Promoting Neuroplasticity and Recovery After Stroke: Future Directions for Rehabilitation Clinical Trials.

Promoting neuroplasticity and recovery after stroke: future directions for rehabilitation clinical trials.

Filed under: Rehab Centers

Curr Opin Neurol. 2012 Dec 15;
Bowden MG, Woodbury ML, Duncan PW

PURPOSE OF REVIEW: The purpose is to establish a theoretical framework by which new interventions for poststroke rehabilitation may be developed incorporating knowledge of neuroplasticity and the critical ingredients of rehabilitation. RECENT FINDINGS: Large phase III randomized controlled trials (RCTs) are rare in neurorehabilitation, and the results of those that have been completed are perplexing because the experimental and control treatments were not different when matched for activity level. In addition, the outcome measures used to define treatment effects reflected behavioral endpoints, but did not reveal how neuroplastic mechanisms or other mechanistic factors may have contributed to the treatment response. Knowledge of both the neurophysiologic basis of recovery and key elements of interventions that drive motor learning, such as intensity and task progression, are critical for optimizing future poststroke motor rehabilitation clinical trials. SUMMARY: Future neurorehabilitation RCTs require a better understanding of the interaction of interventions and neurophysiological recovery in order to target interventions at specific neurophysiologic substrates, develop a more clear understanding of the impact of intervention parameters (e.g. dose, intensity), and advance discussions regarding optimal ways to partner medical and rehabilitation interventions in order to improve outcomes.
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Filed under: Rehab Centers

J Strength Cond Res. 2012 Dec 18;
Judge LW, Bellar DM, Gilreath E, Petersen J, Craig BW, Popp JK, Hindawi OS, Simon L

ABSTRACT: The purpose of this study is to determine the pre and post-activity stretching practices of Division I, II, and III track and field throws programs. A 33-item survey instrument was developed to collect data regarding the warm-up and flexibility practices at the NCAA Division I (n = 320), Division II (n = 175), and Division III (n = 275) universities. A total of 135 surveys were completed for a 17.5% return rate, and although the response rate was generally low it did mirror the distribution percentages of the three divisions. Significant differences were found for the level of USATF certification and the use of static stretching between throws (? = 6.333, p = .048). Significance was also found for the USATF certification level and athletic trainer (AT) assistance in performing static stretching (? = 13.598, p = .01). Significant differences were also found for the NCAA division levels and the use of soft tissue work (? = 5.913, p = .026). Although research supports dynamic warm-up/stretching over other forms of pre-activity protocols (23, 36), it appears that some track and field throws coaches are reluctant to completely discontinue pre-activity static stretching. The results of this study suggest it is necessary for track and field throws coaches to re-evaluate their own practices, perhaps better aligning them with current research findings.
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What predicts 36 item health survey version 2 after total hip arthroplasty.

Filed under: Rehab Centers

Arch Phys Med Rehabil. 2012 Dec 14;
Ieiri A, Tushima E, Ishida K, Abe S, Inoue M, Masuda T

OBJECTIVE: To identify the factors having the greatest effect on the MOS short form 36 item health survey version 2 (SF-36v2) score after total hip arthroplasty (THA). DESIGN: Retrospective review SETTING: Private 150-bed hospital PARTICIPANTS: The subjects were 659 patients who underwent initial THA for osteoarthritis (OA) of the hip at Eniwa Hospital between April 2007 and January 2009. A total of 138 patients who fulfilled the inclusion criteria was seen at the first follow-up, while 108 patients were included in the second follow-up; all 30 patients excluded at the second follow-up underwent contralateral THA between follow-ups. The average time from surgery to first follow-up was 195.1±67.7 days, and that to second follow-up was 443.0±108.5 days. Patients’ average age was 61.1 ± 9.9 years at first follow-up and 61.3 ± 10.3 years at second follow-up. Women accounted for 85.5% of patients at first follow-up and 85.2% at second follow-up. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Eight subscales of the SF-36v2, age, sex, body mass index (BMI), complications, living alone, contralateral hip OA, range of hip joint motion, walking aids, and preoperative mental health (MH) values from the SF-36v2. RESULTS: Canonical correlation analysis showed that contralateral hip OA had a major effect on the SF-36v2 score at the first follow-up. At the second follow-up, excluding the 30 patients who had undergone contralateral THA, physical function (PF) measured by the SF-36v2 was strongly affected by age, and other items were strongly affected by preoperative MH. CONCLUSIONS: When using the SF-36v2 as an assessment scale after THA, adjustments should be made for contralateral hip OA. Moreover, age and preoperative mental health should also be considered.
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