Resting-state connectivity and executive functions after pediatric arterial ischemic stroke.

BACKGROUND: The aim of this study was to compare the relationship between core executive functions and frontoparietal network connections at rest between children who had suffered an arterial ischemic stroke and typically developing peers. METHODS: Children diagnosed with arterial ischemic stroke more than two years previously and typically developing controls were included. Executive function (EF) measures comprised inhibition (Go-NoGo task), fluency (category fluency task), processing speed (processing speed tasks), divided attention, working memory (letter-number sequencing), conceptual reasoning (matrices) and EF in everyday life (questionnaire). High-resolution T1-weighted magnetic resonance (MR) structural images and resting-state functional MR imaging were acquired. Independent component analysis was used to identify the frontoparietal network. Functional connections were obtained through correlation matrices; associations between cognitive measures and functional connections through Pearson's correlations. RESULTS: Twenty participants after stroke (7 females; mean age 16.0 years) and 22 controls (13 females; mean age 14.8 years) were examined. Patients and controls performed within the normal range in all executive tasks. Patients who had had a stroke performed significantly less well in tests of fluency, processing speed and conceptual reasoning than controls. Resting-state functional connectivity between the left and right inferior parietal lobe was significantly reduced in patients after pediatric stroke. Fluency, processing speed and perceptual reasoning correlated positively with the interhemispheric inferior parietal lobe connection in patients and controls. CONCLUSION: Decreased interhemispheric connections after stroke in childhood may indicate a disruption of typical interhemispheric interactions relating to executive functions. The present results emphasize the relationship between functional organization of the brain at rest and cognitive processes.

Cortical reorganisation of cerebral networks after childhood stroke: impact on outcome.

BACKGROUND: Recovery after arterial ischaemic stroke is known to largely depend on the plastic properties of the brain. The present study examines changes in the network topography of the developing brain after stroke. Effects of brain damage are best assessed by examining entire networks rather than single sites of structural lesions. Relating these changes to post-stroke neuropsychological variables and motor abilities will improve understanding of functional plasticity after stroke. Inclusion of healthy controls will provide additional insight into children's normal brain development. Resting state functional magnetic resonance imaging is a valid approach to topographically investigate the reorganisation of functional networks after a brain lesion. Transcranial magnetic stimulation provides complementary output information. This study will investigate functional reorganisation after paediatric arterial ischaemic stroke by means of resting state functional magnetic resonance imaging and transcranial magnetic stimulation in a cross-sectional plus longitudinal study design. The general aim of this study is to better understand neuroplasticity of the developing brain after stroke in order to develop more efficacious therapy and to improve the post-stroke functional outcome. METHODS: The cross-sectional part of the study will investigate the functional cerebral networks of 35 children with chronic arterial ischaemic stroke (time of the lesion >2 years). In the longitudinal part, 15 children with acute arterial ischaemic stroke (shortly after the acute phase of the stroke) will be included and investigations will be performed 3 times within the subsequent 9 months. We will also recruit 50 healthy controls, matched for age and sex. The neuroimaging and neurophysiological data will be correlated with neuropsychological and neurological variables. DISCUSSION: This study is the first to combine resting state functional magnetic resonance imaging and transcranial magnetic stimulation in a paediatric population diagnosed with arterial ischaemic stroke. Thus, this study has the potential to uniquely contribute to the understanding of neuronal plasticity in the brains of healthy children and those with acute or chronic brain injury. It is expected that the results will lead to the development of optimal interventions after arterial ischaemic stroke.

Resultado funcional de la artroplastia de hombro en mayores de 65 años / Functional results of partial shoulder replacement in patients over 65 years

El objetivo de este trabajo es describir los resultados funcionales, a partir del año de la intervención, de un grupo de pacientes mayores de 65 años intervenidos con artroplastia parcial de hombro (APH). Material y método. Estudio descriptivo de 40 pacientes que tras fractura de la extremidad proximal del húmero (FEPH), fueron intervenidos mediante APH entre los años 2006-10. Utilizamos el cuestionario Quick Dash para conocer el resultado funcional, la escala visual analógica (EVA) para el dolor y el goniómetro manual para el recorrido articular del hombro. Para el análisis estadístico se utilizó el programa SPSS versión 15. Resultados. La edad media fue de 75,6 años (rango 65-88). El número de sesiones de rehabilitación fue de 38,8 de media. El tiempo transcurrido desde la cirugía a la valoración funcional final fue de 17,2 meses como media, el valor de la escala Quick Dash en esta valoración fue de 2,44 lo que pasado a porcentajes equivale a 36/100 (entre poca y moderada dificultad para las actividades); al analizar el dolor encontramos un valor medio de la EVA de 3,1. El valor medio de la antepulsión activa al finalizar la rehabilitación fue de 83,6°, la rotación externa: 33,1°, la rotación interna 30,6° y la abducción 74,6°. Conclusiones. Los pacientes mayores obtienen unos resultados funcionales aceptables y con escaso dolor tras APH, a pesar de no conseguir el recorrido articular activo completo del hombro(AU)

The aim of this study is to describe functional results one year after intervention in a group of patients over 65 years with partial shoulder replacement (PSR). Material and methods. A descriptive study, conducted between 2006 and 2010, that included 40 patients with PSR after fracture proximal humerus (FPH). We used Quick Dash questionnaire to evaluate functional results, visual analogue scale (VAS) for pain and manual goniometer for the shoulder joint range. Statistical analysis was performed using SPSS program version 15. Results. The mean of age was 75.6 years (range 65-88). The mean number of rehabilitation sessions was 38.8. The mean time from surgery up to final functional evaluation was 17.2 months. The score on Quick Dash questionnaire in this evaluation was 2.44 which is equal to 36% (between low and moderate difficulty in activities). The VAS score in the analysis of pain gave a mean of 3.1. The mean of the active joint ranges after rehabilitation were, 83.6° in antepulsion, 33.1° in external rotation, 30.6° in internal rotation, and 74.6° in abduction. Conclusions. Elderly patients obtained acceptable functional results and low pain after PSR, although they did not obtain the full active range of movement of the shoulder(AU)

[Functional results of partial shoulder replacement in patients over 65 years]. / Resultado funcional de la artroplastia de hombro en mayores de 65 años.

UNLABELLED: The aim of this study is to describe functional results one year after intervention in a group of patients over 65 years with partial shoulder replacement (PSR). MATERIAL AND METHODS: A descriptive study, conducted between 2006 and 2010, that included 40 patients with PSR after fracture proximal humerus (FPH). We used Quick Dash questionnaire to evaluate functional results, visual analogue scale (VAS) for pain and manual goniometer for the shoulder joint range. Statistical analysis was performed using SPSS program version 15. RESULTS: The mean of age was 75.6 years (range 65-88). The mean number of rehabilitation sessions was 38.8. The mean time from surgery up to final functional evaluation was 17.2 months. The score on Quick Dash questionnaire in this evaluation was 2.44 which is equal to 36% (between low and moderate difficulty in activities). The VAS score in the analysis of pain gave a mean of 3.1. The mean of the active joint ranges after rehabilitation were, 83.6° in antepulsion, 33.1° in external rotation, 30.6° in internal rotation, and 74.6° in abduction. CONCLUSIONS: Elderly patients obtained acceptable functional results and low pain after PSR, although they did not obtain the full active range of movement of the shoulder.