MIME-Version: 1.0 Content-Location: file:///C:/C3542C82/Abstracts_CIMT_NeuPlast_Rehab.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" ***CIMT (constraint induced movement therapy; forced use)


http://villamart= elli.com/Abstracts_CIMT_NeuPlast_Rehab.html


***CIMT <= /b>(constraint induced movement therapy; forced use= )


Top Stroke = Rehabil. 2001 Autumn;8(3):16-30.


Constraint-induced therapy ap= proach to restoring function after neurological injury.

Morris DM, Taub E.<= /o:p>

Department of Physical Therapy, = University of Alabam= a at Birmingham, USA.

   &n= bsp;        Traditional rehabilitation programs for persons with neurologic dysfunction emphasize a compensation, true recovery, or substitution approach to improve functional abilities. Constraint-induced (CI) movement therapy substantially increases more-affected extremity use in the life situation due to the influence of t= wo different underlying mechanisms: overcoming learned nonuse and inducing use-dependent cortical reorganization. In this way, it bypasses the debate = over whether a compensation, true recovery, or substitution approach should be u= sed. The purposes of this article are to describe the CI therapy approach, discu= ss its proposed modes of action, and discuss other unique aspects of CI therap= y as a rehabilitation technique.


The Journal of Head Trauma Rehabilitation, May-June = 2003 v18 i3 p259(9)

Constraint-induced movement therapy for hemiplegic children with acquired brain injuries. (Focus on Clinical Research and Practice). N. Karman; = J. Maryles; R.W. Baker; E. Simpser<= /span>; P. Berger-Gross.

   &n= bsp;        Objective: To evaluate the feasibility and efficacy of constraint-induced movement the= rapy (CIMT) for impaired upper extremity (UE) function in children with acquired brain injury (ABI). Design: Multiple case studies. Setting: Inpatient pedia= tric rehabilitation. Participants: Seven consecutive ABI rehabilitation admissio= ns with hemiparesis were recruited without regard to in= jury etiology, age, or cognitive capacities. Main Outcome Measure: The actual am= ount of use test (AAUT) was used to evaluate change in UE function. AAUT amount = of use (AOU) and quality of movement (QOM) scales were obtained at baseline and follow-up. Results: AOU and QOM item improveme= nts were significant, as were changes in activities of daily living. The effect sizes for these changes were large. Conclusions: Stringent CIMT training, previou= sly only implemented with adults, can be used effectively with children when everyday elements of a child's life are integrated into adult protocols. The use of child-friendly UE shaping exercises, "pushed into" activit= ies by professional therapists as well as trained teachers, paraprofessionals, = and parents, was supported. Effects of impairment, injury, and behavior on outc= omes are discussed. Larger controlled studies with additional outcome measures a= re indicated. Key words: brain injury, children, hemipare= sis, rehabilitation


Neurology. 2003 Sep 23;61(6):842-4.

Motor-improvement following i= ntensive training in low-functioning chronic hemiparesis= .

Sterr A, Freivogel S.   asterr@liverpool.ac.= uk

   &n= bsp;        Constraint-induced movement therapy can improve chronic hemiparesis, but this technique has proven difficult to transfer into clinical practice. The authors studied the benefits of a modified regimen designed to be applicabl= e in the clinical environment. Affected arm movements were trained for 90 min/d = for 3 weeks using the learning principle "shaping." The outcome measu= res indicated a significant increase in performance after the intervention comp= ared with the performance during the 3-week baseline interval.



Phys Ther. 2003 Nov;83(11):1003-13.

Pediatric constraint-induced movement therapy for= a young child with cerebral palsy: two episodes of care.

DeLuca SC, Echols K, Ramey SL, Taub E.


BACKGROUND AND PURPOSE: This case report describes t= he use of "Pediatric Constraint-Induced Therapy (Pediatric CI Therapy)" given on 2 separate occasions for a young child with q= uadriparetic cerebral palsy. CASE DESCRIPTION: The child was 15 months of age at the beginning of the first episode of care. She had previously received weekly physical therapy and occupational therapy for 11 months, but she had no functional use of her right upper extremity (UE), independently or in an assistive manner. She scored from 5 to 7 months below her chronological age= on developmental assessments in gross motor, fine motor, and self-help skills. INTERVENTION: Pediatric CI Therapy involved placement of a full-arm, bivalved cast on the child's less affected UE while providing 3 weeks of intensive intervention (6 hours a day) for the child's more affected UE (intervention 1). Therapy included activities that were go= al oriented but broken down into progressively more challenging step-by-step tasks. Pediatric CI Therapy was administered again 5 months later to promot= e UE skills and independence (intervention 2). OUTCOMES: The child developed new behaviors throughout both interventions. During intervention 1, the child developed independent reach, grasp, release, weight bearing (positioned pro= ne on elbows) of both UEs, gestures, self-feeding, sitting, and increased interactive play using both = UEs. During intervention 2, she had increased indepen= dence and improved quality of UE movement, as supported by blinded clinical evaluations and parent ratings.



Pediatrics.  2004 Feb;113(2):305-12. 

Efficacy of constraint-induced movement therapy f= or children with cerebral palsy

with asymmetric= motor impairment.

Taub E, Ramey SL, DeLuca S, Echols K.

Department of Psychology, University of Alabama, Birmingham, Alabama 35294-0018,

USA. etaub@uab.edu

   &n= bsp;        OBJECTIVE: Constraint-Induced Movement (CI) therapy has been found to be a promising treatment for substantially increasing the use of extremities affected by s= uch neurologic injuries as stroke and traumatic brain injury in adults. The pur= pose of this study was to determine the applicability of this intervention to yo= ung children with cerebral palsy. METHODS: A randomized, controlled clinical tr= ial of pediatric CI therapy in which 18 children with diagnosed hemiparesis associated with cerebral palsy (7-96 months old) were randomly assigned to receive either pediatric CI therapy or conventional treatment. Pediatric CI therapy involved promoting increased use of the more-affected arm and hand = by intensive training (using shaping) of the more-impaired upper extremity for= 6 hours/day for 21 consecutive days coupled with bivalve= d casting of the child's less-affected upper extremity for that period. Children's functional upper-extremity skills were assessed in= the laboratory (blinded scoring) and at home (parent ratings) just prior, after, and 3 weeks posttreatment. Treated child= ren were followed for 6 months. RESULTS: Children receiving pediatric CI therapy compared with controls acquired significantly more new classes of motoric skills (9.3 vs 2.= 2); demonstrated significant gains in the mean amount (2.1 vs 0.1) and quality (1.7 vs 0.3) of more-affected = arm use at home; and in a laboratory motor function test displayed substantial improvement including increases in unprompted use of the more-affected upper extremity (52.1% vs 2.1% of items). Benefits we= re maintained over 6 months, with supplemental evidence of quality-of-life cha= nges for many children. CONCLUSION: Pediatric CI therapy produced major and sustained improvement in motoric function in the young children with hemiparesis in the study.



Phys Ther.  2003 Nov;83(11):1003-13. 

Pediatric constraint-induced movement therapy for= a young child with cerebral palsy: two episodes of care.

DeLuca SC, Echols K, Ramey SL, Taub E.    sdeluca@uab.edu

   &n= bsp;        BACKGROUND AND PURPOSE: This case report describes the use of "Pediatric Constraint-Induced Therapy (Pediatric CI Therapy)" given on 2 separate occasions for a young child with quadriparetic cerebral palsy. CASE DESCRIPTION: The child was 15 months of age at the beginning of the first episode of care. She had previously received weekly physical therapy and occupational therapy for 11 months, but she had no functional use of her right upper extremity (UE), independently or in an assistive manner. She scored from 5 to 7 months below her chronological age= on developmental assessments in gross motor, fine motor, and self-help skills. INTERVENTION: Pediatric CI Therapy involved placement of a full-arm, bivalved cast on the child's less affected UE while providing 3 weeks of intensive intervention (6 hours a day) for the child's more affected UE (intervention 1). Therapy included activities that were go= al oriented but broken down into progressively more challenging step-by-step tasks. Pediatric CI Therapy was administered again 5 months later to promot= e UE skills and independence (intervention 2). OUTCOMES: The child developed = new behaviors throughout both interventions. During intervention 1, the chi= ld developed independent reach, grasp, release, weight bearing (positioned pro= ne on elbows) of both UEs, gestures, self-feeding, sitting, and increased interactive play using both = UEs. During intervention 2, she had increased indepen= dence and improved quality of UE movement, as supported by blinded clinical evaluations and parent ratings.



Dev Med Child Neurol.  2003 May;45(5):357-9. 

'Clinical experience of constraint induced moveme= nt therapy in adolescents with hemiplegic cerebral palsy--a day camp model'.

Eliasson AC, Bonnier B, = Krumlinde-Sundholm L.



Nervenarzt<= /span>.  2003 A= pr;74(4):334-42.  =

[New developments in stroke rehabilitation based = on behavioral and neuroscientific principles: constraint-induced therapy]

[Arti= cle in German]

Elber= t T, Rockstroh B, Bulach D, Meinzer M, Taub E.    thomas.Elbert@uni-konstanz.de

   &n= bsp;        Recent discoveries about the central nervous system's response to injury and how patients reacquire behavioral capabilities by training have yielded promisi= ng new therapies for neurorehabilitation. This fam= ily of interventions is termed constraint-induced (CI) therapy and is essentially behavioral in nature. Constraining movement of the arm which is less affect= ed by the stroke and training (by shaping) the more affected arm for many hour= s a day for two consecutive weeks proved effective in the treatment of hemiplegia in many studies. Successful applications o= ther than for stroke have been for traumatic brain injury, cerebral palsy, spinal cord injury, fractured hip, and focal hand dystonia. Extending the principles to other consequences of stroke such as aphasia is examined. Constraint-induced therapy is shown to produce large changes in t= he organization and function of the brain,which emphasizes the significance of cortical reorganization and learning for neurorehabilitation.




Stroke.  2003 Apr;34(4):1021-6. Epub 2003 Mar 20.

Constraint-induced movement therapy and rehabilit= ation exercises lessen motor deficits and volume of brain injury after striatal hemorrhagic stroke in rats.

DeBow SB, Davies ML, Cla= rke HL, Colbourne F.

   &n= bsp;        BACKGROUND AND PURPOSE: Constraint-induced movement therapy (CIMT) promotes motor reco= very after occlusive stroke in humans, but its efficacy after intracerebral hemorrhage (ICH) has not been investigated clinically or in the laboratory.= In this study we tested whether CIMT and a rehabilitation exercise program wou= ld lessen motor deficits after ICH in rats. METHODS: Rats were subjected to striatal ICH (via infusion of co= llagenase) or sham stroke. Seven days later, treatment began with CIMT (8 h/d of ipsilateral forelimb restraint), rehabilitation exerc= ises (eg, reaching, walking; 1 h/d), or both for 7 days. So= me rats were not treated. Motor deficits were assessed up to the 60-day surviv= al time, after which the volume of tissue lost was determined. RESULTS: Untrea= ted ICH rats made more limb slips traversing a horizontal ladder and showed an asymmetry toward less use of the contralateral = paw in the cylinder test of limb use asymmetry (day 28). These rats were also significantly less successful in the Montoya staircase test (days 55 to 59)= of skilled reaching. Neither therapy alone provided much benefit. However, the combination of daily exercises and CIMT substantially and persistently impr= oved recovery. Unexpectedly, this group had a statistically smaller volume of ti= ssue lost than untreated ICH rats. CONCLUSIONS: The combination of focused rehabilitation exercises and CIMT effectively promotes functional recovery after ICH, while either therapy alone is less effective. This therapy may w= ork in part by reducing the volume of tissue lost, likely through reducing atro= phy while promoting remodeling.




Neurorehabi= l Neural Repair.  2003 Mar;17(1):48-57. 

Erratum in:

    = Neurorehabil Neural Repair. 2003 Sep;17(3):197.

Constraint-induced therapy in stroke: magnetic-stimulation motor maps and cerebral activation.

Witte= nberg GF, Chen R, Ishii K, Bushara KO, Eckloff S, Croarkin E, Taub E, Gerber LH, Hall= ett M, Cohen LG. 

        &= nbsp;   Constraint-induced movement therapy (CI), a standardized intensive rehabilitation intervention, was given to patients a year or more following stroke. The goal was to determine if CI was more effective than a less-intensive control interventi= on in changing motor function and/or brain physiology and to gain insight into= the mechanisms underlying this recovery process. Subjects were recruited and randomized more than 1 year after a single subcortical= infarction. Clinical assessments performed before and after the intervention and at 6 months

postinterve= ntion included the Wolf Motor Function Test (WMFT), the Motor Activity Log (MAL),= and the Assessment of Motor and Process Skills (AMPS). Tra= nscranial magnetic stimulation was used to map the motor cortex. Positron emission tomography was used to measure changes in motor task-related activation due= to the intervention. MAL increased by 1.08 after CI therapy and decreased by 0= .01 after control therapy. The difference between groups was significant (P < 0.001). Changes in WMFT and AMPS were not significantly different between groups. Cerebral activation during a motor task decreased significantly,= and motor map size increased in the affected hemisphere motor cortex in CI pati= ents but not in control patients. Both changes may reflect improved ability of u= pper motor neurons to produce movement.



Clin Rehabil. 2004 Feb;18(1):110-4. Related Articles, Links

Constraint-induced movement therapy: time for a l= ittle restraint?

Siege= rt RJ, Lord S, Porter K. rsiegert@wnmeds.ac.nz

    Our aim was to consider some issues surrounding constraint-induced movement therapy (CIMT), and in particular, its theoretical basis, effectiveness, utility and composition. We examined selected articles and related publications concern= ing CIMT. Considerable evidence from case studies and case series has accumulat= ed but only a limited number of randomized controlled trials (RCTs) exist. The two most positive RCTs represent a combined total of 15 people undergoing CIMT. Other issues include: how analogous deafferentation of an upper limb in m= onkeys is to cerebral infarcts in humans; teasing out the active components of CIM= T; a need for replication by groups not already strongly associated with CIMT; a= nd patient/therapist acceptability. CIMT may hold considerable promise,= but independent, large-scale, multicentre RCTs comparing its effectiveness with conventional th= erapy of equal intensity are required, as is the consideration of some associated issues.



Functional motor amnesia" in stroke (1904) a= nd "learned non-use phenomenon" (1966)

Jean-Marie André ; Jean-Pierre Didier ; Jean Paysant

Journal of Rehabilitation Medicine 2004 May;36(3):138-40.

   &n= bsp;        The "learned non-use phenomenon" described by Ta= ub, one of the most original recent contributions to rehabilitation medicine probably corresponds to what Henry Meige (1866-= 1940), who studied under J.-M. Charcot, described in hemiplegics in 1904 using the expression "functional motor amnesia". He specified in 1914 at the time of t= he Babinski description of anosogno= sia, that: "Even with educated subjects who are still relatively young we a= re sometimes confronted with strange incapacities that are not due to impotenc= e, negligence, or lack of confidence in the results. [] With the transitory halting of the motility all memory of the function appears to have disappeared". Meige describes motor disord= ers that are: (i) distinct from lesional paralyses; (ii) secondary to the absence of activity; (iii) linked to a learning process; (iv) linked to a phenomenon of functional memory loss; (v) reversible; and (vi) motor re-education focusing on extended and repeated practice of the lost function: the same characteristics as the "phenom= enon of learned non-use" described by Taub in m= onkeys then in man.




Forced use after TBI: promoting plasticity and fu= nction through practice

Stephen Page

Source: Brain Injury      Volume: 17 Number: 8 Page: 675 -- 684

Publisher:T= aylor & Francis Health Sciences

   &n= bsp;        Abstract: Objective: To review the literature supporting, and determine the efficacy = of, modified constraint-induced therapy (mCIT) in improving more affected upper limb use and function in patients with trauma= tic brain injury (TBI).  Design: Multiple-baseline, pre-post, case series.&= nbsp; Setting: Outpatient clinic.  Patients: Three patients with TBI occurring >1 year ago and exhibiting stable upper limb hemiparesis and le= arned non-use.  Intervention: Patien= ts participated in 10 sessions of 30 minute, structured physical and occupatio= nal therapy, emphasizing more affected arm use in valued, functional activities, three times/week for 10 weeks and using shaping techniques. Their less affe= cted upper limbs were also restrained 5 days/week during 5 hours identified as t= imes of frequent use during the same 10-week period.   Main outcome measures: The A= ction Research Arm Test (ARA), Wolf Motor Function Test (WMFT) and Motor Activity= Log (MAL).  Results: Following intervention, subjects exhibited improvements > 2.0 in their amount and quality of more affected limb use, as measured by the MAL. Subjects 1, 2 an= d 3 also displayed functional improvements on the ARA (14.0, 5.5 and 6.0, respectively), improvements in ratings of WMFT t= ask performance (1.15, 1.7 and 1.35, respectively) and diminished time needed to perform all WMFT tasks.   Conclusions: mCIT is a promising approac= h by which improved more affected limb use and function can be realized following TBI.



J Rehabil Med. 2004;36(4):159-164.

Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional reco= very of the hemiplegic lower limb.

Kawahira K, Shimodozono M, Ogata A, Tanaka N.

Department of Rehabilitation and= Physical Medicine, Faculty of Medicine Kagoshima University= Kagoshima Japan.

   &n= bsp;        Objective: To evaluate the effects of the intensive repetition of movements elicited by the facilitation technique to improve voluntary movement of a hemiplegic lower limb in patients with brain damage. Design: A multiple-baseline design (A-B-A-B: A without specific therapy, B = with specific therapy) across individuals. Patients: The sample comprised 22 subjects with stroke and 2 brain tumour-operated subjects (age: 50.7 +/- 9.6 years, time after onset: 7.1 +/- 2.6 weeks). Th= ey were selected from among 165 patients with stroke who were admitted to our rehabilitation centre from September 1, 1995 to March 31, 1997. Methods: Two 2-week facilitation technique sessions (more than 100 repetitions a day for each of 5 kinds of movement) were applied at 2-week intervals in patients w= ith hemiplegia, who were being treated with continuous conventional rehabilitation exercise without the facilitation technique for= hemiplegia. Motor function of the affected lower limb= (Brunnstrom Recovery Stage of hem= iplegia, the foot-tap test and the strength of knee extension/flexion) and walking velocity were evaluated at 2-week intervals. Results: Significant improveme= nts in Brunnstrom Stage, foot-tapping and the stren= gth of knee extension/flexion of the affected lower limb were seen after the first conventional rehabilitation exercise session and after the first and second facilitation technique and conventional rehabilitation exercise sessions. T= he improvements after facilitation technique and conventional rehabilitation exercise sessions were significantly greater than those after the preceding conventional rehabilitation exercise sessions. Conclusion: Intensive repeti= tion of movement elicited by the facilitation technique (chiefly proprioceptive neuromuscural facilitation pattern, stretch ref= lex and skin-muscle reflex) improved voluntary movement of a hemiplegic lower limb in patients with brain damage.


Useful CIMT Link=

http://villamart= elli.com/CIMT.html


CIMT END (contin= ued in Neural Plasticity)




***NEURAL PLASTI= CITY (overlaps with CIMT)=


Neuroscientist. 2004 Apr<= span class=3DGramE>;10(2):129-41.

Reorganization of human cerebral cortex: the rang= e of changes following use and injury.

Elbert T, Rockstroh B.

Univers= ity of Konstanz, Germany. thomas.elbert@uni-konstanz.de

   &n= bsp;        Animal and human research over the past decades have increasingly detailed the brain's capacity for reorganization of neural net= work architecture to adapt to environmental needs. In this article, the authors outline the range of reorganization of human representational cortex, encompassing 1) reconstruction in concurrence with enhanced behaviorally relevant afferent activity (examples include skilled musicians and blind Braille readers); 2) injury-related response dynamics as, for instance, dri= ven by loss of input (examples include stroke, amputation, or in blind individuals); and 3) maladaptive reorganization pushed by the interaction between neuroplastic processes and aberrant environmental requirements (examples include synchronicity of input nurturi= ng focal hand dystonia). These types of neuroplasticity have consequences for both understand= ing pathological dynamics and therapeutic options. This will be illustrated in examples of motor and language rehabilitation after stroke, the treatment of focal hand dystonia, and concomitants of injury-related reorganization such as phantom limb pain.



Eur J Neurosci. 2004 Feb;19(4):1093-104.

Enhancement of steady-state auditory evoked magne= tic fields in tinnitus.

Diesch E, Struve M, Rupp A, Ritter S, Hulse M, Flor H. diesch@zi-mannheim.de

   &n= bsp;        The steady-state auditory evoked magnetic field and the Pb= m, the magnetic counterpart of the second frontocentrally= positive middle latency component of the transitory auditory evoked potenti= al, were measured in ten tinnitus patients using a 122-channel gradiometer syst= em. The patients had varying degrees of hearing loss. In all patients, the tinn= itus frequency was located above the frequency of the audiometric edge, i.e. the location on the frequency axis above which hearing loss increases more rapi= dly. Stimuli were amplitude-modulated sinusoids with carrier frequencies at the tinnitus frequency, the audiometric edge, two frequencies below the audiome= tric edge, and two frequencies between the audiometric edge and the tinnitus frequency. Below the audiometric edge, the root-mean-square field amplitude= of the steady-state response computed across the whole head as well as the contralateral and the ipsilatera= l dipole moment decreased as a function of carrier frequency. With carrier frequency above the audiometric edge, the steady-state response increased again. The amplitudes of the transitory Pbm com= ponent were patterned in a qualitatively similar way, but without the differences being significant. For the steady-state response, both whole-head root-mean= -square field amplitude and the dipole moment of the sources at the tinnitus freque= ncy showed significant positive correlations with subjective ratings of tinnitus intensity and intrusiveness. These correlations remained significant when the influence of hearing loss was partialled out. The observed steady-state response amplitude pattern likely reflect= s an enhanced state of excitability of the frequency region in primary auditory cortex above the audiometric edge. The relationship of tinnitus to auditory= cortex hyperexcitability and its independence of heari= ng loss is discussed with reference to loss of surr= ound inhibition in and map reorganization of primary auditory cortex.




Behav Neurosci. 2004 Feb;118(1):214-22.

Coupling between "hand&q= uot; primary sensorimotor cortex and lower limb musc= les after ulnar nerve surgical transfer in parapleg= ia.

Babiloni C, Vecchio F, Babiloni F, Brunelli GA, Carducci F, Cincotti F, Pizzella V, Romani GL, Tecchio FT, Rossini PM. claudio.= babiloni@uniromal.it

   &n= bsp;        Previous neuroimaging evidence revealed an "invasion" of "hand" over "lower limb" primar= y sensorimotor cortex in paraplegic subjects, with the exception of a rare patient who received a surgical motor reinnervation of hip-thigh muscles by the ulnar nerve. Here, = the authors show that a functional reorganization of corti= co-muscular and cortico-cortical oscillatory coupling was r= elated to the recovery of the rare patient, as a paradigmatic case of long-term plasticity in human sensorimotor cortex after m= otor reinnervation of paraplegic muscles. This conclus= ion was based on electroencephalographic and electromyogra= phic data collected while the patient and normal control subjects performed isometric muscle contraction of the left hand or lower limb. Cortico-muscular and cortico-cortical coupling was estimated by electroencephalographic-elec= tromyographic coherence and directed transfer function of a multivariate autoregressive model.




J Comput Neurosci. 2004 Mar-Apr;16<= /span>(2):177-201.

A dynamical model of fast cor= tical reorganization.

Mazza M, de Pinho M, Piqueira JR, Roque AC.

Departament= o de Fisica e Matematica, FFCLRP, Universidade de Sao Paulo, Sao Paulo, Brazil.

   &n= bsp;        In this work we study the connection between some dynamic effects at the synap= tic level and fast reorganization of cortical sensory maps. By using a biologic= ally plausible computational model of the primary somatosen= sory system we obtained simulation results that can be used to relate the dynami= cs of the interactions of excitatory and inhibitory neurons to the process of = somatotopic map reorganization immediately after peri= pheral lesion. The model consists of three regions integrated into a single struct= ure: tactile receptors representing the glabrous surface of the hand, ventral posterior lateral nucleus of the thalamus and area 3b of the primary somatosensory cortex, reproducing the main aspects of= the connectivity of these regions. By applying informational measures to the simulation results of the dynamic behavior of AMPA, NMDA and GABA synaptic = conductances we draw some conjectures about how the s= everal neuronal synaptic elements are related to the initial stage of the digit-induced reorganization of the hand map in the so= matosensory cortex.



NeuroRehabi= litation. 2003;18(4):299-305.<= /o:p>

Cortical remapping in amputees and dysmelic patients: a functional MRI study.

Cruz = VT, Nunes B, Reis AM, Pereira JR.  vcruz@hospitalfeira.min-saude.pt

   &n= bsp;        OBJECTIVES: To investigate motor cortex function in upper and lower limb amputees and <= span class=3DSpellE>dysmelic patients using fMRI. MATERIAL AND METHODS: Five amputees and two dysmelic patients were examined. Motor and imagery tasks were defined according to e= ach patient limb deficiency. Cortical activation patterns were analysed for each patient and compared between groups, integrating patients clinical data. RESULTS: There is a consistent pattern of cortical reorganization in all amputees: predominance of activation in the ipsilateral motor cortex and extension to premotor and sensory areas of the contralateral cortex. On the contrary, cortical maps of dysmelic patients were similar to those of healthy volunteers, predominantly with activation of contralateral primary motor cortex areas. CONCLUSIONS: fMRI discloses sp= ecific patterns of cortical reorganization on amputees and dy= smelic patients, suggesting influence by prosthesis adaptation or stump use with dexterity. These findings could be further applied in influencing neurorehabilitation and development of prosthetic dev= ices.




Lakartidnin= gen. 2003 Dec 18;100(51-52):42= 89-92.

[Rehabilitation after stroke.= Imaging techniques show how the cortical reorganization is affected by training] [Article in Swedish]

Lindb= erg P, Forssberg H, Borg J.  <= span class=3DSpellE>pavel.lindberg@rehab.uu.se

   &n= bsp;        It is widely accepted that reorganisation of the b= rain occurs after a focal brain lesion such as stroke. Neur= oimaging methods are used to study such reorganisation in vivo. Improvements in arm and hand motor function during recovery post-stroke have been related to reorganisation= in primary and secondary sensorimotor areas by ind= irect measure of synaptic activity with functional MRI. Reor= ganisation occurs in both the affected and the unaffected hemispheres. Preliminary training studies post-stroke have shown correlations between improvements in motor function and brain activity changes. Recent research findings are reviewed herein. Further understanding of the neurobiological mechanism= s of post-stroke recovery will lead to development of optimal treatment strategi= es during rehabilitation of stroke survivors.



J Neurol Sci. 2004 Mar 15;218(1-2):9-15.

Functional imaging during cov= ert auditory attention in multiple sclerosis.

Santa Maria MP, Benedict RH, Ba= kshi R, Coad ML, Wack D,= Burkard R, Weinstock-Guttman B, Roberts S, Lockwood AH.

   &n= bsp;        Recent literature suggests that the brain in multiple sclerosis (MS) undergoes reorganization that subserves the performance of visual and motor tasks. We identified sites of cerebral activity in 16 MS p= atients while performing a covert attention (CA) task, presented in the auditory modality. Positron emission tomography (PET) revealed activation of rostral/dorsal anterior cingulat= e cortex (ACC) in normal subjects studied previously. Activity in this region= was not significant in MS patients, but there was a large region of activity in superior temporal cortex. Decreased activation of frontal attentional networks and greater activity in sensory/perceptual cortical areas (auditory association cortex) suggests a reduction of transmission along white matter tracts connecting these regions. This study demonstrates cingulate hypoactivity and cerebral reorganization during auditory attention in MS.



J Neuroimag= ing. 2004 Jan;14(1):49-53.

Cortical reorganization allows for motor recovery= after crossed cerebrocerebellar atrophy.

Feydy A, Krainik A, Bussel B, Maier MA.

Services d'= Imagerie Medicale, INSERM U483, <= st1:City w:st=3D"on">Paris, France.

   &n= bsp;        The authors report the case of a 33-year-old woman who exhibited, at the age of= 17, a left-sided hemiplegia, which was followed by = good motor recovery, though with a permanent deficit in fine finger movements. S= he had a widespread loss of neural tissue in the right hemisphere (crossed cerebrocerebellar atrophy), including (1) marked atro= phy and thinning of the precentral and postcentral gyri; (2) wid= espread deep white matter destruction, including the corticosp= inal tract; and (3) crossed cerebellar atrophy. Exce= pt over the supplementary motor area (SMA), transcranial<= /span> magnetic stimulation did not elicit motor evoked potentials in the affected hand. Nevertheless, during opening and closing of the affected hand, functi= onal magnetic resonance imaging showed an activation = of the lesioned primary sensorimo= tor cortex (SMC), as well as of the intact SMA and the parietal areas, but not = of the ipsilateral motor areas. The authors spe= culate that recovery was achieved by a motor command generated in the SMC and the parietal cortex, passing through corticospinal = axons originating in the SMA.



Clin Neurophysiol. 2004 Feb;115(2):435-47.

Is there training-dependent reorganization of dig= it representations in area 3b of string players?

Hashimoto I, Suzuki A, Kimura T, Iguchi Y, Tanosaki M, Takino R, Haruta Y, Taira M.


   &n= bsp;        OBJECTIVE: The digit representations in area 3b were studied to examine whether there = is training-dependent reorganization in string players. METHODS: Somatosensory evoked magnetic fields were recorded following electrical stimulation of digits 1 (D1), 2 (D2) and 5 (D5) of both hands in 8 string players and of the left hand in 12 control subjects. The = N20m and P30m responses, and high-frequency oscillati= ons (HFOs) were separated by 3-300 Hz and 300-900 Hz bandpass filtering. RESULTS: The dipole locations on = the coronal plane and strengths of D1, D2 and D5, and D1-D5 cortical distance estimated at the peak of N20m or P30m did= not differ between left and right hand in string players or between left hand in string players and controls. On the other hand, the dipole locations of D2 estimated from N20m and P30m and of D1 from N20m were significantly anterio= r, the D2-D5 distance from P30m longer, and the number of HFO peaks larger for= D5 in string players than controls. CONCLUSIONS/SIGNIFICANCE: With strong mutu= al competition among the fingering digits, the scale of reorganization should = be much smaller as compared with the competition-free den= ervation-induced reorganizations. Taken together, the training-dependent reorganization o= f somatosensory cortex in string players is manifest no= t only in the enlarged cortical representation but also in the enhanced HFOs presumably representing activity of the fast-spi= king interneurons.



J Neurosci<= /span>. 2004 Jan 14;24(2):442-6.

Improvement and decline in tactile discrimination behavior after cortical plasticity induced by passive tactile coactivation.

Hodzic A, Veit R, Karim AA, Erb M,= Godde B.

Institute of Medical Psychology = and Behavioral Neurobiology, University of Tubingen, D-72074 T= ubingen, Germany.<= /span>

   &n= bsp;        Perceptual learning can be induced by passive tactile coactivatio= n without attention or reinforcement. We used functional MRI (fMRI) and psychophysics to investigate in detail the specificity of this type of learning for different tactile discrimination tasks and the underlying cort= ical reorganization. We found that a few hours of Hebbian coactivation evoked a significant increase of primary= (SI) and secondary (SII) somatosensory cortical areas representing the stimulated body parts. The amount of plastic changes was strongly correlated with improvement in spatial discrimination performance. However, in the same subjects, frequency discrimination was impaired after = coactivation, indicating that even maladaptive proces= ses can be induced by intense passive sensory stimulation.



Neurology. 2003 Dec 23;61(12):1707-15.

Patterns of cortical reorgani= zation in complex regional pain syndrome.

Maiho= fner C, Handwerker HO, Neundorfer B, Birklein F. maihoefner@physiologie1.uni-erlangen.de

        &= nbsp;   OBJECTIVE: To use magnetoencephalography to assess possible cortical reorganization in the primary somatosensory cortex (S1) of patients with complex regional pain syndrome (CRPS). BACKGRO= UND: Patterns of pain and sensory symptoms in CRPS may indicate plastic changes = of the CNS. METHODS: Magnetic source imaging was used to explore changes in the cortical representation of digits (D) 1 and 5 in relation to the lower lip = on the unaffected and affected CRPS side in 12 patients. RESULTS: The authors found a significant shrinkage of the extension of the cortical hand representation for the CRPS affected side. The center of the hand was shift= ed toward the cortical representation of the lip. The cortical reorganization correlated with the amount of CRPS pain (r =3D 0.792), as measured by the M= cGill questionnaire, and the extent of mechanical hyperalges= ia (r =3D 0.860). Using multiple regression analysis, the best predictor for t= he plastic changes was found to be mechanical hyperalgesi= a. Additionally, S1 sources following tactile stimulation were significantly increased on the CRPS side compared to the unaffected limb. CONCLUSIONS: This study showed reorganization of the S1 cortex contralat= eral to the CRPS affected side. The reorganization appeared to be linked to complaints of neuropathic pain.<= /p>




Neuroimage<= /span>. 2003 Dec;20(4):2166-80.

Correlation between cerebral reorganization and motor recovery after subcortical infarcts.

Loubinoux I, Carel C, Pariente J, Dechaumont<= /span> S, Albucher JF, Marque P, Manelfe C, Chollet F.


   &n= bsp;        Our objective was to investigate correlations between clinical motor scores and cerebral sensorimotor activation to demonstrate= that this reorganization is the neural substratum of motor recovery. Correlation analyses identified reorganization processes shared by all patients. Nine patients with first-time corticospinal tract la= cuna were clinically evaluated using the NIH stroke scale, the motricity index, and the Barthel index. Patients were str= ictly selected for pure motor deficits. They underwent a first fMRI session (E1) 11 days after stroke, and then a second (E2) 4 weeks later. The task used was a calibrated repetitive passive flexion/extension of the pare= tic wrist. The control task was rest. Six healthy subjects followed the same protocol. Patients were also clinically evaluated 4 and 12 months after str= oke. All patients improved significantly between E1 and E2. For E1 and E2, the <= span class=3DSpellE>ipsilesional primary sensorimoto= r and premotor cortex, supplementary motor area (= SMA), and bilateral Broadmann area (BA) 40 were activ= ated. Activation intensity was greater at the second examination except in the ipsilesional superior BA 40. Magnitude of activation = was lower than that of controls except for well-recovered patients. E1 clinical hand motor score and E1 cerebral activation correlated in the SMA proper an= d inferior ipsilesional BA 40. Thus, we demonstrated ea= rly functionality of the sensorimotor system. The w= hole sensorimotor network activation correlated with motor status at E2, indicating a recovery of its function when activated. Moreove= r, the activation pattern in the acute phase (E1) had a predictive value: early recruitment and high activation of the SMA and inferior BA 40 were correlat= ed with a faster or better motor recovery. On the contrary, activation of the = contralesional hemisphere (prefrontal cortex and BA 3= 9-40) and of the posterior cingulate/precuneus (BA 7-= 31) predicted a slower recovery.



Top Stroke = Rehabil. 2003 Fall;10(3):1-20.

Brain reorganization after st= roke.

Green JB.

Unive= rsity of Tennessee, Memphis, Tennessee, USA.

   &n= bsp;        After a stroke, recovery that continues beyond 3 or 4 weeks has been attributed to plasticity, a reorganization of the brain in which functions previously performed by the ischemic area are assumed by other ip= silateral or contralateral brain areas. Neuronal plastici= ty has been variously attributed to redundancy (parallel distributed pathways), changes in synaptic strength, axonal sprouting with formation of new synaps= es, assumption of function by contralateral homolog= ous cortex, and substitution of uncrossed pathways. Transc= ranial magnetic stimulation, positron emission tomography (PET), functional magnet= ic resonance imaging (fMRI), and 128-electrode high-resolution electroencephalography have been successfully applied to demonstrate cortical reorganization after hemiplegia. Recording the motor potential is a promising noninvasive method for the localization of motor control after hemispheric lesions. Most patients with= hemiparetic stroke show some improvement, usually dur= ing the first 3 to 6 months after the ictus. Improvement and prognosis depend o= n a number of variables including volume and location of the infarction, age of= the patient, and the elimination of risk factors to avoid future episodes (i.e., dietary control of lipids, the elimination of tobacco, and the control of diabetes and hypertension). Currently, emphasis has been placed on fibrinolytic treatment in the first 3 hours to preven= t or minimize neurological deficit. Aside from the above listed factors, impr= ovement after stroke may be due to reorganization of the brain, particularly the cerebral cortex, and repair of damaged tissue and reca= nalization. It is also important to relate such changes to functional improvement and successful rehabilitation.



Neuroscientist. 2003 Dec<= span class=3DGramE>;9(6):463-74.

Properties and mechanisms of = LTP maintenance.

Abraham WC, Williams JM.  cabraham@psy.otago.ac.nz

   &n= bsp;        Memory is fundamentally important to everyday life, and memory loss has devastating consequences to individuals and society. Understanding the neurophysiological and cellular basis of memory paves the way for gaining insights into the molecular steps involved in memory formation, thereby revealing potential therapeutic targets for neurological diseases. For three decades, long-term= potentiation (LTP) has been the gold standard synaptic model for mammalian memory mechanisms, in large part because of its long-lasting nature. Here, the authors summarize the characteristics of LTP persistence in the dentate gyrus of the hippoca= mpus, comparing this with other hippocampal subregions and neocortex.= They consider how long LTP can last and how its persistence is affected by subsequent behavioral experiences. Next, they review the molecular mechanis= ms known to contribute to LTP induction and persistence, in particular the rol= e of new gene expression and protein synthesis and how they may be associated wi= th potential structural reorganization of the synapse. A temporal schema for t= he processes important for consolidating LTP into a persistent form is present= ed. The parallels between the molecular aspects of LTP and memory strongly support = the continuation with LTP as a model system for studying the mechanisms underly= ing long-term memory consolidation and retention.



Suppl Clin Neurophysiol. 2003;56:358-67.

Modulation of sensorimotor performances and cognition abilities induced by RPMS: clinical and experime= ntal investigations.

Struppler A, Angerer B, Havel P.  struppler@lrz.tum.de

   &n= bsp;        The investigations presented in this chapter lead to the conclusion that proprioceptive afferent inflow to the CNS induced by = RPMS elicits various modulatory effects in sensorimotor and cognitive systems. Since the build-u= p of the conditioning effects is delayed and the effects itself are long-lasting= , it has to be assumed that these effects are caused via ne= uromodulators. Therefore, the presented approach is promising to improve sensorimotor and cognitive disturbances after lesions in the CNS, e.g. after a stroke, by facilitation of reorganization.



Anasthesiol Intensivmed Notfallmed Schmerzther. 2003 Dec;38(12):762-6.

[Phantom limb pain: aspects of neuroplasticity and intervention] [Article in German]

Gruss= er SM, Diers M, Flor H.

        &= nbsp;   Phantom-limb pain is a common sequel of amputation, occurring in up to 80 % of the amput= ee population. It must be differentiated from non-painful phantom phenomena, residual-limb pain, and non-painful residual-limb phenomena. A comprehensive model of phantom-limb pain is presented that assigns a major role to pain occurring before the amputation and to central as well as peripheral changes related to it. Special emphasis is put on the role of cortical reorganization in the development of phantom limb pain. Finally, new approa= ches to the prevention and treatment of phantom limb pain are presented that hav= e a positive influence on phantom limb pain by preventing or reversing cortical reorganization.



Prog Brain Res. 2004;143:467-75.

Functional recovery after les= ions of the primary motor cortex.

Rouiller EM, Olivier E.<= span style=3D'mso-spacerun:yes'>  eric.rouiller@unifr.ch<= /p>

   &n= bsp;        After a lesion in the motor cortex of an adult primate, are cortical motor maps reorganized? This important question has attracted much interest throughout= the past decade. In human subjects, substantial progress has resulted from the = use of noninvasive imaging and stimulation techniques. For example, there is recent, well-accepted, albeit indirect evidence that following such a lesio= n on one side of the human brain, a dramatic reorganization of the hand representation occurs within either the ipsilateral primary motor cortex, nonprimary motor areas or both. T= he contribution of contralateral motor areas to functional recovery of the paretic hand remains uncertain, however, because= of the lack of direct confirmatory evidence obtained from experiments undertak= en on nonhuman primates. A better understanding of how the brain selects the optimal strategy for functional recovery following cortical lesions, and the neuronal mechanisms underlying cortical plasticity, will be important challenges for the next decade. To this end, the purpose of the present cha= pter is to provide an update on what is truly known about the functional recovery that takes place after a lesion in the primary motor cortex of both the nonhuman primate and the human. It bears emphasis that work on these fundamental issues is an essential prerequisite to the development of impro= ved therapeutic and rehabilitation procedures for the brain-injured human.=



Clin Neurophysiol. 2003 Dec;114(12):2434-46.

Plasticity of the human motor system following mu= scle reconstruction: a magnetic stimulation and functional magnetic resonance imaging study.

Chen R, Anastakis DJ, Ha= ywood CT, Mikulis DJ, Manktelow<= /span> RT.  robert.chen@uhn.on.ca

   &n= bsp;        OBJECTIVE: Although motor system plasticity in response to neuromuscular injury has be= en documented, few studies have examined recovered and functioning muscles in = the human. We examined brain changes in a group of patients who had a muscle transfer. METHODS: Transcranial magnetic stimul= ation (TMS) was used to study a unique group of 9 patients who had upper extremity motor function restored using microneurovascular transfer of the gracilis muscle. The findings f= rom the reconstructed muscle were compared to the homologous muscle of the inta= ct arm. One patient was also studied with functional magnetic resonance imagin= g (fMRI). RESULTS: TMS showed that the motor threshold a= nd short interval intracortical inhibition was red= uced on the transplanted side while at rest but not during muscle activation. The difference in motor threshold decreased with the time since surgery. TMS mapping showed no significant difference in the location and size of the representation of the reconstructed muscle in the motor cortex compared to = the intact side. In one patient with reconstructed biceps muscle innervated by = the intercostal nerves, both TMS mapping and fMRI showed that the upper limb area rather than the = trunk area of the motor cortex controlled the reconstructed muscle. CONCLUSIONS: = Plasticity occurs in cortical areas projecting to functionally relevant muscles. Chang= es in the neuronal level are not necessarily accompanied by changes in motor representation. Brain reorganization may involve multiple processes mediate= d by different mechanisms and continues to evolve long after the initial injury<= /b>. SIGNIFICANCE: Central nervous system plasticity following neuromuscular inj= ury may have functional relevance.



Neurology. 2003 Oct 14;61(7):977-80.  Related Articles, Links 

Plasticity of motor cortex excitability induced by rehabilitation therapy for writing.

Papathanassiou I, Filipovic SR, Whurr R, Jahanshahi M.

   &n= bsp;        The mechanisms of rehabilitation-induced plasticity in the motor system after stroke are not defined. The authors studied seven patients with residual poststroke agraphia, apha= sia, and right hemiparesis. After a 40-minute rehabilita= tion therapy that promoted use of the paretic hand for writing, the authors obse= rved a task-specific increase in recruitment of ipsilateral= corticospinal pathways. Rehabilitation aimed to increase the use of the paretic hand may induce recruitment of previously silent ipsilateral cortico= spinal pathways even in poorly recovered poststroke patients.


In Press.

Behavioural Brain Resear= ch

Consequences of forced disuse of the impaired for= elimb after unilateral cortical injury

J. Leigh Leasure,  and Ti= mothy Schallert

   &n= bsp;        Extreme over-reliance on the impaired forelimb following unilateral lesions of the forelimb representation area of the rat sensorimotor cortex (FL-SMC) leads to exaggeration of injury when overuse is begun durin= g the first week, but not later periods, after injury. Behavioral impairment is partially worsened by the additional tissue loss. In the present study, we = show that complete disuse of the impaired forelimb during the first post-operati= ve week renders surviving tissue vulnerable to later overuse of the same limb,= in effect extending the window of vulnerability in which use-dependent exaggeration of brain injury can occur. Behavioral recovery is disrupted by complete disuse, but the degree of impairment is variable depending on the nature of the behavioral test employed. Our results uphold the idea that mild rehabilitative training early after injury is beneficial, while either extreme overuse or complete disuse may disrupt functional recovery.



Jul 2003, Vol. 26, pp. 411-440


Samuel David and Steve Lacroix<= /span>; email: sdavid11@po-box.mcgill.ca; steve.lacroix@mail.mcgill.ca <= /p>

   &n= bsp;        Axon growth inhibitors associated with myelin and the glial= scar contribute to the failure of axon regeneration in the injured adult mammalian central nervous system (CNS). A number of these inhibitors, their receptors, and signaling pathways have been identified. These inhibitors can now be neutralized by a variety of approaches that point to the possibility= of developing new therapeutic strategies to stimulate regeneration after spinal cord injury.



Neuroscientist. 2004 Apr<= span class=3DGramE>;10(2):163-73.

Plasticity in the human cerebral cortex: lessons = from the normal brain and from stroke.

Butefisch CM.=

Neurological Therapeutic Center, Department of Neurology, Heinrich-Heine University, Dusseldorf, Germany. cathrin.buetefisch@uni-duesseldorf.de

   &n= bsp;        The adult brain maintains the ability for reorganization or plasticity througho= ut life. Results from neurophysiological and <= span class=3DSpellE>neuroanatomical experiments in animals and noninvasiv= e neuroimaging and electrophysiological studies in huma= ns show considerable plasticity of motor representations with use or nonuse, s= kill learning, or injury to the nervous system. An important concept of reorganization in the motor cortex is that of a distributed neuronal networ= k in which multiple overlapping motor representations are functionally connected through an extensive horizontal network. By changing the strength of horizontal connections between motor neurons, functionally different neuron= al assemblies can form, thereby providing a substrate to construct dynamic mot= or output zones. Modulation of inhibition and synaptic efficacy are mechanisms involved. Recent evidence from animal experiments indicates that these functional changes are accompanied by anatomical changes. Because plasti= city of the brain plays a major role in the recovery of function after stroke, t= he knowledge of the principles of plasticity may help to design strategies to enhance plasticity when it is beneficial, such as after brain infarction.



Neuroplasticity: Changes in grey matter induced by training


Nature 427, 311 - 312 (22 January 2004)

   &n= bsp;        Does the structure of an adult human brain alter in response to environmental demands? Here we use whole-brain magnetic-resonance imaging to visualize learning-induced plasticity in the brains of volunteers who have learned to= juggle. We find that these individuals show a transient and selective structural ch= ange in brain areas that are associated with the processing and storage of compl= ex visual motion. This discovery of a stimulus-dependent alteration in the bra= in's macroscopic structure contradicts the traditionally held view that cortical plasticity is associated with functional rather than anatomical changes.



Proc. Natl. Acad. Sci. U= SA, 10.1073/pnas.0307840101


Changes in corticothalamic modulation of receptive fields during peripheral injury-induced reorganizat= ion

S. A. Chowdhury, K. A. G= reek, and D. D. Rasmusson, E-mail: rasmus@dal.ca=

   &n= bsp;        The influence of corticothalamic projections on the thalamus during different stages of reorganization was determined in anesthetized raccoons that had undergone previous removal of a single forep= aw digit. Single-unit recordings were made from 522 sites in the somatosensory nucleus of the thalamus (ventroposterior lateral nucleus) before and after lesioning par= ts of primary somatosensory cortex. In those parts of= ventroposterior lateral nucleus that had intact input= from the periphery, the cortical lesion resulted in an immediate 85% increase in receptive field (RF) size. In animals studied 2-6 weeks after digit amputation, peripherally denervated thalamic ne= urons had unique RFs that were larger than normal, and these were not further enlarged by cortical lesion. However, at longer peri= ods of reorganization (>4 mo), when the new RFs = of denervated neurons had decreased in size, cortical le= sion again produced expansion of RF size. These data demonstrate that corticothalamic fibers modulate the spatial extent of thalamic RFs in intact animals, probably by controlling intrathalamic inhibition. This corticothalamic modulation is ineffective during the = early stages of injury-induced reorganization when new RFs are being formed, but is reinstated after the new RFs<= /span> have become stabilized. The fact that neurons in the denervated thalamic region retained their unique RFs after cortical lesion indicates that their new inputs are not being relayed from a reorganized cortex and support the view that some plasticity occurs in or b= elow the thalamus.




Proc. Natl. Acad. Sci. U= SA, 10.1073/pnas.0401200101


Improving vision in adult am= blyopia by perceptual learning

Uri Polat, Tova Ma-Naim, Michael Belkin, and Dov Sagi.  <= /span>upolat@sheba.health.gov.il

   &n= bsp;        Practicing certain visual tasks leads, as a result of a process termed "perceptua= l learning," to a significant improvement in performance. Learning is specific for basic stimulus features such as local orientation, retinal location, and eye of presentation, suggesting modification of neuronal processes at the primary visual cortex in adults. It is not known, however, whether such low-level learning affects higher-level visual tasks such as recognition. By systematic low-level training of an adult visual system malfunctioning as a result of abnormal development (leading to amblyopia) of the primary visual cortex during the "critical period," we show here that induction of low-level changes might yield significant perceptual benefits that transfer to higher visual tasks. The training procedure resul= ted in a 2-fold improvement in contrast sensitivity and in letter-recognition tasks. These findings demonstrate that perceptual learning can improve basic representations within an adult visual system that did not develop during t= he critical period.



lin<= /span> Rehabil. 2004 Feb;18(1):11= 0-4.

Constraint-induced movement therapy: time for a l= ittle restraint?

Siege= rt RJ, Lord S, Porter K.   rsiegert@wnmeds.ac.nz

   &n= bsp;        Our aim was to consider some issues surrounding constraint-induced movement the= rapy (CIMT), and in particular, its theoretical basis, effectiveness, utility and composition. We examined selected articles and related publications concern= ing CIMT. Considerable evidence from case studies and case series has accumulat= ed but only a limited number of randomized controlled trials (RCTs) exist. The two most positive RCTs represent a combined total of 15 people undergoing CIMT. Other issues include: how analogous deafferentation of an upper limb in m= onkeys is to cerebral infarcts in humans; teasing out the active components of CIM= T; a need for replication by groups not already strongly associated with CIMT; a= nd patient/therapist acceptability. CIMT may hold considerable promise, but independent, large-scale, multicentre RCTs comparing its effectiveness with conventional th= erapy of equal intensity are required, as is the consideration of some associated issues.


Blocking activation of a death receptor enhances = axonal regeneration and functional recovery in an animal model of spinal cord inju= ry

Catherine Barthélé= ;my; Christopher E. Henderson

Nat Med 10(4):339-340, 2004

   &n= bsp;        Spinal cord injury will permanently handicap about 1 in 1,000 individuals over the course of their lifetime.[1] Much effort has been devoted to understanding the complex cellular changes that develop after injury, and to inventing ways to overcome the poor capacity of the adult sp= inal cord for spontaneous regeneration.[2] Programmed cell death within the dama= ged tissue is one of these changes, but whether it hinders recovery has been controversial.

   &n= bsp;        In this issue, Demjen et al.[<= /span>3] show that the death receptor CD95/Fas is a major trigger of cell death in t= he injured spinal cord. They find that mice treated with neutralizing antibodi= es to CD95/Fas recover from a spinal cord lesion that leaves untreated animals heavily handicapped. This shows that keeping cells alive at the lesion site promotes subsequent recovery, and provides a potential tool for doing so in human patients.

   &n= bsp;        Programmed cell death is a tightly regulated process that can be initiated by diverse stimuli, including extracellular signals acting= at specific receptors such as CD95/Fas and tumor necrosis factor (TNF) receptor.[4] Both of these receptors have a predominant role in apoptosis (hence the commonly used term 'death receptor'), but they can activate a variety of other pathways and cellular phenomena.[5] In the nervous system, CD95/Fas activation can lead to cell death of neurons[6] and glial cells,[7] but also to enhanced axonal growth.[8] CD95/Fas may have an important role in pathological degeneration in vivo: CD95/Fas and its ligand, CD95L/FasL, have been implicated in cell death after nerve transection,[9] ischemia,[10] amyotrophic lateral sclerosis,[11] multiple sclerosis, Parkin= son disease[12] and Alzheimer disease.

   &n= bsp;        After spinal cord injury in human patients and in animal models, some cells at the lesion site die by post-traumatic necrosis, whereas others, including oligodendrocytes, die by apoptosis.[13] In line with = this, spinal cord trauma leads to increased expression of death receptors and the= ir ligands, as well as to activation of death-promoting = caspases.[14] Initial experiments showed that caspase inhibition has a protective effect in models = of spinal cord injury, providing the first indication that reducing cell death= might be beneficial.[15] Others, however, have observed no protection.[16] Further uncertainty about the role of cell death arose when it was shown that inactivation of TNF or its receptor did not improve prognosis.[17]

   &n= bsp;        These ambiguous results probably reflect the known capacity of TNF to be both pro- and antiapoptotic. Demjen<= /span> et al. therefore asked instead whether a less ambivalent death receptor, CD95/Fas, might be involved. They first confirmed that in their model, spin= al cord injury led to rapid upregulation of the components of the CD95/Fas system and to increased apoptosis (measured as t= he number of neurons and oligodendrocytes with fragmented nuclear DNA). Intraperitoneal injection of blocking antibodies to CD95L/FasL at the time of injury led to= a 60% reduction in the number of dying cells three days later. When analyzed up to one month after injury and treatment, animals showed signifi= cant functional recovery in behavioral tests of reflexive and voluntary motor function. This recovery was correlated with increased sprouting and regrowth of descending corticosp= inal fibers toward the lesion, and with decreased loss of staining for myelin ba= sic protein, a marker for myelinating oligodendrocytes. On the basis of these results, Demjen et al. pr= opose that the CD95/Fas system be considered a new therapeutic target.=

   &n= bsp;        A true understanding of how antibodies to CD95/Fas reduce cell death and enha= nce recovery will require more detailed knowledge. The cellular source and targ= et of the ligand in damaged spinal cord need to be identified, and the links between axonal sprouting and recovery of motor function need to be defined.

   &n= bsp;        Nonetheless, the following model (Fig. 1) may apply: After injury, CD95L/FasL is upregulated at the lesion site on neurons, astrocytes and invading lymphocytes and microglia. CD95L/FasL triggers death of oligodendrocytes a= nd local spinal interneurons, resulting in an environment that is not favorable to regrowth of descending corticospinal axons. Preventing cell= death provides an environment more conducive to spontaneous regeneration, and formation of new circuits leads to functional recovery in voluntary motor tests.

   &n= bsp;        This model may in some respects be reductionist. For example, it ignores the possible role of autocrine CD95/Fas activation, and possible effects of CD95L/FasL or the blocking antibodies on more distant targets such as circulating lymphocytes or the <= span class=3DSpellE>corticospinal neurons themselves.

   &n= bsp;        What remains to be done before these findings can lead to tests in human patient= s, in parallel with the wide range of other strategies being developed? Several differences with the clinical setting are apparent. First, the lesion used = here (surgical transection of the spinal cord) is qu= ite different from human cases of spinal cord injury, many of which result from local compression. Second, for the behavioral experiments mice were treated with antibodies immediately before injury. Clearly, protocols will need to = be developed to deliver antibodies to the lesion site within the human CNS at later stages. Third, the oncogenic risks of blo= cking cell death cannot be ignored, although the authors point out that these ris= ks should be minor over short periods of treatment.

   &n= bsp;        As with other experimental strategies, many questions remain to be addressed. = The experimental paradigm of Demjen et al. is particularly stringent, meaning that functional recovery may be greater in other models. The new work thus firmly places a new actor on the list of players in spinal cord repair.




Proc Nat Acad Sci | June 1, 2004 | vol. 101 | no. 22 | 8473-8478

Voluntary exercise increases axonal regeneration = from sensory neurons

Raffaella Molteni, Jun-Qi Zheng, Zhe Ying, Fernando Gómez-= Pinilla , and Jeffer= y L. Twiss

Edited by Eric M. Shooter

   &n= bsp;        Recent advances in understanding the role of neurotrophins on activity-dependent plasticity have provided insight into how behavior can affect specific aspects of neuronal biology. We present evidence that voluntary exercise can prime adult dorsal root ganglion neurons for increas= ed axonal regeneration through a neurotrophin-depe= ndent mechanism. Dorsal root ganglion neurons showed an increase in neurite outgrowth when cultured from animals that had undergone 3 or 7 days of exercise compared with sedentary animals. Neurite length over 18–22 h in culture correlat= ed directly with the distance that animals ran. The exercise-conditioned anima= ls also showed enhanced regrowth of axons after an= in vivo nerve crush injury. Sensory ganglia from the 3- and 7-day-exercised animals contained higher brain-derived neurotrophic factor, neurotrophin 3, sy= napsin I, and GAP43 mRNA levels than those from sedentary animals. Consistent with= the rise in brain-derived neurotrophic factor and <= span class=3DSpellE>neurotrophin 3 during exercise, the increased grow= th potential of the exercise-conditioned animals required activation of the neurotrophin signaling in vivo during the exercise pe= riod but did not require new mRNA synthesis in culture.



Developmental Brain Research, Article in Press<= /o:p>

Evidence of newly generated neurons in the human olfactory bulb

Andréanne Bédard and André Parent,

   &n= bsp;        The subventricular zone (SVZ) is known to be the ma= jor source of neural stem cells in the adult brain. In rodents and nonhuman primates, many neuroblasts generated in the SVZ migrate in chains along the rostral migratory s= tream (RMS) to populate the olfactory bulb (OB= ) with new granular and periglomerular interneurons. In order to know if such a phenomenon exists in the adult human brain, we applied single and double immunostaining proced= ures to olfactory bulbs obtained following brain necropsy in normal adult human subjects. Double immunofluorescence labelling with a confocal microscope served to visualize cells that express markers of proliferation = and immature neuronal state as well as markers that are specific to olfactory <= span class=3DSpellE>interneurons. Newborn cells that express cell cycle proteins [Ki-67, proliferating cell nuclear antigen (PCNA)] were detected in the granular and glomerular layers (GLs) of the human olfactory bulb; these cells coexpressed markers of immature neuronal state, such = as Doublecortin (DCX), NeuroD and Nestin. Numerous differentiating cells expressed mole= cular markers of early committed neurons [-tubulin cl= ass III (TuJ1)] and were also immunoreactive for glutamic acid decarboxylase (GAD), a marker of GABAergic neurons, or tyrosi= ne hydroxylase (TH), a marker of do= paminergic neurons. Other early committed neurons expressed the calcium-binding protei= ns calretinin (CR) or parvalbumin (PV). These results provide strong evidence for the existence of adult <= span class=3DSpellE>neurogenesis in the human olfactory system. Despite i= ts relatively small size compared to that in rodents and nonhuman primates, the olfactory bulb in humans appears to be populated, throughout life, by new granular and periglomerular neurons that expres= s a wide variety of chemical phenotypes.




Annual Review of Neuroscience  Volume 27: Pages 145-167, 2= 004


V. Reggie Edgerton, Niranjala J.K. Tillakaratne, Allison J. Bigbee, Ray D. de Leon, and Roland R. Roy: vre@ucla.edu, nirat@lifesci.ucla.edu, rrr@ucla.edu

   &n= bsp;        Abstract Motor function is severely disrupted following spinal cord injury (SCI). The spinal circuitry, however, exhibits a great degree of = automaticity and plasticity after an injury. Automaticity im= plies that the spinal circuits have some capacity to perform complex motor tasks following the disruption of supraspinal input, = and evidence for plasticity suggests that biochemical changes at the cellular level in t= he spinal cord can be induced in an activity-dependent manner that correlates = with sensorimotor recovery. These characteristics should be strongly considered as advantageous in developing therapeutic strategies to assist in the recovery of locomotor function following SCI. Rehabilitative efforts combining locomotor training pharmacological means and/or spina= l cord electrical stimulation paradigms will most likely result in more effective methods of recovery than using only one intervention.




Experimental Brain Research Issue: Volume 157, Numbe= r 3 August 2004, 377 - 382

Recovery of forward stepping in spinal cord injur= ed patients does not transfer to untrained backward stepping

Renato Grasso, Yuri P. Ivanenko, Myrka Zago, Marco Molinari, Gio= rgio Scivoletto and Francesco Lacquan= iti

   &n= bsp;        Abstract  Six spinal cord injured (SCI) patients were trained to step on a treadmill with body-weight support for 1.5–3 months. At the end of training, foot mo= tion recovered the shape and the step-by-step reproducibility that characterize normal gait. They were then asked to step backward on the treadmill belt th= at moved in the opposite direction relative to standard forward training. In contrast to healthy subjects, who can immediately reverse the direction of walking by time-reversing the kinematic wavefor= ms, patients were unable to step backward. Similarly patients were unable to perform another untrained locomotor task, namely stepping in place on the idle treadmill. Two patients who were trained to s= tep backward for 2–3 weeks were able to develop control of foot motion appropriate for this task. The results show that locom= otor improvement does not transfer to untrained tasks, thus supporting the idea = of task-dependent plasticity in human locomotor



J Geriatr Psychiatry 200= 4; 12:395–402

Cognitive Rehabilitation of Mildly Impaired Alzhe= imer Disease Patients on Cholinesterase Inhibitors

David A. Loewenstein, Ph.D., Amarilis Acevedo, Ph.D. Sara J. Czaja, Ph.D., Ranjan Duara, M.D.

   = ;         Objective: The authors evaluated the efficacy of a new cognitive rehabilitation program on memory and functional performance of mildly impaired Alzheimer disease (AD) patients receiving a cholinesterase inhibitor. Methods: Twenty-five participants in the Cognitive Rehabilitation (CR) condition participated in= two 45-minute sessions twice per week for 24 total sessions. CR training includ= ed face– association tasks, object recall training, functional tasks (e.= g., making change, paying bills), orientation to time and place, visuo-motor speed of processing ,= and the use of a memory notebook. Nineteen participants in the Mental Stimulation (MS) condition had equivalent therapist contact and number of sessions, which consisted of interactive computer games involving memory, concentration, and problem-solving skills. Results: Compared with th= e MS condition, participants in CR demonstrated improved performance on tasks th= at were similar to those used in training. Gains in recall of face– associations, orientation, cognitive processing speed, and specific functio= nal tasks were present post-intervention and at a 3-month follow-up. Conclus= ion: A systematic program of cognitive rehabilitation can result in maintained improvement in performance on specific cognitive

and functional = tasks in mildly impaired AD patients.




Top Stroke = Rehabil. 2004 Spring;11(2):12-22.

Motor recovery strategies after stroke.

Stein J.

Spaul= ding Rehabilitation Hospital, Boston, Massachusetts, USA.

Impaired motor function after stroke is a major caus= e of disability in young stroke survivors. The plasticity of the adult human bra= in provides opportunities to enhance traditional rehabilitation programs for t= hese individuals. Younger stroke patients appear to have a greater ability to recover from stroke and are likely to benefit substantially from treatments that facilitate plasticity-mediated recovery. The use of new exercise treatments, such as constraint-induced movement therapy, robot-aided rehabilitation, and partial body weight supported treadmill training are be= ing studied intensively and are likely to ultimately be incorporated into stand= ard poststroke rehabilitation. Medications to enhance rec= overy, growth factors, and stem cells will also be components of rehabilitation for the young stroke survivor in the foreseeable future.



Title: Traumatic brain injury and its effects on syn= aptic plasticity

Author(s): Benedict C. Albensi ; Damir Janigro<= /p>

Source: Brain Injury      Volume: 17 Number: 8 Page: 653 -- 663

DOI: 10.1080/0269905031000107142

Publisher:T= aylor & Francis Health Sciences

Abstract: Animal models have been used to simulate t= he effects of human head trauma. Some of these models have been further utiliz= ed to explore how trauma affects specific mechanisms of synaptic plasticity, a cellular model for memory consolidation. Unfortunately, these studies have = been more limited in number in spite of their importance for understanding alterations in synaptic plasticity and memory impairments in trauma patient= s. Research in this area includes well characterized trauma models, genetically engineered animals and neuroprotective studies.= One largely ignored but important idea that is entertained here is that trauma = may be a crucial aetiological factor for the loss of potassium homeostasis. Moreover, high extracellular potassium has been shown to promote abnormal expression of hippocampal synaptic plasticity due to K+-induced glutamate release, thus showing impor= tant relationships among trauma, glia, potassium and synaptic plasticity. Collectively, this mini review surveys investigations = of head trauma involving altered mechanisms of synaptic plasticity and how tra= uma may be related to increased risk for dementia.



Neuroplasticity following non-penetrating traumatic brain injury

Author(s): Harvey S. Levin

Source: Brain Injury      Volume: 17 Number: 8 Page: 665 -- 674

   &n= bsp;        Abstract: The primary objective of this review is to examine the methodology and evid= ence for neuroplasticity operating in recovery from traumatic brain injury (TBI), as compared with previous findings in patients sustaining perinatal and infantile focal vascul= ar lesions. The evidence to date indicates that the traditional view of enhanc= ed reorganization of function after early focal brain lesions might apply to e= arly focal brain lesions, but does not conform with studies of early severe diff= use brain injury. In contrast to early focal vascular lesions, young age confer= s no advantage in the outcome of severe diffuse brain injury. Disruption of myelination could potentially alter connectivity, a suggestion which could be confirmed through diffusion tensor imaging (DTI). Initial reports of DTI in TBI patients support the possibility that this technique can demonstrate alterations in white matter connections which are= not seen on conventional magnetic resonance imaging (MRI) and might change over time or with interventions. Preliminary functional MRI studies of TBI patients indicate alterations in the pattern of brain activation, suggesting recruitment of more extensive cortical regions to perform tasks which stress computational resources. Functional MRI, coupled with DTI and possibly other imaging modalities holds the promise of elucidating mechanisms of neuroplasticity and repair following TBI.<= /b>



Title: Neuropharmacology= of TBI-induced plasticity

Author(s): Larry B. Goldstein

Source: Brain Injury      Volume: 17 Number: 8 Page: 685 -- 694

DOI: 10.1080/0269905031000107179

Publisher:T= aylor & Francis Health Sciences

   &n= bsp;        Abstract: Primary objective: The purpose of this report is to review both fundamental studies in laboratory animals and preliminary clinical data suggesting that certain drugs may affect behavioural recovery a= fter brain injury. Main outcomes and results: Laboratory studies show that systemically-administered drugs that affect specific central neurotransmitt= ers including norepinephrine and GABA influence aff= ect recovery in a predictable manner. Although some drugs such as d-amphetamine have the potential to enhance recovery, others such as neuroleptics and other central dopamine receptor antagonists, benzodiazepines and the an= ti-convulsants phenytoin and= phenobarbital may be detrimental. In one study= , 72% of patients with traumatic brain injury received one or a combination of the drugs that may impair recovery based on both animal experiments and studies= in recovering stroke patients.  Conclusions: Until the true impact of these clas= ses of drugs are better understood, care should be exercised in the use of medications that may interfere with the recovery process in patients with traumatic brain injury. Additional research needs to be completed be= fore the clinical efficacy of drugs that may enhance recovery can be established= .


Yonsei Med J. 2004 Apr 3= 0;45(2):241-6.

Plastic changes of motor netw= ork after constraint-induced movement therapy.

Kim Y= H, Park JW, Ko MH, Jang SH, Lee PK.


   &n= bsp;        The effects of short-term constraint-induced movement (CIM) therapy on the activation of the motor network were investigated with functional magnetic resonance imaging (fMRI). Movement of the less-= affected arms of five patients was restricted and intensive training of the affected upper limb was performed. Functional MRI was acquired before and after two-weeks of CIM therapy. All patients showed significant improvement of mo= tor function in their paretic limbs after CIM therapy. For three patients, new activation in the contralateral motor/premotor cortices was observed after CIM therapy. Inc= reased activation of the ipsilateral motor cortex and = SMA was observed in the other patient. Our results demonstrated that plastic changes of the motor network occurred as a neural basis of the improvement subsequent to CIM therapy following brain injury.


Taeha= n Kanho Hakhoe Chi. 2003 Aug;33(5):591-600.

[Effects of Upper Extremity Exercise Training Usi= ng Biefeedback and Constraint-induced Movement on the Up= per Extremity Function of Hemiplegic Patients]<= span style=3D'mso-spacerun:yes'>   [Article in Korean]

Kim K= S, Kim KS, Kang JY.

Seoul N= ational University, Korea. kimks@snu.ac.kr

   &n= bsp;        PURPOSE: The purpose of this study was to investigate the effects of exercise traini= ng using biofeedback and constraint-induced movement on the upper extremity function of hemiplegic patients. METHOD: A non-equivalent pretest-posttest design was used. Study subjects were a conveniently selected group of 40 hemiplegic patients(20 experimental subjects, 20 control subjects= ) who have been enrolled in two community health centers. After biofeedback train= ing the subjects of experimental group were given constraint-induced movement, involving restraint of unaffected U/E in a sling for about 6 hours in a day over a period of two weeks, while at the same time intensively training the affected U/E. Outcomes were evaluated on the basis of the U/E motor ability(hand function, grip power, pinch power, U/E RO= Ms), and motor activity(amount, quality). RESULT: 1. After 2 weeks of treatment,= the motor abilities of affected U/E(hand function, grip power, pinch power, ROM= s of wrist flexion, elbow flexion and shoulder flexion/extension) were significa= ntly higher in subjects who participated in exercise training than in subjects in the control group with no decrement at 4-week follow-up. However, there was= no significant difference in wrist extension between experimental or control group. 2. After 2 weeks of treatment, the amount of use and the quality of motor activity of affected U/E were significantly higher in subjects who participated in exercise training than in subjects in the control group wit= h no decrement at 4-week follow-up. CONCLUSION: The above results state that exercise training using biofeedback and constraint-induced movement could b= e an effective intervention for improving U/E function of chronic hemiplegic patients. Long-term studies are needed to determine the lasting effects of constraint-induced movement.



Neurorehabi= l Neural Repair. 2004 Jun;18= (2):95-105.

Changes in serial optical topography and TMS duri= ng task performance after constraint-induced movement therapy in stroke: a case study.

Park SW, Butler AJ, Cavalheiro V, Alberts<= /span> JL, Wolf SL.

   &n= bsp;        The authors examined serial changes in optical topography in a stroke patient performing a functional task, as well as clinical and physiologic measures while undergoing constraint-induced therapy (CIT). A 73-year-old right hemiparetic patient, who had a s= ubcortical stroke 4 months previously, received 2 weeks of CIT. During the therapy, da= ily optical topography imaging using near-infrared light was measured serially while the participant performed a functional key-turning task. Clinical out= come measures included the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and functional key grip test. Transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) were also used to map cortical areas and hemodynamic brain responses, respectively. Optical topography measurement showed an overall decrease in oxy-hemoglobin concentration in both hemispheres as therapy progressed and the laterality index increased toward the contralateral hemisp= here. An increased TMS motor map area was observed in the co= ntralateral cortex following treatment. Posttreatment fMRI showed bilateral primary motor cortex activation, although slightly greater in the contralateral hemisphere, during affected hand movement. Clinical scores revealed mark= ed improvement in functional activities. In one patient who suffered a stroke,= 2 weeks of CIT led to improved function and cortical reorganization in the hemisphere contralateral to the affected hand.<= /b>



Arch Phys Med Rehabil. 2004 Jan;85(1):14-8.

Efficacy of modified constraint-induced movement = therapy in chronic stroke: a single-blinded randomized controlled trial.=

Page SJ, Sisto S, Levine= P, McGrath RE.  Stephen.Page@uc.e= du

OBJECTIVE: To determine efficacy of a modified constraint-induced movement therapy (mCIMT) pro= tocol for patients with chronic stroke. DESIGN: Multiple-baseline, pre-post, single-blinded randomized controlled trial. SETTING: Outpatient clinic. PARTICIPANTS: Seventeen patients who experienced stroke more than 1 year be= fore study entry and who had upper-limb hemiparesis = and learned nonuse. INTERVENTION: Seven patients participated in structured the= rapy sessions emphasizing more affected arm use in valued activities, 3 times a = week for 10 weeks. Their less affected arms were also restrained 5d/wk for 5 hou= rs (mCIMT). Four patients received regular therapy with s= imilar contact time to mCIMT. Six patients received no therapy (control). MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (FMA), Action Research Arm (ARA) Test, and Mot= or Activity Log (MAL). RESULTS: The mCIMT patients exhibited greater motor changes on the FMA and ARA (18.4, 11.4) than regular therapy (6.0, 7.1) or control (-2.9, -4.5). Statistical analyses showed significant differences in motor improvement on the FMA (F(2,12)=3D11.2, P=3D.002) and the ARA (F(2,12)=3D14.0, P=3D.001). Post hoc analyses showed = that, when pretreatment motor differences are controlled, mCIMT resulted in substantially higher posttreatment = FMA and ARA scores. Amount and quality of arm use, measured= by the MAL, improved only in mCIMT patients. CONCLUSIONS: mCIMT may be an efficaci= ous method of improving function and use of the more affected arms of chronic stroke patients. Findings further affirm that repeated, task-specific pract= ice is critical to reacquisition of function, whereas practice schedule intensi= ty is less critical.



Can J Physiol Pharmacol. 2004 Apr;82(4):= 231-7.

Immediate constraint-induced movement therapy cau= ses local hyperthermia that exacerbates cerebral cortical injury in rats.<= /o:p>

DeBow= SB, McKenna JE, Kolb B, Colbourne F.

        &= nbsp;   Constraint-induced movement therapy (CIMT), which involves restraint of the nonimpaired arm coupled with physiotherapy for the impaired arm, lessens impairment and disability in stroke patients. Surprisingly, immediate ipsilateral forelimb immobilization exacerbates brain injury in rats. We tested whether immediate ipsilateral restraint for 7 days aggr= avates injury after a devascularization lesion in rats. Furthermore, we hypothesized that ipsilateral restraint aggravates injury by causing hyperthermia. In experiment 1, each = rat received two lesions, one in the motor cortex and one in the visual cortex.= Ipsilateral restraint increased only the motor cortex lesion. In additional rats, no differences in core temperature occurred aft= er ipsilateral or contralateral restraint. Thus, ipsilateral restraint does not aggravate injury by a systemic side effect. In experiment 2, we hypothesized that ipsilateral restraint = causes hyperthermia in the region surrounding the initial cortical lesion. Brain temperature, measured via telemetry, was significantly higher (approximatel= y 1 degrees C for 24 h) with ipsilateral restraint.= A third experiment similarly found that ipsilateral restraint aggravates injury and causes local cortical hyperthermia and that= contralateral restraint with externally induced mild hyperthermia aggravates injury. In conclusion, immediate ipsilateral restraint aggravates injury apparently by localized events that include hyperthermia. Caution must be exercised in applying early CIMT to humans, as hyperthermia is detrimental.  = (We already know that CIMT can’t work until resolution of diaschesis, etc., which takes at least 6 months in humans...). 



Stroke. 2004 Sep 16 [Epub ahead of print]&= nbsp;   

Constraint-Induced Movement T= herapy.

Grotta JC, Noser EA, Ro T, Boake C, Levin H, Aronowski J, Schallert T.

   &n= bsp;        Constraint-induced movement therapy improves outcome after chronic stroke, conforms experiment= al observations of neuronal plasticity, and proves the efficacy of intensive occupational therapy. More acutely instituted constraint-induced movement therapy has both practical and theoretic risks and benefits that deserve further careful evaluation.







**********PLASTICIT= Y end*








Arq Neuropsiquiatr. 2002 Mar;60(1):21-7

Cognitive rehabilitation of n= aming deficits following viral meningo-encephalitis.<= /b>

Miotto EC

Department of Neuropsychology, T= he National Hospital for Neurology and Neurosurgery, London, UK.<= /o:p>

   &n= bsp;        OBJECTIVE: This case study describes the neuropsychological assessment and cognitive rehabilitation of a patient who developed word retrieval deficits for objec= ts and people's names, following an episode of viral meni= ngo-encephalitits. It shows the implementation and outcome of two techniques adapted to the patient's individual characteristics and context providing a more ecologica= lly valid approach. METHODS: In the first technique, "verbal semantic association", the patient was required to describe what she knew about= an object as a strategy to help her retrieve its name. In the second one, "face-name association" she was taught to apply a visual-imagery technique in order to retrieve relevant people's names. RESULTS: Following = the implementation of these procedures there was a decrease in the number of episodes of failure to retrieve objects and people's names in her everyday = life context. CONCLUSION: The improvement found in the patient's ability to retrieve words is discussed in terms of the utility of cognitive rehabilita= tion programmes and cognitive models of language processing



Journal of Neurology Neurosurgery and Psychiatry 200= 2;73:173-181

Functional reorganisation of memory after traumatic brain injury: a study with H2150 positron emission tomography

B Levine, R Cabeza, AR M= cIntosh, SE Black, CL Grady, DT Stuss; levine@psych.utoronto.ca

   &n= bsp;        Objective: To study the effects of moderate to severe traumatic brain injury (TBI) on = the functional neuroanatomy supporting memory retri= eval.

   &n= bsp;        Methods: Subjects were six patients who had sustained a moderate to severe TBI about four years before scanning and had since made a good recovery. Eleven healt= hy young adults matched to the patients for age and education served as contro= ls. An established H2150 positron emission tomography paradigm was used to elic= it brain activations in response to memory retrieval. TBI patients' patterns of brain activation were compared statistically with those of control subjects. Both group and individual case data were analysed.

   &n= bsp;        Results: Both TBI patients and controls engaged frontal, temporal, and parietal regi= ons known to be involved in memory retrieval, yet the TBI patients showed relat= ive increases in frontal, anterior cingulate, and occipital activity. The hemispheric asymmetry characteristic of controls was attenuated in patients with TBI. Reduced activation was noted in the right = dorsomedial thalamus. Although local aspects of this = pattern were affected by the presence of focal lesions and performance differences,= the overall pattern was reliable across patients and comparable to functional <= span class=3DSpellE>neuroimaging results reported for normal aging, Alzhe= imer's disease, and other patients with TBI.

   &n= bsp;        Conclusions: The TBI patients performed memory tasks using altered functional neuroanatomical networks. These changes are probably = the result of diffuse axonal injury and may reflect either cortical disinhibition attributable to disconnection or compen= sation for inefficient mnemonic processes.



Curr= Opin Pediat= r. 2004 Apr;16(2):217-26.

Update on attention-deficit/hyperactivity disorde= r.

Daley KC.

Department of Medicine, Children= 's Hospital Boston, Boston, Massachusetts 02115, USA. katie_daley@vmed.org

   &n= bsp;        PURPOSE OF REVIEW: Attention-deficit/hyperactivity disorder (ADHD) is present in 3%= to 10% of children in the United States. Children with ADHD can have academic impairments, social dysfunction, and poor self-esteem. There is al= so a higher risk of both cigarette smoking and substance abuse. Given this, = the importance of treatment for ADHD needs to be underscored. This article will briefly review the diagnosis, etiology, and treatment of ADHD, with particu= lar focus on nonstimulant medication and alternativ= e treatment modalities. RECENT FINDINGS: Recent evidence suggests that the overall r= ate of medication treatment for ADHD has been increasing, with over 2 milli= on children being treated with stimulants in 1997. With this increase, cont= roversy has arisen over the possible association of stimulants with growth suppress= ion. In addition, estimates indicate that as many as 30% of children with ADHD either do not respond to stimulant treatment or cannot tolerate the treatment secondary to side effects. This has lead to the considera= tion of treatment with both nonstimulan= t medications as well as alternative therapies, including diet, iron supplementation, herbal medications, and neurofeedback= . Considering the various treatment options now available for ADHD, along with the complexity of the condition, clinical practice guidelines are emergi= ng for the treatment of ADHD and will be discussed. SUMMARY: ADHD continue= s to be a serious health problem. Adequate treatment is needed to avoid academic impairments, social dysfunction, and poor self-esteem. This treatment inclu= des consideration of stimulant medication, nonstimulant medication, as well as alternative therapies. The child with ADHD is likely better served with a mutimodal treatment plan, including medication, parent/school counseling, and behavioral therapy. Implementing an evidenced based algorithm for the treatment of ADHD may pro= ve to be most effective.  (from Discussuion: ̶= 0;among (alternative teatments) the therapy most promis= ing by recent clinical trials appears to be EEG biofeedback")


Neuroimage<= /span>. 2004 Jan;21(1):436-43.

Learned regulation of spatial= ly localized brain activation using real-time fMRI= .

deCharms RC, Christoff K, Glover GH, Pauly JM, Whitfield S, Gabrieli JD.

Department of Psychology, Stanford University<= /st1:PlaceType>, Stanford, CA 94305, USA. decharms@psych.standford.edu

   &n= bsp;        It is not currently known whether subjects can learn to voluntarily control activation in localized regions of their own brain using neuroimaging. Here, we show that subjects were able to learn enhanced voluntary control o= ver task-specific activation in a chosen target region, the somatomotor cortex. During an imagined manual action task, subjects were provided with continuous direction regarding their cognitive processes. Subjects received feedback information about their current level of activation in a target re= gion of interest (ROI) derived using real-time functional magnetic resonance ima= ging (rtfMRI), and they received automatically-adjus= ted instructions for the level of activation to achieve. Information was provid= ed both as continously upated= graphs and using a simple virtual reality interface that provided an image analog of the level of activation. Through training, subjects achieved an enhancement in their control over brain activation that was anatomically specific to the target ROI, the somatomotor cor= tex. The enhancement took place when rtfMRI-based tr= aining was provided, but not in a control group that received similar training wit= hout rtfMRI information, showing that the effect was= not due to conventional, practice-based neural plasticity alone. Following training, using cognitive processes alone subjects could volitionally induc= e fMRI activation in the somatomot= or cortex that was comparable in magnitude to the activation observed during actual movement. The trained subjects increased fMR= I activation without muscle tensing, and were able to continue to control bra= in activation even when real-time fMRI information= was no longer provided. These results show that rtfMRI information can be used to direct cognitive processes, and that subjects are able to learn volitionally regulate activation in an anatomically-targeted brain region, surpassing the task-driven activation present before training. (impact factor >= .6)



Appl= Psychophysiol Biofeedback. 2002 Dec;27(4):231-49.

The effects of stimulant ther= apy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder.

Monas= tra VJ, Monastra DM, George S.

FPI Attention Disorders Clinic, = 2102 E. Main Street, Endicott, New York 13760, USA. poppidoc@aol.com

   &n= bsp;        One hundred children, ages 6-19, who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), either inattentive or comb= ined types, participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD. All of the patients participated in a 1-year, multimodal, outpatient program that incl= uded Ritalin, parent counseling, and academic support at school (either a 504 Pl= an or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Posttreatment assessments were conduct= ed both with and without stimulant therapy. Significant improvement was noted = on the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995) when participants were tested while using Ritalin. However, only t= hose who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical slowing only in patients who = had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.




J Clin Exp Neuropsychol. 2003 Sep;25(6):805-14.    Related Articles, Links     &nb= sp;    

Implicit learning in memory rehabilitation: a meta-analysis on errorless learning and vanishing cues methods.

Kessels RP, de Haan EH.;R.Kessels@fss.uu.nl

The objective of this study was to present a quantitative review on the treatme= nt effects of memory rehabilitation techniques based on intact implicit learni= ng capacity in amnesic patients, that is, errorless learning and the method of vanishing cues. English-language journal articles focusing on these rehabilitation techniques were examined using MedLine<= /span> (1966-2002) or PsychInfo (1887-2002), as well as additional papers listed in the references of these articles. Studies had to meet the following inclusion criteria: (1) original data were reported, (2) memory rehabilitation was studied in memory-impaired patients, (3) a control intervention was included, (4) exact scores were listed for both interventi= on conditions, or the exact statistics were presented. Studies were classified= on the basis of the to-be-learned material and the method of intervention (errorless learning, vanishing cues, control intervention), patient characteristics were determined, and the tasks that were used were taken in= to account. Effect sizes and variances were computed for each individual study compared to control treatment using within-group statistics. A "large&= quot; and statistically significant ES was found for errorless learning treatment, but no significant ES was demonstrated for the vanishing cues method. The results of the present study show that the errorless learning technique is effective in amnesic patients. The effects on the vanishing cues method are only small (and nonsignificant).

 <= /o:p>

 <= /o:p>

Age Ageing. 2003 Sep;32(5):= 529-33.

Mnemonic strategies in older people: a comparison of errorless and errorful learning.

Kessels RP, de Haan EH.; r.kessels@fss.uu.nl

OBJECTIVE: To compare the efficacy of errorless and errorful learning on memory performance in older people and young adults. METHODS: Face-name association learning was examined in 18 older people and 16 young controls. Subjects were either prompted to guess the correct name during the presentation of photographs of unknown faces (errorful= learning) or were instructed to study the face without guessing (errorless learning). The correct name was given after the presentation of each face in both task conditions. Uncued testing followed immediately after the two study phases and after a 10-minute delay. RESULTS: Older subjects had an overall lower memory performance and flatter learning curves compared to the young adults, regardless of task conditions. Also, errorless learning resulted in a higher accuracy than = errorful learning, to an equal amount in both groups. CONCLUSIONS: Older people have difficulty in the encoding stages of face-name association learning, whereas retrieval is relatively unaffected. In addition, the prevention of errors occurring during learning results in a better memory performance, and is perhaps an effective strategy for coping with age-related memory decrement<= o:p>

&nbs= p;

&nbs= p;

Neuropsycho= logia. 2003;41(9):1230-40.<= /o:p>

An investigation of errorless learning in memory-= impaired patients: improving the technique and clarifying theory.

Tailby R, Haslam C.

In rehabilitating individuals who demonstrate severe memory impairment, errorless learning techniques have proven particularly effective. Prevention of errors during acquisition of information leads to better memory than does learning under errorful conditions. This paper presents results of a study investigating errorless learning in three patient groups: those demonstrating mild, moderate, and severe memory impairments. The first goal of the study was to trial a new version of errorless learning, one encouraging more active participation in learning by patients via the use of elaboration and self-generation. This technique led to significantly better memory performance than seen under standard errorless conditions. This finding highlights the value of encoura= ging active and meaningful involvement by patients in errorless learning, to bui= ld upon the benefits flowing from error prevention. A second goal of the study= was to clarify the mechanisms underlying errorless learning. Memory performance under errorless and errorful conditions was com= pared within and across each group of patients, to facilitate theoretical insight into the memory processes underlying performance. The pattern of results observed was equivocal. The data most strongly supported the hypothesis = that the benefits seen under errorless learning reflect the operation of residual explicit memory processes, however a concurrent role for implicit memory processes was not ruled out.



J Neuropsychiatry Clin Neurosci. 2003 Spring;15(2):130-44.

A critical review of memory stimulation programs = in Alzheimer's disease.

Grandmaison E, Simard M.

Geriatric Neuropsychology Laboratory, School of Psychology, Universit de M= oncton, Moncton, New Brunswick, Canada. eric.grandmaison@gnb.ca

   &n= bsp;        The authors describe the memory stimulation programs used in the treatment of Alzheimer's disease (AD) and review their efficacy. Visual imagery, errorle= ss learning, dyadic approaches, spaced retrieval techniques, encoding specific= ity with cognitive support at retrieval, and external memory aids were the memo= ry stimulation programs used alone or in combination in AD. Preliminary eviden= ce suggests that the errorless learning, spaced retrieval, and vanishing cues techniques and the dyadic approach, used alone or in combination, are efficacious in stimulating memory in patients with AD.




Psychol Med. 2003 Apr;33(3):433-42.

Does 'errorless learning' compensate for neurocog= nitive impairments in the work rehabilitation of persons with schizophrenia?<= /o:p>

Kern RS, Green MF, Mintz J, Liberman RP.

   &n= bsp;        BACKGROUND: Because neurocognitive impairments of schizophrenia appear to be 'rate limiting' in the acquisition of skills for community functioning, it is important to develop efficacious rehabilitative interventions that can compensate for these impairments. Procedures based on errorless learning may facilitate work rehabilitation because they effectively automate training of work and other skills, thereby reducing the cognitive burden on persons with schizophrenia. METHOD: The present study examined the ability of a training method based on errorless learning to compensate for neurocognitive deficit= s in teaching two entry-level job tasks (index card filing and toilet-tank assem= bly) to a sample of 54 unemployed, clinically stable schizophrenic and schizoaffective disorder out-patients. Participants were randomly assigned = to one of two training groups, errorless learning v. conventional trial-and-er= ror type instruction. Prior to randomization, all subjects were administered a neurocognitive battery. Job task performance was assessed by percentage accuracy scores immediately after training. RESULTS: For three of the six inter-relationships among neurocognitive functioning and training condition, the pattern was the same: the errorless learning group scored high in job t= ask performance regardless of neurocognitive impairment, whereas the convention= al instruction group showed a close correspondence between job task performanc= e and degree of neurocognitive impairment. CONCLUSIONS: These findings support errorless learning as a technique that can compensate for neurocognitive deficits as they relate to the acquisition of new skills and abilities in t= he work rehabilitation of persons with schizophrenia.



Neurofee= dback in Psychological Practice.

Masterpasqu= a, Frank; Healey, Kathryn N.

Professional Psychology - Resear= ch & Practice. 34(6):652-656, December 2003.

   &n= bsp;        Advances in technology occasionally allow for innovations in the practice of psychol= ogy. Neurofeedback is one such modality; in it, individuals learn to change patterns of brain waves through operant conditioning. Research shows that a number of neurological and psychological disorders can be characterized by distinctive EEG patterns and that neurofeedback may help clients to change those patter= ns. The evidence regarding neurofeedback's efficacy= for attention-deficit/hyperactivity disorder (ADHD), depression, and other disorders is reviewed. Using control group designs, four different resea= rch teams have found neurofeedback to be effective = for ADHD participants; research on outcomes for other disorders is at a much mo= re preliminary stage. Practicing psychologists are encouraged to explore the potential of this alternative and distinctly psychological modality.



J Autism Dev Disord. 2003 Oct;33(5):519-26.

Sequential evaluation of rein= forced compliance and graduated request delivery for the treatment of noncomplianc= e in children with developmental disabilities.

Ducharme JM, Harris K, M= illigan K, Pontes E.

Department of Human Development = and Applied Psychology, University o= f Toronto, 252 Bloor Street, Toronto, O= ntario M5S 1V6, Canada.

   &n= bsp;        Errorless compliance training is a recently developed approach that has been demonstr= ated to be effective in treating severe oppositional behavior in children. In conjunction with several ancillary techniques, the approach comprises two fundamental components: reinforcement for child compliance and delivery of requests in a four-level hierarchy, from requests that yield high levels of compliance to those that yield low levels. To determine the relative contribution of each component, four children with developmental disabiliti= es and severe oppositional behavior were observationally assessed in baseline = and then treated using reinforcement following each instance of compliance to parental requests. Following this first treatment phase, we used the gradua= ted request hierarchy in conjunction with reinforced compliance. Results indica= ted that use of reinforcement for compliance in isolation was ineffective in bringing about clinically significant improvements in child compliance. The addition of the graduated request hierarchy appeared to be associated with substantial changes in child compliance that maintained in follow-up assessments.



Journal of Rehabilitation Medicine     Volume 35, Number 6 / December 2003, 276 - 283=  

Explaining labor force status following spinal co= rd injury: the contribution of psychological variables

Gregory C. Murphy, Amanda E. Young, Douglas J. Brown, Neville J. King

   &n= bsp;        Objective: To investigate the relative influence of demographic, injury and psychologi= cal characteristics on the labor force status of people living with spinal cord injury. Design: Cross-sectional survey. Subjects: 459 persons who had experienced a traumatic spinal cord injury. All participants were patients = of 1 of 2 specialist spinal cord injury services located in south-eastern Australia. Methods: A survey, administered on average of 11.2 years after their injury, was used to collect the data. The study's main outcome measure was labor fo= rce status at the time of survey. Of those invited to participate in the study,= 73% agreed to do so. Results: Demographic, injury and psychological variables w= ere found to explain 30% of the variance in the employment criterion: "in = the labor force" vs "not in the labor force". Psychological variables contributed significantly to the separation of the 2 labor force groups. Conclusion: The inclusion of the selected psychological variables has advanced the understanding of the fact= ors related to return to work following spinal cord injury,= however this understanding is still not complete. Future efforts in this fi= eld would likely benefit from the inclusion of additional psychological characteristics, as well as environmental factors.



Experimental Neurology, In press

Sodium channel blockade with phenytoin protects spinal cord axons, enhances axonal conduction, and improves functi= onal motor recovery after contusion SCI

Bryan C. Hains, Carl Y. = Saab, Albert C. Lo and Stephen G. Waxman,

   &n= bsp;        Accumulation of intracellular sodium through voltage-gated sodium channels (VGSCs) is an important event in the cascade leading to anatomic degeneration of spinal cord axons and poor functional outcome following traumatic spinal cord injury (SCI). In this study, we hypothesized that phenytoin, a sodium channel blocker, would result in protection of axons with concomitant improvement of functional recovery after SCI. Adult male Sprague–Dawley rats underwent T9 contusion SCI after being fed normal chow or chow contain= ing phenytoin; serum levels of pheny= toin were within therapeutic range at the time of injury. At various timepoints after injury, quantitative assessment of l= esion volumes, axonal degeneration, axonal conduction, and functional locomotor recovery were performed. When compared to controls, phenytoin-treated animals demonstrated reductions in the degree of destruction of gray and white matter surrounding the lesion epicenter, sparing of axons within the dorsal corticospinal tract (dCST) and dorsal column (DC) system rostral to the lesion site, and within the dorsolateral funiculus (D= LF) caudal to the lesion site, and enhanced axonal conduction across the lesion site. Improved performance in measures of skilled loco= motor function was observed in phenytoin-treated anim= als. Based on these results, we conclude that phenytoin<= /span> provides neuroprotection and improves functional outcome after experimental SCI, and that it merits further examination as a potential treatment strategy in human SCI.



Archives of Physical Medicine and Rehabilitation, 85= , 7 , July 2004, Pages 1198-1204

Hyperbaric oxygen therapy for traumatic brain inj= ury: a systematic review of the evidence

Marian McDonagh PharmD, Mark Helfand MD, = MS, Susan Carson MPH and Barry S. Russman MD

   &n= bsp;        McDonagh M, Helfand M, Ca= rson S, Russman BS. Hyperbaric oxygen therapy for traumatic b= rain injury: a systematic review of the evidence. Arch Phys Med Rehabil 2004;85:1198–204.   Objectiv= e   To identify the benefits and= harms of hyperbaric oxygen therapy (HBOT) to treat traumatic brain injury (TBI).<= /span>   Data sources   MEDLINE, EMBASE, the Cochrane Library, HealthSTAR, CINAHL, MANTIS, profession= al society databases, and reference lists. Databases were searched from incept= ion through December 2003.   = Study selection   We included English-language studies of patients with TBI given HBOT and evaluating functional health outcomes.   Data extraction   Data were abstracted by 1 re= viewer and checked by a second. Study quality was rated as good, fair, or poor.   Data syn= thesis  Two fair-quality randomized controlled trials of patients with severe brain injury reported conflicting results. One found no difference in mortality (48% HBOT vs 55% control) or morbidity at 1 year. In young patients with brainstem contusion, significantly more regained consciousness at 1 month with HBOT (= 67%) than control (11%) (P<.03). The other found a significant decrease in mortality in the HBOT group at 1 year (17%) compared with controls (31%) (P=3D.037). This decrease in mortality was accompanied = by an increase in proportion of patients with severe disability. Patients with intracranial pressure (ICP) greater than 20mmHg or a Glasgow Coma Scale sco= re of 4 to 6 had significantly lower mortality at 1 year than controls. Five observational studies did not provide better evidence of effectiveness or adverse events. Two indicated a potential for initially reducing elevated I= CP in some patients. However, rebound elevations higher than pretreatment leve= ls occurred in some patients. Adverse events, including seizures, pulmonary symptoms, and neurologic deterioration, were reported; however, no study systematically assessed adverse events, and none reported adverse events in= control groups.

Conclusions &n= bsp; The evidence for HBOT for TBI is insufficient to prove effectiven= ess or ineffectiveness, and more high-quality studies are needed. The evidence indicates that there is a small chance of a mortality benefit, which may de= pend on subgroup selection. The effect on functional status and the incidence and clinical significance of adverse effects are unclear.



Rehabilitation following acquired brain injury: c= oncise guidance

Clinical Medicine, Journal of the Royal College of Physicians   1 January 2004, vol. 4, no. 1,   pp. 61-65(5)

Turner-Stokes L.; Wade D.

   &n= bsp;        The national clinical guidelines for Rehabilitation following acquired brain in= jury were developed by a multidisciplinary working party convened by the British Society of Rehabilitation Medicine, and are published in collaboration with= the Royal College of Physicians (2003). They have been produced to complement t= he National Institute of Clinical Excellence head injury guidelines, and to address the medium- to longer-term needs of patients with acquired brain in= jury and of their families/carers. This article s= erves as an introduction to make physicians aware of the guidelines, and to highl= ight in particular the advice to doctors in the acute services regarding early discharge and referral to rehabilitation.



Investigating the neurobiological basis of cognit= ive rehabilitation therapy with fMRI=

L. K. Laats= ch ; K. R. Thulborn ; C. M. = Krisky ; D. M. Shobat ; J= . A. Sweeney

Source: Brain Injury      Volume: 18 Number: 10 Page: 957 -- 974

   &n= bsp;        Abstract: The neurobiological changes occurring during cognitive rehabilitation thera= py (CRT) have yet to be systematically studied. In the present study, function= al magnetic resonance imaging (fMRI) was used to demonstrate brain plasticity in response to CRT (n =3D 5) following mild traumatic brain injury. Neuropsychological tests and two fMRI activation tasks, a visually guided saccades and a reading comprehension ta= sk, were employed pre- and post-CRT. CRT was used to systematically address the identified deficits in visual scanning and language processing. As hypothesized, changes in the pattern and extent of activation within expect= ed neuroanatomical areas occurred post-CRT. Changes in fMRI activation are discus= sed for each subject and related to changes on neuropsychological measures. This study demonstrates how fMRI can illus= trate the neurobiological mechanisms of recovery in individual subjects. The variability in subject responses to CRT supports the notion of tailoring rehabilitation strategies to each subject in order to optimize recovery following brain injury.



Cognitive training in home environment=

I.-L. Boman= ; M. Lindstedt ; H. Hemmingsson ; A. Bartfai<= o:p>

Source: Brain Injury      Volume: 18 Number: 10 Page: 985 -- 995

   &n= bsp;        Abstract: Primary objective: To examine the efficacy of cognitive rehabilitation in t= he patient's home or vocational environment. Research design: Pre-post-follow-= up design. Methods and procedures: Ten outpatients with acquired attention and memory problems received cognitive training three times weekly, for 3 weeks. They received individual attention training with Attention Process Training, training for generalization for everyday activities and education in compensatory strategies for self-selected cognitive problems. Treatment eff= ects were evaluated with neuropsychological and occupational therapy instruments before and after the training and after 3 months on impairment, activity and participation levels. Main outcomes and results: The results indicated a positive effect on some measures on impairment level, but no differences on activity or participation levels at follow-up.

Conclusions: The study indicates that home-based cognitive training improves some attentional and memory functions and facilitates learning of strategies. Future controlled studies are needed to confirm the results and analyse<= /span> the efficacy of different aspects of home-based training.



Neurology. 2004 Aug 10;63(3):475-84.

Corticocortical coupling in chronic stroke: its relevance to recovery.

Strens LH, Asselman P, Pogosyan A, Loukas C, Thompson AJ, Brown P.

    BACKGROUND: The mechanisms behind motor recovery from stroke are not clearly understood. Functional imaging studies have demonstrated task-relat= ed brain activation in several motor areas, but few studies have attempted to correlate this with stroke outcome. Moreover, these studies have focused on= how motor areas may individually contribute to compensation. Here, the authors investigate whether different cortical areas interact to form dynamic assemblies that may then compensate for disability. METHODS: The authors investigated corticocortical coherence in 16 he= althy subjects and 25 patients with chronic stroke involving one cerebral hemisph= ere and having varying degrees of motor recovery. Scalp EEG was recorded at rest and while right-handed subjects performed a unimanual<= /span> grip task. The degree of functional recovery after stroke was assessed usin= g a range of outcome measures. RESULTS: Compared with healthy subjects, hand-related asymmetries in task-related EEG-EEG coherence were increased between mesial and lateral frontal regions of t= he affected hemisphere, over mesial frontal region= s, and over lateral frontal areas of the unaffected hemisphere when patients with stroke gripped with their affected hand. Mesial hand-related asymmetries in task-related power and coherence were negatively correlated with recovery. CONCLUSION: Increases in task-related coup= ling between cortical areas may dynamically compensate for brain damage after st= roke. Some of this increased coupling, particularly that over mesial frontal areas, decreases as patients make a functional recovery.=



Brain, Vol. 127, No. 8, 1853-1867, August 2004<= /o:p>

The scope of preserved procedural memory in amnes= ia

Sara Cavaco, Steven W. A= nderson, John S. Allen, Alexandre Castro-Caldas and Hanna Damasio


   &n= bsp;        The finding that patients with amnesia retain the ability to learn certain procedural skills has provided compelling evidence of multiple memory syste= ms in the human brain, but the scope, defining features and ecological significance of the preserved mnemonic abilities have not yet been explored. Here, we tested the hypothesis that subjects with amnesia would be able to learn and retain a broad range of procedural skills, by examining their acquisition and retention performance on five novel experimental tasks. The tasks are based on real-world activities and encompass a broad range of perceptual–motor demands: (i) the weaving= task involves weaving pieces of fabric from woollen strings, using a manual weaver's loom; (ii) the geometric figures task cons= ists of tracing geometric figures with a stylus as they move horizontally across= a touch screen monitor; (iii) the control stick task involves tracking a sequ= ence of visual target locations using a joystick control; (iv) the pouring task consists of pouring 200 ml of water from a watering can into a series of graduated cylinders, from a point 20 cm above the cylinders; and (v) the spatial sequence task involves learning an ordered sequence of pushing five spatially distributed buttons without visual guidance. Ten chronic and stab= le amnesic subjects (nine with bilateral medial temporal lobe damage due to he= rpes simplex encephalitis or anoxia, and one with thalamic stroke) and 25 matchi= ng normal comparison subjects were tested on three occasions: initial learning= at time 1; retention at time 2 (24 h later); and retention at time 3 (2 months later). Despite impaired declarative memory for the tasks, the amnesic subj= ects demonstrated acquisition and retention of the five skills; their learning slopes over repeated trials were comparable with those of comparison subjec= ts. These findings indicate that preserved learning of complex perceptual–motor skills in patients with amnesia is a robust phenomenon, and that it can be demonstrated across a variety of conditions and perceptual–motor dema= nds. The comparability of the tasks employed in this study with real-world activities highlights the potential application of this memory dissociation= in the rehabilitation of patients with amnesia.



Brain, Vol. 127, No. 8, 1899-1908, August 2004<= /o:p>

Globus pallidus internus stimula= tion in primary generalized dystonia: a H215O PET study=

Olivier Detante, Laurent= Vercueil, Stéphane= Thobois, Emmanuel Broussolle, Nicolas Costes, Franck Lav= enne, Stéphan Chabardes, Didier Lebars, Marie Vidai= lhet, Alim-Louis Benabid = and Pierre Pollak


   &n= bsp;        Globus pallidus internus (GPi) deep brain stimulation (DBS) increasingly shows promising efficacy in the treatment of severe primary generalized dystonia. Functional imaging studies have shown previously that dystonia could be related to abnormal cortical activation during voluntary movement.= In the present study, the effects of GPi DBS on re= gional cerebral blood flow (rCBF) during a motor task = were studied in patients with primary generalized dystonia<= /span>. rCBF was measured us= ing H215O and PET in eight control subjects and six patients with dystonia treated with bilateral = GPi DBS. Subjects were scanned at rest and while performing joystick movements.= Dystonic patients were tested in two conditions: ‘OFF’ (stimulator bilaterally switched off) and ‘ON’ (unilateral stimulation). In the ‘OFF’ condition, compared with rest, motor activation of the most dystonic han= d was associated with overactivity in the contralateral dorsolateral prefrontal cortex, gyrus f= rontalis medialis, superior frontal gyrus (area 10), frontoorbital cortex and thalamus. I= n the ‘ON’ condition, GPi DBS contralaterally to the most dyst= onic hand induced a decrease of the overactivation i= n the same areas, as well as the putamen. Accordin= g to the present study, generalized dystonia is asso= ciated with prefrontal overactivation which can be rev= ersed by effective GPi DBS.