Long-term functional consequences of quinolinic acid striatal lesions and their alteration following an addition of a globus pallidus lesion assessed using pharmacological magnetic resonance imaging

The present study tested the hypothesis that lesion to the rat globus pallidus (GP) can "normalize" the functioning of the basal ganglia-thalamocortical circuits in striatal-lesioned rats by assessing the functional connectivity of these regions using functional magnetic resonance imaging (fMRI). Changes in brain activation following systemic administration of amphetamine were assessed in (1) rats sustaining a unilateral lesion to the striatum, (2) rats sustaining a combined striatal and pallidal lesion, and (3) control rats. Striatal-lesioned rats showed attenuated cortical activation following amphetamine administration and lower correlations between the responses to amphetamine in different brain regions compared to control rats. Although the addition of an excitotoxic GP lesion failed to prevent striatal lesion-induced attenuation of cortical activation by amphetamine, it was effective in "normalizing" the correlations between the responses to amphetamine in the different areas. These results suggest that, although the GP lesion is ineffective in correcting the global changes in activity caused by the striatal lesion, it may have the capacity to partially restore alterations in functional connectivity resulting from the striatal lesion. These results are further discussed in view of our previous demonstration that lesions to the GP can reverse several behavioral deficits produced by a striatal lesion.     

Lateralized changes in behavior and striatal dopamine release following unilateral tactile stimulation of the perioral region: a microdialysis study

Intracranial microdialysis was used to measure dopamine (DA) release in the ventrolateral neostriatum of freely moving rats before and after unilateral tactile stimulation was applied to the orofacial region. Several behavioral parameters which have been linked to changes in nigrostriatal DA transmission (scanning, or snout contact with the walls of the observation chamber, turning and locomotion) were measured as well. Orofacial stimulation was followed by an asymmetrical increase in DA release with concentrations of transmitter higher in the neostriatum ipsilateral to the side of stimulation. Asymmetrical scanning behavior was observed during the time period when DA release was asymmetric, with rats favoring use of the side of the face contralateral to increased DA release. Increase in the DA metabolites DOPAC and HVA were found in the striatum ipsilateral to stimulation, but were delayed 40 min following the increase in DA.     

Characteristics of the shoulder in patients following acute stroke: a case series

Background: Stroke can result in pain and loss of motor control in the hemiplegic shoulder, and while prevention of secondary changes is likely to be the most effective management, there is limited evidence directing clinicians towards the most at-risk patients.

Objectives: The aim of this case series was to investigate the presentation of shoulder pain, motor impairment, shoulder passive range of motion (PROM) and alignment of the hemiplegic shoulder following acute stroke.

Methods: This study reported data that was collected as part of a pilot randomized controlled trial investigating kinesiology taping of the hemiplegic shoulder. Participants with a diagnosis of acute stroke and severe upper limb motor impairment were included. From 24-h post stroke and continuing every three days until discharge, measurements of shoulder pain (visual analogue scale, Ritchie Articular Index), motor impairment (Chedoke McMaster Stroke Assessment), PROM and alignment (both clinical measures) were collected. Clinical trial registry number – ACTRN12615000502538.

Results: Of 156 patients screened over six months, 10 of 15 eligible participants were recruited. On initial assessment, three participants reported pain and all had severe upper limb motor impairment. All participants initially demonstrated close to full shoulder PROM. Six participants had shoulder subluxation and five demonstrated scapula malalignment.

Conclusions: Given the severity of upper limb motor impairment, pain and reduced PROM were seen in a small number of participants. The clinical course of shoulder pain and PROM following stroke remains unclear. Large observational studies tracking shoulder characteristics from acute through to rehabilitation settings are needed.     

What is the effect of additional physiotherapy on sitting balance following stroke compared to standard physiotherapy treatment: a systematic review

Background: Sitting balance dysfunction is commonly experienced following stroke. Physiotherapists utilize interventions to address this problem but it is unclear whether treatment type, target or practice intensity may affect outcomes.

Objective: To compare the effects of standard physiotherapy to standard physiotherapy plus an additional physiotherapy treatment after stroke.

Data Sources: The databases of Cochrane Library, CINAHL, Embase, Ovid Medline, AMED, and the Physiotherapy Evidence Database (PEDro) up to December 2014 were searched.

Study Selection: Randomized controlled trials in English reported in peer-reviewed journals regarding the effect of additional physiotherapy on sitting balance were retrieved.

Data Extraction: The PEDro scale was used to assess study quality.

Results: Eleven studies met inclusion criteria. Nine targeted the ICF (International Classification of Function, Disability and Health) domain of Activity. The Trunk control test (TCT) was used as a primary outcome measure in five studies, and the Trunk Impairment Scale (TIS) was used in four. There was a significant effect (mean difference?=?1.67, 95% CI?=?0.54–2.80) favoring intervention, as measured by the TIS. There was no evidence to support the effect of additional treatment on sitting balance as measured by the TCT (mean difference?=???1.53, 95% CI?=???9.37 to 6.32).

Conclusion:The current evidence supports strategies that target deficits at the activity level and increase total treatment time. The TIS is most responsive as a measure of treatment efficacy. Further research is required using recommended outcome measures to facilitate generation of a minimum data set and data pooling.     

反馈式功能性电刺激治疗对脑梗死患者上肢运动功能恢复的影响及其机制的fMRI究

目的 探讨反馈式功能性电刺激治疗对脑梗死患者上肢运动功能恢复的影响以及应用功能核磁共振成像(MRI)分析其作用机制. 方法 将自2011年8月至2012年12月在中国康复研究中心神经康复中心住院的脑梗死患者21例(一侧肢体瘫痪且偏瘫侧肢体腕背屈关节活动度大于15°及肌张力为改良Ashworth Ⅰ+级及以下的可完成部分主动运动的患者、按随机数字表法分为反馈式功能性电刺激组8例、单纯功能性电刺激组7例及常规康复治疗组6例.3组患者均进行常规神经内科药物治疗和康复治疗,其中反馈式功能性电刺激组进行反馈式功能性电刺激治疗,单纯功能性电刺激组行功能性电刺激治疗,疗程4周.分别在治疗前及治疗4周后次日进行Fugl-Meyer运动功能量表上肢部分项目及腕背伸角度评估,以及3d内应用fMRI进行脑M1区激活强度检查. 结果 (1)治疗后4周时,3组患者的Fugl-Meyer运动功能量表上肢部分项目评分及腕背伸角度较治疗前均有改善,其中反馈式功能性电刺激组、单纯功能性电刺激组差异均有统计学意义(P＜0.05);反馈式功能性电刺激组亦明显优于单纯功能性电刺激组,差异有统计学意义(P＜0.05).(2)治疗后4周时,3组患者的患侧脑M1区激活强度较治疗前均有改善,其中反馈式功能性电刺激组差异有统计学意义(P＜0.05);反馈式功能性电刺激组亦明显优于单纯功能性电刺激组,差异有统计学意义(P＜0.05). 结论 单纯功能性电刺激和反馈式功能性电刺激均有利于脑梗死后上肢运动功能的提高,并有助于脑功能的重组,且后者较前者疗效更佳.