RESUMEN
BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) and Repetitive facilitative exercise (RFE) improves motor impairment after stroke. OBJECTIVE: To investigate whether neuromuscular electrical stimulation (NMES) can facilitate the effects of rTMS and RFE on the function of the hemiparetic hand in stroke patients. METHODS: This randomized double-blinded crossover study divided 20 patients with hemiparesis into two groups and provided treatment for 4 weeks at 5 days/week. NMES-before-sham group and NMES-following-sham group performed NMES sessions and sham NMES sessions for each 2 weeks. Patients received NMES or sham NMES for the affected extensor muscle concurrently with 1âHz rTMS for the unaffected motor cortex for 10âmin and performed RFE for 60âmin. The Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Box and Block Test (BBT) and Modified Ashworth Scale (MAS) were used for evaluation. RESULTS: FMA and ARAT improved significantly during both sessions. The gains in the BBT during an NMES session were significantly greater than those during a sham NMES session. MAS for the wrist and finger significantly decreased only during an NMES session. CONCLUSIONS: NMES combined with rTMS might facilitate, at least in part, the beneficial effects of RFE on motor function and spasticity of the affected upper limb.
Asunto(s)
Terapia por Ejercicio/métodos , Mano , Paresia/rehabilitación , Rehabilitación de Accidente Cerebrovascular/métodos , Estimulación Transcraneal de Corriente Directa/métodos , Estimulación Magnética Transcraneal/métodos , Adulto , Anciano , Terapia Combinada/métodos , Terapia Combinada/tendencias , Estudios Cruzados , Método Doble Ciego , Terapia por Estimulación Eléctrica/métodos , Terapia por Estimulación Eléctrica/tendencias , Terapia por Ejercicio/tendencias , Femenino , Mano/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Paresia/fisiopatología , Distribución Aleatoria , Accidente Cerebrovascular/complicaciones , Rehabilitación de Accidente Cerebrovascular/tendencias , Estimulación Transcraneal de Corriente Directa/tendencias , Estimulación Magnética Transcraneal/tendencias , Resultado del TratamientoRESUMEN
With countless research papers using preclinical models and showing the superiority of nanoparticle design over current drug therapies used to treat cancers, it is surprising how deficient the translation of these nano-sized drug carriers into the clinical setting is. This review article seeks to compare the preclinical and clinical results for Doxil®, PK1, Abraxane®, Genexol-PM®, Xyotax™, NC-6004, Mylotarg®, PK2, and CALAA-01. While not comprehensive, it covers nano-sized drug carriers designed to improve the efficacy of common drugs used in chemotherapy. While not always available or comparable, effort was made to compare the pharmacokinetics, toxicity, and efficacy between the animal and human studies. Discussion is provided to suggest what might be causing the gap. Finally, suggestions and encouragement are dispensed for the potential that nano-sized drug carriers hold.