Understanding the role of the primary somatosensory cortex: Opportunities for rehabilitation.

Emerging evidence indicates impairments in somatosensory function may be a major contributor to motor dysfunction associated with neurologic injury or disorders. However, the neuroanatomical substrates underlying the connection between aberrant sensory input and ineffective motor output are still under investigation. The primary somatosensory cortex (S1) plays a critical role in processing afferent somatosensory input and contributes to the integration of sensory and motor signals necessary for skilled movement. Neuroimaging and neurostimulation approaches provide unique opportunities to non-invasively study S1 structure and function including connectivity with other cortical regions. These research techniques have begun to illuminate casual contributions of abnormal S1 activity and connectivity to motor dysfunction and poorer recovery of motor function in neurologic patient populations. This review synthesizes recent evidence illustrating the role of S1 in motor control, motor learning and functional recovery with an emphasis on how information from these investigations may be exploited to inform stroke rehabilitation to reduce motor dysfunction and improve therapeutic outcomes.

Comparison of the effects of nebulised and inhaled salbutamol on breathlessness in severe COPD.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) often report greater relief of breathlessness with nebulised bronchodilators than with the same medicine administered from a metered dose inhaler (MDI). This suggests that the nebulised medicines may have an effect on breathlessness over and above changes in lung function resulting from bronchodilatation. METHODS: Twenty-four subjects with COPD and breathlessness at rest participated in this randomised, crossover trial. The mean age was 72 years and the mean FEV(1) was 26% of predicted. Subjects were studied on four separate days. On two days they were treated with nebulised salbutamol and on the other 2 days with salbutamol from an MDI and spacer. With each method of delivery, local anaesthetic cream was applied to the face on one day and to the back of the hand on the other. RESULTS: Five minutes after administration of salbutamol the subjects were significantly less breathless with nebulised salbutamol but by 45 min both treatments resulted in equivalent relief. There was no difference between the treatments in the change in FEV(1) or VC and application of local anaesthetic to the face did not influence the response. CONCLUSION: There was a small early benefit with nebulised salbutamol but this was not sustained and was not affected by topical anaesthesia. The benefit of nebulisation does not appear to be large enough to warrant the routine, widespread use of nebulised bronchodilators for the treatment of stable COPD.

Sensitivity to fungal allergens is a risk factor for life-threatening asthma.

BACKGROUND: Previous studies have suggested that sensitivity to Alternaria and Cladosporium may be risk factors for life-threatening asthma. We have investigated this by studying the relationship between skin tests for fungal spores and admission to an intensive care unit (ICU) for asthma. METHODS: Skin prick tests for fungal spores (Alternaria tenuis, Cladosporium cladosporoides, Helminthosporium maydis, and Epicoccum nigrum), cat dander, house-dust mite (Dermatophagoides pteronyssinus), and a seven-grass mix were performed in three groups of patients: patients admitted to an ICU with an attack of asthma; those who had received emergency treatment for asthma but had not been admitted to an ICU, and those who had never required emergency treatment for their asthma. RESULTS: Twenty of 37 patients (54%) admitted to the ICU had a positive skin test for one or more fungal allergens compared with 15/50 patients (30%) in each of the other groups (P=0.005). The ICU patients were no more likely to have positive skin tests for the grass mix, cat dander, or house-dust mite than the other patients. CONCLUSIONS: A positive skin test for fungal allergens is a risk factor for admission to an ICU with an acute attack of asthma.

The effects of nebulised isotonic saline and terbutaline on breathlessness in severe chronic obstructive pulmonary disease (COPD).

BACKGROUND: There is anecdotal evidence that nebulised saline relieves breathlessness at rest in patients with severe chronic obstructive pulmonary disease (COPD). It is unclear whether nebulised beta agonists are any more effective than nebulised saline in relieving breathlessness at rest in these individuals. AIM: To compare the effects of nebulised saline and nebulised terbutaline on breathlessness at rest in patients with severe COPD. METHODS: We studied 18 patients with severe COPD with a mean age of 71.1 years, forced expiratory volume in 1 second (FEV1) of 0.58 L and vital capacity (VC) of 1.59 L, in a randomised, double-blind, crossover trial. The subjects received three doses of nebulised saline on one study day, and three doses of nebulised terbutaline (cumulative dose 10 mg) on the other. Breathlessness was measured using Likert and Visual Analogue Scales (VAS). RESULTS: Both treatments led to a significant improvement in breathlessness on VAS and Likert scales but there was no significant difference in breathlessness scores for saline compared with terbutaline. There was a small but significant increase in FEV1 with terbutaline of 74 mL, but no change with saline. CONCLUSIONS: A saline aerosol has no effect on lung function but reduces breathlessness at rest in subjects with severe COPD. Nebulised saline may be considered as an adjunct to the use of nebulised bronchodilators for the treatment of breathlessness in patients with COPD.

Characteristics of patients admitted to hospital with chronic obstructive pulmonary disease.

AIMS: To examine the characteristics of patients admitted to Auckland Hospital with chronic obstructive pulmonary disease (COPD) and to assess their management prior to hospitalisation. METHODS: Prospective survey of 99 patients admitted with COPD over an 8 week period. Of these, 80 patients were interviewed about their social circumstances, physical functioning, smoking habits and medical treatment. They also had their inhaler technique checked and FEV1 measured. RESULTS: Subjects had a mean age of 70.6 years with a mean FEV1 of 29% of predicted. 45% lived alone and a third still smoked. The mean value for their usual physical functioning was 15.4 (possible 10-30) on the SF-36 health status questionnaire. 84% of all subjects used a beta-agonist, 50% an anticholinergic bronchodilator, 69% inhaled steroids, 18% oral steroids, and 19% theophylline. 40% used nebulised medication and only 6% had domiciliary oxygen. 40% reported having an influenza vaccination in the preceding year and 27% had participated in some form of pulmonary rehabilitation. The mean length of stay was 7.5 days. CONCLUSIONS: Patients hospitalized for COPD report marked impairment in physical functioning, despite which many live alone. They frequently use inhaled and oral steroids, and nebulised medication, but only a minority had received an influenza vaccination or attended pulmonary rehabilitation.