Bidirectional and multi-user telerehabilitation system: clinical effect on balance, functional activity, and satisfaction in patients with chronic stroke living in long-term care facilities.

BACKGROUND: The application of internet technology for telerehabilitation in patients with stroke has developed rapidly. OBJECTIVE: The current study aimed to evaluate the effect of a bidirectional and multi-user telerehabilitation system on balance and satisfaction in patients with chronic stroke living in long-term care facilities (LTCFs). METHOD: This pilot study used a multi-site, blocked randomization design. Twenty-four participants from three LTCFs were recruited, and the participants were randomly assigned into the telerehabilitation (Tele) and conventional therapy (Conv) groups within each LTCF. Tele group received telerehabilitation but the Conv group received conventional therapy with two persons in each group for three sessions per week and for four weeks. The outcome measures included Berg Balance Scale (BBS), Barthel Index (BI), and the telerehabilitation satisfaction of the participants. SETTING: A telerehabilitation system included "therapist end" in a laboratory, and the "client end" in LTCFs. The conventional therapy was conducted in LTCFs. RESULTS: Training programs conducted for both the Tele and Conv groups showed significant effects within groups on the participant BBS as well as the total and self-care scores of BI. No significant difference between groups could be demonstrated. The satisfaction of participants between the Tele and the Conv groups also did not show significant difference. CONCLUSIONS: This pilot study indicated that the multi-user telerehabilitation program is feasible for improving the balance and functional activity similar to conventional therapy in patients with chronic stroke living in LTCFs.

Postnatal development of microcyst in the anteroventral cochlear nucleus of the Mongolian gerbil: a light- and electron microscopic study.

We investigated the postnatal formation and origin of the microcyst, which are not fully elucidated at present, in the cochlear nucleus of gerbils. Sixty-six Mongolian gerbils were investigated at the light microscope level, and 35 of them were observed at the electron microscopic level. Foamy structures were evidently found at 2 days of age and remained unchanged through 4-8 days. The first small vacuole, presumably the former microcyst, appeared at 8 days. Myelin sheath bundles first appeared at 13 days. Electron-dense bodies were frequently found in the junction of the superficial layer and the deep layer at 2 days. The medium-sized vacuole was found in close association with the spherical bushy cells in the anteroventral cochlear nucleus (AVCN) as early as 5 weeks. Various large and small vacuoles were presumably coalesced to form a large vacuole at 3 and 6 months. Membranous structures and red blood cells were in the budding-like vacuoles at 6 months. In addition to membranous structures, the microcyst contained distorted mitochondria and parts of myelin sheaths. The vacuole was interposed between spherical bushy cells at age of 10 months. Small vacuoles were mainly located in the flame-shaped neurons at 14 months. An internal detachment and an external protrusion of the myelin sheath into the adjacent microcyst were found. Thus, this study suggests the first appearance of microcysts at 8 days. Also, the microcyst and the blood vessel may exchange their contents through a leakage in the anteroventral cochlear nucleus.

Elevation of plasma and cerebrospinal fluid osteopontin levels in patients with atypical teratoid/rhabdoid tumor.

Osteopontin, a cancer metastasis-associated gene, is specifically up-regulated in central nervous system (CNS) atypical teratoid/rhabdoid tumor (AT/RT), but its biological behavior in the progression of CNS AT/RT has never been studied. We obtained plasma, cerebrospinal fluid (CSF), and brain tissue specimens from lobectomy or hemispherectomy samples from 39 patients (medulloblastoma, 16; AT/RT, 8; epilepsy, 6; hydrocephalus, 9). By enzyme-linked immunosorbent assay, the median osteopontin levels in plasma and CSF in AT/RT (852.0 and 1,175.0 ng/mL, respectively) were significantly higher than in medulloblastoma (492.5 and 524.5 ng/mL, respectively) and hydrocephalus and epilepsy (208.0 and 168.0 ng/mL, respectively) (P < .05). The results of real-time reverse transcriptase-polymerase chain reaction and immunohistochemical analysis demonstrated that osteopontin expression in AT/RT (n = 5) was significantly higher than in medulloblastoma (n = 8) samples. The differences in osteopontin expression in plasma, CSF, and tumor samples in AT/RT and medulloblastoma correlated with survival differences. In 5 patients with AT/RT, plasma osteopontin levels decreased after treatment but increased with relapse. Osteopontin might be a potential marker to aid in identifying AT/RT recurrence.

Treadmill training effects in different age groups following middle cerebral artery occlusion in rats.

BACKGROUND: Despite the increased understanding of treadmill training on stroke patients, its effects on different age groups are not clearly known. The present study presents such effects through a model of cerebral ischemia on young and old groups of rats. OBJECTIVES: To investigate the effect of treadmill training on young and old rats after cerebral ischemia caused by middle cerebral artery occlusion (MCAO). METHODS: Forty old (22-24 months of age) and 32 young (3-4 months of age) rats underwent the MCAO procedure for 60 min. Rats that survived the procedure were randomly assigned to a 1- or a 2-week treadmill training group, or a time-matched control group (n=6-8 for each group). The infarct volume was compared between the treadmill training and the control groups for both the young and old rats at 1 or 2 weeks. RESULTS: After treadmill training for 1 week, the mean infarct volume was 7.26+/-0.49 and 9.51+/-0.84% for the young and old rats, respectively. The 1-week treadmill training effect was significant in the young rats (p=0.0207) but not in the old rats (p=0.0840). The mean infarct volume was 6.84+/-0.51 and 7.63+/-0.52% for the young and old rats, respectively, after the 2-week treadmill training. Both the young and old rat groups demonstrated a significant reduction in the infarct volume compared with that of the control group (p=0.021 for the young group and p=0.039 for the old group) after 2 weeks of treadmill training. CONCLUSION: The present findings clearly demonstrate the different training effects of locomotor activity in reducing ischemic infarction in young and old rats. The delayed reduction in ischemic infarction in old rats was notable and may be attributable to the slow response of angiogenic and neurogenic mechanisms in the old rats.

Treadmill training effects on neurological outcome after middle cerebral artery occlusion in rats.

BACKGROUND: Treadmill training is used for promoting rhythmical vigorous walking and for task-related training in patients with stroke. The neurological impact of treadmill training has not been established. The present investigation is aimed at (1) examining neurological changes over a four-week period after middle cerebral artery occlusion (MCAO) in rats and (2) assessing the impact of one-week, two-week and four-week treadmill training in MCAO rats. METHODS: Male Sprague-Dawley rats were subjected to 60-minute right MCAO. All rats were randomly assigned to one of seven groups. Infarct volume and neurological score were measured. RESULTS: Rats sacrificed 24 hours post MCAO had the largest infarct volumes (171.4 +/- 14.4 mm3) and the highest neurological score (median: 2, range: 1-3). We noted that without treadmill training, infarct sizes and neurological score diminished with time. Treadmill training for at least one week further reduced infarct volume and significantly improved neurologic function in MCAO rats. CONCLUSION: Treadmill training after focal cerebral ischemia significantly improves neurological outcome in MCAO rats. Treadmill training may be beneficial for ischemic brain recovery.