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1.
Handb Clin Neurol ; 183: ix-x, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34389128
2.
Handb Clin Neurol ; 183: 283-297, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34389123

RESUMO

Neurological disease can impair emotional communication by several means: damaging the networks important in understanding the meaning of emotional stimuli (emotional semantics); damaging networks important in the perceptual recognition and production of emotional stimuli, and damaging the connections between networks supporting emotional semantics and recognition/production networks. Disorders of emotional expression, comprehension, and emotional semantics may improve with pharmacological or behavioral treatments. Pharmacological treatments can be used to redress naturally occurring or disease-related alterations in the computational properties of target neural systems. No drug treatment can replace a loss of cerebral knowledge related to the pathological loss of neural connectivity. Behavioral treatments that benefit either comprehension or expression of specific emotions may be of value if these emotions are particularly important in enabling human social interaction. However, behavioral treatments that achieve generalization, that is, improve performance with untrained exemplars and in daily life, are much to be preferred, even as they pose the greatest methodological challenges. This chapter will discuss possible mechanisms of generalization and then review what is known about the treatment of expressive and receptive affective aprosodia, deficits in recognition of facial emotions, and pseudobulbar affect. The final section of the chapter is devoted to a discussion of three disorders of emotional semantics, apathy, alexithymia, and impaired empathy.


Assuntos
Compreensão , Semântica , Sintomas Afetivos , Emoções , Empatia , Humanos
3.
Handb Clin Neurol ; 183: 299-313, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34389124

RESUMO

This chapter brings the powerful conceptual tools of the science of parallel distributed processing (PDP) to bear on the cognitive neuroscience of emotions discussed in this book. Cerebral representations are encoded as patterns of activity involving billions of neurons. PDP across these neuronal populations provides the basis for a number of emergent properties: (1) processing occurs and knowledge (long term memories) is stored (as synaptic connection strengths) in exactly the same networks; (2) networks have the capacity for setting into stable attractor states corresponding to concepts, symbols, implicit rules, or data transformations; (3) networks provide the scaffold for the acquisition of knowledge, but knowledge is acquired through experience; (4) PDP networks are adept at incorporating the statistical regularities of experience as well as frequency and age of acquisition effects; (5) networks enable content-addressable memory; (6) because knowledge is distributed throughout networks, they exhibit the property of graceful degradation; (7) networks intrinsically provide the capacity for inference. With this perspective, I propose a new model of emotional function that reasonably accounts for the effects of focal lesions at various points (insula, orbitofrontal cortex, convexity cortex, and intervening white matter) due to stroke, trauma, surgery, and degenerative disease, as reflected in disorders of affective prosody, facial emotional comprehension and expression, emotional behavior, and personality. I consider a modification of the James Lange theory that takes into account the role of a lifetime of subjective knowledge acquisition by the orbitofrontal cortex. Alexithymia is conceptualized as a disorder of the insula/orbitofrontal cortex/dorsolateral prefrontal cortex (DL-PFC) system, the function of which can be disrupted by degradation of knowledge at a number of different locations. Finally, I consider the possibility that depression reflects pathological learning involving the medial and lateral orbitofrontal cortices such that there is a pathologic engagement of the two regions, as suggested by Rolls. I conclude with a consideration of the peculiar responsivity of depression to serotonergic and noradrenergic agents, as well as to surgical orbitofrontal undercutting, and what that might be telling us about the mechanisms of depression and its treatment.


Assuntos
Sintomas Afetivos , Depressão , Mapeamento Encefálico , Emoções , Humanos , Imageamento por Ressonância Magnética , Córtex Pré-Frontal
4.
Neuropsychol Rev ; 31(3): 495-515, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33512608

RESUMO

Cerebral representations are encoded as patterns of activity involving billions of neurons. Parallel distributed processing (PDP) across these neuronal populations provides the basis for a number of emergent properties: 1) processing occurs and knowledge (long term memories) is stored (as synaptic connection strengths) in exactly the same networks; 2) networks have the capacity for setting into stable attractor states corresponding to concepts, symbols, implicit rules, or data transformations; 3) networks provide the scaffold for the acquisition of knowledge but knowledge is acquired through experience; 4) PDP networks are adept at incorporating the statistical regularities of experience as well as frequency and age of acquisition effects; 5) networks enable content-addressable memory; 6) because knowledge is distributed throughout networks, they exhibit the property of graceful degradation; 7) networks intrinsically provide the capacity for inference. This paper details the features of the basal ganglia and thalamic systems (recurrent and distributed connectivity) that support PDP. The PDP lens and an understanding of the attractor trench dynamics of the basal ganglia provide a natural explanation for the peculiar dysfunctions of Parkinson's disease and the mechanisms by which dopamine deficiency is causal. The PDP lens, coupled with the fact that the basal ganglia of humans bears strong homology to the basal ganglia of lampreys and the central complex of arthropods, reveals that the fundamental function of the basal ganglia is computational and involves the reduction of the vast dimensionality of a complex multi-dimensional array of sensorimotor input into the optimal choice from a small repertoire of behavioral options - the essence of reactive intention (automatic responses to sensory input). There is strong evidence that the sensorimotor basal ganglia make no contributions to cognitive or motor function in humans but can cause serious dysfunction when pathological. It appears that humans, through the course of evolution, have developed cortical capacities (working memory and volitional and reactive attention) for managing sensory input, however complex, that obviate the need for the basal ganglia. The functions of the dorsal tier thalamus, however, even viewed with an understanding of the properties of population encoded representations, remain somewhat more obscure. Possibilities include the enabling of attractor state constellations that optimize function by taking advantage of simultaneous input from multiple cortical areas; selective engagement of cortical representations; and support of the gamma frequency synchrony that enables binding of the multiple network representations that comprise a full concept representation.

5.
Front Hum Neurosci ; 14: 50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226366

RESUMO

Representations in the brain are encoded as patterns of activity of large populations of neurons. The science of population encoded representations, also known as parallel distributed processing (PDP), achieves neurological verisimilitude and has been able to account for a large number of cognitive phenomena in normal people, including reaction times (and reading latencies), stimulus recognition, the effect of stimulus salience on attention, perceptual invariance, simultaneous egocentric and allocentric visual processing, top-down/bottom-up processing, language errors, the effect of statistical regularities of experience, frequency, and age of acquisition, instantiation of rules and symbols, content addressable memory and the capacity for pattern completion, preservation of function in the face of noisy or distorted input, inference, parallel constraint satisfaction, the binding problem and gamma coherence, principles of hippocampal function, the location of knowledge in the brain, limitations in the scope and depth of knowledge acquired through experience, and Piagetian stages of cognitive development. PDP studies have been able to provide a coherent account for impairment in a variety of language functions resulting from stroke or dementia in a large number of languages and the phenomenon of graceful degradation observed in such studies. They have also made important contributions to our understanding of attention (including hemispatial neglect), emotional function, executive function, motor planning, visual processing, decision making, and neuroeconomics. The relationship of neural network population dynamics to electroencephalographic rhythms is starting to emerge. Nevertheless, PDP approaches have scarcely penetrated major areas of study of cognition, including neuropsychology and cognitive neuropsychology, as well as much of cognitive psychology. This article attempts to provide an overview of PDP principles and applications that addresses a broader audience.

6.
J Speech Lang Hear Res ; 62(12): 4464-4482, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31805247

RESUMO

Purpose The ultimate goal of anomia treatment should be to achieve gains in exemplars trained in the therapy session, as well as generalization to untrained exemplars and contexts. The purpose of this study was to test the efficacy of phonomotor treatment, a treatment focusing on enhancement of phonological sequence knowledge, against semantic feature analysis (SFA), a lexical-semantic therapy that focuses on enhancement of semantic knowledge and is well known and commonly used to treat anomia in aphasia. Method In a between-groups randomized controlled trial, 58 persons with aphasia characterized by anomia and phonological dysfunction were randomized to receive 56-60 hr of intensively delivered treatment over 6 weeks with testing pretreatment, posttreatment, and 3 months posttreatment termination. Results There was no significant between-groups difference on the primary outcome measure (untrained nouns phonologically and semantically unrelated to each treatment) at 3 months posttreatment. Significant within-group immediately posttreatment acquisition effects for confrontation naming and response latency were observed for both groups. Treatment-specific generalization effects for confrontation naming were observed for both groups immediately and 3 months posttreatment; a significant decrease in response latency was observed at both time points for the SFA group only. Finally, significant within-group differences on the Comprehensive Aphasia Test-Disability Questionnaire (Swinburn, Porter, & Howard, 2004) were observed both immediately and 3 months posttreatment for the SFA group, and significant within-group differences on the Functional Outcome Questionnaire (Glueckauf et al., 2003) were found for both treatment groups 3 months posttreatment. Discussion Our results are consistent with those of prior studies that have shown that SFA treatment and phonomotor treatment generalize to untrained words that share features (semantic or phonological sequence, respectively) with the training set. However, they show that there is no significant generalization to untrained words that do not share semantic features or phonological sequence features.


Assuntos
Anomia/terapia , Afasia/psicologia , Generalização Psicológica , Terapia da Linguagem/métodos , Semântica , Idoso , Anomia/psicologia , Afasia/complicações , Feminino , Humanos , Testes de Linguagem , Masculino , Pessoa de Meia-Idade , Fonética , Desempenho Psicomotor , Resultado do Tratamento
8.
Phys Ther ; 97(11): 1066-1074, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29077960

RESUMO

Background: Evidence-based guidelines are needed to inform rehabilitation practice, including the effect of number of exercise training sessions on recovery of walking ability after stroke. Objective: The objective of this study was to determine the response to increasing number of training sessions of 2 interventions-locomotor training and strength and balance exercises-on poststroke walking recovery. Design: This is a secondary analysis of the Locomotor Experience Applied Post-Stroke (LEAPS) randomized controlled trial. Setting: Six rehabilitation sites in California and Florida and participants' homes were used. Participants: Participants were adults who dwelled in the community (N=347), had had a stroke, were able to walk at least 3 m (10 ft) with assistance, and had completed the required number of intervention sessions. Intervention: Participants received 36 sessions (3 times per week for 12 weeks), 90 minutes in duration, of locomotor training (gait training on a treadmill with body-weight support and overground training) or strength and balance training. Measurements: Talking speed, as measured by the 10-Meter Walk Test, and 6-minute walking distance were assessed before training and following 12, 24, and 36 intervention sessions. Results: Participants at 2 and 6 months after stroke gained in gait speed and walking endurance after up to 36 sessions of treatment, but the rate of gain diminished steadily and, on average, was very low during the 25- to 36-session epoch, regardless of treatment type or severity of impairment. Limitations: Results may not generalize to people who are unable to initiate a step at 2 months after stroke or people with severe cardiac disease. Conclusions: In general, people who dwelled in the community showed improvements in gait speed and walking distance with up to 36 sessions of locomotor training or strength and balance exercises at both 2 and 6 months after stroke. However, gains beyond 24 sessions tended to be very modest. The tracking of individual response trajectories is imperative in planning treatment.


Assuntos
Treinamento de Força , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Caminhada/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia , Recuperação de Função Fisiológica , Método Simples-Cego , Resultado do Tratamento , Velocidade de Caminhada
9.
J Stroke Cerebrovasc Dis ; 25(4): 792-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26794264

RESUMO

BACKGROUND: Risk-adjusted poststroke mortality has been proposed for use as a measure of stroke care quality. Although valid measures of stroke severity (e.g., the National Institutes of Health Stroke Scale [NIHSS]) are not typically available in administrative datasets, radiology reports are often available within electronic health records. We sought to examine whether admission head computed tomography data could be used to estimate stroke severity. MATERIALS AND METHODS: Using chart review data from a cohort of acute ischemic stroke patients (1998-2003), we developed a radiographic measure ([BIS]) of stroke severity in a two-third development set and assessed in a one-third validation set. The retrospective NIHSS was dichotomized as mild/moderate (<10) and severe (≥10). We compared the association of this radiographic score with NIHSS and in-hospital mortality at the patient level. RESULTS: Among 1348 stroke patients, 86.5% had abnormal findings on initial head computed tomography. The c-statistic for the BIS for modeling severe stroke (development, .581; validation, .579) and in-hospital mortality (development, .623; validation, .678) were generated. CONCLUSIONS: Although the c-statistics were only moderate, the BIS provided significant risk stratification information with a 2-variable score. Until administrative data routinely includes a valid measure of stroke severity, radiographic data may provide information for use in risk adjustment.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Neuroimagem/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Isquemia Encefálica/complicações , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia
10.
Neurorehabil Neural Repair ; 30(7): 615-25, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26498434

RESUMO

Background Paresis in stroke is largely a result of damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right-hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. Methods Lesion type, locus, and extent were characterized by the 2 neurologists in the LEAPS trial on the basis of clinical computed tomography and magnetic resonance imaging scans. A series of regression models was used to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2- to 12-month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score. Results Gait speed change at 1 year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right-hemisphere cortical involvement had no significant impact on outcome. Conclusions Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect as a result of prior stroke may affect long-term outcome of rehabilitation of hemiparetic gait.


Assuntos
Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Modalidades de Fisioterapia , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/complicações , Adulto , Feminino , Lateralidade Funcional , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Humanos , Locomoção , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Análise de Regressão , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto Jovem
11.
J Clin Exp Neuropsychol ; 37(10): 1062-73, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26340588

RESUMO

BACKGROUND/OBJECTIVES: In most right-handed people, the left hemisphere is dominant for programming the temporal and spatial "how" (praxis) aspects of purposeful skilled movements, and the right hemisphere is dominant for control of the intentional "when" aspects of actions that mediate initiation, persistence, termination, and inhibition. Since the interhemispheric axons of the corpus callosum are especially susceptible to shearing from torsional forces during traumatic brain injury (TBI), the goal of this study was to learn whether participants with a history of severe traumatic brain injury demonstrate three types of cognitive-motor impairments that may result from callosal injury: ideomotor apraxia of the left hand, limb kinetic apraxia of the left hand, and hypokinesia of the right hand in response to left hemispatial stimuli. METHOD: Nine participants with severe TBI and nine healthy control participants were studied for the presence of ideomotor apraxia, limb kinetic apraxia, and hypokinesia. RESULTS: When compared to the control participants, the participants with TBI revealed ideomotor apraxia and limb kinetic apraxia of the left hand and hypokinesia in response to left-sided visual stimuli when tested with the right hand. CONCLUSIONS: TBI appears to cause unilateral disorders of cognitive-motor functions. Future research is needed to understand how these cognitive-motor disorders are related to interhemispheric disconnection most likely induced by injury to the corpus callosum.


Assuntos
Lesões Encefálicas/complicações , Transtornos Cognitivos/etiologia , Corpo Caloso/patologia , Lateralidade Funcional/fisiologia , Transtornos dos Movimentos/etiologia , Adulto , Análise de Variância , Apraxias/etiologia , Córtex Cerebral/patologia , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico , Testes Neuropsicológicos , Tempo de Reação/fisiologia , Adulto Jovem
12.
Front Neurol ; 6: 172, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26322013

RESUMO

White matter (WM) injury in relation to acute neurologic conditions, especially stroke, has remained obscure until recently. Current advances in imaging technologies in the field of stroke have confirmed that WM injury plays an important role in the prognosis of stroke and suggest that WM protection is essential for functional recovery and post-stroke rehabilitation. However, due to the lack of a reproducible animal model of WM injury, the pathophysiology and mechanisms of this injury are not well studied. Moreover, producing selective WM injury in animals, especially in rodents, has proven to be challenging. Problems associated with inducing selective WM ischemic injury in the rodent derive from differences in the architecture of the brain, most particularly, the ratio of WM to gray matter in rodents compared to humans, the agents used to induce the injury, and the location of the injury. Aging, gender differences, and comorbidities further add to this complexity. This review provides a brief account of the techniques commonly used to induce general WM injury in animal models (stroke and non-stroke related) and highlights relevance, optimization issues, and translational potentials associated with this particular form of injury.

13.
Neurology ; 85(7): 646-51, 2015 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-26138946

RESUMO

The recent American Academy of Neurology position paper by Franklin, "Opioids for chronic noncancer pain," suggests that the benefits of opioid treatment are very likely to be substantially outweighed by the risks and recommends avoidance of doses above 80-120 mg/day morphine equivalent. However, close reading of the primary literature supports a different conclusion: opioids have been shown in randomized controlled trials (RCTs) to be highly effective in the treatment of chronic nonmalignant pain; long-term follow-up studies have shown that this effectiveness can be maintained; and effectiveness has been limited in many clinical trials by failure to take into account high variability in dose requirements, failure to adequately treat depression, and use of suboptimal outcome measures. Frequency of side effects in many RCTs has been inflated by overly rapid dose titration and failure to appreciate the high interindividual variability in side effect profiles. The recent marked increase in incidence of opioid overdose is of grave concern, but there is good reason to believe that it has been somewhat exaggerated. Potential causes of overdose include inadequately treated depression; inadequately treated pain, particularly when compounded by hopelessness; inadvertent overdose; concurrent use of alcohol; and insufficient practitioner expertise. Effective treatment of pain can enable large numbers of patients to lead productive lives and improve quality of life. Effective alleviation of suffering associated with pain falls squarely within the physician's professional obligation. Existing scientific studies provide the basis for many improvements in pain management that can increase effectiveness and reduce risk. Many potentially useful areas of further research can be identified.


Assuntos
Analgésicos Opioides , Dor Crônica/tratamento farmacológico , Prescrições de Medicamentos/normas , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/farmacologia , Humanos
14.
J Speech Lang Hear Res ; 58(3): 798-812, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25766309

RESUMO

PURPOSE: The ultimate goal of aphasia therapy should be to achieve gains in function that generalize to untrained exemplars and daily conversation. Anomia is one of the most disabling features of aphasia. The predominantly lexical/semantic approaches used to treat anomia have low potential for generalization due to the orthogonality of semantic and phonologic representations; this has been borne out in a meta-analysis of treatment studies. The intensive, neurally distributed, phonologic therapy reported here can, in principle, generalize to untrained phonologic sequences because of extant regularities in phonologic sequence knowledge and should, in principle, generalize to production of words trained as well as those untrained. METHOD: Twenty-six persons with chronic aphasia due to stroke were treated, in a staggered (immediate vs. delayed treatment) open trial design, with 60 hr of intensive, multimodal therapy designed to enhance access to and efficiency of phonemes and phonologic sequences. RESULTS: There was an absolute increase of 5% in confrontation naming of "untrained" nouns at 3 months, and there were 9% to 10% increases on measures of generalization of phonologic processes. CONCLUSION: The results of this trial demonstrate generalization of training effects on laboratory measures, which were sustained at 3 months, and provide support for the theories that motivated the treatment.


Assuntos
Afasia/terapia , Terapia da Linguagem/métodos , Adulto , Idoso , Afasia/etiologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Fonética , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Resultado do Tratamento
15.
Artigo em Inglês | MEDLINE | ID: mdl-27512724

RESUMO

BACKGROUND AND PURPOSE: White matter (WM) injury during stroke increases the risk of disability and gloomy prognosis of post-stroke rehabilitation. However, modeling of WM loss in rodents has proven to be challenging. METHODS: We report improved WM injury models in male C57BL/6 mice. Mice were given either endothelin-1 (ET-1) or L-N5-(1-iminoethyl)ornitine (L-NIO) into the periventricular white matter (PVWM), in the corpus callosum (CC), or in the posterior limb of internal capsule (PLIC). Anatomical and functional outcomes were quantified on day 7 post injection. RESULTS: Injection of ET-1 or L-NIO caused a small focal lesion in the injection site in the PVWM. No significant motor function deficits were observed in the PVWM lesion model. We next targeted the PLIC by using single or double injections of L-NIO and found that this strategy induced small focal infarction. Interestingly, injection of L-NIO in the PLIC also resulted in gliosis, and significant motor function deficits. CONCLUSIONS: By employing different agents, doses, and locations, this study shows the feasibility of inducing brain WM injury accompanied with functional deficits in mice. Selective targeting of the injury location, behavioral testing, and the agents chosen to induce WM injury are all keys to successfully develop a mouse model and subsequent testing of therapeutic interventions against WM injury.

16.
Int J Stroke ; 9(8): 1097-104, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25156340

RESUMO

BACKGROUND: Coronary artery disease is highly prevalent in patients with stroke, but because revascularization does not improve major clinical outcomes in patients with stable coronary artery disease relative to intensive medical therapy, routine evaluation for this disease is not warranted in stroke patients. However, it might be warranted in patients destined to undergo vigorous physical therapy. The Locomotor Experience Applied Post-Stroke study, a randomized controlled trial of 408 participants that tested the relative efficacy of two rehabilitation techniques on functional walking level, provided the opportunity to address this question. AIM: The study aims to test the efficacy of screening for cardiovascular disease and an exercise tolerance test in assuring safety among patients undergoing vigorous rehabilitation for gait impairment. METHODS: All participants were screened for serious cardiovascular and pulmonary conditions. At six-weeks poststroke, they also completed a cardiovascular screening inventory and underwent an exercise tolerance test involving bicycle ergometry. Participants received 36, 90-min sessions of a prescribed physical therapy (three per week), initiated at either two-months or six-months poststroke. RESULTS: Twenty-nine participants were excluded on the basis of the cardiac screening questionnaire, and 15 failed the exercise tolerance test for cardiovascular reasons. No participant experienced a cardiac event during a treatment session. Two participants experienced myocardial infarctions, but continued in the trial. In three additional participants, myocardial infarctions caused or contributed to death. CONCLUSIONS: The combination of a negative cardiac screen and the absence of exercise tolerance test failure appeared to have a high negative predictive value for cardiac events during treatment, despite the likelihood of a high prevalence of coronary artery disease in our population.


Assuntos
Terapia por Exercício/efeitos adversos , Tolerância ao Exercício/fisiologia , Locomoção/fisiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Reabilitação do Acidente Vascular Cerebral , Adulto , Idoso , Pressão Sanguínea , Feminino , Frequência Cardíaca/fisiologia , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Inquéritos e Questionários , Adulto Jovem
17.
Cogn Behav Neurol ; 27(2): 77-87, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24968008

RESUMO

BACKGROUND AND OBJECTIVE: We previously reported a randomized, sham-controlled trial of 5 Hz dorsolateral prefrontal left- and right-side repetitive transcranial magnetic stimulation (rTMS) in 48 participants with a medically refractory major depressive disorder. Depression improved most with right-side cranial stimulation, both rTMS and sham, and to a lesser degree with left rTMS. Because depression is often associated with cognitive impairment, in this study we sought to determine whether our earlier participants had treatment-induced changes in cognition, which cognitive domains (language, executive, visuospatial, verbal episodic memory, attention) were affected, and whether treatment-induced cognitive changes were related either to improvement in depression or to other treatment variables, such as right versus left treatment and rTMS versus sham. METHODS: We used hierarchical regression analyses to determine how variables measured at baseline or associated with treatment affected changes in neuropsychological functions. The variables were neuropsychological function in the 5 domains, severity of depression, change in depression with treatment, rTMS versus sham, laterality of stimulation, and rTMS-laterality interaction. RESULTS: Compared to sham, right rTMS was associated with 1.24 standard deviations greater gain in language function, 1.09 standard deviations greater gain in visuospatial function, and 2.38 standard deviations greater gain in verbal episodic memory than left rTMS. These improvements did not appear to be directly related to the relief from depression. CONCLUSIONS: Our results suggest that disorders of cognition and mood in depression may have different mechanisms, but right rTMS may treat both. We propose potential mechanisms underlying the right-side rTMS effect. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov NCT00711568.


Assuntos
Cognição , Depressão/terapia , Transtorno Depressivo Maior/terapia , Estimulação Magnética Transcraniana , Adulto , Idoso , Atenção , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/terapia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Função Executiva , Feminino , Lateralidade Funcional , Humanos , Idioma , Modelos Lineares , Masculino , Memória Episódica , Pessoa de Meia-Idade , Testes Neuropsicológicos , Córtex Pré-Frontal , Percepção Espacial , Estimulação Magnética Transcraniana/métodos , Resultado do Tratamento , Percepção Visual
18.
J Rehabil Res Dev ; 51(1): 39-50, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24805892

RESUMO

The Locomotor Experience Applied Post Stroke rehabilitation trial found equivalent walking outcomes for body weight-supported treadmill plus overground walking practice versus home-based exercise that did not emphasize walking. From this large database, we examined several clinically important questions that provide insights into recovery of walking that may affect future trial designs. Using logistic regression analyses, we examined predictors of response based on a variety of walking speed-related outcomes and measures that captured disability, physical impairment, and quality of life. The most robust predictor was being closer at baseline to the primary outcome measure, which was the functional walking speed thresholds of 0.4 m/s (household walking) and 0.8 m/s (community walking). Regardless of baseline walking speed, a younger age and higher Berg Balance Scale score were relative predictors of responding, whether operationally defined by transitioning beyond each speed boundary or by a continuous change or a greater than median increase in walking speed. Of note, the cutoff values of 0.4 and 0.8 m/s had no particular significance compared with other walking speed changes despite their general use as descriptors of functional levels of walking. No evidence was found for any difference in predictors based on treatment group.


Assuntos
Atividades Cotidianas , Socorristas/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral , Caminhada , Adulto , Idoso , Idoso de 80 Anos ou mais , Teste de Esforço , Terapia por Exercício , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Modalidades de Fisioterapia , Equilíbrio Postural , Qualidade de Vida , Amplitude de Movimento Articular , Método Simples-Cego
19.
Neurorehabil Neural Repair ; 28(9): 885-95, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24769437

RESUMO

Background. Phase III trials of rehabilitation of paresis after stroke have proven the effectiveness of intensive and extended task practice, but they have also shown that many patients do not qualify, because of severity of impairment, and that many of those who are treated are left with clinically significant deficits. Objective. To test the value of 2 potential adjuvants to normal learning processes engaged in constraint-induced movement therapy (CIMT): greater distribution of treatment over time and the coadministration of d-cycloserine, a competitive agonist at the glycine site of the N-methyl-D-aspartate glutamate receptor. Methods. A prospective randomized single-blind parallel-group trial of more versus less condensed therapy (2 vs 10 weeks) and d-cycloserine (50 mg) each treatment day versus placebo (in a 2 × 2 design), as potential adjuvants to 60 hours of CIMT. Results. Twenty-four participants entered the study, and 22 completed it and were assessed at the completion of treatment and 3 months later. Neither greater distribution of treatment nor treatment with d-cycloserine significantly augmented retention of gains achieved with CIMT. Conclusions. Greater distribution of practice and treatment with d-cycloserine do not appear to augment retention of gains achieved with CIMT. However, concentration of CIMT over 2 weeks ("massed practice") appears to confer no advantage either.


Assuntos
Antimetabólitos/uso terapêutico , Ciclosserina/uso terapêutico , Terapia por Exercício/métodos , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/tratamento farmacológico , Constrição , Feminino , Seguimentos , Humanos , Masculino , Movimento , Modalidades de Fisioterapia , Projetos Piloto , Método Simples-Cego
20.
Int J Stroke ; 9(4): 449-56, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23088350

RESUMO

BACKGROUND: Extensive data, primarily from animal studies, suggest that several classes of drugs may have antineuroplastic effects that could impede recovery from brain injury or reduce the efficacy of rehabilitation. AIMS: The Locomotor Experience Applied Post-Stroke trial, a randomized controlled study of 408 subjects that tested the relative efficacy of two rehabilitation techniques on functional walking level at one-year poststroke, provided us the opportunity to prospectively assess the potential antineuroplastic effects of several classes of drug. METHODS: Subjects were randomized to receive one of the two rehabilitation therapies at two-months poststroke. Drugs taken were recorded at time of randomization. Outcome was assessed at one-year poststroke. Regression models were used to determine the amount of variance in success in improving functional walking level, gains in walking speed, and declines in lower extremity, upper extremity, and cognitive impairment accounted for by α1 noradrenergic blockers + α2 noradrenergic agonists, benzodiazepines, voltage-sensitive sodium channel anticonvulsants, and α2δ voltage-sensitive calcium channel blockers. RESULTS: The maximum variance accounted for by any drug class was 1.66%. Drug effects were not statistically significant when using even our most lenient standard for correction for multiple comparisons. CONCLUSIONS: Drugs in the classes we were able to assess do not appear to exert a clinically important effect on outcome over the period between two- and 12 months poststroke. However, the potential antineuroplastic effects of certain drugs remain an incompletely settled scientific question.


Assuntos
Locomoção/efeitos dos fármacos , Locomoção/fisiologia , Neurotransmissores/uso terapêutico , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/tratamento farmacológico , Feminino , Humanos , Modelos Logísticos , Masculino , Modalidades de Fisioterapia , Estudos Prospectivos , Centros de Reabilitação , Método Simples-Cego , Resultado do Tratamento
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