Five Functional Classes Identified Among Patients Hospitalized for Pneumonia Characterized by Activity Limitations With Mobility and Self-Care Tasks.

Objective: Latent class analysis was used to identify functional classes among patients hospitalized for pneumonia. Then, we determined predictors of class membership and examined variation in distal outcomes among the functional classes. Design: An observational, cross-sectional study design was used with retrospectively collected data between 2014 and 2018. Setting: The study setting was a single health system including 5 acute care hospitals. Participants: A total of 969 individuals hospitalized with the primary diagnosis of pneumonia and receipt of an occupational and/or physical therapy evaluation were included in the study. Interventions: Not applicable. Main Outcomes: The following 5 distal outcomes were examined: (1) occupational therapy treatment use, (2) physical therapy treatment use, (3) discharge to home with no services, (4) discharge to home with home health, and (5) institutional discharge. Results: Five functional classes were identified and labeled as follows: Globally impaired, Independent with low-level self-care, Independent low-level mobility, Independent self-care, and Independent. Probability of occupational therapy treatment use (χ2[4]=50.26, P<.001) and physical therapy treatment use (χ2[4]=50.86, P<.001) varied significantly across classes. The Independent with low-level self-care class had the greatest probability of occupational therapy treatment use and physical therapy treatment use. Probability of discharging to home without services (yes/no; χ2[4]=88.861, P<.001), home with home health (yes/no; χ2[4]=15.895, P=.003), and an institution (yes/no; χ2[4]=102.013, P<.001) varied significantly across the 5 classes. The Independent class had the greatest probability of discharging to home without services. Conclusions: Five functional classes were identified among individuals hospitalized for pneumonia. Functional classes could be used by the multidisciplinary team in the hospital as a framework to organize the heterogeneity of functional deficits after pneumonia, improve efficiency of care processes, and help deliver targeted rehabilitation treatment.

Identification of Disability Subgroups for Patients After Ischemic Stroke.

OBJECTIVE: The aims of this study were to identify disability subgroups among patients hospitalized for ischemic stroke and to determine the predictors and distal outcomes for the disability subgroups. METHODS: A retrospective, cross-sectional study design was used. Data on patients after ischemic stroke were collected from the electronic health records at 5 hospitals within a single health system. Covariates included social and demographic factors. Disability was characterized according to the Activity Measure for Post-Acute Care assessment. Distal outcomes were physical therapist treatment use, occupational therapist treatment use, and discharge disposition. Latent class analysis was used to identify disability subgroups of patients hospitalized for ischemic stroke. RESULTS: A total of 1549 patients were included in the analyses. Five disability subgroups were identified and labeled as follows: globally impaired (subgroup 1), impaired dynamic balance (subgroup 2), impaired self-care (subgroup 3), impaired mobility (subgroup 4), and independent (subgroup 5). Physical therapist treatment use (χ24 = 113.21 [P < .001]) and occupational therapist treatment use (χ24 = 122.97 [P < .001]) varied significantly across the disability subgroups. The globally impaired group had the highest probability of physical and occupational therapist treatment use. Similarly, discharge disposition varied across the subgroups (for home without services, χ24 = 246.61 [P < .001]; for home with home health care, χ24 = 35.49 [P < .001]; for institutional discharge, χ24 = 237.18 [P < .001]). The independent subgroup had the highest probability of discharge to home without services. CONCLUSION: Five disability subgroups were identified for patients after ischemic stroke. The disability subgroups provide a common language for clinicians to organize the heterogeneity of disability after stroke. IMPACT: Using the disability subgroups, the multidisciplinary team might be able to improve the accuracy and efficiency of care decisions. The number of current rehabilitation interventions is indeterminable; these subgroups may help to guide clinicians in selecting the most beneficial interventions for patients based on subgroup membership.

Yoga improves quality of life and fall risk-factors in a sample of people with chronic pain and Type 2 Diabetes.

OBJECTIVE: Assess pre to-post outcomes for people with chronic pain and Type 2 Diabetes Mellitus (T2DM) randomized to an 8-week yoga intervention or usual care. METHODS: Participants were included if they self-reported: chronic pain; T2DM; >18 years old; no exercise restrictions or consistent yoga; and consented to the study. RESULTS: After yoga, there were significant improvements in: Brief Pain Inventory pain interference (49 ±â€¯15.00 vs. 41.25 ±â€¯19.46, p = .034); Fullerton Advanced Balance scale (14.2 ±â€¯14.1 vs. 20.4 ±â€¯13.5, p = .03); upper extremity strength (7.7 ±â€¯6.3 vs.10.8 ±â€¯6.5, p = .02); lower extremity strength (4.1 ±â€¯3.8 vs. 6.7 ±â€¯4.8, p = .02); and RAND 36-item Health Survey quality of life scores (81.1 ±â€¯7.7 vs. 91.9 ±â€¯8.9, p = .04). Balance scores became significantly worse during the 8 weeks for people randomized to the control (27.1 ±â€¯9.9 vs. 21.7 ±â€¯13.4, = p.01). CONCLUSION: Data from this small RCT indicates yoga may be therapeutic and may improve multiple outcomes in this seemingly at-risk population. CLINICAL TRIALS NUMBER: NCT03010878.

The impact of assistive technology services in post-secondary education for students with disabilities: Intervention outcomes, use-profiles, and user-experiences.

The outcomes of assistive technology (AT) support services for post-secondary education students with disabilities are under-reported, and little is known about use-profiles and user experiences when AT interventions are applied to this rapidly growing population. We examined AT service outcomes related to performance and satisfaction of common academic tasks (using the Canadian Occupational Performance Measure [COPM]), as well as how students with disabilities use and experience AT and AT services (employing an AT-use survey). Three-hundred fifty-three students with disabilities completed the AT-use survey, with a subset of these (n = 216) also participating with pre-post AT intervention COPM assessment. COPM performance and satisfaction ratings significantly increased from pre- to post-AT intervention in all academic task categories (reading, writing, note-taking, test-taking, and studying; p < 0.001). The AT-use survey most notably revealed these students preferred face-to-face training, used their AT at least 3 days per week, used AT in a variety of environments, felt AT positively impacted their academic success, and believed they would continue using AT post-graduation. The study findings contribute to evidence-base for AT services with a hope we may improve AT services to best meet the changing needs of the growing number of college students with disabilities.

Biomechanical contributions of the trunk and upper extremity in discrete versus cyclic reaching in survivors of stroke.

BACKGROUND: Stroke rehabilitation interventions and assessments incorporate discrete and/or cyclic reaching tasks, yet no biomechanical comparison exists between these 2 movements in survivors of stroke. OBJECTIVE: To characterize the differences between discrete (movements bounded by stationary periods) and cyclic (continuous repetitive movements) reaching in survivors of stroke. METHODS: Seventeen survivors of stroke underwent kinematic motion analysis of discrete and cyclic reaching movements. Outcomes collected for each side included shoulder, elbow, and trunk range of motion (ROM); peak velocity; movement time; and spatial variability at target contact. RESULTS: Participants used significantly less shoulder and elbow ROM and significantly more trunk flexion ROM when reaching with the stroke-affected side compared with the less-affected side (P < .001). Participants used significantly more trunk rotation during cyclic reaching than discrete reaching with the stroke-affected side (P = .01). No post hoc differences were observed between tasks within the stroke-affected side for elbow, shoulder, and trunk flexion ROM. Peak velocity, movement time, and spatial variability were not different between discrete and cyclic reaching in the stroke-affected side. CONCLUSIONS: Survivors of stroke reached with altered kinematics when the stroke-affected side was compared with the less-affected side, yet there were few differences between discrete and cyclic reaching within the stroke-affected side. The greater trunk rotation during cyclic reaching represents a unique segmental strategy when using the stroke-affected side without consequences to end-point kinematics. These findings suggest that clinicians should consider the type of reaching required in therapeutic activities because of the continuous movement demands required with cyclic reaching.

Repeated sessions of functional repetitive transcranial magnetic stimulation increases motor cortex excitability and motor control in survivors of stroke.

OBJECTIVE: To determine the impact of a single-session of repetitive transcranial magnetic stimulation (rTMS) and an rTMS intervention on neurophysiology and motor control in survivors of stroke. METHODS: Twelve stroke survivors were randomized into functional-rTMS or passive-rTMS conditions. Measures of short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF), and force steadiness (coefficient of variation, CV) at 10 and 20% of maximum voluntary contraction were assessed at baseline and after a single-session of rTMS (post single-session), and again following an intervention of 8 rTMS sessions (2 sessions per day; post-intervention). Functional-rTMS required subjects to exceed a muscle activation threshold assessed by surface electromyography to trigger each rTMS train; the passive-rTMS group received rTMS while relaxed. RESULTS: ICF scores significantly increased following the single-session of functional-rTMS compared to the decrease following passive-rTMS. The increase in APB SICI and ICF scores following the intervention was significantly greater for the functional-rTMS group compared to the decreases following passive-rTMS. The groups were significantly different in the CV of force (20%) following the single-session of rTMS, and in the 10 and 20% tasks following the intervention. The functional-rTMS group increased steadiness overtime, whereas the passive group demonstrated a return to baseline following the intervention session. No differences were observed in first dorsal interosseus (FDI) measures (SICI and ICF) between groups. CONCLUSIONS: The functional-rTMS protocol enhanced cortical excitability following a single-session and after repeated sessions and improved steadiness, whereas the passive stimulation protocol tended to decrease excitation and no improvements in steadiness were observed.

Functional repetitive transcranial magnetic stimulation increases motor cortex excitability in survivors of stroke.

OBJECTIVE: To determine if repetitive transcranial magnetic stimulation (rTMS) applied to the motor cortex with simultaneous voluntary muscle activation, termed functional-rTMS, will promote greater neuronal excitability changes and neural plasticity than passive-rTMS in survivors of stroke. METHODS: Eighteen stroke survivors were randomized into functional-rTMS (EMG-triggered rTMS) or passive-rTMS (rTMS only; control) conditions. Measures of short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF), force steadiness (coefficient of variation, CV) at 10% of maximum voluntary contraction, and pinch task muscle activity were assessed before and after rTMS. Functional-rTMS required subjects to exceed a muscle activation threshold to trigger each rTMS train; the passive-rTMS group received rTMS while relaxed. RESULTS: Significant interactions (time × condition) were observed in abductor pollicis brevis (APB) SICI, APB ICF, CV of force, and APB muscle activity. Functional-rTMS decreased APB SICI (p < 0.05) and increased ICF (p < 0.05) after stimulation, whereas passive-rTMS decreased APB muscle activity (p < 0.01) and decreased CV of force (p < 0.05). No changes were observed in FDI measures (EMG, ICF, SICI). CONCLUSION(S): Functional-rTMS increased motor cortex excitability, i.e., less SICI and more ICF for the APB muscle. Passive stimulation significantly reduced APB muscle activity and improved steadiness. SIGNIFICANCE: Functional-rTMS promoted greater excitability changes and selectively modulated agonist muscle activity.

Considerations for stimulus-response curves in stroke: an investigation comparing collection and analysis methods.

Stimulus-response curves (SRCs) provide information about the neurophysiological strength of corticospinal connections. The method for measuring and/or drawing meaningful conclusions of SRCs has not been well established in the stroke population. This study sought to characterize the use of an abbreviated SRC in stroke by comparing two data collection and two analysis approaches. SRCs were obtained using transcranial magnetic stimulation (TMS) in 25 survivors of stroke. The SRC data were collected with TMS intensities referenced to either motor threshold (MT; 5% increments between 100% and 140% of MT) or stimulator output (5% increments between 30% and 100% output) with peak-to-peak motor evoked potential amplitudes determined and averaged for each intensity level. Data were modeled with a three-parameter sigmoid function and a linear regression and were analyzed with a mixed design analysis of variance. There was no difference in the accuracy of prediction (r2) between the different analyses. There were significant differences in the slope parameters depending on the analysis method, but this was not dependent on the SRC data collection method. A linear regression of the SRC accurately represents the slope of the modeled data and is strongly correlated with the calculated peak slope, yet is less computationally complex than the sigmoid function. This study demonstrates the use of a linear analysis approach for SRCs as outcome measures for stroke studies.

Kinematic motion analysis and muscle activation patterns of continuous reaching in survivors of stroke.

Coordinated reaching requires continuous interaction between the efferent motor output and afferent feedback; this interaction may be significantly compromised following a stroke. The authors sought to characterize how survivors of stroke generate continuous, goal-directed reaching. Sixteen survivors of stroke completed functional testing of the stroke-affected side and a continuous reaching task between 2 targets with both sides. Motion analysis and electromyography data were collected to determine segmental contributions to reach (e.g., amount of compensatory trunk), spatiotemporal parameters (e.g., peak velocities), and muscle activation patterns (MAP). Repeated measures analyses of variance compared how survivors of stroke reach with the stroke-affected versus less affected sides. Correlations were determined between kinematic outcomes and functional ability. Participants used significantly more trunk movement and less shoulder flexion and elbow extension when reaching with the stroke-affected side. This corresponded with less muscle activity in the proximal musculature including the anterior, middle, and posterior deltoid on the stroke-affected side. There were significant correlations between the segmental contributions to reach, functional ability, and MAPs. Survivors of stroke generate reduced MAPs in the stroke-affected side corresponding to altered segmental kinematics and function ability. These findings suggest that impairments in the ability to generate sufficient MAPs may contribute to the difficulty in generating continuous reaching motions.

Instructions emphasizing speed improves hemiparetic arm kinematics during reaching in stroke.

BACKGROUND: Stroke severely compromises the capacity for skilled motor control including the ability to reach with the stroke-affected upper-extremity. Research incorporating intensive motor therapies has broadly demonstrated the ability to improve hemiparetic reaching post-stroke, yet the role of specific task parameters has received less attention. These task parameters, such as speed-of-performance, may be important to the structure and delivery of motor rehabilitation. The objective of the study was to determine the influence of task pacing demands on hemiparetic reaching strategies in survivors of stroke. METHODS: Kinematic motion analysis was used to examine upper-extremity reaching patterns in 11 survivors of stroke. Participants were instructed to reach between two targets at a self-selected pace and as fast as possible. Outcome measures included maximal movement speed, accuracy, movement smoothness, and reaching strategies (anterior trunk flexion, elbow extension, and shoulder flexion). RESULTS: Participants reached significantly faster and smoother during the task that emphasized speed while maintaining target accuracy. Participants used significantly less anterior trunk displacement during the fast condition, yet no change in shoulder flexion. CONCLUSION: Task parameters that emphasize speed positively influence reaching strategies with the more-affected upper-extremity. Survivors of stroke were able to respond to changes in pacing demands while significantly reducing reliance on compensatory trunk movement. This outcome highlights the need to further understand the impact of task parameters during intensive motor therapies.

Elbow extension predicts motor impairment and performance after stroke.

Background and Purpose. Kinematic motion analysis has helped to characterize poststroke reaching strategies with the hemiparetic arm. However, the relationships between reaching strategy and performance on common functional outcome measures remain unclear. Methods. Thirty-five participants were tested for motor performance and motor impairment using the Wolf Motor Function Test (time and functional ability measure) and Fugl-Meyer assessment, respectively. Kinematic motion analysis of a forward reaching paradigm provided potential predictors of reaching strategy including shoulder flexion, elbow extension, and trunk displacement. A stepwise linear regression model with three potential predictors was used in addition to Pearson-product moment correlations. Results. Kinematic analysis of elbow extension predicted performance on both the Wolf Motor Function Test and Fugl-Meyer assessment. Shoulder flexion and trunk displacement did not significantly predict functional or reaching time outcomes. The Wolf Motor Function Test and the Fugl-Meyer assessment were highly correlated. Conclusions. The ability to incorporate elbow extension during reach is a significant predictor of motor performance and hemiparetic arm motor capacity after stroke.

Sympathetic responses to repetitive trans-spinal magnetic stimulation.

PURPOSE: Electromagnetic fields have been administered, with mixed success, in order to treat a variety of ailments. Transcranial magnetic stimulation (TMS) elicits brief changes in peripheral sympathetic nervous system (SNS) activity. The purpose of this study was to explore the utility of repetitive trans-spinal magnetic stimulation (rTSMS) for acute and prolonged modulation of SNS in adult humans. METHODS: 23 healthy men and women were randomly assigned to receive either rTSMS (figure-eight coil aligned with the sixth and seventh cervical vertebrae; 10 Hz; n = 14, at 100% intensity of stimulator output) or sham stimulation (n = 13). RESULTS: Compared with sham, rTSMS did not affect skeletal muscle SNS activity (via microneurography) during the 60-s or 10-min period following stimulation. rTSMS also had no effect on R-to-R interval (RR(int)) and standard deviation of RR(int) (a marker of heart rate variability), blood pressure or plasma concentrations of norepinephrine, epinephrine, insulin and glucose (condition/time interaction, all P > 0.10). CONCLUSION: These data suggest that rTSMS does not influence SNS in adults. While rTSMS represents a novel application of TMS technology, further study and perhaps modification of the technique is required before use in clinical studies of peripheral SNS function.

Does provision of extrinsic feedback result in improved motor learning in the upper limb poststroke? A systematic review of the evidence.

BACKGROUND: Recovery of the upper limb (UL) after a stroke occurs well into the chronic stage. Stroke survivors can benefit from adaptive plasticity to improve UL movement through motor relearning. The provision of feedback has been shown to decrease the use of compensatory UL movement patterns. However, the effectiveness of feedback in improving UL motor recovery after a stroke has not yet been systematically reviewed. OBJECTIVE: The objective of this review was to systematically examine the role of extrinsic feedback on implicit motor learning after stroke, focusing on UL movement and functional recovery. RESULTS: The authors retrieved 9 studies that examined the role of feedback on UL motor recovery. Of these, 6 were randomized controlled trials (RCTs), 1 was a single-subject design, 1 was a pre-post design, and 1 was a cohort study. The studies were rated on the basis of Sackett's levels of evidence and PEDro (Physiotherapy Evidence Database) scores for RCTs. Levels of evidence were limited (level 2b) for UL motor learning of the less-affected extremity and strong (level 1a) for the more-affected extremity. DISCUSSION AND CONCLUSIONS: The results suggest that people with stroke may be capable of using extrinsic feedback for implicit motor learning and improving UL motor recovery. Emergent questions regarding the advantages of using different media for feedback delivery and the optimal type and schedule of feedback to enhance motor learning in patient populations still need to be addressed.

Rhythmic auditory-motor entrainment improves hemiparetic arm kinematics during reaching movements: a pilot study.

PURPOSE: Recovery of skilled upper limb movement remains a critical focus of rehabilitation in individuals post stroke. Conventional treatments, however, have demonstrated limited capability to produce substantial improvements in poststroke quality of movement. Recently, rhythmic auditory stimulation (RAS) has emerged as efficacious in improving and normalizing limb movements in neurologically impaired populations. This pilot study examined changes in pre- to post-RAS reach kinematics and functional outcomes in survivors of stroke. METHOD: Five individuals in the chronic poststroke phase participated in a 2-week program of RAS training. Kinematic reaching variables were trunk, shoulder, and elbow segment contribution; movement time; and reach velocity. Functional outcomes were the Wolf Motor Function Test, Motor Activity Log, and Fugl-Meyer Assessment. RESULTS: Post-RAS assessment of reaching kinematics revealed a significant (p < .05) decrease in compensatory trunk movement, increase in shoulder flexion, and a slight increase in elbow extension. Movement time and velocity significantly improved post RAS. Significant gains were observed on all functional assessments. CONCLUSIONS: Post RAS, participants demonstrated substantial decreases in compensatory reaching movements. These changes in motor control strategy were paralleled by gains in functional abilities, suggesting that reduced reliance on compensatory movements may translate to improved performance of daily activities.

The effects of constraint-induced therapy on kinematic outcomes and compensatory movement patterns: an exploratory study.

OBJECTIVE: To determine changes in kinematic variables and compensatory movement patterns of survivors of stroke completing constraint-induced therapy (CIT). DESIGN: Pre-post, case series. SETTING: Clinical rehabilitation research laboratory. PARTICIPANTS: Men (n=7) and women (n=3) with unilateral stroke occurring at least 9 months prior to study entry with moderate, stable motor deficits. INTERVENTION: Participants completed 10 consecutive weekdays of CIT for 6 hours a day comprised of trainer-supervised, functionally based activities using massed practice. MAIN OUTCOME MEASURES: Kinematic measures included movement time, average velocity, trajectory stability, shoulder abduction, and segmental contribution. Functional measures included Wolf Motor Function Test (WMFT) performance time and functional ability scores and Motor Activity Log (MAL) "how-well" scores. All measures were administered before and after the 2-week CIT intervention. RESULTS: Movement time, average velocity, and trajectory stability significantly improved after CIT. Participants used more shoulder flexion to reach after CIT, but also demonstrated increased compensatory shoulder abduction. Functional scores also significantly improved, including WMFT performance time and functional ability and MAL scores. There was no change in trunk movement or amount of elbow extension. CONCLUSIONS: CIT improved motor capacities in the hemiparetic arm as reflected in the functional outcomes and in some kinematic measures. Participants' reliance on common compensatory movements was not beneficially affected by CIT. The results of this study demonstrate that while functional capacity and some movement strategies in the hemiparetic arm improve after CIT, participants may not overcome their reliance on common compensatory movement patterns. Based on these findings, this study suggests that CIT may encourage subjects to generate movement through compensatory and/or synergy-dominated movement rather than promote the normalization of motor control. This outcome highlights the need to develop CIT further as an intervention that improves functional capacity and more normative movement strategies.

Repetitive transcranial magnetic stimulation interrupts phase synchronization during rhythmic motor entrainment.

Rhythmic stimuli delivered through the auditory system can facilitate improved motor control following a motor impairment. The synchronization of movement to rhythmic auditory cues is characterized by quick, stable coupling of motor responses to rhythmic auditory cues. The exact neural sites responsible for this transformation of auditory input into timed rhythmic motor output are not clear. Neuroimaging studies have identified left ventral premotor cortex (vPMC) and left superior temporal-parietal (STP) activation during rhythmic auditory-motor synchronization. To investigate brain areas necessary for different types of rhythmic auditory-motor synchronization, we delivered repetitive transcranial magnetic stimulation (rTMS) to 15 healthy individuals prior to a rhythmic-auditory tapping task. Subthreshold rTMS was administered separately to the left vPMC and STP at a frequency of 0.9Hz for 15 min. Phase synchronization error (difference between auditory stimulus and response onsets) significantly increased after rTMS to STP as compared to baseline. Synchronization error also increased after rTMS to vPMC as compared to baseline, but not significantly. Absolute period error, (absolute difference between metronome interval and response interval) was not affected by rTMS. The significant effect of rTMS at the STP expands upon previous imaging research, suggesting that this area is part of the network responsible for rhythmic auditory-motor synchronization. The effect of rTMS on phase synchronization, but not period synchronization suggests these are separate neural processes controlled by different neural networks.

Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial.

OBJECTIVE: To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (rTMS) on motor learning in a group of stroke survivors undergoing constraint-induced therapy (CIT) for upper-limb hemiparesis. DESIGN: This was a prospective randomized, double-blind, sham-controlled, parallel group study. Nineteen individuals, one or more years poststroke, were randomized to either a rTMS + CIT (n = 9) or a sham rTMS + CIT (n = 10) group and participated in the 2-wk intervention. RESULTS: Regardless of group assignment, participants demonstrated significant gains on the primary outcome measures: the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL)--Amount of Use, and on secondary outcome measures including the Box and Block Test (BBT) and the MAL--How Well. Participants receiving rTMS failed to show differential improvement on either primary outcome measure. CONCLUSIONS: Although this study provided further evidence that even relatively brief sessions of CIT can have a substantial effect, it provided no support for adjuvant use of rTMS.

Feasibility of electromyography-triggered neuromuscular stimulation as an adjunct to constraint-induced movement therapy.

BACKGROUND AND PURPOSE: The purpose of this case report is to explore the feasibility of electromyography-triggered neuromuscular stimulation (EMG-stim) as an adjunct to constraint-induced movement therapy (CIMT). CASE DESCRIPTION: The patient was a 72-year-old man, 10 years poststroke, who did not meet traditional CIMT criteria. The EMG-stim was applied to the wrist extensors of the patient's weaker arm for one half of the CIMT training hours. OUTCOMES: The intervention was feasible for this individual. Improvements were observed in motor behavior, quality and amount of use, muscle activity, wrist range of motion, and reaction time of the more-affected extremity. These improvements were paralleled by a change in the size and location of the extensor digitorum communis muscle representation in the primary motor cortex, as measured by transcranial magnetic stimulation mapping. DISCUSSION: These changes suggest that using EMG-stim as an adjunct to CIMT should be further investigated in individuals who have low functional abilities following stroke.

A pneumatic vibrotactile stimulation device for fMRI.

Mapping the functional response of the somatosensory cortex is useful both for characterizing normal brain activity and for determining the functional integrity of damaged cortex compromised by stroke or other neurological insults. A variety of stimulators have been used to produce somatosensory cortex activation in functional brain imaging, including brushes and swabs operated manually, pneumatically and mechanically powered mechanical vibrators, air puffs, and vibrating ceramic piezoelectric wafers and benders. A closed-system, pneumatically driven rubber diaphragm is reported that overcomes many of the limitations of existing vibrotactile devices and produces robust sensory cortex activation in an fMRI experiment.