Broad Therapeutic Time Window for Driving Motor Recovery After TBI Using Activity-Dependent Stimulation.

BACKGROUND: After an acquired injury to the motor cortex, the ability to generate skilled movements is impaired, leading to long-term motor impairment and disability. While rehabilitative therapy can improve outcomes in some individuals, there are no treatments currently available that are able to fully restore lost function. OBJECTIVE: We previously used activity-dependent stimulation (ADS), initiated immediately after an injury, to drive motor recovery. The objective of this study was to determine if delayed application of ADS would still lead to recovery and if the recovery would persist after treatment was stopped. METHODS: Rats received a controlled cortical impact over primary motor cortex, microelectrode arrays were implanted in ipsilesional premotor and somatosensory areas, and a custom brain-machine interface was attached to perform the ADS. Stimulation was initiated either 1, 2, or 3 weeks after injury and delivered constantly over a 4-week period. An additional group was monitored for 8 weeks after terminating ADS to assess persistence of effect. Results were compared to rats receiving no stimulation. RESULTS: ADS was delayed up to 3 weeks from injury onset and still resulted in significant motor recovery, with maximal recovery occurring in the 1-week delay group. The improvements in motor performance persisted for at least 8 weeks following the end of treatment. CONCLUSIONS: ADS is an effective method to treat motor impairments following acquired brain injury in rats. This study demonstrates the clinical relevance of this technique as it could be initiated in the post-acute period and could be explanted/ceased once recovery has occurred.

Earlier Acupuncture Enhancing Long-Term Effects on Motor Dysfunction in Acute Ischemic Stroke: Retrospective Cohort Study.

Stroke is the leading fatal disease in China. This retrospective study aimed to explore the optimal acupuncture intervention time for long-term efficacy on motor dysfunction in patients suffering from acute ischemic stroke through 1-year of follow-up. Three hundred and nine patients collected at Longhua Hospital from January 2016 to December 2017 were classified into 3 groups based on the acupuncture intervention time, including groups A (within 2 days), B (within 3-7 days) and C (within 8-14 days). All patients had received standard treatment combined with acupuncture therapy. Specifically, acupuncture was performed at the acupoints including LI4 (Hegu), ST40 (Fenglong), DU20 (Baihui), and motor area of the scalp, followed by 2 electroacupuncture protocols based on different muscle tensions once a day for 5 days consecutively. The time-effect relationship was assessed using both the Fugl-Meyer Assessment (FMA) and the modified Barthel index (MBI) on the 90th day and 1st year, respectively. Meanwhile, the modified Rankin scale (mRS), high-sensitivity C-reactive protein (hs-CRP), and fibrinogen (FIB) were also measured during the 1-year follow-up. The favorable outcome rate was 74.4%. One-way univariate analysis of variance (ANOVA) revealed significant differences in FMA and MBI on the 90th day among the 3 groups ([Formula: see text] < 0.05), while no significant differences were observed in FMA, MBI or mRS at the 1st year between groups A and B. The levels of hs-CRP and FIB ([Formula: see text] < 0.05) were markedly reduced. Binary logistic regression analysis suggested that patients with atrial fibrillation (AF) (odds ratio (OR): 3.156), chronic kidney disease (CKD) (OR: 2.563), diabetes mellitus (DM) (OR: 2.174) or stroke history (OR: 1.883) were more inclined to recover poorly from nerve function deficit ([Formula: see text] < 0.05). Earlier acupuncture intervention may have a better long-term effect on motor dysfunction and inflammation during the 1-year follow-up. Moreover, acupuncture within 2 days is probably the optimal treatment time for early recovery on the 90th day.

[The efficacy of tes-therapy for treatment of anxiety-like behavior and motor disorders in rats with an experimental model of parkinsonism]. / Éffektivnost' TÉS-terapii dlia kupirovaniia trevogopodobnogo povedeniia i motornykh narushenii u krys s éksperimental'noi model'iu parkinsonizma.

AIM: To assess the efficacy of transcranial electrostimulation TES for treatmnet of anxiety-like behavior and motor disorders in rats with rotenone-induced parkinsonism. MATERIAL AND METHODS: The study was performed on 30 mature male-rats. Animals were divided into following groups: control, intact rats (group 1); rats with an experimental model of parkinsonism without treatment (group 2); rats with an experimental model of parkinsonism, which had 7 sessions of TES-therapy (group 3), the number of rats in each group was 10. The parkinsonism model was achieved by daily rotenone administration for 28 days. Parkinsonism's markers were assessed using 3-point scale; anxiety-like behavior and motor activity were assessed in the open-field test. TES was performed using TRANSAIR-stimulator for 7 days. Substantia nigra slices were stained with hematoxylin and Lillie's staining for neuromelanin. RESULTS: The rats of group 3 show less neurological deficits, less anxiety-like behavior and less neurodegeneration in the substantia nigra. There are a decrease in individual total scores of motor disorders by 50%, a decrease in the level of anxiety-like behavior or the absence of its increase in the open-field test. CONCLUSION: TES-therapy may be used as an additional non-pharmacological treatment of motor and related non-motor damage in Parkinson's disease.

Efectos de la hipoterapia sobre la función motora en personas con síndrome de Down: revisión sistemática / Effects of hypotherapy on the motor function of persons with Down’s syndrome: a systematic review

Introducción. El síndrome de Down es la principal causa de discapacidad intelectual y la alteración genética humana más común. Entre las alteraciones más importantes que se presentan se encuentran las deficiencias motoras. La hipoterapia es un tratamiento sobre el caballo y con el caballo, y se usa en la actualidad como terapia en la corrección de dichas disfunciones. Objetivo. Analizar las evidencias científicas existentes sobre el efecto que la hipoterapia ejerce en la función motora de personas con síndrome de Down. Sujetos y métodos. Se efectuó una amplia búsqueda de la bibliografía en las siguientes bases de datos: CINAHL, Medline, The Cochrane Library, PEDro, Scopus y Web of Science. Además, se consultaron las revistas Fisioterapia y Cuestiones de Fisioterapia. Las búsquedas se realizaron incluyendo los artículos publicados entre los años 2000 y 2016. La estrategia de búsqueda electrónica se planteó en dos bloques temáticos: síndrome de Down e hipoterapia. La selección de artículos se llevó a cabo siguiendo unos criterios de inclusión y exclusión, y se eliminaron los artículos duplicados. Resultados. En la búsqueda realizada para esta investigación se encontraron 23 artículos, y quedaron como válidos ocho después de excluir el resto por diferentes motivos. Conclusiones. No existen evidencias sólidas sobre la mejora o no de la función motora en personas con síndrome de Down tras el tratamiento con hipoterapia. Son necesarios más estudios, y de mayor calidad metodológica, para poder constatar la efectividad de la hipoterapia en el tratamiento de la función motora gruesa en sujetos con síndrome de Down

Introduction. Down's syndrome is the main cause of intellectual disability and the most common human genetic alteration. Motor impairments are among the most important alterations presented by Down's syndrome subjects. Hippotherapy is a treatment on and with a horse, and it is currently being used as a therapy to correct those dysfunctions. Aim. To review published research literature on the effect exerted by hippotherapy on the gross motor function of people with Down's syndrome. Subjects and methods. The bibliography in the following databases has been widely searched: CINAHL, Medline, The Cochrane Library, PEDro, Scopus, and Web of Science. The journals Fisioterapia and Cuestiones de Fisioterapia have also been consulted. The electronic literature search strategy was addressed in two thematic fields: Down's syndrome and hippotherapy. Studies selection was carried out following inclusion and exclusion criteria and rejecting duplicate papers. That search included articles published between 2000 and 2016. Results. For this work, 23 articles were found, 15 of which were discarded for different reasons, leaving 8 valid ones. Conclusions. There is no strong evidence on the improvement of gross motor function in people with Down's syndrome after treatment with hippotherapy. More studies with higher methodological quality, are needed to verify the effectiveness of hippotherapy in the treatment of gross motor function in subjects with Down's syndrome

Efeito do exercício físico nas funções cognitivas e motoras de idosos com doença de Alzheimer: uma revisão / Effect of physical exercise on the cognitive and motor functions of the older people with Alzheimer's disease: a review

OBJETIVO: Analisar o efeito do exercício físico nos aspectos cognitivos e motores de idosos com doença de Alzheimer. MÉ- TODOS: Foi realizada busca nas seguintes bases de dados: Pub- Med, MEDLINE, LILACS, Periódico CAPES e Web of Science ™, no período de 2011 a 2016. Foram utilizadas as seguintes palavras-chave: "physical exercise", "exercise", "training", "motor intervention", "aged", "older", "elderly", "Alzheimer's dementia", "Alzheimer's disease", "Alzheimer", "Cognition", "cognitive performance", "motor" e "motor performance". RESULTADOS: Além da busca em base de dados, foi realizada busca manual nas listas de referências dos artigos selecionados. Foram encontrados três estudos que preencheram todos os critérios de inclusão adotados neste trabalho. Todos demonstraram melhoras tanto no desempenho cognitivo quanto motor de idosos com doença de Alzheimer submetidos a exercícios físicos. CONCLUSÃO: Observou-se melhora e/ou manutenção das funções cognitivas e motoras em todos os estudos. Apesar disso, não houve consenso sobre o tipo de exercício, sua intensidade e a duração adequada para idosos com doença de Alzheimer. (AU)

OBJECTIVE: To analyze the effect of physical exercise on the cognitive and motor aspects of older people with Alzheimer's disease. METHODS: The following databases were searched: Pubmed, Medline, Lilacs, CAPES Journal, and Web of Science from 2011 to 2016. The following keywords were used: "Physical exercise", "exercise", "training "" Motor intervention "," Aged "," older "," elderly","Alzheimer's dementia","Alzheimer's disease","Alzheimer", "Cognition", "cognitive performance", "Motor". RESULTS: In addition to database search, a manual search was performed in the reference lists of the selected articles. Three studies were found that fulfilled all the inclusion criteria adopted in this study. All of them demonstrated improvements in both the cognitive and motor performance of older people with Alzheimer's disease undergoing physical exercises. CONCLUSION: Improvement and/or maintenance of cognitive and motor functions was observed in all studies. Despite this, there was no consensus on the type of exercise, its intensity and adequate duration for elderly people with Alzheimer's disease. (AU)

Electroacupunctre improves motor impairment via inhibition of microglia-mediated neuroinflammation in the sensorimotor cortex after ischemic stroke.

AIMS: Electroacupuncture (EA) is one of the safety and effective therapies for improving neurological and sensorimotor impairment via blockade of inappropriate inflammatory responses. However, the mechanisms of anti-inflammation involved is far from been fully elucidated. MAIN METHODS: Focal cerebral ischemic stroke was administered by the middle cerebral artery occlusion and reperfusion (MCAO/R) surgery. The MCAO/R rats were accepted EA treatment at the LI 11 and ST 36 acupoints for consecutive 3days. The neurological outcome, animal behaviors test and molecular biology assays were used to evaluate the MCAO/R model and therapeutic effect of EA. KEY FINDINGS: EA treatment for MCAO rats showed a significant reduction in the infarct volumes accompanied by functional recovery in mNSS outcomes, motor function performances. The possible mechanisms that EA treatment attenuated the over-activation of Iba-1 and ED1 positive microglia in the peri-infract sensorimotor cortex. Simultaneously, both tissue and serum protein levels of the tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß) and interleukin-6 (IL-6) were decreased by EA treatment in MCAO/R injured rats. The levels of inflammatory cytokine tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), interleukin-6 (IL-6) were decreased in the peri-infract sensorimotor cortex and blood serum of MCAO/R injured rats after EA treatment. Furthermore, we found that EA treatment prevented from the nucleus translocation of NF-κB p65 and suppressed the expression of p38 mitogen-activated protein kinase (p38 MAPK) and myeloid differentiation factor 88 (MyD88) in the peri-infract sensorimotor cortex. SIGNIFICANCE: The findings from this study indicated that EA improved the motor impairment via inhibition of microglia-mediated neuroinflammation that invoked NF-κB p65, p38 MAPK and MyD88 produced proinflammatory cytokine in the peri-infract sensorimotor cortex of rats following ischemic stroke.

Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review.

Person-centered care (PCC) shifts focus away from the traditional biomedical model in favor of embracing personal choice and autonomy for people receiving health services. It has become an important avenue for improving primary care, and older adults remain a priority target for PCC because they are more likely to have complex care needs than younger individuals. Nevertheless, despite a growing body of evidence regarding its use, PCC still lacks an agreed-upon definition. A literature review was conducted to explore extant scholarship on PCC for older adults, assess corresponding definitions of PCC, and identify important elements of quality PCC. Nearly 3,000 articles published between 1990 and 2014 were identified. Excluding search results outside the parameters of this study, the final review comprised 132 nonduplicate sources focused on patient-centered care or PCC in older adults. Fifteen descriptions of PCC were identified, addressing 17 central principles or values. The six most-prominent domains of PCC were holistic or whole-person care, respect and value, choice, dignity, self-determination, and purposeful living. The body of evidence reviewed suggests that PCC is an important area of growing interest. Although multiple definitions and elements of PCC abound-with many commonalities and some overlap-the field would benefit from a consensus definition and list of essential elements to clarify how to operationalize a PCC approach to health care and services for older adults. This work guided the development of a separate American Geriatrics Society expert panel statement presenting a standardized definition and a list of PCC elements for older adults with chronic conditions or functional impairment.

Rizotomia seletiva posterior ou tratamento neuroevolutivo bobath para a criança com disfunção neuromotora espástica? / Selective posterior rhizotomy or bobath neuro-developmental treatment for the child with spastic neuromotor dysfunction?

A espasticidade encontra-se geralmente presente em crianças com Disfunção Neuromotora. Neste estudo, abordamos duas formas de tratamento que atuam na normalização do tônus, sendo uma cirúrgica e outra conservadora. A Rizotomia Seletiva Posterior caracteriza-se pela secção parcial das raízes aferentes lombo-sacrais. Já o Tratamento Neuroevolutivo Bobath utiliza técnicas manuais para adequar o tônus e, concomitantemente, proporcionar funcionalidade a criança. O objetivo do trabalho consiste na análise criteriosa das duas terapias, visando avaliar a necessidade de submeter o paciente a um procedimento invasivo. Pretendemos, desta forma, ampliar os conhecimentos dos profissionais que constituem uma equipe multidisciplinar, no sentido de facilitar a escolha do tratamento adequado para estas crianças com Disfunção Neuromotora. Independentemente do método eleito, é importante ressaltar que a qualidade de vida deve ser sempre priorizada. Portanto, o paciente precisa ser tratado como um todo, adequando o tônus e permitindo-lhe função. E de extrema importância a avaliação criteriosa individualizada, uma vez que a Rizotomia Seletiva Posterior pode atuar come complemento a reabilitação, na promoção de melhores resultados.

Spasticity is generally found in children with Neuromotor Dysfunction. In this study, we approach two forms of treatment that act in the normalization of the tone: one surgical and other conservative. The Selective Posterior Rhizotomy is characterized by the partial section of the afferent lombosacral roots. As for the Bobath Neuro-developmental treatment, some manual techniques are used to adequate the tone, and accordingly, to allow the children to make use of their functions. The objective of this paper is to analyze carefully both therapies, aiming at evaluating the need to submit the patient to surgery. We intend to enlarge the knowledge of professionals taking part of a Multidiscipline team, to facilitate the choice of the best treatment for children with Neuromotor Dysfunction. Regardless of the method chosen it is important to remark that the quality of life must be a priority. Therefore, the patients have to be treated as a whole, enabling them to adequate tone and allowing them to use the function. It is extremely important to have a very careful individual evaluation, once the Selective Posterior Rhizotomy can be a complement to rehabilitation for a better outcome.

Rizotomia seletiva posterior ou tratamento neuroevolutivo bobath para a criança com disfunção neuromotora espástica? / Selective posterior rhizotomy or bobath neuro-developmental treatment for the child with spastic neuromotor dysfunction?

A espasticidade encontra-se geralmente presente em crianças com Disfunção Neuromotora. Neste estudo, abordamos duas formas de tratamento que atuam na normalização do tônus, sendo uma cirúrgica e outra conservadora. A Rizotomia Seletiva Posterior caracteriza-se pela secção parcial das raízes aferentes lombo-sacrais. Já o Tratamento Neuroevolutivo Bobath utiliza técnicas manuais para adequar o tônus e, concomitantemente, proporcionar funcionalidade a criança. O objetivo do trabalho consiste na análise criteriosa das duas terapias, visando avaliar a necessidade de submeter o paciente a um procedimento invasivo. Pretendemos, desta forma, ampliar os conhecimentos dos profissionais que constituem uma equipe multidisciplinar, no sentido de facilitar a escolha do tratamento adequado para estas crianças com Disfunção Neuromotora. Independentemente do método eleito, é importante ressaltar que a qualidade de vida deve ser sempre priorizada. Portanto, o paciente precisa ser tratado como um todo, adequando o tônus e permitindo-lhe função. E de extrema importância a avaliação criteriosa individualizada, uma vez que a Rizotomia Seletiva Posterior pode atuar come complemento a reabilitação, na promoção de melhores resultados.(AU)

Spasticity is generally found in children with Neuromotor Dysfunction. In this study, we approach two forms of treatment that act in the normalization of the tone: one surgical and other conservative. The Selective Posterior Rhizotomy is characterized by the partial section of the afferent lombosacral roots. As for the Bobath Neuro-developmental treatment, some manual techniques are used to adequate the tone, and accordingly, to allow the children to make use of their functions. The objective of this paper is to analyze carefully both therapies, aiming at evaluating the need to submit the patient to surgery. We intend to enlarge the knowledge of professionals taking part of a Multidiscipline team, to facilitate the choice of the best treatment for children with Neuromotor Dysfunction. Regardless of the method chosen it is important to remark that the quality of life must be a priority. Therefore, the patients have to be treated as a whole, enabling them to adequate tone and allowing them to use the function. It is extremely important to have a very careful individual evaluation, once the Selective Posterior Rhizotomy can be a complement to rehabilitation for a better outcome.(AU)

Three 'anecdotes': food for thought

16 years from onset, a patient with motor neurone disease lives a normal life. A lady presenting with chronic myeloid leukaemia, the diagnosis confirmed by bone marrow studies, was treated with busulphan for a total of 5 weeks. 14 years later, bone marrow examination was normal and the condition could only be diagnosed from the Philadelphia chromosome