Rehab Centers: Rehabilitation Interventions for Chronic Motor Deficits With Repetitive Transcranial Magnetic Stimulation.

Rehabilitation interventions for chronic motor deficits with repetitive transcranial magnetic stimulation.

Filed under: Rehab Centers

J Neurosurg Sci. 2012 Dec; 56(4): 299-306
Paquette C, Thiel A

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive electrophysiological method to modulate cortical excitability. As such, rTMS can be used in conjunction with conventional physiotherapy or occupational therapy to facilitate rehabilitation of motor function in patients with focal brain lesions. This review summarizes the rationale for using rTMS in the rehabilitation of motor deficits as derived from imaging and electrophysiological studies of the human motor system. rTMS methodology and its various stimulation modalities are introduced and current evidence for rTMS as supportive therapy for the rehabilitation of chronic motor deficits is discussed.
HubMed – rehab


Constraint-Induced Movement Therapy for the Lower Extremities in Multiple Sclerosis: Case Series with 4-Year Follow-up.

Filed under: Rehab Centers

Arch Phys Med Rehabil. 2012 Oct 27;
Mark VW, Taub E, Uswatte G, Bashir K, Cutter GR, Bryson CC, Bishop-McKay S, Bowman MH

OBJECTIVE: To evaluate in a preliminary manner the feasibility, safety, and responsiveness of persons with impaired lower extremity use from multiple sclerosis (MS) to Constraint-Induced Movement therapy (CI therapy). DESIGN: Clinical trial with periodic follow-up for up to 4 years. SETTING: University-based rehabilitation research laboratory. PARTICIPANTS: A referred sample of 4 ambulatory adults with chronic MS with at least moderate loss of lower extremity use (average item score ? 6.5/10 on the Functional Performance measure of the Lower Extremity Motor Activity Log [LE-MAL]). INTERVENTIONS: CI therapy was administered for 52.5 hours over 3 consecutive weeks (15 consecutive weekdays) to each patient. MAIN OUTCOME MEASURES: The primary outcome was the LE-MAL score at post-treatment. Secondary outcomes were post-treatment scores on laboratory assessments of maximal lower extremity movement ability. RESULTS: All of the patients improved substantially at post-treatment on the LE-MAL, with smaller improvements on the laboratory motor measures. Scores on the LE-MAL continued to improve for 6 months afterward. By 1 year, patients remained on average at post-treatment levels. At 4 years, half of the patients remained above pre-treatment levels. There were no adverse events, and fatigue ratings were not significantly changed by the end of treatment. CONCLUSIONS: This initial trial of lower extremity CI therapy for MS indicates that the treatment can be safely administered, is well tolerated, and produces substantially improved real-world lower extremity use for as much as 4 years afterward. Further trials are needed to determine the consistency of these findings.
HubMed – rehab


Commentary: reflections on diversity and inclusion in medical education.

Filed under: Rehab Centers

Acad Med. 2012 Nov; 87(11): 1461-3
Delisa JA, Lindenthal JJ

The authors discuss how the strategy of fostering greater diversity and inclusion regarding minorities can help decrease health disparities and improve health outcomes. They propose that examining admission to medical school of qualified individuals with physical disabilities and fostering better communication with these individuals should be part of that strategy. Whereas people with disabilities constitute about 20% of the population, only between 2% and 10% are practicing physicians. The two major barriers to having more persons with disabilities as medical students are the cost of accommodating these persons and medical schools’ technical standards. The authors offer suggestions for overcoming these barriers, and the additional barrier of communication with persons with various disabilities, such as deafness or visual impairment.The authors also discuss some of the issues involved in having greater representation of minorities in medicine. In addition, they stress the need for more training in cultural awareness for students and residents and for physicians well along in their careers. Medical educators will be increasingly called on to create new models designed to sensitize students and faculty to racial, ethnic, and other types of diversity, while documenting the efficacy and costs of extant ones, from the standpoint of both practitioner and consumer.The authors hope that the moves toward greater diversity and more training in cultural awareness will increase the efficacy of health care while reducing its cost. The demands of these efforts will require the commitment of diverse, intellectually capable, and compassionate people at many levels of academic medicine.
HubMed – rehab



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