Department of Occupational Therapy, School of Allied Health, Medical College of Ohio, 3015 Arlington Avenue, Toledo, Ohio 43614-5803, USA.
OBJECTIVE Cross-transfer effects were investigated during an occupationally embedded task that involved learning a fine motor skill. Cross-transfer is a phenomenon that occurs when an untrained limb receives some of the same benefits in performance from unilateral training that the contralateral limb received. It was hypothesized that cross-transfer would occur after a unilateral training regime using an occupationally embedded task. METHOD Forty-eight participants (mean age = 24.4 years) volunteered for this repeated-measures study. Participants were randomly assigned to a training or control group and were asked to complete a toy maze with their right and left hands for the pretest and posttest. Whereas participants in the control group did not train, participants in the training group completed a toy maze three times a day for 7 days with their left hands. All participants returned in 1 week to complete the posttest portion of the experiment. Dependent variables included movement time, movement units, force oscillations, and average force. RESULTS Significant decreases in movement time and force oscillations were found for the untrained limbs (p <.0125) in the training group. No significant differences were found in movement units or average force. The improved movement time and force oscillations in the untrained limb provides evidence suggesting that cross-transfer occurred. CONCLUSION This study indicates that with a population without impairments, cross-transfer can occur during an occupationally embedded task. This phenomenon may prove useful to the field of occupational therapy to rehabilitate immobilized extremities. Further research is needed to test this phenomenon with special populations.
School of Kinesiology, University of Western Ontario, London, ON, Canada.
OBJECTIVE To evaluate the effect of an upper-body exercise program on cardiorespiratory fitness in older adults with hip fracture during inpatient rehabilitation. DESIGN Randomized controlled trial using a convenience sample. SETTING An inpatient rehabilitation unit. PARTICIPANTS Twenty older patients (age, 81.3+/-7.2y; 14 women). INTERVENTION Patients were randomly assigned to a control group (n=10) or a training group (n=10). Both groups attended physical and occupational therapy sessions 5 times a week during rehabilitation (mean length of stay, 32.9+/-5.3d). Patients in the training program used an arm crank ergometer 3 times a week for 4 weeks. MAIN OUTCOME MEASURE Peak oxygen consumption (Vo(2)peak). RESULTS Vo(2)peak increased significantly in the training group (8.9+/-1.4 to 10.8+/-1.7mL x kg(-1) x min(-1)) and did not change in the control group (8.9+/-1.2 to 8.8+/-1.6mL x kg(-1).min(-1)). At discharge, both groups were significantly improved in all functional outcome measures (Timed Up & Go [TUG] test, Berg Balance Scale [BBS], FIM instrument, two-minute walk test [2MWT], and ten-minute walk test [10MWT]). The training group performed significantly better in mobility (TUG, 2MWT, 10MWT) and balance (BBS) compared with the control group. There was a significant correlation between Vo(2)peak and the 2MWT (r=.81) and 10MWT (r=.85) in the training group at discharge. CONCLUSIONS The upper-body exercise program had a significant effect on aerobic power. Our results suggest that aerobic endurance exercise should be integrated into standard rehabilitation to enhance patients' aerobic fitness and mobility after hip fracture surgery.
Translating principles of neural plasticity into research on speech motor control recovery and rehabilitation.
Christy L Ludlow, Jeannette Hoit, Raymond Kent, Lorraine O Ramig, Rahul Shrivastav, Edythe Strand, Kathryn Yorkston, Christine M Sapienza
National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA. email@example.com
PURPOSE To review the principles of neural plasticity and make recommendations for research on the neural bases for rehabilitation of neurogenic speech disorders. METHOD A working group in speech motor control and disorders developed this report, which examines the potential relevance of basic research on the brain mechanisms involved in neural plasticity and discusses possible similarities and differences for application to speech motor control disorders. The possible involvement of neural plasticity in changes in speech production in normalcy, development, aging, and neurological diseases and disorders was considered. This report focuses on the appropriate use of functional and structural neuroimaging and the design of feasibility studies aimed at understanding how brain mechanisms are altered by environmental manipulations such as training and stimulation and how these changes might enhance the future development of rehabilitative methods for persons with speech motor control disorders. CONCLUSIONS Increased collaboration with neuroscientists working in clinical research centers addressing human communication disorders might foster research in this area. It is hoped that this article will encourage future research on speech motor control disorders to address the principles of neural plasticity and their application for rehabilitation.
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Science. 2012 May 4;336 (6081):570-6 22556248
S W Squyres, R E Arvidson, J F Bell 3rd, F Calef 3rd, B C Clark, B A Cohen, L A Crumpler, P A de Souza Jr, W H Farrand, R Gellert, J Grant, K E Herkenhoff, J A Hurowitz, J R Johnson, B L Jolliff, A H Knoll, R Li, S M McLennan, D W Ming, D W Mittlefehldt, T J Parker, G Paulsen, M S Rice, S W Ruff, C Schröder, A S Yen, K Zacny
Department of Astronomy, Cornell University, Ithaca, NY 14853, USA. firstname.lastname@example.org
The rover Opportunity has investigated the rim of Endeavour Crater, a large ancient impact crater on Mars. Basaltic breccias produced by the impact form the rim deposits, with stratigraphy similar to that observed at similar-sized craters on Earth. Highly localized zinc enrichments in some breccia materials suggest hydrothermal alteration of rim deposits. Gypsum-rich veins cut sedimentary rocks adjacent to the crater rim. The gypsum was precipitated from low-temperature aqueous fluids flowing upward from the ancient materials of the rim, leading temporarily to potentially habitable conditions and providing some of the waters involved in formation of the ubiquitous sulfate-rich sandstones of the Meridiani region.
Children's Center, Elkhart, Indiana, USA.
OBJECTIVE The purpose of this study was to investigate whether practicing a complex self-care occupation in a contextually relevant environment would enhance the learning and transfer of skill. METHOD The design consisted of an acquisition phase, a rest period, and a transfer phase. Fifty-six women were recruited for this study and randomly assigned to one of three groups:(a) a contextually relevant (CR) group that practiced tying a necktie knot onto a mannequin,(b) a non-contextually relevant (NCR) group that practiced tying the same type of knot with a rope onto a wooden pole, and (c) a control group that did not practice at all during the acquisition phase. Participants in all three groups tied a necktie onto themselves during the transfer phase. Dependent variables were movement time, movement units, and the quality of the necktie knot. RESULTS No difference in the rate of performance change was found during the acquisition phase between the CR and NCR groups. The difference among the CR, NCR, and control groups' initial transfer phase performance was near significance for movement time and movement units. A significant difference in the rate of performance change was found among the three groups in movement time and movement units during the transfer phase but not in the quality of necktie knot measures. CONCLUSION The degree of similarity during the acquisition of a dressing skill may influence the rate of performance improvement in a similar dressing skill during a transfer phase. Until further research has been established, generalization of these results to special populations should be done conservatively.
Molecular relapse can be detected in blood in a sensitive and timely fashion in B-lineage acute lymphoblastic leukemia.
Department of Botany and Plant Pathology, Oregon State University, Corvallis 97331-2902, USA.
We have previously identified two auxin-binding polypeptides in plasma membrane (PM) preparations from zucchini (Cucurbita pepo L.)(Hicks et al. 1989, Proc. Natl. Acad. Sci. USA 86, 4948-4952). These polypeptides have molecular weights of 40 kDa and 42 kDa and label specifically with the photoaffinity auxin analog 5-N3-7-3H-IAA (azido-IAA). Azido-IAA permits both the covalent and radioactive tagging of auxin-binding proteins and has allowed us to characterize further the 40-kDa and 42-kDa polypeptides, including the nature of their attachment to the PM, their relationship to each other, and their potential function. The azido-IAA-labeled polypeptides remain in the pelleted membrane fraction following high-salt and detergent washes, which indicates a tight and possibly integral association with the PM. Two-dimensional electrophoresis of partially purified azido-IAA-labeled protein demonstrates that, in addition to the major isoforms of the 40-kDa and 42-kDa polypeptides, which possess isoelectric points (pIs) of 8.2 and 7.2, respectively, several less abundant isoforms that display unique pIs are apparent at both molecular masses. Tryptic and chymotryptic digestion of the auxin-binding proteins indicates that the 40-kDa and 42-kDa polypeptides are closely related or are modifications of the same polypeptide. Phase extraction with the nonionic detergent Triton X-114 results in partitioning of the azido-IAA-labeled polypeptides into the aqueous (hydrophilic) phase. This apparently paradoxical behavior is also exhibited by certain integral membrane proteins that aggregate to form channels. The results of gel filtration indicate that the auxin-binding proteins do indeed aggregate strongly and that the polypeptides associate to form a dimer or multimeric complex in vivo. These characteristics are consistent with the hypothesis that the 40-kDa and 42-kDa polypeptides are subunits of a multimeric integral membrane protein which has an auxin-binding site, and which may possess transporter or channel function.
Comparison of methods for assessment of minimal residual disease in childhood B-lineage acute lymphoblastic leukemia.
M J Brisco, P J Sykes, E Hughes, S H Neoh, L E Snell, G Dolman, L M Peng, I R Toogood, K Cheney, M S Rice, C J Story, A A Morley
Department of Haematology and Genetic Pathology, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, Australia.
The level of minimal residual disease (MRD) early in treatment of acute lymphoblastic leukemia (ALL) strongly predicts the risk of marrow relapse. As a variety of methods of varying complexity have been separately used for detecting and quantifying MRD, we compared the prognostic utility of three methods measurement of blast percentage on day 14 of treatment, detection of monoclonality on day 14 or day 35, and measurement of MRD by PCR-based limiting dilution analysis on day 14 or day 35. The study group comprised 38 children aged 1-15 with Philadelphia-negative B-lineage ALL who were uniformly treated and followed until relapse or for a minimum of 5 years. We also studied some of the technical factors which influence the ability to detect MRD. Measurement of blast percentage on day 14 by an expert morphologist, detection of monoclonality on day 35, and PCR-based measurement of MRD levels on days 14 and 35 all showed significant ability to divide patients into prognostic groups. Measurement of blast percentage on day 14 by routine morphology or detection of monoclonality on day 14 were not useful. The quality of DNA samples varied greatly, as determined by amplifiability in the PCR. However, virtually all amplifiable leukemic targets in a sample were detectable which suggests that the level of detection achieved by limiting dilution analysis is essentially determined by the amount of DNA which it is practicable to study. We conclude that quantification of MRD at the end of induction provides the full range of prognostic information for marrow relapse but is complex; detection of monoclonality on day 35 is simple and has good positive predictive value; and quantification of MRD on day 14 merits further study. PCR-based methods for measurement of MRD levels should incorporate a correction for variation in DNA amplifiability.
M J Brisco, P J Sykes, G Dolman, E Hughes, S H Neoh, L Peng, L E Snell, I R Toogood, M S Rice, A A Morley
Department of Hematology and Genetic Pathology, Flinders University of South Australia and Flinders Medical Center, Bedford Park, Australia.
Many patients with acute lymphoblastic leukemia (ALL) are not cured by current therapy because of the development of drug resistance. It is not clear when resistance develops during the growth of the leukemic clone and whether resistant cells are already present at diagnosis or develop later during treatment. Twenty-two uniformly treated children with ALL were studied throughout induction treatment. The size of the leukemic clone in blood and marrow was estimated by limiting dilution PCR analysis, using the rearranged immunoglobulin heavy chain gene as a molecular marker. The decline in the number of leukemic cells was biphasic in virtually all patients. For both marrow and blood, the logarithmic mean of the number of leukemic cells fell by approximately four orders of magnitude during the first 2 weeks, one order of magnitude during the third week, and not at all during the last two weeks of induction treatment. For marrow, the median of the fraction of leukemic cells in each patient that survived per week of treatment was 0.008 for the first 2 weeks, 0.12 for the third week, and 1.4 for the last 2 weeks; for blood, the corresponding figures were 0.003, 0.14, and 0.69, respectively. In individual patients, the results for marrow and blood showed good correlation. The biphasic decline of leukemic cell number suggests that most leukemic cells were sensitive to treatment and were rapidly killed, leaving behind a minor but substantial population of drug-resistant cells. The most likely explanation for this phenomenon is that these resistant cells were already present at diagnosis, their resistance having originated from genetic or epigenetic mutations during prior growth of the leukemic clone.
Department of Occupational Therapy, School of Allied Health, Medical College of Ohio, Toledo 43614-5803, USA. email@example.com
OBJECTIVE Occupational therapists are interested in quality of movement under different environmental conditions. It has been shown that during reaching tasks, the physical aspects of the objects to be grasped can influence the quality of movement. This study investigated whether perceived risk (water temperature) affected the quality of movement during a pouring task. METHOD In a counterbalanced, repeated measures design, 56 participants (M = 27.1 years, SD = 7.4 years) poured hot, then cold water to prepare hot and cold beverages. Dependent variables included movement time, displacement, peak velocity, percentage of movement time to peak velocity, and movement units. Data were analyzed with paired t tests. RESULTS Participant performance in displacement and movement time was significantly different when considering the entire pouring task for both the hot and the cold conditions (ps <.05). In addition, significant differences were found in the discrete movement "sub-portions" of the pouring task (ps <.05). CONCLUSION Perceived risk is an element of meaning that the occupational therapist can consider in providing the person with just enough challenge to facilitate successful performance. By varying the amount of perceived risk in the occupational form, the therapist can help the person experience and develop the range of movement strategies required by everyday occupations. Future research is needed to corroborate these findings in simple and more complex occupations as well as to examine perceived risk in special populations.
Overrepresentation of aboriginal children in acute myeloid leukaemia: the experience of one institution.
The auxin-resistant diageotropica mutant of tomato responds to gravity via an auxin-mediated pathway.
Department of Botany and Plant Pathology, Oregon State University, Corvallis 97331-2902, USA.
Hypocotyls of the diageotropica (dgt) mutant of tomato (Lycopersicon esculentum Mill.) do not elongate in response to exogenous auxin, but can respond to gravity. This appears paradoxical in light of the Cholodny-Went hypothesis, which states that shoot gravicurvature results from asymmetric stimulation of elongation by auxin. While light-grown dgt seedlings can achieve correct gravitropic reorientation, the response is slow compared to wild-type seedlings. The sensitivity of dgt seedlings to inhibition of gravicurvature by immersion in auxin or auxin-transport inhibitors is similar to that of wild-type plants, indicating that both an auxin gradient and auxin transport are required for the gravitropic response and that auxin uptake, efflux, and at least one auxin receptor are functional in dgt. Furthermore, dgt gravicurvature is the result of asymmetrically increased elongation as would be expected for an auxin-mediated response. Our results suggest differences between elongation in response to exogenous auxin (absent in dgt) and elongation in response to gravistimulation (present but attenuated in dgt) and confirm the presence of two phases during the gravitropic response, both of which are dependent on functional auxin transport.
Department of Family Practice, Madigan Army Medical Center, Fort Lewis, Wash., USA.
BACKGROUND: Diagnosis of acute myocardial infarction relies upon the clinical history, interpretation of the electrocardiogram, and measurement of serum levels of cardiac enzymes. Newer biochemical markers of myocardial injury, such as cardiac troponin I and cardiac troponin T, are now being used instead of or along with the standard markers, the MB isoenzyme of creatine kinase (CK-MB) and lactate dehydrogenase. METHODS: We performed a MEDLINE literature search (1987 to 1997) using the key words "troponin I,""troponin T," and "acute myocardial infarction." We reviewed selected articles related to the diagnostic and prognostic usefulness of these cardiac markers in evaluating patients with suspected myocardial infarction. RESULTS: We found that (1) troponin I is a better cardiac marker than CK-MB for myocardial infarction because it is equally sensitive yet more specific for myocardial injury;(2) troponin T is a relatively poorer cardiac marker than CK-MB because it is less sensitive and less specific for myocardial injury; and (3) both troponin I and troponin T may be used as independent prognosticators of future cardiac events. CONCLUSIONS: Troponin I is a sensitive and specific marker for myocardial injury and can be used to predict the likelihood of future cardiac events. It is not much more expensive to measure than CK-MB. Overall, troponin I is a better cardiac marker than CK-MB and should become the preferred cardiac enzyme when evaluating patients with suspected myocardial infarction.
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Corticospinal adaptations and strength maintenance in the immobilized arm following 3 weeks unilateral strength training.
Cognitive and Exercise Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Victoria, Australia.
Cross-education strength training has being shown to retain strength and muscle thickness in the immobilized contralateral limb. Corticospinal mechanisms have been proposed to underpin this phenomenon; however, no transcranial magnetic stimulation (TMS) data has yet been presented. This study used TMS to measure corticospinal responses following 3 weeks of unilateral arm training on the contralateral, immobilize arm. Participants (n = 28) were randomly divided into either immobilized strength training (Immob + train) immobilized no training (Immob) or control. Participants in the immobilized groups had their nondominant arm rested in a sling, 15 h/day for 3 weeks. The Immob + train group completed unilateral arm curl strength training, while the Immob and control groups did not undertake training. All participants were tested for corticospinal excitability, strength, and muscle thickness of both arms. Immobilization resulted in a group x time significant reduction in strength, muscle thickness and corticospinal excitability for the untrained limb of the Immob group. Conversely, no significant change in strength, muscle thickness, or corticospinal excitability occurred in the untrained limb of the Immob + train group. These results provide the first evidence of corticospinal mechanisms, assessed by TMS, underpinning the use of unilateral strength training to retain strength and muscle thickness following immobilization of the contralateral limb.
US Army Med Dep J. ;:38-45 22388679
The effects of animal-assisted therapy on wounded warriors in an occupational therapy life skills program.
Christine E Beck, Florie Gonzales Jr, Carol Haertlein Sells, Cynthia Jones, Theresa Reer, Yao Yao Zhu
528th Medical Detachment (COSC), Bagram, Afghanistan.
Animal-assisted therapy (AAT) has gained much attention in civilian and military health care. Evidence supports its benefits with varied populations with diseases and disabilities, but no research has been done with injured or ill service members. This pretest, posttest nonrandomized control group study evaluated the effects of AAT on Warriors in transition (N=24) attending an Occupational Therapy Life Skills program with the long-term goal of improving their successful reintegration. Although significant differences were not found between the groups on most measures, anecdotal reports by participants and observers indicate that participants eagerly anticipated being with the therapy dogs, expressed pleasure and satisfaction with the experience, and regretted seeing it end. There were significant correlations between mood, stress, resilience, fatigue, and function at various measurement points. This is the first study to formally assess the benefits of AAT with wounded service members in garrison. Suggestions for future research are provided.
Effects of virtual reality training on functional reaching movements in people with Parkinson's disease: a randomized controlled pilot trial.
Hui-Ing Ma, Wen-Juh Hwang, Jing-Jing Fang, Jui-Kun Kuo, Ching-Yi Wang, Iat-Fai Leong, Tsui-Ying Wang
Department of Occupational Therapy and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. firstname.lastname@example.org
OBJECTIVE To investigate whether practising reaching for virtual moving targets would improve motor performance in people with Parkinson's disease. DESIGN Randomized pretest-posttest control group design. SETTING A virtual reality laboratory in a university setting. PARTICIPANTS Thirty-three adults with Parkinson's disease. INTERVENTIONS The virtual reality training required 60 trials of reaching for fast-moving virtual balls with the dominant hand. The control group had 60 practice trials turning pegs with their non-dominant hand. MAIN OUTCOME MEASURES Pretest and posttest required reaching with the dominant hand to grasp real stationary balls and balls moving at different speeds down a ramp. Success rates and kinematic data (movement time, peak velocity and percentage of movement time for acceleration phase) from pretest and posttest were recorded to determine the immediate transfer effects. RESULTS Compared with the control group, the virtual reality training group became faster (F = 9.08, P = 0.005) and more forceful (F = 9.36, P = 0.005) when reaching for real stationary balls. However, there was no significant difference in success rate or movement kinematics between the two groups when reaching for real moving balls. CONCLUSION A short virtual reality training programme improved the movement speed of discrete aiming tasks when participants reached for real stationary objects. However, the transfer effect was minimal when reaching for real moving objects.
José Francisco Filipe Marmeleira, Filipe Manuel Soares de Melo, Mouhaydine Tlemcani, Mária Adriano Bandeira Godinho
Dept. of Sport and Health, and Tlemcani, the Geophysics Center, University of Évora, Évora, Portugal.
The main aim of this research was to study the effects of a specific exercise program on the speed of behavior of older adults during on-the-road driving. Twenty-six drivers (55-78 yr old) were randomly assigned to either an exercise group or a control group. The exercise program (3 sessions of 60 min/wk for 8 wk) incorporated tasks that induced the participants to respond quickly to challenging situations. On-the-road driving tasks (under single- and dual-task conditions) included measures of simple and choice reaction time, movement time, and response time. Significant positive effects were found at follow-up resulting from participation in the exercise program: Improvements were found for several measures in all driving tasks, and a composite score reflected a better general drivers' speed of behavior. These results show that exercise can enhance speed of behavior in older drivers and should therefore be promoted.
A pneumatic glove and immersive virtual reality environment for hand rehabilitative training after stroke.
Rehabilitation Institute of Chicago, Chicago, IL 60611, USA. email@example.com
While a number of devices have recently been developed to facilitate hand rehabilitation after stroke, most place some restrictions on movement of the digits or arm. Thus, a novel glove was developed which can provide independent extension assistance to each digit while still allowing full arm movement. This pneumatic glove, the PneuGlove, can be used for training grasp-and-release movements either with real objects or with virtual objects in a virtual reality environment. Two groups of stroke survivors, with seven subjects in each group, completed a six-week rehabilitation training protocol, consisting of three 1-h sessions held each week. One group wore the PneuGlove during training, performed both within a novel virtual reality environment and outside of it with physical objects, while the other group completed the same training without the device. Across subjects, significant improvements were observed in the Fugl-Meyer Assessment for the upper extremity (p < 0.001), the hand/wrist portion of the Fugl-Meyer Assessment (p < 0.001), the Box and Blocks test (p < 0.005), and palmar pinch strength (p < 0.005). While changes in the two groups were not statistically different, the group using the PneuGlove did show greater mean improvement on each of these measures, such as gains of 3.7 versus 2.4 points on the hand/wrist portion of the Fugl-Meyer Assessment and 14 N versus 5 N in palmar pinch.
Prolonged mechanical and physiological changes in the upper extremity following short-term simulated power hand tool use.
Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA.
This study investigated in-vivo changes in upper limb dynamic mechanical properties and magnetic resonance imaging (MRI) parameters following short-term power hand tool operation. Previous studies have found reduction in mechanical properties following short-term power tool usage at long build-up times. This study advances that work by having participants operate a simulated pistol grip power hand tool and evaluating changes in mechanical properties, strength, discomfort level and MRI prior to tool operation and daily for 3 d after tool operation. Twenty-four participants were randomly assigned to operate a simulated power hand tool for either a high peak reaction force of 123 N (peak torque=8 Nm, build-up time=250 ms) or at a low peak reaction force of 5 N (peak torque=2 Nm, build-up time=50 ms). Subjects operated the tool for 60 min at the rate of six times per min. A reduction in stiffness (27%, p<0.05) was observed 24 h after tool operation for the high force group and this change persisted (26%, p<0.05) up to 72 h after tool operation. Similar changes were not observed for the low force group. No changes were observed in mass moment of inertia, damping, isometric strength and damping for either group (p>0.05). There was a signal intensity increase (12%, CI 19%, 5.06%) in the supinator muscle MRI for both groups 24 h after tool operation but only the high force group remained elevated (10%, CI 13.7%, 0.06%) 72 h after tool operation. Persistent short-term changes in mechanical and MRI parameters at high force levels could indicate increased strain on the upper limb and may negatively affect ability to react during rapid forceful loading of the upper limb. This research can ultimately lead to better ergonomic interventions through quantitative power hand tool design guidelines and work practices based on understanding the damaging effects of exposure to specific levels of reaction force, build-up time and repetition, as well as providing new outcome measures for epidemiological studies.
Motor training of upper extremity with functional electrical stimulation in early stroke rehabilitation.
Balgrist University Hospital, Spinal Cord Center, Zurich, Switzerland. firstname.lastname@example.org
BACKGROUND Functional electrical stimulation (FES) allows active exercises in stroke patients with upper extremity paralysis. OBJECTIVE To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and/or hand paralysis. METHODS For this pilot study, 23 acute and subacute stroke patients were randomly assigned to the intervention (n = 12) and control group (n = 11). Distributed over 4 weeks, FES training replaced 12 conventional training sessions in the intervention group. An Extended Barthel Index (EBI) subscore assessed the performance of activities of daily living (ADL). The Chedoke McMaster Stroke Assessment (CMSA) measured hand and arm function and shoulder pain. The Modified Ashworth Scale (MAS) assessed resistance to passive movement. Unblinded assessments were performed prior to and following the end of the training period. RESULTS The EBI subscore and CMSA arm score improved significantly in both groups. The CMSA hand function improved significantly in the FES group. Resistance to passive movement of finger and wrist flexors increased significantly in the FES group. Shoulder pain did not change significantly. None of the outcome measures, however, demonstrated significant gain differences between the groups. CONCLUSIONS We did not find clear evidence for superiority or inferiority of FES. Our findings, and those of similar trials, suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences.
Motor Behavior Laboratory, Applied Physiology and Kinesiology Department, University of Florida, Gainesville, FL 32611, USA. email@example.com
BACKGROUND The current treatment intervention study determined the effect of coupled bilateral training (i.e., bilateral movements and EMG-triggered neuromuscular stimulation) and resistive load (mass) on upper extremity motor recovery in chronic stroke. METHODS Thirty chronic stroke subjects were randomly assigned to one of three behavioral treatment groups and completed 6 hours of rehabilitation in 4 days:(1) coupled bilateral training with a load on the unimpaired hand,(2) coupled bilateral training with no load on the unimpaired hand, and (3) control (no stimulation assistance or load). RESULTS Separate mixed design ANOVAs revealed improved motor capabilities by the coupled bilateral groups. From the pretest to the posttest, both the coupled bilateral no load and load groups moved a higher number of blocks and demonstrated more regularity in the sustained contraction task. Faster motor reaction times across test sessions for the coupled bilateral load group provided additional evidence for improved motor capabilities. CONCLUSIONS Together these behavioral findings lend support to the contribution of coupled bilateral training with a load on the unimpaired arm to improved motor capabilities on the impaired arm. This evidence supports a neural explanation in that simultaneously moving both limbs during stroke rehabilitation training appears to activate balanced interhemispheric interactions while an extra load on the unimpaired limb provides stability to the system.
Alveolar rhabdomyosarcoma of the left hand with bilateral breast metastases in an adolescent female.
Geok-Chin Tan, Mohd-Sidik Shiran, Abdul-Rahman Hayati, Noor-Akmal Sharifah, Aida-Selamat Nuru, Mohammad Rohaizak
Department of Pathology, Faculty of Medicine, Universiti Kebangsaan, Kuala Lumpur, Malaysia. firstname.lastname@example.org
Rhabdomyosarcoma is a common extramammary malignancy in pediatric age groups, but it rarely metastasizes to the breast. Breast rhabdomyosarcomas are commonly metastatic, with possible primary locations at the head and neck, trunk, extremities, retroperitoneum and perianal region. We report a case of primary alveolar rhabdomyosarcoma of the upper extremities in a 17-year-old adolescent female who presented with bilateral lower limb weakness and bilateral breast lumps.
University of Maryland Baltimore, School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD 21201, USA. email@example.com
Principles of motor control and learning such as bilateral coordination and task-specificity, are increasingly incorporated in the design of upper extremity rehabilitation protocols for stroke survivors. Yet most studies investigating the efficacy of new protocols report composite scores of standardized tests, such as the Fugl-Meyer Upper Extremity test (FM) and the Wolf Motor Arm Test, rather than determining how the motor control and coordination of arm movements has changed. Here we present a sub-study of a larger randomized controlled trial comparing a bilateral and unilateral training protocol where participants were assessed on bilateral and unilateral arm reaching. Eligible participants for the arm reaching analysis were 9 (FM=37) and 9 (FM=34) in Bilateral Arm Training with Rhythmic Auditory Cueing (BATRAC) and Dose Matched Therapeutic Exercises (DMTE), respectively. Participants undertook 18 sessions of training for 6 weeks with 20min of active training per session. For bilateral arm reaching, participants after BATRAC were faster, with increased peak acceleration, fewer movement units, and smoother hand paths for each arm. The BATRAC training group showed greater improvements with training than the DMTE group during bilateral reaching for parameters of movement units and smoothness of hand path. For unilateral arm reaching, participants were faster after DMTE for paretic arm reaching; however, this group did not improve to a greater extent than the BATRAC training group. Within group functional gains were seen after BATRAC on FM, Wolf Motor Arm Test (time and weight) and after DMTE on FM and Wolf Weight. There was a positive correlation between movement units and the time component of the Wolf Motor Arm Test. The reaching analysis demonstrates task-specificity in training since BATRAC improves performance in bilateral reaching and DMTE improves performance in unilateral reaching. Temporal/spatial control outcomes in studies of post-stroke interventions can identify functionally relevant motor control changes that are not captured by traditional standardized tests.