Cortical Reorganization After Motor Imagery Training in Chronic Stroke Patients With Severe Motor Impairment: A Longitudinal fMRI Study.

Cortical reorganization after motor imagery training in chronic stroke patients with severe motor impairment: a longitudinal fMRI study.

Neuroradiology. 2013 Apr 26;
Sun L, Yin D, Zhu Y, Fan M, Zang L, Wu Y, Jia J, Bai Y, Zhu B, Hu Y

INTRODUCTION: Despite its clinical efficacy, few studies have examined the neural mechanisms of motor imagery training (MIT) in stroke. Our objective was to find the cortical reorganization patterns after MIT in chronic stroke patients. METHODS: Twenty stroke patients with severe motor deficits were randomly assigned to the MIT or conventional rehabilitation therapy (CRT) group, but two lost in the follow-up. All 18 patients received CRT 5 days/week for 4 weeks. Nine subjects in the MIT group received 30-min MIT 5 days/week for 4 weeks. Before and after the interventions, the upper limb section of the Fugl-Meyer Scale (FM-UL) was blindly evaluated, and functional magnetic resonance imaging was administered while the patients executed a passive fist clutch task. RESULTS: Two cortical reorganization patterns were found. One pattern consisted of the growth in activation in the contralateral sensorimotor cortex (cSMC) for most patients (six in the MIT group, five in the CRT group), and the other consisted of focusing of the activation in the cSMC with increasing of the laterality index of the SMC for a small portion of patients (three in the MIT group, one in the CRT group). When we applied correlation analyses to the variables of relative ?cSMC and ?FM-UL in the 11 patients who experienced the first pattern, a positive relationship was detected. CONCLUSIONS: Our results indicate that different cortical reorganization patterns (increases in or focusing of recruitment to the cSMC region) exist in chronic stroke patients after interventions, and patients may choose efficient patterns to improve their motor function. HubMed – rehab

A Longitudinal Evaluation of Maturational Effects on Lower Extremity Strength in Female Adolescent Athletes.

Pediatr Phys Ther. 2013 Apr 24;
Quatman-Yates CC, Myer GD, Ford KR, Hewett TE

PURPOSE:: Recent studies demonstrate that adolescent growth without corresponding strength adaptations may lead to the development of risk factors for patellofemoral pain and anterior cruciate ligament injuries. Our purpose was to investigate the longitudinal trajectories of lower extremity strength across maturational stages for a cohort of female student athletes. METHODS:: A nested cohort design was used to identify 39 subjects who had complete knee flexion, knee extension, and hip abduction strength data for 3 test sessions spaced approximately 1 year apart and during which they transitioned from prepubertal to a pubertal status. RESULTS:: Knee extension strength increased while hip abduction and hamstrings-to-quadriceps ratio strength decreased from prepubertal to pubertal stages (P < .05). No effects of time with respect to knee flexion strength or nondominant/dominant limb differences were found (P > .05). CONCLUSION:: These data provide support that preadolescence is an optimal time to institute strength training programs aimed toward injury prevention. HubMed – rehab

Practice of laryngectomy rehabilitation interventions: a perspective from South America.

Curr Opin Otolaryngol Head Neck Surg. 2013 Apr 24;
Vartanian JG, Carrara-de-Angelis E, Kowalski LP

PURPOSE OF REVIEW: Treatment of laryngeal cancer will depend on several factors, including tumor factors, patient factors, as well as the technical resource and expertise of the surgical team and treatment center. In developing countries, most patients have their diagnosis performed at advanced stages, with a significant proportion at very advanced locoregionally, which results in a limitation to the use of organ-preserving approaches. A total laryngectomy is still the most frequent treatment for larynx cancer patients. The rehabilitation in such scenarios can be more demanding and can cost more compared with developed countries. RECENT FINDINGS: For early-stage tumors, function-preserving strategies are mandatory, and can include partial laryngectomies and radiation therapy. In such cases, functional rehabilitation usually is easily achieved, with lower negative impact on the patient’s daily life. For advanced tumor stages, a treatment shift toward a more conservative management has been observed. However, the success rates of organ-preserving strategies, mainly with chemoradiation approaches, will rely on a rigorous patient selection process. SUMMARY: The rehabilitation of laryngectomy patients in developing countries can be more demanding and can cost more compared with developed countries. In such scenarios, some strategies can be employed by the multidisciplinary team, mainly by the surgical and speech-pathology teams, aiming to decrease the costs involved in the rehabilitation of total laryngectomy patients in developing countries. HubMed – rehab

Practice of laryngectomy rehabilitation interventions: a perspective from India.

Curr Opin Otolaryngol Head Neck Surg. 2013 Apr 24;
Chaukar DA, Vaidya AD, D’Cruz AK

PURPOSE OF REVIEW: Total laryngectomy remains the treatment for a significant number of locally advanced cancers (T4) or as a salvage procedure following failure of chemoradiotherapy. Loss of natural voice is the most important disadvantage of this surgery, and impacts quality of life. In the past few decades, there has been emphasis on rehabilitative efforts after laryngectomy. Laryngectomy rehabilitation is practiced globally, and is subject to regional problems and constraints. This calls for better understanding of experiences of differing geographical regions, and the impact of the local socioeconomic conditions on post-laryngectomy rehabilitation. RECENT FINDINGS: Current world literature focuses on advances in voice prosthesis, which would lead to better rehabilitation as well as improve the life of prostheses. The current review focuses on voice rehabilitation post-laryngectomy: the existing world literature, and how it has impacted prosthetic voice rehabilitation in India, within the local constraints. SUMMARY: The practice of prosthetic voice rehabilitation is well established in the Indian scenario, with results favorably comparing to world literature. However, few centers have the expertise and support staff to implement an effective post-laryngectomy rehabilitative program. There is need for assessment in a structured manner of outcomes and economic benefits of post-laryngectomy rehabilitation. HubMed – rehab