Effect of methylphenidate and/or levodopa coupled with physiotherapy on functional and motor recovery after stroke – a randomized,double‐blind,placebo‐controlled trial

Lokk J, Salman Roghani R, Delbari A. Effect of methylphenidate and/or levodopa coupled with physiotherapy on functional and motor recovery after stroke – a randomized, double‐blind, placebo‐controlled trial.
Acta Neurol Scand: 2011: 123: 266–273.
© 2010 John Wiley & Sons A/S. Objective – Amphetamine‐like drugs are reported to enhance motor recovery and activities of daily living (ADL) in stroke rehabilitation, but results from trials with humans are inconclusive. This study is aimed at investigating whether levodopa (LD) and/or methylphenidate (MPH) in combination with physiotherapy could improve functional motor recovery and ADL in patients with stroke. Material and methods – A randomized, double‐blind, placebo‐controlled trial with ischemic stroke patients randomly allocated to one of four treatment groups of either MPH, LD or MPH+LD or placebo combined with physiotherapy was performed. Motor function, ADL, and stroke severity were assessed by Fugl‐Meyer (FM), Barthel index (BI), and National Institute of Health Stroke Scale (NIHSS) at baseline, 15, 90, and 180 days respectively. Results – All participants showed recovery of motor function and ADL during treatment and at 6‐month follow‐up. There were slightly but significant differences in BI and NIHSS compared to placebo at the 6‐month follow‐up. Conclusion – Ischemic chronic stroke patients having MPH and/or LD in combination with physiotherapy showed a slight ADL and stroke severity improvement over time. Future studies should address the issue of the optimal therapeutic window and dosage of medications to identify those patients who would benefit most.     

Prior knowledge of illumination for 3D perception in the human brain

In perceiving 3D shape from ambiguous shading patterns, humans use the prior knowledge that the light is located above their head and slightly to the left. Although this observation has fascinated scientists and artists for a long time, the neural basis of this “light from above left” preference for the interpretation of 3D shape remains largely unexplored. Combining behavioral and functional MRI measurements coupled with multivoxel pattern analysis, we show that activations in early visual areas predict best the light source direction irrespective of the perceived shape, but activations in higher occipitotemporal and parietal areas predict better the perceived 3D shape irrespective of the light direction. These findings demonstrate that illumination is processed earlier than the representation of 3D shape in the visual system. In contrast to previous suggestions, we propose that prior knowledge about illumination is processed in a bottom-up manner and influences the interpretation of 3D structure at higher stages of processing.     

When touch elicits cold: functional imaging of an abnormal sensation.

The authors report a 58-year-old man who presented with touch-induced cold sensations and loss of pain and normal temperature sensation in the left leg and trunk. He was found to have syringomyelia at the level of the third thoracic vertebrae. A functional magnetic resonance imaging (fMRI) study was performed to evaluate the underlying cortical processing of the touch-induced cold sensations. Blood oxygen level-dependent(BOLD) responses were measured in response to light tonic pressure stimuli and to cold stimuli applied to both the symptomatic area on the left leg and to the unaffected contralateral side. Tonic pressure applied on the unaffected right thigh and the left hand resulted in activations of contralateral primary (S1) and bilateral secondary somatosensory cortices (S2). In contrast, application of tonic pressure to the affected left thigh, ie, where touch stimuli elicited cold sensations, induced robust activations not only in contralateral S1 and bilateral S2, but also in bilateral insular cortices, which are cortical areas known to be pivotally involved in the central processing of cold. The fMRI data argue in favor of supraspinal cross-submodal plastic changes within the somatosensory system.     

Prenatal and early life factors and risk of Parkinson's disease

Few studies have investigated the relation between early life factors and risk of Parkinson's disease (PD), although a potential role of exposures during pregnancy and childhood has been hypothesized. The study population comprised participants in two prospective cohorts: the Nurses' Health Study (121,701 female nurses followed up from 1976–2002) and the Health Professionals Follow‐up Study (51,529 male health professionals followed up from 1986–2002). PD risk was examined in relation to season of birth, birthweight, parental age at birth, preterm birth, multiple birth, ever having been breast‐fed, and handedness. We identified 659 incident PD cases. No significant relation with PD was observed for birthweight, paternal age, preterm birth, multiple birth, and having been breast‐fed. A modest nonsignificant association was suggested for season of birth (30% higher risk of PD associated with spring versus winter birth) and for older maternal age at birth (75% increased risk among those with mothers aged 30 years and older versus younger than 20 years). Left‐handedness was associated with a 62% increased risk of PD in women but not in men. Further investigation of the relation between prenatal, perinatal, or neonatal factors and PD in other study populations is suggested. © 2010 Movement Disorder Society     

Examination of the use of a dual-channel functional electrical stimulation system on gait,balance and balance confidence of an adult with spastic diplegic cerebral palsy

Abstract

The purpose of this case report is to determine the effects of a dual-channel functional electrical stimulation (FES) system on gait and balance of a 57-year-old male diagnosed with spastic diplegic cerebral palsy (CP). Outcome measures included the: Activities-specific Balance Confidence Scale (ABC); Dynamic Gait Index (DGI); Observational Gait Scale (OGS) and Tinetti Performance Oriented Mobility Assessment (POMA). Assessments were completed with and without use of FES during the initial examination and after two, four and six weeks of intervention with FES. ABC Scale scores improved from 32.8 to 48.1% during the 6-week intervention. Scores on the DGI improved from 6/24 to 9/24 without FES and from 9/24 to 14/24 with FES. OGS scores improved on both legs with and without FES. Tinetti POMA scores improved from 12/28 to 15/28 without FES and decreased from 16/28 to 15/28 with FES. The patient demonstrated improvement in both objective and subjective measures. The use of FES facilitated improved gait and balance; however, the patient was still at increased risk for falls after the 6-week intervention despite improved scores on the ABC Scale, DGI, OGS and Tinetti POMA.     

Interrater reliability of the Physical Ability Scale for patients after stroke: A pilot study

This study aimed to evaluate the interrater reliability of the Physical Ability Scale (PAS) and secondly to test the statistical methods to analyse the scoring. Williamson () stated that the PAS measures the degree of compatibility of the trunk with gravity and the supporting surface through investigation of limb, head, and posture in five different positions, each with six levels of ability. Four experienced physiotherapists observed a video of 10 inpatients from a general hospital stroke unit being assessed with the PAS up to 5 months after a stroke. The intraclass coefficient (ICC) for the total scores was 0.7 (95% CI 0.35–0.91) with the highest individual position scores in standing 0.86 (95% CI 0.68–0.96) and long sitting 0.74 (95% CI 0.46–0.92). The ICC for the levels of ability indicated good agreement in standing 0.79 (95% CI 0.55–0.93) and long sitting 0.77 (95% CI 0.52–0.93). Kappa values for each body part yielded the highest values in long sitting (0.62) and standing (0.56). Interrater reliability is variable, with the greatest level of agreement in long sitting and standing but with poor to fair agreement in sitting, prone, and supine. The study has also shown that the scoring can be analysed to yield meaningful repeatable results. Further investigation is needed to examine validity and reliability with a larger sample of diverse ability, therapists with varying clinical experience, and with direct observation of the assessment.