Pre-therapy Neural State of Bilateral Motor and Premotor Cortices Predicts Therapy Gain After Subcortical Stroke: A Pilot Study.

OBJECTIVE: The aim of the study was to examine whether neural state of spared motor and premotor cortices captured before a therapy predicts therapy-related motor gains in chronic subcortical stroke. DESIGN: Ten survivors, presenting chronic moderate upper limb impairment, underwent proton magnetic resonance spectroscopy, magnetic resonance imaging, clinical, and kinematics assessments before a 4-wk impairment-oriented training. Clinical/kinematics assessments were repeated after therapy, and motor gain was defined as positive values of clinical upper limb/elbow motion changes and negative values of trunk motion changes. Candidate predictors were N-acetylaspartate-neuronal marker, glutamate-glutamine-indicator of glutamatergic neurotransmission, and myo-inositol-glial marker, measured bilaterally within the upper limb territory in motor and premotor (premotor cortex, supplementary motor area) cortices. Traditional predictors (age, stroke length, pre-therapy upper limb clinical impairment, infarct volume) were also investigated. RESULTS: Poor motor gain was associated with lower glutamate-glutamine levels in ipsilesional primary motor cortex and premotor cortex (r = 0.77, P = 0.01 and r = 0.78, P = 0.008, respectively), lower N-acetylaspartate in ipsilesional premotor cortex (r = 0.69, P = 0.02), higher glutamate-glutamine in contralesional primary motor cortex (r = -0.68, P = 0.03), and lower glutamate-glutamine in contralesional supplementary motor area (r = 0.64, P = 0.04). These predictors outperformed myo-inositol metrics and traditional predictors (P ≈ 0.05-1.0). CONCLUSIONS: Glutamatergic state of bilateral motor and premotor cortices and neuronal state of ipsilesional premotor cortex may be important for predicting motor outcome in the context of a restorative therapy.

Stroke Rehabilitation: Current American Stroke Association Guidelines, Care, and Implications for Practice.

Stroke attacked approximately 795,000 Americans last year, and it was the fifth leading cause of death in the United States. In 2016, the American Stroke Association published updated guidelines for stroke rehabilitation, with recommendations intended to improve systems of care and functional outcomes for people who suffer stroke and important recommendations regarding specific aspects of care. This article summarizes some of these recommendations with implications for those who treat stroke patients in their practices.

Pharmacologic approaches to geriatric pain management.

UNLABELLED: This focused review highlights pharmacologic approaches to geriatric pain management. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on age-specific differences in pain assessment and use of medications for pain management in older adults. The common disorders leading to acute and chronic pain conditions in the older adult are also described. The article contains practical recommendations regarding use of acetaminophen, anti-inflammatories, opioids, antiepileptics, antidepressants, and topical counterirritant drugs for pain management in older adults. OVERALL ARTICLE OBJECTIVE: To summarize pharmacologic approaches to geriatric pain management.