Search

Keywords: EEG, fNIRS, MoBI, Rehabilitation, Stroke, While regaining walking and arm use are top priorities for individuals with stroke, (1) there is a significant gap between interventions that show changes in clinical outcome measures and their [...]

ABSTRACTBackgroundFatigue is a common problem for adults with cerebral palsy (CP) and may be related to the decline in physical function, including the loss of the ability to walk.ObjectiveTo estimate the overall prevalence of fatigue in adolescents and adults with cerebral palsy.MethodsMEDLINE (OVID), EMBASE (OVID), CINAHL, PsycINFO, and Web of Science electronic databases were searched in September 2021. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration CRD42021275596. Two authors independently screened studies according to Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the methodological quality of included studies was assessed using the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Checklist.ResultsOf the 1022 studies identified, fifteen met the inclusion criteria. Study quality assessment was performed using the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Checklist, with scores ranging from 4 out of 10 to 10 out of 10. Pooled prevalence estimates for twelve studies were 52.9% (95% confidence interval [CI]40.9–64.6). Fatigue was higher in people with bilateral CP than unilateral CP, and higher in people classified as Gross Motor Function Classification System (GMFCS) levels III-V.ConclusionMore than half of the adults with CP (52.9%) reported living with fatigue. Adults with CP frequently reported fatigue that may lead to activity limitations and/or restrictions. Fatigue was strongly correlated with pain, depression, and reduced quality of life. Assessment and appropriate fatigue management techniques are necessary to enhance capacity for everyday functioning and quality of life.

Attention and planning can be altered by stroke, which can influence motor performance. Although the influence of these factors on recovery from stroke has been explored for the upper extremity (UE), their impact on balance and gait are unknown. This perspective article presents evidence that altered motor and visuospatial attention influence motor planning of voluntary goal-directed movements poststroke, potentially affecting balance and gait. Additionally, specific strategies for rehabilitation of balance and gait poststroke in the presence of these factors are discussed. Visuospatial attention selects relevant sensory information and supports the preparation of responses to this information. Motor attentional impairments may produce difficulty with selecting appropriate motor feedback, potentially contributing to falls. An original theoretical model is presented for a network of brain regions supporting motor and visuospatial attention, as well as motor planning of voluntary movements. Stroke may influence this functional network both locally and distally, interfering with input or output of the anatomical or functional regions involved and affecting voluntary movements. Although there is limited research directly examining leg function, evidence suggests alterations in motor and visuospatial attention influence motor planning and have a direct impact on performance of gait and balance. This model warrants testing comparing healthy adults with individuals with stroke., After stroke, many people experience sensorimotor impairments that disrupt motor performance of balance and gait. (1) Most of the movements executed in a given day are voluntary and goal directed, [...]

Background and Purpose. For rehabilitation strategies to be effective, training should be based on principles of motor learning, such as feedback-error learning, that facilitate adaptive processes in the nervous system by inducing errors and recalibration of sensory and motor systems. This case report suggests that locomotor resistance training can enhance somatosensory and corticospinal excitability and modulate resting-state brain functional connectivity in a patient with motor-incomplete spinal cord injury (SCI). Case Description. The short-term cortical plasticity of a 31-year-old man who had sustained an incomplete SCI 9 5 years previously was explored in response to body-weight-supported treadmill training with velocity-dependent resistance applied with a robotic gait orthosis. The following neurophysiological and neuroimaging measures were recorded before and after training. Sensory evoked potentials were elicited by electrical stimulation of the tibial nerve and recorded from the somatosensory cortex. Motor evoked potentials were generated with transcranial magnetic stimulation applied over the tibialis anterior muscle representation in the primary motor cortex. Resting-state functional magnetic resonance imaging was performed to evaluate short-term changes in patterns of brain activity associated with locomotor training. Outcomes. Somatosensory excitability and corticospinal excitability were observed to increase after locomotor resistance training. Motor evoked potentials increased (particularly at higher stimulation intensities), and seed-based resting-state functional magnetic resonance imaging analyses revealed increased functional connectivity strength in the motor cortex associated with the less affected side after training. Discussion. The observations suggest evidence of short-term cortical plasticity in 3 complementary neurophysiological measures after one session of locomotor resistance training. Future investigation in a sample of people with incomplete SCI will enhance the understanding of potential neural mechanisms underlying the behavioral response to locomotor resistance training., Gait retraining strategies after neurological injury have been focused on body-weight-supported treadmill training (BWSTT) approaches, in which repetitive movement of the legs through the gait cycle is enabled by the [...]

•Cerebrovascular function, which is unique to a standing posture, is related to cognition.•Standing, not supine, middle cerebral artery velocity predicts MoCA scores.•Higher standing pulsatility index is associated with slower gait speed.•Sex differences in hemodynamics with cognitive function and motor control.•Mild cognitive impairment is a potential clinical cohort to target.

Supplemental Digital Content is Available in the Text.

Presents several letters to the editor related to articles published in the previous issue of the journal. Criticism of journalist Eric Alterman; Information related to San Francisco mayoral race, where City Supervisor Tom Ammiano is being pitted against Democrat Willie Brown; Discussion on Jacob S. Hacker's article titled "Bradley Does Healthcare."

The article reports on the advocacy against the proposal of school superintendent Maria Goodloe-Johnson to close school buildings in Seattle, Washington. It mentions that the proposal consists of closing school buildings, dissolving 14 educational programs, and moving as many as 4,000 school children. It states that many parents and Parents' and Teachers' Associations (PTAs) have tried hard to understand the proposal and to come up with counterproposals.

One male with unilateral osteoarthritis (OA) of the knee underwent testing of corticospinal (CS) excitability (as quantified from motor-evoked potentials (MEPs) in the rectus femoris (RF) using transcranial magnetic stimulation) and quadriceps muscle strength. Baseline data indicated reduced MEP amplitudes in the RF of the affected limb compared to the unaffected limb. Increases in RF MEP amplitudes from both limbs were observed immediately following a 30-minute exercise session focusing on muscle strengthening. Following an 8-week muscle strengthening intervention, the participant exhibited increased MEP amplitudes and muscle strength in the affected limb. These findings suggest that alterations in peripheral muscle function found in patients with knee OA may have an origin centrally within the motor cortex and that interlimb differences may be evident in those with unilateral disease. These findings also suggest that CS excitability may be improved following a muscle strengthening intervention.