another nerve injury. This is known as the conditioning lesion effect (CLE). While the CLE is one of the most robust and well characterized means to enhance motor axon regeneration in experimental models, it is not considered a clinically feasible strategy. A pharmacological means to re-produce the CLE is highly desirable. OBJECTIVE: To test whether chemodenervation with a clinical grade formulation of botulinum toxin A (BoTX) would be sufficient to reproduce the CLE...
August 2018: Neurorehabilitation and Neural Repair
Tarkeshwar Singh, Christopher M Perry, Stacy L Fritz, Julius Fridriksson, Troy M Herter
BACKGROUND: Humans use voluntary eye movements to actively gather visual information during many activities of daily living, such as driving, walking, and preparing meals. Most stroke survivors have difficulties performing these functional motor tasks, and we recently demonstrated that stroke survivors who require many saccades (rapid eye movements) to plan reaching movements exhibit poor motor performance. However, the nature of this relationship remains unclear. OBJECTIVE: Here we investigate if saccades interfere with speed and smoothness of reaching movements in stroke survivors, and if excessive saccades are associated with difficulties performing functional tasks...
August 2018: Neurorehabilitation and Neural Repair
Laure Jacquemin, Giriraj Singh Shekhawat, Paul Van de Heyning, Griet Mertens, Erik Fransen, Vincent Van Rompaey, Vedat Topsakal, Julie Moyaert, Jolien Beyers, Annick Gilles
BACKGROUND: Contradictory results have been reported for transcranial direct current stimulation (tDCS) as treatment for tinnitus. The recently developed high-definition tDCS (HD tDCS) uses smaller electrodes to limit the excitation to the desired brain areas. OBJECTIVE: The current study consisted of a retrospective part and a prospective part, aiming to compare 2 tDCS electrode placements and to explore effects of HD tDCS by matched pairs analyses. METHODS: Two groups of 39 patients received tDCS of the dorsolateral prefrontal cortex (DLPFC) or tDCS of the right supraorbital-left temporal area (RSO-LTA)...
August 2018: Neurorehabilitation and Neural Repair
Natalia Sánchez, James M Finley
Changes in the control of the lower extremities poststroke lead to persistent biomechanical asymmetries during walking. These asymmetries are associated with an increase in energetic cost, leading to the possibility that reducing asymmetry can improve walking economy. However, the influence of asymmetry on economy may depend on the direction and cause of asymmetry. For example, impairments with paretic limb advancement may result in shorter paretic steps, whereas deficits in paretic support or propulsion result in shorter nonparetic steps...
August 2018: Neurorehabilitation and Neural Repair
Leonardo Boccuni, Sarah Meyer, Simon S Kessner, Nele De Bruyn, Bea Essers, Bastian Cheng, Götz Thomalla, André Peeters, Stefan Sunaert, Thierry Duprez, Lucio Marinelli, Carlo Trompetto, Vincent Thijs, Geert Verheyden
BACKGROUND: Proportional motor recovery in the upper limb has been investigated, indicating about 70% of the potential for recovery of motor impairment within the first months poststroke. OBJECTIVE: To investigate whether the proportional recovery rule is applicable for upper-limb somatosensory impairment and to study underlying neural correlates of impairment and outcome at 6 months. METHODS: A total of 32 patients were evaluated at 4 to 7 days and 6 months using the Erasmus MC modification of the revised Nottingham Sensory Assessment (NSA) for impairment of (1) somatosensory perception (exteroception) and (2) passive somatosensory processing (sharp/blunt discrimination and proprioception); (3) active somatosensory processing was evaluated using the stereognosis component of the NSA...
August 2018: Neurorehabilitation and Neural Repair
Maurits H J Hoonhorst, Rinske H M Nijland, Peter J S van den Berg, Cornelis H Emmelot, Boudewijn J Kollen, Gert Kwakkel
BACKGROUND: The added prognostic value of transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEPs) to clinical modeling for the upper limb is still unknown early poststroke. OBJECTIVE: To determine the added prognostic value of TMS of the adductor digiti minimi (TMS-ADM) to the clinical model based on voluntary shoulder abduction (SA) and finger extension (FE) during the first 48 hours and at 11 days after stroke. METHODS: This was a prospective cohort study with 3 logistic regression models, developed to predict upper-limb function at 6 months poststroke...
August 2018: Neurorehabilitation and Neural Repair
Jennifer K Ferris, Jason L Neva, Beatrice A Francisco, Lara A Boyd
BACKGROUND: In the chronic phase after stroke, cortical excitability differs between the cerebral hemispheres; the magnitude of this asymmetry depends on degree of motor impairment. It is unclear whether these asymmetries also affect capacity for plasticity in corticospinal tract excitability or whether hemispheric differences in plasticity are related to chronic sensorimotor impairment. METHODS: Response to paired associative stimulation (PAS) was assessed bilaterally in 22 individuals with chronic hemiparesis...
August 2018: Neurorehabilitation and Neural Repair
Chia-Lin Koh, Pei-Fang Tang, Hsiu-I Chen, Yung-Chin Hsu, Ching-Lin Hsieh, Wen-Yih Isaac Tseng
BACKGROUND: Damage to the callosal motor fibers (CMFs) may affect motor recovery in patients with stroke. However, whether the severity of CMF impairment varies with lesion locations remains unclear. OBJECTIVE: To investigate (1) whether CMF impairment occurs after stroke and whether the impairment varies with lesion locations and (2) the associations of CMF impairment and upper extremity (UE) motor impairment. METHODS: Twenty-nine patients with lesions involving the corticospinal tract (CST) were categorized into 2 groups: lesions involving the CMFs (CMF group, n = 15), and lesions not involving the CMFs (non-CMF group, n = 14)...
June 2018: Neurorehabilitation and Neural Repair
Digna de Kam, Alexander C Geurts, Vivian Weerdesteyn, Gelsy Torres-Oviedo
Defective muscle coordination for balance recovery may contribute to stroke survivors' propensity for falling. Thus, we investigated deficits in muscle coordination for postural control and their association to body sway following balance perturbations in people with stroke. Specifically, we compared the automatic postural responses of 8 leg and trunk muscles recorded bilaterally in unimpaired individuals and those with mild to moderate impairments after unilateral supratentorial lesions (>6 months). These responses were elicited by unexpected floor translations in 12 directions...
June 2018: Neurorehabilitation and Neural Repair
Karin L de Gooijer-van de Groep, Jurriaan H de Groot, Hanneke van der Krogt, Erwin de Vlugt, J Hans Arendzen, Carel G M Meskers
BACKGROUND: The mechanism and time course of increased wrist joint stiffness poststroke and clinically observed wrist flexion deformity is still not well understood. The components contributing to increased joint stiffness are of neural reflexive and peripheral tissue origin and quantified by reflexive torque and muscle slack length and stiffness coefficient parameters. OBJECTIVE: To investigate the time course of the components contributing to wrist joint stiffness during the first 26 weeks poststroke in a group of patients, stratified by prognosis and functional recovery of the upper extremity...
June 2018: Neurorehabilitation and Neural Repair
Valeria Pingue, Alberto Priori, Alberto Malovini, Caterina Pistarini
BACKGROUND: Poststroke dysphagia is associated with considerable morbidity and has high health care cost implications. OBJECTIVE: To evaluate whether anodal transcranial direct current stimulation (tDCS) over the lesioned hemisphere and cathodal tDCS to the contralateral one during the early stage of rehabilitation can improve poststroke dysphagia. METHODS: A total of 40 patients referred to our neurorehabilitation department were randomized to receive anodal tDCS over the damaged hemisphere plus cathodal stimulation over the contralateral one versus sham stimulation during swallowing maneuvers over the course of 10 sessions of treatment...
June 2018: Neurorehabilitation and Neural Repair
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