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1.
Biomed Res Int ; 2022: 5426643, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35586813

RESUMO

Medical imaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI) imaging are indispensable for contemporary neurorehabilitation diagnostics, intervention, and monitoring. It would be desirable to reconstruct images from sparse measurements to reduce the ionizing radiation and motion artifacts. Although recent coordinate-based representation methods have shown promise advances for sparse-view reconstruction, they overfit a single MLP on a single patient. In this work, we generalize it across many patients by incorporating an interpatient prior into the ill-posed inverse/reconstruction problem, which is the missing ingredient in the previous works. The experiment demonstrates that our method significantly improves image quality over the state-of-the-art both qualitatively and quantitatively. Thus, our method provides a powerful and principled means to deal with the measurement-scarce problem.


Assuntos
Processamento de Imagem Assistida por Computador , Reabilitação Neurológica , Artefatos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagens de Fantasmas
2.
Ann Med ; 54(1): 1265-1276, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35510813

RESUMO

BACKGROUND: Lower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke. PATIENTS AND METHODS: In a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment. RESULTS: One hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R2: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02). CONCLUSIONS: Higher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.KEY MESSAGEHigher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.Higher SES is associated with significantly higher utilization of outpatient therapies.Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery. Article registration: clinicaltrials.gov NCT04119479.


Assuntos
Reabilitação Neurológica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Pacientes Internados , Estudos Prospectivos , Recuperação de Função Fisiológica , Classe Social , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do Tratamento , Extremidade Superior
3.
J Med Syst ; 46(5): 24, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35377012

RESUMO

Outcome of acquired brain injury (ABI) and the potential for neurorehabilitation are subject to distinct heterogeneity between patients. Limited knowledge of the complex constellation of determinants at play interferes with the possibility to deploy precision medicine in neurorehabilitation. Measurement Feedback Systems (MFS) structure clinical data collection and deliver the measurement results as feedback to clinicians, thereby facilitating progress monitoring, promoting balanced patient-centered discussion and shared decision making. Accumulation of clinical data in the MFS also enables data-driven precision rehabilitation medicine. This article describes the development and implementation of a MFS for neurorehabilitation after ABI. The MFS consists of specialized measurement tracks which are developed together with representatives of each discipline in the multidisciplinary team. The MFS is built into a digital platform that automatically distributes measurements among clinicians, at predetermined time points during the inpatient treatment, outpatient treatment and follow-up. The results of all measurements are visualized in individual patient dashboards that are accessible for all clinicians involved in treatment. Since step-wise implementation, 124 patients have been registered on the MFS platform so far, providing an average of more than 200 new measurements per week. Currently, more than 15,000 clinical measurements are captured in the MFS. The current overall completion rate of measurements is 86,4%. This study shows that structured clinical assessment and feedback is feasible in the context of neurorehabilitation after severe ABI. The future directions are discussed for MFS data in our Health Intelligence Program, which aims at periodic care evaluation and the transition of neurorehabilitation care towards precision medicine.


Assuntos
Lesões Encefálicas , Reabilitação Neurológica , Lesões Encefálicas/reabilitação , Retroalimentação , Humanos , Reabilitação Neurológica/métodos
4.
J Med Life ; 15(2): 162-167, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35419106

RESUMO

The study aims to add a new and beneficial perspective using Immunoinstant G food supplement as an adjuvant treatment. It is essential to study the bibliographic resources in the field to identify the current stage of knowledge on this topic. For this purpose, we have prepared a systematic literature review, focusing on the possibilities of improving the treatment of Clostridium difficile (Clostridioides difficile) enterocolitis in patients who need/benefit from neurorehabilitation. The systematic literature review was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We obtained a number of 6 articles that were considered in the elaboration of our systematic literature review. We identified that this field is insufficiently studied and needs additional clinical trials. Our study contributes to increasing this understanding based on the thorough theoretical and practical approach of this topic.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Enterocolite Pseudomembranosa , Enterocolite , Reabilitação Neurológica , Clostridioides , Infecções por Clostridium/tratamento farmacológico , Comorbidade , Enterocolite/tratamento farmacológico , Enterocolite Pseudomembranosa/tratamento farmacológico , Enterocolite Pseudomembranosa/epidemiologia , Humanos , Imunoglobulinas , Extratos Vegetais/uso terapêutico
5.
PLoS One ; 17(4): e0266388, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35390052

RESUMO

Nature has long demonstrated the capacity to facilitate wellbeing. Interventions involving the natural environment such as surf therapy, are increasingly being used to facilitate aspects of wellbeing in clinical populations. However, explorations of how nature-based interventions such as surf therapy may be used to promote wellbeing in the context of neurorehabilitation are missing from the peer-reviewed literature. Here we characterize the experience of a five-week surfing intervention involving fifteen adults living with the psycho-social and cognitive sequelae of acquired brain injury. Insights were analysed using reflexive thematic analysis, which highlighted the importance of seven overarching themes, including: 1) Connection to Nature, 2) Facilitating Trust and Safety, 3) Managing and Accepting Difficult Emotions, 4) Facilitating Positive Emotion, Meaning and Purpose, 5) Building Community through Social Connection, and 6) Positive Change. Barriers and opportunities (theme 7) were also identified as components on which clinical services may be improved. We present a theoretical model for the benefits of surf therapy in people living with acquired brain injury (ABI) based on these themes and reflections on findings from the wider literature. Findings emphasise the importance of leveraging community partnerships to augment the holistic model of neurorehabilitation and potential implications for service redesign are discussed, focusing on recent developments in wellbeing science.


Assuntos
Lesões Encefálicas , Reabilitação Neurológica , Esportes , Adulto , Lesões Encefálicas/reabilitação , Emoções , Humanos
6.
Clin Neurophysiol ; 138: 61-73, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35364465

RESUMO

OBJECTIVE: Surface electromyography (sEMG) is a common electrophysiological assessment used in clinical trials in individuals with spinal cord injury (SCI). This scoping review summarizes the most common sEMG techniques used to address clinically relevant neurorehabilitation questions. We focused on the role of sEMG assessments in the clinical practice and research studies on neurorehabilitation after SCI, and how sEMG reflects the changes observed with rehabilitation. Additionally, this review emphasizes the limitations and pitfalls of the sEMG assessments in the field of neurorehabilitation after SCI. METHODS: A comprehensive search of Medline (Ovid), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, Emcare, Cumulative Index to Nursing & Allied Health Literature, and PubMed was conducted to find peer-reviewed journal articles that included individuals post-SCI that participated in neurorehabilitation interventions using sEMG assessments. This is a scoping review using a systematic search (hybrid review). RESULTS: Of 4522 references captured in the primary database searches, 100 references were selected and included in the scoping review. The main focus of the studies was on neurorehabilitation using sEMG biofeedback, brain stimulation, locomotor training, neuromuscular electrical stimulation (NMES), paired-pulse stimulation, pharmacology, posture and balance training, spinal cord stimulation, upper limb training, vibration, and photobiomodulation. CONCLUSIONS: Most studies employed sEMG amplitude to understand the effects of neurorehabilitation on muscle activation during volitional efforts or reduction of spontaneous muscle activity (e.g., spasms, spasticity, and hypertonia). Further studies are needed to understand the long-term reliability of sEMG amplitude, to circumvent normalization issues, and to provide a deeper physiological background to the different sEMG analyses. SIGNIFICANCE: This scoping review reveals the potential of sEMG in exploring promising neurorehabilitation strategies following SCI and discusses the barriers limiting its widespread use in the clinic.


Assuntos
Reabilitação Neurológica , Traumatismos da Medula Espinal , Eletromiografia/métodos , Humanos , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/reabilitação , Revisões Sistemáticas como Assunto
7.
Curr Neurol Neurosci Rep ; 22(3): 183-195, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35278172

RESUMO

PURPOSE OF REVIEW: Stroke is the leading cause of permanent motor disability in the United States (US), but there has been little progress in developing novel, effective strategies for treating post-stroke motor deficits. The past decade has seen the rapid development of many promising, gamified neurorehabilitation technologies; however, clinical adoption remains limited. The purpose of this review is to evaluate the recent literature surrounding the adoption and use of gamification in neurorehabilitation after stroke. RECENT FINDINGS: Gamification of neurorehabilitation protocols is both feasible and effective. Deployment strategies and scalability need to be addressed with more rigor. Relationship between engaged time on task and rehabilitation outcomes should be explored further as it may create benefits beyond repetitive movement. As gamification becomes a more common and feasible way of delivering exercise-based therapies, additional benefits of gamification are emerging. In spite of this, questions still exist about scalability and widespread clinical adoption.


Assuntos
Pessoas com Deficiência , Transtornos Motores , Reabilitação Neurológica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/métodos
8.
J Neurooncol ; 157(3): 435-443, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35338454

RESUMO

INTRODUCTION: Transcranial magnetic stimulation (TMS) is a neuromodulation technology capable of targeted stimulation and inhibition of cortical areas. Repetitive TMS (rTMS) has demonstrated efficacy in the treatment of several neuropsychiatric disorders, and novel uses of rTMS for neurorehabilitation in patients with acute and chronic neurologic deficits are being investigated. However, studies to date have primarily focused on neurorehabilitation in stroke patients, with little data supporting its use for neurorehabilitation in brain tumor patients. METHODS: We performed a review of the current available literature regarding uses of rTMS for neurorehabilitation in post-operative neuro-oncologic patients. RESULTS: Data have demonstrated that rTMS is safe in the post-operative neuro-oncologic patient population, with minimal adverse effects and no documented seizures. The current evidence also demonstrates potential effectiveness in terms of neurorehabilitation of motor and language deficits. CONCLUSIONS: Although data are overall limited, both safety and effectiveness have been demonstrated for the use of rTMS for neurorehabilitation in the neuro-oncologic population. More randomized controlled trials and specific comparisons of contralateral versus ipsilateral rTMS protocols should be explored. Further work may also focus on individualized, patient-specific TMS treatment protocols for optimal functional recovery.


Assuntos
Reabilitação Neurológica , Acidente Vascular Cerebral , Humanos , Idioma , Reabilitação Neurológica/métodos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/etiologia , Estimulação Magnética Transcraniana/efeitos adversos , Estimulação Magnética Transcraniana/métodos
9.
South Med J ; 115(3): 227-231, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35237843

RESUMO

Abstract: COVID-19 has affected many people all around the world for more than two years now have suffered many long-term consequences which is commonly referred to as long-haulers. Despite multiorgan complaints in long haulers, symptoms related to cognitive functions commonly referred as brain fog are seen in the high risk covid patients with age more than 50, women more than men, obesity, asthma and those who experienced more than five symptoms during the first week of covid illness. Long term isolation has certainly contributed to high level of anxiety and stress calling for an empathetic response to this group of covid patients as there is no specific test to detect long haulers and no specific cognitive rehabilitation techniques available as of today.


Assuntos
COVID-19/psicologia , COVID-19/reabilitação , Transtornos Neurocognitivos/reabilitação , Transtornos Neurocognitivos/virologia , Reabilitação Neurológica , Humanos
10.
Ann Agric Environ Med ; 29(1): 94-102, 2022 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-35352911

RESUMO

INTRODUCTION AND OBJECTIVE: The results of kinesiotherapy treatment in patients after incomplete spinal cord injury (iSCI) are inconclusive, mostly due to different, subjective evaluation methods. The study aims to evaluate the range of functional regeneration in long-term 13 months follow-up using comparative neurophysiological tests after uniform kinesiotherapy in patients with thoracic iSCI. MATERIAL AND METHODS: Comparative tests were performed of sensory perception in dermatomes Th1-S1, electromyography (at rest-rEMG and during maximal contraction-mcEMG) in the muscles of the trunk and lower extremities, electroneurography (ENG) of the motor fibres of the lower extremities, and motor-evoked potential induced transcranially (MEP) before and after treatment in 25 iSCI patients. All subjects were treated with the same kinesiotherapeutic procedures. RESULTS: A moderate increase was found in amplitudes in rEMG and mcEMG recordings fromthe rectus abdominis and rectus femoris muscles, MEPs amplitudes, and amplitudes after peroneal nerve stimulations in ENG studies. There was no improvement in sensory perception. CONCLUSIONS: Following the proposed kinesiotherapy algorithm, patients after thoracic iSCI presented a moderate more motor than sensory functions improvement. Applied neurorehabilitation evoked normalization of muscle tension, moderate improvement of rectus abdominis and rectus femoris muscles motor units activity, and motor central and peripheral neural impulses transmission. The comparative neurophysiological assessment provide a more precise and objective insight into the functional status of afferent and efferent systems than the classical clinical approach in iSCI patients.


Assuntos
Reabilitação Neurológica , Traumatismos da Medula Espinal , Eletromiografia/métodos , Potencial Evocado Motor/fisiologia , Humanos , Músculo Esquelético , Traumatismos da Medula Espinal/reabilitação
11.
Sci Robot ; 7(64): eabo1966, 2022 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-35353599

RESUMO

A preclinical robotic platform aids rehabilitation, therapy development, and assessment of recovery for upper limb impairments.


Assuntos
Reabilitação Neurológica , Robótica , Humanos , Traduções , Extremidade Superior
12.
BMC Health Serv Res ; 22(1): 372, 2022 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-35313879

RESUMO

BACKGROUND: Research on the optimal period for administering health services, especially rehabilitation interventions, is scarce. The aims of this study were to explore the construct of patients' convenient therapy periods and to identify indicators based on the perspectives of patients and different health professionals from inpatient neurological rehabilitation clinics. METHODS: This study was part of a larger project on patients' convenient therapy periods following a mixed methods approach. In the current study a grounded theory approach was employed based on the use of focus group interviews. Focus group interviews were conducted in three different inpatient neurological rehabilitation clinics. Patients and therapists from inpatient neurological rehabilitation clinics who were able to speak and to participate in conversations were included. RESULTS: A total of 41 persons, including 23 patients and 18 therapists, such as music and occupational therapists, participated in a total of six focus group interviews. The analysis of the focus group interviews resulted in the identification of a total of 1261 codes, which could be summarised in fifteen categories. However, these categories could be divided into five indicators and ten impact factors of convenient therapy periods. Identified indicators were verbal and non-verbal communication, mental functions, physiological needs, recreational needs, and therapy initiation. CONCLUSIONS: The results provide initial evidence that convenient therapy periods are clinically relevant for patients and therapists. Different states of patients' ability to effectively participate in a rehabilitation intervention exist. A systematic consideration of patients' convenient therapy periods could contribute to a personalised and more efficient delivery of intervention in neurological rehabilitation. To our knowledge, this study is one of the first attempts to research convenient therapy periods.


Assuntos
Pacientes Internados , Reabilitação Neurológica , Pessoal Técnico de Saúde , Grupos Focais , Humanos
14.
Sci Rep ; 12(1): 3039, 2022 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-35197490

RESUMO

The human brain is a highly plastic 'complex' network-it is highly resilient to damage and capable of self-reorganisation after a large perturbation. Clinically, neurological deficits secondary to iatrogenic injury have very few active treatments. New imaging and stimulation technologies, though, offer promising therapeutic avenues to accelerate post-operative recovery trajectories. In this study, we sought to establish the safety profile for 'interventional neurorehabilitation': connectome-based therapeutic brain stimulation to drive cortical reorganisation and promote functional recovery post-craniotomy. In n = 34 glioma patients who experienced post-operative motor or language deficits, we used connectomics to construct single-subject cortical networks. Based on their clinical and connectivity deficit, patients underwent network-specific transcranial magnetic stimulation (TMS) sessions daily over five consecutive days. Patients were then assessed for TMS-related side effects and improvements. 31/34 (91%) patients were successfully recruited and enrolled for TMS treatment within two weeks of glioma surgery. No seizures or serious complications occurred during TMS rehabilitation and 1-week post-stimulation. Transient headaches were reported in 4/31 patients but improved after a single session. No neurological worsening was observed while a clinically and statistically significant benefit was noted in 28/31 patients post-TMS. We present two clinical vignettes and a video demonstration of interventional neurorehabilitation. For the first time, we demonstrate the safety profile and ability to recruit, enroll, and complete TMS acutely post-craniotomy in a high seizure risk population. Given the lack of randomisation and controls in this study, prospective randomised sham-controlled stimulation trials are now warranted to establish the efficacy of interventional neurorehabilitation following craniotomy.


Assuntos
Craniotomia/reabilitação , Reabilitação Neurológica/métodos , Idoso , Afasia/etiologia , Afasia/terapia , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Mapeamento Encefálico , Conectoma/métodos , Feminino , Glioma/complicações , Glioma/cirurgia , Hemiplegia/etiologia , Hemiplegia/terapia , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estimulação Magnética Transcraniana/efeitos adversos , Estimulação Magnética Transcraniana/métodos
15.
Int J Neural Syst ; 32(4): 2250009, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35139774

RESUMO

Brain network analysis can offer useful information to guide the rehabilitation of post-stroke patients. We applied functional network connection models based on multiplex-multilayer network analysis (MMN) to explore functional network connectivity changes induced by robot-aided gait training (RAGT) using the Ekso, a wearable exoskeleton, and compared it to conventional overground gait training (COGT) in chronic stroke patients. We extracted the coreness of individual nodes at multiple locations in the brain from EEG recordings obtained before and after gait training in a resting state. We found that patients provided with RAGT achieved a greater motor function recovery than those receiving COGT. This difference in clinical outcome was paralleled by greater changes in connectivity patterns among different brain areas central to motor programming and execution, as well as a recruitment of other areas beyond the sensorimotor cortices and at multiple frequency ranges, contemporarily. The magnitude of these changes correlated with motor function recovery chances. Our data suggest that the use of RAGT as an add-on treatment to COGT may provide post-stroke patients with a greater modification of the functional brain network impairment following a stroke. This might have potential clinical implications if confirmed in large clinical trials.


Assuntos
Reabilitação Neurológica , Robótica , Reabilitação do Acidente Vascular Cerebral , Encéfalo , Marcha , Humanos
16.
Biomed Res Int ; 2022: 8447080, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35187173

RESUMO

The present study was aimed at examining thyroid hormones and other clinical factors to improve the accuracy of outcome prediction among critically ill patients undergoing early neurological rehabilitation. Patients consecutively admitted to an intensive or intermediate care unit were screened for eligibility. Serum levels of free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were collected during the first three days after admission. The Glasgow Outcome Scale (GOS) was defined as the primary outcome measure. Thyroid hormone levels and other clinical factors were entered into a binary logistic regression model to predict a good outcome at the end of early rehabilitative treatment. 395 patients (268 males) with a median age of 62 years (IQR = 52 - 76) and a median disease duration of 19 days (IQR = 13 - 28) were included in the study. Most patients (80%) had decreased fT3 values. Patients with low fT3 were admitted earlier to the rehabilitation facility and had more severe impairment upon admission compared to patients with fT3 values within the normal range. Both decreased fT3 and TSH levels were associated with an unfavorable outcome (GOS ≤ 3), but only TSH proved to be an independent predictor in multivariate analyses (OR = 1.11; 95%CI = 1.02 - 1.22). These data suggest that decreased fT3 and TSH levels upon admission may predict an unfavorable outcome at the end of early rehabilitative treatment. Thus, thyroid hormone levels are not only important during acute treatment but also in prolonged critical illness.


Assuntos
Estado Terminal , Reabilitação Neurológica , Hormônios Tireóideos/sangue , Idoso , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
17.
Artigo em Inglês | MEDLINE | ID: mdl-35162136

RESUMO

BACKGROUND: Medicine requires the brightest minds, regardless of gender. Women working in the health sciences have time and again demonstrated the value of their technical training, communication skills, emotional support, and ability to provide understandable explanations to their patients. The objective of this work was to carry out a historical review of the main female authors linked to classic sensorimotor neurorehabilitation techniques throughout the nineteenth and twentieth centuries, as well as female authors linked to eponymous tests or assessments, exposing their scientific trajectory and main contributions to the field of neurological rehabilitation. A literature review was conducted. The databases of Physiotherapy Evidence Database (PEDro), Scopus, CINAHL Medical Science, Medline through EBSCO and PubMed were used to obtain the biographical information of each author, searches of papers were limited until August 2021 in English and Spanish languages. Seventeen female authors were identified who linked to the main rehabilitation techniques or approaches described for neurological rehabilitation and for scales or tests with an eponymous origin as an example of female contribution on neurorehabilitation. Biographical information based on the computerized search in the electronic databases showed 57 potentially relevant articles. Of those articles, 43 were subsequently excluded. Fourteen articles were used to show their contribution to neurorehabilitation. This paper demonstrates the influential role of women in the history of sensorimotor neurorehabilitation throughout the nineteenth and twentieth centuries, linked to the methods, techniques, concepts, or approaches used in physical therapy or occupational therapy.


Assuntos
Reabilitação Neurológica , Terapia Ocupacional , Feminino , Humanos , Idioma , MEDLINE , Modalidades de Fisioterapia
18.
Behav Brain Res ; 422: 113731, 2022 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-34979221

RESUMO

Animal models of cervical spinal cord injury (SCI) have frequently utilized partial transection injuries to evaluate plasticity promoting treatments such as rehabilitation training of skilled reaching and grasping tasks. Though highly useful for studying the effects of cutting specific spinal tracts that are important for skilled forelimb motor function, cervical partial-transection SCI-models underappreciate the extensive spread of most human SCIs, thus offering poor predictability for the clinical setting. Conversely, moderate cervical contusion SCI models targeting the spinal tracts important for skilled reaching and grasping can better replicate the increased size of most human SCIs and are often considered more clinically relevant. However, it is unknown whether animals with moderate cervical contusion SCIs that damage key spinal motor tracts can train in skilled reaching and grasping tasks. In this study, we quantify the impact of injury size and distribution on recovery in a skilled motor task called the single pellet reaching, grasping and retrieval (SPRGR) task in rats with cervical unilateral contusion injuries (UCs), and compare to rats with a partial transection SCIs (i.e., dorsolateral quadrant transection; DLQ). We found that UCs damage key tracts important for performing skilled motor tasks, similar to DLQs, but UCs also produce more extensive grey matter damage and more ventral white matter damage than DLQs. We also compared forelimb functionality at 1, 3, and 5 weeks of rehabilitative motor training between trained and untrained rats and found a more severe drop in SPRGR performance than in DLQ SCIs. Nevertheless, despite more severe injuries and initially low SPRGR performance, rehabilitative training for contusion animals resulted in significant improvements in SPRGR performance and proportionally more recovery than DLQ rats. Our findings show that rehabilitative motor training can facilitate considerable amounts of motor recovery despite extensive spinal cord damage, especially grey matter damage, thus supporting the use of contusion or compression SCI models and showing that ventral grey and white matter damage are not necessarily detrimental to recovery after training.


Assuntos
Medula Cervical/lesões , Terapia por Exercício , Membro Anterior/fisiopatologia , Destreza Motora/fisiologia , Reabilitação Neurológica , Condicionamento Físico Animal/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Animais , Comportamento Animal/fisiologia , Contusões/fisiopatologia , Contusões/reabilitação , Modelos Animais de Doenças , Ratos
19.
Sci Rep ; 12(1): 1101, 2022 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-35058514

RESUMO

The effective decoding of movement from non-invasive electroencephalography (EEG) is essential for informing several therapeutic interventions, from neurorehabilitation robots to neural prosthetics. Deep neural networks are most suitable for decoding real-time data but their use in EEG is hindered by the gross classes of motor tasks in the currently available datasets, which are solvable even with network architectures that do not require specialized design considerations. Moreover, the weak association with the underlying neurophysiology limits the generalizability of modern networks for EEG inference. Here, we present a neurophysiologically interpretable 3-dimensional convolutional neural network (3D-CNN) that captured the spatiotemporal dependencies in brain areas that get co-activated during movement. The 3D-CNN received topography-preserving EEG inputs, and predicted complex components of hand movements performed on a plane using a back-drivable rehabilitation robot, namely (a) the reaction time (RT) for responding to stimulus (slow or fast), (b) the mode of movement (active or passive, depending on whether there was an assistive force provided by the apparatus), and (c) the orthogonal directions of the movement (left, right, up, or down). We validated the 3D-CNN on a new dataset that we acquired from an in-house motor experiment, where it achieved average leave-one-subject-out test accuracies of 79.81%, 81.23%, and 82.00% for RT, active vs. passive, and direction classifications, respectively. Our proposed method outperformed the modern 2D-CNN architecture by a range of 1.1% to 6.74% depending on the classification task. Further, we identified the EEG sensors and time segments crucial to the classification decisions of the network, which aligned well with the current neurophysiological knowledge on brain activity in motor planning and execution tasks. Our results demonstrate the importance of biological relevance in networks for an accurate decoding of EEG, suggesting that the real-time classification of other complex brain activities may now be within our reach.


Assuntos
Encéfalo/fisiologia , Movimento/fisiologia , Neurofisiologia/métodos , Algoritmos , Encéfalo/diagnóstico por imagem , Interfaces Cérebro-Computador , Coleta de Dados/métodos , Eletroencefalografia/métodos , Feminino , Previsões/métodos , Humanos , Masculino , Fenômenos Fisiológicos do Sistema Nervoso , Redes Neurais de Computação , Reabilitação Neurológica/métodos , Tempo de Reação , Projetos de Pesquisa , Adulto Jovem
20.
BMC Neurol ; 22(1): 30, 2022 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-35039012

RESUMO

BACKGROUND: The present study intended to analyze the outcome of patients with severe brain injury one-year after discharge from early rehabilitation. METHODS: Early neurological rehabilitation patients admitted to intensive or intermediate care units and discharged between June 2018 and May 2020 were screened for eligibility. The level of consciousness was evaluated using the Coma Recovery Scale-Revised (CRS-R) upon admission and at discharge. At one-year follow-up, the outcome was assessed with the Glasgow Outcome Scale-extended (GOSE). Demographical and clinical data collected during inpatient rehabilitation were used to predict the outcome 1 year after discharge. RESULTS: Two hundred sixty-four patients (174 males, 90 females) with a median age of 62 years (IQR = 51-75) and a median duration of their disease of 18 days (IQR = 12-28) were included in the study. At follow-up, the mortality rate was 27% (n = 71). Age and discharge CRS-R total score were independent predictors in a Cox proportional hazards model with death (yes/no) as the dependent variable. According to the GOSE interviews, most patients were either dead (n = 71; 27%), in a vegetative state (n = 28; 11%) or had a severe disability (n = 124; 47%), whereas only a few patients showed a moderate disability (n = 18; 7%) or a good recovery (n = 23; 9%) 1 year after discharge. Age, non-traumatic etiology, discharge CRS-R total score and length of stay independently predicted whether the outcome was good or poor at follow-up. CONCLUSION: Age was an important predictor for outcome at one-year follow-up, which might be due to altered brain plasticity and more comorbidities in elderly subjects. In addition, the present study demonstrated that the CRS-R total score at discharge might be more important for the prediction of one-year outcome than the initial assessment upon admission.


Assuntos
Lesões Encefálicas , Reabilitação Neurológica , Idoso , Encéfalo , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento
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