Adaptation in the motor cortex following cervical spinal cord injury.

BACKGROUND: The nature of the adaptive changes that occur in the cerebral cortex following injury to the cervical spinal cord are largely unknown. OBJECTIVE: To investigate these adaptive changes by examining the relationship between the motor cortical representation of the paretic right upper extremity compared with that of the tongue. The tongue was selected because the spinal cord injury (SCI) does not affect its movement and the cortical representation of the tongue is adjacent to that of the paretic upper extremity. METHODS: FMRI was used to map cortical representations associated with simple motor tasks of the right upper extremity and tongue in 14 control subjects and 9 patients with remote (>5.5 months) cervical SCI. RESULTS: The mean value for the site of maximum cortical activation during upper limb movement was identical between the two groups. The site of maximum left hemispheric cortical activation during tongue movement was 12.8 mm (p < 0.01) medial and superior to that of control subjects, indicating the presence of a shift in cortical activation. CONCLUSION: The findings indicate that the adult motor cortex does indeed adapt following cervical SCI. The nature of the adaptation and the underlying biological mechanisms responsible for this change require further investigation.

Implementing dual diagnosis services for clients with severe mental illness.

After 20 years of development and research, dual diagnosis services for clients with severe mental illness are emerging as an evidence-based practice. Effective dual diagnosis programs combine mental health and substance abuse interventions that are tailored for the complex needs of clients with comorbid disorders. The authors describe the critical components of effective programs, which include a comprehensive, long-term, staged approach to recovery; assertive outreach; motivational interventions; provision of help to clients in acquiring skills and supports to manage both illnesses and to pursue functional goals; and cultural sensitivity and competence. Many state mental health systems are implementing dual diagnosis services, but high-quality services are rare. The authors provide an overview of the numerous barriers to implementation and describe implementation strategies to overcome the barriers. Current approaches to implementing dual diagnosis programs involve organizational and financing changes at the policy level, clarity of program mission with structural changes to support dual diagnosis services, training and supervision for clinicians, and dissemination of accurate information to consumers and families to support understanding, demand, and advocacy.

Area Agencies on Aging: the community care connection.

This article reviews the conceptual difficulties in using the existing Medicare and Medicaid systems to provide community-based long-term care to older persons, discusses the role of the Older American's Act and Area Agencies on Aging in the effective provision of community-based long-term care, and presents several basic principles for long-term care legislation.

Conference on interdisciplinary issues in mental health and aging: workshop issues and recommendations.

The Conference of Interdisciplinary Issues in Mental Health and Aging included four workshops which focused on issues pertaining to the well elderly, the short-term impaired elderly, the chronic mentally ill elderly, and the organically impaired elderly. The Conference was convened to review and assess the impact of policy and program changes in the field of mental health and aging since the 1981 White House Conference on Aging and to reaffirm and strengthen interdisciplinary cooperation in addressing the mental health needs of older persons. This article presents the issues discussed in the workshops and recommendations regarding services, research, financing, and training and education which resulted from these sessions.