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  • 1
    Online Resource
    Online Resource
    Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study
    SAGE Publications ; 2020
    In:  Neurorehabilitation and Neural Repair Vol. 34, No. 9 ( 2020-09), p. 814-830
    Details
    In: Neurorehabilitation and Neural Repair, SAGE Publications, Vol. 34, No. 9 ( 2020-09), p. 814-830
    Abstract: Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. Objective Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. Methods Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. Results In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). Conclusions Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.
    Type of Medium: Online Resource
    ISSN: 1545-9683 , 1552-6844
    URL: Article
    DOI: 10.1177/1545968320946038
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 2
    Online Resource
    Online Resource
    Enhanced Spontaneous Motor Recovery After Stroke in Mice Treated With Cerebrolysin
    SAGE Publications ; 2021
    In:  Neurorehabilitation and Neural Repair Vol. 35, No. 6 ( 2021-06), p. 525-533
    Details
    In: Neurorehabilitation and Neural Repair, SAGE Publications, Vol. 35, No. 6 ( 2021-06), p. 525-533
    Abstract: Motor recovery after stroke in humans and in rodent models is time sensitive. Recovery in patients is a result of biological spontaneous recovery via endogenous repair mechanisms and is likely improved by enhancing the synaptic plasticity required for endogenous repair. Cerebrolysin is a polypeptide preparation known to enhance neuroplasticity and may improve recovery in patients. In mice, we tested the hypothesis that Cerebrolysin can act poststroke to enhance both spontaneous and training-associated motor recovery. Methods Mice were trained to perform a skilled prehension task. We then induced a photothrombotic stroke in the caudal forelimb area, after which we retrained animals on the prehension task in the presence or absence of Cerebrolysin after a 2-day or 8-day delay. Mice received daily intraperitoneal Cerebrolysin or saline injections starting poststroke day 1 or poststroke day 7. Results Prior studies showed that poststroke recovery of prehension can occur if animals receive rehabilitative training during an early sensitive period but is incomplete if rehabilitative training is delayed. In contrast, we show complete recovery of prehension, despite a delay in rehabilitative training, when mice receive daily Cerebrolysin administration starting on poststroke day 1 or on poststroke day 8. When Cerebrolysin is given on poststroke day 1, recovery occurred even in the absence of training. Stroke volumes were similar across groups. Conclusions Poststroke Cerebrolysin administration leads to recovery of motor function independent of rehabilitative training without a protective effect on stroke volume. This is one of the first demonstrations of training-independent motor recovery in rodent stroke models.
    Type of Medium: Online Resource
    ISSN: 1545-9683 , 1552-6844
    URL: Article
    DOI: 10.1177/15459683211000734
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 3
    Online Resource
    Online Resource
    Paradoxical Motor Recovery From a First Stroke After Induction of a Second Stroke : Reopening a Postischemic Sensitive Period
    SAGE Publications ; 2016
    In:  Neurorehabilitation and Neural Repair Vol. 30, No. 8 ( 2016-09), p. 794-800
    Details
    In: Neurorehabilitation and Neural Repair, SAGE Publications, Vol. 30, No. 8 ( 2016-09), p. 794-800
    Abstract: Background and objective. Prior studies have suggested that after stroke there is a time-limited period of increased responsiveness to training as a result of heightened plasticity—a sensitive period thought to be induced by ischemia itself. Using a mouse model, we have previously shown that most training-associated recovery after a caudal forelimb area (CFA) stroke occurs in the first week and is attributable to reorganization in a medial premotor area (AGm). The existence of a stroke-induced sensitive period leads to the counterintuitive prediction that a second stroke should reopen this window and promote full recovery from the first stroke. To test this prediction, we induced a second stroke in the AGm of mice with incomplete recovery after a first stroke in CFA. Methods. Mice were trained to perform a skilled prehension (reach-to-grasp) task to an asymptotic level of performance, after which they underwent photocoagulation-induced stroke in CFA. After a 7-day poststroke delay, the mice were then retrained to asymptote. We then induced a second stroke in the AGm, and after only a 1-day delay, retrained the mice. Results. Recovery of prehension was incomplete when training was started after a 7-day poststroke delay and continued for 19 days. However, a second focal stroke in the AGm led to a dramatic response to 9 days of training, with full recovery to normal levels of performance. Conclusions. New ischemia can reopen a sensitive period of heightened responsiveness to training and mediate full recovery from a previous stroke.
    Type of Medium: Online Resource
    ISSN: 1545-9683 , 1552-6844
    URL: Article
    DOI: 10.1177/1545968315624783
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 4
    Online Resource
    Online Resource
    Peripheral Nerve Injury Induces Immediate Increases in Layer V Neuronal Activity
    SAGE Publications ; 2013
    In:  Neurorehabilitation and Neural Repair Vol. 27, No. 7 ( 2013-09), p. 664-672
    Details
    In: Neurorehabilitation and Neural Repair, SAGE Publications, Vol. 27, No. 7 ( 2013-09), p. 664-672
    Abstract: Background. Peripheral nerve injury leads to changes in neuronal activity in the contralateral and ipsilateral primary somatosensory cortices (S1), which may lead to enduring sensory dysfunction and pain. Plasticity in the barrel and visual cortices has been shown to occur in a layer-specific manner. However, little is known about the layer specific changes associated with limb injury. Objective. To determine the layer-specific changes in neuronal activity associated with short-term plasticity induced by peripheral nerve injury in the rat. Methods. In vivo electrophysiology recordings (multiunit activity and local field potential) and high-resolution functional magnetic resonance imaging techniques were applied to characterize neuronal and hemodynamic responses across the depth of S1 contralateral and ipsilateral to the injury. Results. Within 60 minutes following injury, atypical increases in neuronal and hemodynamic responses in the deprived S1, ipsilateral to the noninjured limb, were observed in response to stimulation of the noninjured limb. The most prominent increases in neuronal activity in the deprived S1 occurred in layer V. Conclusion. Layer V neurons provide the major output of S1 and they send and receive transcallosal input. Thus, the immediate changes in neuronal firing patterns in layer V induced by the injury, can adversely affect the activity of subcortical regions and also interfere with normal cortical processing and interhemispheric communication. Therefore, a rehabilitation strategy that targets layer V neurons activity and starts immediately after the injury may benefit the functional outcome.
    Type of Medium: Online Resource
    ISSN: 1545-9683 , 1552-6844
    URL: Article
    DOI: 10.1177/1545968313484811
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
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  • 5
    Online Resource
    Online Resource
    Alternate Day Fasting Leads to Improved Post-Stroke Motor Recovery in Mice
    SAGE Publications ; 2024
    In:  Neurorehabilitation and Neural Repair
    Details
    In: Neurorehabilitation and Neural Repair, SAGE Publications
    Abstract: Caloric restriction promotes neuroplasticity and recovery after neurological injury. In mice, we tested the hypothesis that caloric restriction can act post-stroke to enhance training-associated motor recovery. Methods Mice were trained to perform a skilled prehension task. We then induced a photothrombotic stroke in the caudal forelimb area, after which we retrained animals on the prehension task following an 8-day delay. Mice underwent either ad libitum feeding or alternate day fasting beginning 1-day after stroke and persisting for either 7 days or the entire post-stroke training period until sacrifice. Results Prior studies have shown that post-stroke recovery of prehension can occur if animals receive rehabilitative training during an early sensitive period but is incomplete if rehabilitative training is delayed. In contrast, we show complete recovery of prehension, despite a delay in rehabilitative training, when mice underwent alternate day fasting beginning 1-day post-stroke and persisting for either 7 days or the entire post-stroke training period until sacrifice. Recovery was independent of weight loss. Stroke volumes were similar across groups. Conclusions Post-stroke caloric restriction led to recovery of motor function independent of a protective effect on stroke volume. Prehension recovery improved even after ad libitum feeding was reinstituted suggesting that the observed motor recovery was not merely a motivational response. These data add to the growing evidence that post-stroke caloric restriction can enhance recovery.
    Type of Medium: Online Resource
    ISSN: 1545-9683 , 1552-6844
    URL: Article
    DOI: 10.1177/15459683241232680
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2024
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  • 6
    Online Resource
    Online Resource
    Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial
    SAGE Publications ; 2021
    In:  Neurorehabilitation and Neural Repair Vol. 35, No. 5 ( 2021-05), p. 393-405
    Details
    In: Neurorehabilitation and Neural Repair, SAGE Publications, Vol. 35, No. 5 ( 2021-05), p. 393-405
    Abstract: Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period. Objective To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT). Methods A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day. Results There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P = .011) but not the FM-UE (1.4 ± 2.6 points; P = .564) when compared with the HC. Conclusions Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy.
    Type of Medium: Online Resource
    ISSN: 1545-9683 , 1552-6844
    URL: Article
    DOI: 10.1177/15459683211000730
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 7
    Online Resource
    Online Resource
    Special Issue: Novel Technologies for Recovery after Neurological Injuries
    SAGE Publications ; 2023
    In:  Neurorehabilitation and Neural Repair Vol. 37, No. 6 ( 2023-06), p. 355-355
    Details
    In: Neurorehabilitation and Neural Repair, SAGE Publications, Vol. 37, No. 6 ( 2023-06), p. 355-355
    Type of Medium: Online Resource
    ISSN: 1545-9683 , 1552-6844
    URL: Article
    DOI: 10.1177/15459683231186235
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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