Development and Preliminary Validity Study of a Modified Version of the Upper Extremity Fugl-Meyer Assessment for Use in Telerehabilitation.

BACKGROUND/PURPOSE: The Upper Extremity Fugl-Meyer Assessment (UEFMA, maximum 66) is widely used in clinics and research studies to examine poststroke upper extremity (UE) impairment. This study aimed to develop and provide pilot data to support the validity of a remote version of the UEFMA to examine UE impairment after stroke through telerehabilitation. METHODS: Team members developed a remote version of the UEFMA for telerehabilitation (tUEFMA, maximum 44) using subscales II to IV and VII of the UEFMA. Twenty-two participants with moderate to severe arm impairment (UEFMA, median = 19) and chronic stroke (>1 year post) were evaluated using the UEFMA (face-to-face) and the tUEFMA (remotely). A prediction equation was used to identify the function to predict the UEFMA based on the tUEFMA. Intraclass correlation (ICC) was used to test the absolute agreement between the subscales included in the UEFMA and the tUEFMA, and between their 2 normalized total scores. RESULTS: A strong and significant agreement was found between the total scores of the UEFMA and the projected value based on the tUEFMA (ICC = 0.79, P < 0.05). The ICC test also reported a good agreement in subscales II to IV and a poor agreement in subscale VII between the UEFMA and the tUEFMA using a real-time video link. DISCUSSION AND CONCLUSIONS: The study findings suggest that the tUEFMA is a promising tool to remotely examine UE impairment in individuals with chronic stroke and moderate to severe arm impairment. Future research should evaluate additional psychometric properties and clinical utility of the tUEFMA across stroke participants with a broad range of arm impairments.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A441 ).

Two Latinx, Non-Tenure Clinical Faculty Navigating Academia: A Roadmap to Diversity and Inclusion in Academia.

Increased diversity in academic institutions may potentially result in more diversity seen in practicing clinicians. Colleges and universities have recently implemented strategies to diversify their faculty. However, current efforts and scholarly publications are often limited to recruitment and retention strategies. This article aims to provide a comprehensive DEI (diversity, equity, and inclusion) critique on professional development through the personal journey of two Latinx physical therapists in higher education on a non-tenured, clinician-educator track. A personal narrative of the two authors examines some barriers and challenges faced, as well as accounting for catalysts that facilitated their professional development at a tier one academic institution. These perspectives follow the model principles adopted by the University of Pittsburgh. Program for underrepresented minority (URM) faculty members, which considers URM educational background, recruitment, retention, research opportunities, community building, counseling, mentoring, scientific writing, and scientific presentation skills training. To create conditions where URM individuals can thrive, organizations should resist using a "quick fix" by only attempting to hire diverse individuals and fill a quota. Professional development efforts should assess failures and accomplishments, fostering an environment of trust to address the specific needs of URM faculty members to ensure their success in their academic journey.

Diagnóstico del síndrome coronario agudo en primer nivel de atención en Colombia e indicaciones de traslado emergente a mayor nivel de complejidad, ¿es posible sin enzimas cardiacas?

El dolor torácico es un motivo de consulta frecuente en el servicio de urgencias y la falta de diagnóstico oportuno del síndrome coronario agudo se asocia a una alta mortalidad y demandas médicas. Existen múltiples algoritmos para descartar esta enfermedad que, sin embargo, están diseñados para instituciones con disponibilidad de biomarcadores cardíacos; en Colombia pocos primeros niveles de atención cuentan con estos. En este artículo se realiza una revisión sobre las herramientas que se han descrito en la literatura para descartar este diagnóstico en el servicio de urgencias de baja complejidad. Se encuentran tres escalas Vancouver Chest Pain Rule, INTERCHEST y Marburg Heart, la última es la que tiene mayor evidencia con algunas limitaciones al ser desarrollada en el contexto de dolor intermitente y no agudo. Se plantea un algoritmo diagnóstico que incluye clínica, electrocardiograma y escalas de predicción.

Summary Chest pain is a frequent complaint in the emergency department, and the lack of timely diagnosis of the acute coronary syndrome is associated with high mortality and malpractice lawsuits. There are multiple algorithms to rule out this disease; however, they are designed for institutions with the availability of cardiac biomarkers; In Colombia, few primary care settings have these. This article reviews the tools that have been described in the literature to rule out this diagnosis in the low-complexity emergency department. There are three scales: Vancouver Chest Pain Rule, INTERCHEST, and Marburg Heart; the latter has the most evidence with some limitations as it was developed in the context of intermittent and non-acute pain. We propose a diagnostic algorithm including physical findings, electrocardiogram, and prediction scales.

Todo a la vez: cotidianidades de jóvenes universitarios padres/madres en pandemia / Everything at the same time: Daily life of young university parents in the Pandemic / A simultaneidade: Vida cotidiana dos jovens pais/mães universitários durante a Pandemia

Resumen (analítico) La pandemia derivada del covid-19 significó para madres y padres estudiantes universitarios de Manizales (Colombia) experimentar dinámicas cotidianas de simultaneidad del cuidado y de la formación académica. A partir del análisis narrativo, se presenta la configuración de un escenario que trajo consigo el entrecruzamiento de tiempos individuales, escolares y familiares, generando un entorno dual como sujetos de rendimiento. Para las universitarias la oportunidad de estar cerca de sus hijas/hijos, conocer sus actividades de aprendizaje, «verles crecer¼, configurando una maternidad no delegada, contrastada con una triple exigencia de cumplir con todo: estudio, cuidado y trabajo. Para los universitarios que no conviven con sus hijos/hijas, este escenario derivó en un debilitamiento de los vínculos por el distanciamiento social y el surgimiento de la coordinación como alternativa para el cuidado parental.

Abstract (analytical) The pandemic derived from COVID-19 implied for mothers and fathers who were university students in Manizales Colombia, experience daily dynamics of simultaneous care and academic training. The narrative analysis reveals the configuration of a scenario that brought with it the intertwining of individual, school, and family time, generating a dual environment as subjects of performance; for university students the opportunity to be close to their daughters/son, to know their learning activities, to «see them grow¼ configuring non-delegated maternity, contrasted with a triple demand to comply with everything: study, care, and work. For university students, the opportunity to be close to their daughters/sons, to know their learning activities, to "see them grow" configuring non-delegated maternity, contrasted with a triple demand to comply with everything: study, care, and work. For university students who do not live with their sons/daughters, this scenario resulted in a weakening of ties due to social distancing and the emergence of coordination as an alternative for parental care.

Resumo (analítico) A pandemia derivada do Covid-19 significou para mães e pais estudantes universitários de Manizales, Colômbia, vivenciar diariamente dinâmicas de simultaneidade de cuidado e formação acadêmica. A partir de um análise de narrativa, se revelou a configuração de um cenário que trouxe consigo a intersecção dos tempos individuais, escolar e familiar, gerando um ambiente de dualidade como sujeitos de desempenho; para as universitárias a oportunidade de estar perto de seus filhos/filhas, conhecer suas atividades de aprendizagem, «ver como crescem¼ configurando uma maternidade não delegada, em contraste com uma tripla exigência de cumprir com tudo: estudo, cuidado e trabalho; Para os universitários que não moram com os filhos/filhas, esse cenário levou ao enfraquecimento dos vínculos devido ao distanciamento social e ao surgimento da coordenação como alternativa para o cuidado parental.

Perfil epidemiológico de pacientes atendidos en policlínico de dolor crónico no oncológico (DCNO), Hospital Hernán Henríquez Aravena (HHHA). Servicio de Salud Araucanía Sur, Región de la Araucanía / Epidemiological profile of patients served in chronic non-oncological pain polyclinic (DCNO), Hernán Henríquez Aravena Hospital (HHHA). Health Service Araucanía Sur, Region of la Araucanía

Introducción: El dolor crónico no oncológico (DCNO) es un tema de salud pública con alta prevalencia en Chile. Existe evidencia sobre la necesidad de abordaje multidisciplinario por profesionales capacitados. El año 2013 se crea el policlínico de DCNO por la especialidad de fisiatría, coordinando atención con anestesista para intervencionismo. El Objetivo de este trabajo es conocer las características clínicas de los usuarios en control en policlínico de DCNO. Material y Método: Estudio retrospectivo, descriptivo, observacional. Desde la base de datos de usuarios atendidos entre inicios del 2013 y mayo 2018 de policlínico DCNO del Servicio de Medicina Física y Rehabilitación del HHHA; se recogen variables como: sexo, edad, etnia, previsión, ruralidad, diagnóstico ingreso, intensidad dolor (según NRS), tratamiento farmacológico, entre otras. Para manejo estadístico se utiliza planilla Excel, con pruebas paramétricas (promedio, mínimo, máximo), tablas y gráficos. Resultados: Los usuarios en control en el periodo fueron 125, con un 67,2% de mujeres y una mediana de edad de 55,5 años (mínimo 12, máximo 88). El 58,4% tenía como previsión Fonasa B, 83.2% presenta domicilio urbano, 16% etnia mapuche. El mayor número de ingresos ocurrió el año 2017. Las derivaciones provienen de especialidades médicas (25,6%), quirúrgicas (29,6%), fisiatría (24,8%). Según tipo de dolor, el 49,6% es nociceptivo, 32% neuropático y 18,4% mixto. Al ingreso, la intensidad fue 90% severa y 10% moderada (según NRS). Los principales diagnósticos de ingreso fueron 44,8% patología de columna, 27,2% patología neurológica, 12,8% fibromialgia y 15,2% otras. Al ingreso mayoría de los usuarios usaba paracetamol, tramadol gotas o comprimidos; actualmente 23% recibe metadona, 8% parches buprenorfina, 20% paracetamol, 27,2% tramadol en gotas/comprimidos y 23,2% pregabalina/ gabapentina. En el 51,2% se requirió cambio de terapia; en el 79,7% por analgesia insuficiente y 20,3% por reacción adversa a medicamentos. Se realizó derivación a intervencionismo en 21 usuarios. 15 usuarios fueron dados de alta de policlínico DCNO (12%). Conclusiones: Estos datos servirán para futuras investigaciones y medir impacto de nuestras intervenciones. Se presenta como desafío aumentar recursos de la unidad, demostrar beneficio de atención interdisciplinaria y bajar costos para la institución.

Introduction: Non-oncological chronic pain (NOCP) is a public health issue with high prevalence in Chile. There is evidence of the need for a multidisciplinary approach by trained professionals. In 2013, the NOCP polyclinic was created for the specialty of physiatry, coordinating care with anesthesiologist for interventionism. The objective of this work is to know the clinical characteristics of users in control in NOCP polyclinic. Material and Methods: Retrospective, descriptive, observational study. From the database of users attended between the beginning of 2013 and May 2018, from the NOCP polyclinic of the Physical Medicine and Rehabilitation Service of the HHHA; variables such as: sex, age, ethnicity, foresight, rurality, income diagnosis, pain intensity (according to NRS), and pharmacological treatment, among others are collected. For statistical management Excel spreadsheet isused, with parametric tests (average, minimum, maximum), tables and graphs. Results: The users in control in the period were 125, with 67.2% of women, a median age of 55.5 years (minimum 12, maximum 88). 58.4% had Fonasa B as a forecast, 83.2% have an urban address, 16% Mapuche ethnicity. The highest number of admissions occurred in 2017. The referrals come from medical specialties (25.6%), surgical specialties (29.6%), and physiatry (24.8%). According to type of pain, 49.6% is nociceptive, 32% neuropathic and 18.4% mixed. At admission, the intensity was 90% severe and 10% moderate (according to NRS). The main diagnoses of admission were 44.8% spinal pathology, 27.2% neurological pathology, 12.8% fibromyalgia and 15.2% others. On admission, most users used paracetamol, tramadol drops or tablets; currently 23% receive methadone, 8% patches buprenorphine, 20% paracetamol, 27.2% tramadol in drops / tablets and 23.2% pregabalin / gabapentin. In 51.2%, therapy change was required; in 79.7% due to insufficient analgesia and 20.3% due to adverse drug reaction. A derivation to interventionism was carried out in 21 users. 15 users were discharged from polyclinic DCNO (12%). Conclusions: These data will serve for future research and measure the impact of our interventions. It is a challenge to increase the resources of the unit, demonstrate the benefit of interdisciplinary attention and lower costs for the institution.

Oxidative stress and neuroinflammation in a rat model of co-morbid obesity and psychogenic stress.

BACKGROUND: There is growing recognition for a reciprocal, bidirectional link between anxiety disorders and obesity. Although the mechanisms linking obesity and anxiety remain speculative, this bidirectionality suggests shared pathophysiological processes. Neuroinflammation and oxidative damage are implicated in both pathological anxiety and obesity. This study investigates the relative contribution of comorbid diet-induced obesity and stress-induced anxiety to neuroinflammation and oxidative stress. METHODS: Thirty-six (36) male Lewis rats were divided into four groups based on diet type and stress exposure: 1) control diet unexposed (CDU) and 2) exposed (CDE), 3) Western-like high-saturated fat diet unexposed (WDU) and 4) exposed (WDE). Neurobehavioral tests were performed to assess anxiety-like behaviors. The catalytic concentrations of glutathione peroxidase and reductase were measured from plasma samples, and neuroinflammatory/oxidative stress biomarkers were measured from brain samples using Western blot. Correlations between behavioral phenotypes and biomarkers were assessed with Pearson's correlation procedures. RESULTS: We found that WDE rats exhibited markedly increased levels of glial fibrillary acidic protein (185 %), catalase protein (215 %), and glutathione reductase (GSHR) enzymatic activity (418 %) relative to CDU rats. Interestingly, the brain protein levels of glutathione peroxidase (GPx) and catalase were positively associated with body weight and behavioral indices of anxiety. CONCLUSIONS: Together, our results support a role for neuroinflammation and oxidative stress in heightened emotional reactivity to obesogenic environments and psychogenic stress. Uncovering adaptive responses to obesogenic environments characterized by high access to high-saturated fat/high-sugar diets and toxic stress has the potential to strongly impact how we treat psychiatric disorders in at-risk populations.

Limited capacity for ipsilateral secondary motor areas to support hand function post-stroke.

KEY POINTS: Ipsilateral-projecting corticobulbar pathways, originating primarily from secondary motor areas, innervate the proximal and even distal portions, although they branch more extensively at the spinal cord. It is currently unclear to what extent these ipsilateral secondary motor areas and subsequent cortical projections may contribute to hand function following stroke-induced damage to one hemisphere. In the present study, we provide both structural and functional evidence indicating that individuals increasingly rely on ipsilateral secondary motor areas, although at the detriment of hand function. Increased activity in ipsilateral secondary motor areas was associated with increased involuntary coupling between shoulder abduction and finger flexion, most probably as a result of the low resolution of these pathways, making it increasingly difficult to open the hand. These findings suggest that, although ipsilateral secondary motor areas may support proximal movements, they do not have the capacity to support distal hand function, particularly for hand opening. ABSTRACT: Recent findings have shown connections of ipsilateral cortico-reticulospinal tract (CRST), predominantly originating from secondary motor areas to not only proximal, but also distal muscles of the arm. Following a unilateral stroke, CRST from the ipsilateral side remains intact and thus has been proposed as a possible backup system for post-stroke rehabilitation even for the hand. We argue that, although CRST from ipsilateral secondary motor areas can provide control for proximal joints, it is insufficient to control either hand or coordinated shoulder and hand movements as a result of its extensive spinal branching compared to contralateral corticospinal tract. To address this issue, we combined magnetic resonance imaging, high-density EEG, and robotics in 17 individuals with severe chronic hemiparetic stroke and 12 age-matched controls. We tested for changes in structural morphometry of the sensorimotor cortex and found that individuals with stroke demonstrated higher grey matter density in secondary motor areas ipsilateral to the paretic arm compared to controls. We then measured cortical activity when participants were attempting to generate hand opening either supported on a table or when lifting against a shoulder abduction load. The addition of shoulder abduction during hand opening increased reliance on ipsilateral secondary motor areas in stroke, but not controls. Crucially, the increased use of ipsilateral secondary motor areas was associated with decreased hand opening ability when lifting the arm as a result of involuntary coupling between the shoulder and wrist/finger flexors. Taken together, this evidence implicates a compensatory role for ipsilateral (i.e. contralesional) secondary motor areas post-stroke, although with no apparent capacity to support hand function.

Corrigendum: Improving Hand Function of Severely Impaired Chronic Hemiparetic Stroke Individuals Using Task-Specific Training With the ReIn-Hand System: A Case Series.

[This corrects the article DOI: 10.3389/fneur.2018.00923.].

The post-stroke upper limb improvement effort survey (IMPETUS): a survey of individuals with chronic stroke.

BACKGROUND: There is a considerable literature on arm/hand dysfunction post stroke, but little information on the participants' opinions about perceived and desired arm/hand strength, recovery, and function. OBJECTIVE: The objective of this study was to examine the perceptions of individuals with stroke about arm/hand function and training devices. METHODS: A 69-item survey was developed addressing: activity before and after stroke, involved arm/hand function, willingness to use a training device, and important device characteristics. The survey included items from the Hand Function and Strength Subscales of the Stroke Impact Scale (SIS). Face validity was established by physical therapists and individuals with stroke. The survey was administered via phone and online. RESULTS: 852 registry participants were recruited. Ninety-seven responded; 83 completed the survey. Subjects were 51 males, 31 females; mean age: 65 (25-95); meantime since stroke: 13 years (1-34; SD 6.678). There was a statistically significant difference between perceived and desired arm/hand strength, recovery, and function p<0.0001. Impairment factors, such as weakness and spasticity were greater barriers to recovery than socio-economic ones. Most participants (94%) were willing to use a device; functional gains during/following use were the most important characteristics. LIMITATIONS: Participants had greater arm impairment and were more chronic than other studies. CONCLUSIONS: Participants desired more arm/hand strength, function, and recovery that they perceived they had achieved. Impairment - level factors posed more barriers to arm recovery than socioeconomic ones. Most participants were interested in using arm/hand training devices; the most important device characteristic is functional gain.

Hemicraniectomy in Traumatic Brain Injury: A Noninvasive Platform to Investigate High Gamma Activity for Brain Machine Interfaces.

Brain-machine interfaces (BMIs) translate brain signals into control signals for an external device, such as a computer cursor or robotic limb. These signals can be obtained either noninvasively or invasively. Invasive recordings, using electrocorticography (ECoG) or intracortical microelectrodes, provide higher bandwidth and more informative signals. Rehabilitative BMIs, which aim to drive plasticity in the brain to enhance recovery after brain injury, have almost exclusively used non-invasive recordings, such electroencephalography (EEG) or magnetoencephalography (MEG), which have limited bandwidth and information content. Invasive recordings provide more information and spatiotemporal resolution, but do incur risk, and thus are not usually investigated in people with stroke or traumatic brain injury (TBI). Here, in this paper, we describe a new BMI paradigm to investigate the use of higher frequency signals in brain-injured subjects without incurring significant risk. We recorded EEG in TBI subjects who required hemicraniectomies (removal of a part of the skull). EEG over the hemicraniectomy (hEEG) contained substantial information in the high gamma frequency range (65-115 Hz). Using this information, we decoded continuous finger flexion force with moderate to high accuracy (variance accounted for 0.06 to 0.52), which at best approaches that using epidural signals. These results indicate that people with hemicraniectomies can provide a useful resource for developing BMI therapies for the treatment of brain injury.

Neuromodulatory Inputs to Motoneurons Contribute to the Loss of Independent Joint Control in Chronic Moderate to Severe Hemiparetic Stroke.

In chronic hemiparetic stroke, increased shoulder abductor activity causes involuntary increases in elbow, wrist, and finger flexor activation, an abnormal muscle coactivation pattern known as the flexion synergy. Recent evidence suggests that flexion synergy expression may reflect recruitment of contralesional cortico-reticulospinal motor pathways following damage to the ipsilesional corticospinal tract. However, because reticulospinal motor pathways produce relatively weak post-synaptic potentials in motoneurons, it is unknown how preferential use of these pathways could lead to robust muscle activation. Here, we hypothesize that the descending neuromodulatory component of the ponto-medullary reticular formation, which uses the monoaminergic neurotransmitters norepinephrine and serotonin, serves as a gain control mechanism to facilitate motoneuron responses to reticulospinal motor commands. Thus, inhibition of the neuromodulatory component would reduce flexion synergy expression by disfacilitating spinal motoneurons. To test this hypothesis, we conducted a pre-clinical study utilizing two targeted neuropharmacological probes and inert placebo in a cohort of 16 individuals with chronic hemiparetic stroke. Test compounds included Tizanidine (TIZ), a noradrenergic α2 agonist and imidazoline ligand selected for its ability to reduce descending noradrenergic drive, and Isradipine, a dihyropyridine calcium-channel antagonist selected for its ability to post-synaptically mitigate a portion of the excitatory effects of monoamines on motoneurons. We used a previously validated robotic measure to quantify flexion synergy expression. We found that Tizanidine significantly reduced expression of the flexion synergy. A predominantly spinal action for this effect is unlikely because Tizanidine is an agonist acting on a baseline of spinal noradrenergic drive that is likely to be pathologically enhanced post-stroke due to increased reliance on cortico-reticulospinal motor pathways. Although spinal actions of TIZ cannot be excluded, particularly from Group II pathways, our finding is consistent with a supraspinal action of Tizanidine to reduce descending noradrenergic drive and disfacilitate motoneurons. The effects of Isradipine were not different from placebo, likely related to poor central bioavailability. These results support the hypothesis that the descending monoaminergic component of the ponto-medullary reticular formation plays a key role in flexion synergy expression in chronic hemiparetic stroke. These results may provide the basis for new therapeutic strategies to complement physical rehabilitation.

Progressive Abduction Loading Therapy with Horizontal-Plane Viscous Resistance Targeting Weakness and Flexion Synergy to Treat Upper Limb Function in Chronic Hemiparetic Stroke: A Randomized Clinical Trial.

BACKGROUND: Progressive abduction loading therapy has emerged as a promising exercise therapy in stroke rehabilitation to systematically target the loss of independent joint control (flexion synergy) in individuals with chronic moderate/severe upper-extremity impairment. Preclinical investigations have identified abduction loading during reaching exercise as a key therapeutic factor to improve reaching function. An augmentative approach may be to additionally target weakness by incorporating resistance training to increase constitutive joint torques of reaching with the goal of improving reaching function by "overpowering" flexion synergy. The objective was, therefore, to determine the therapeutic effects of horizontal-plane viscous resistance in combination with progressive abduction loading therapy. METHODS: 32 individuals with chronic hemiparetic stroke were randomly allocated to two groups. The two groups had equivalent baseline characteristics on all demographic and outcome metrics including age (59 ± 11 years), time poststroke (10.1 ± 7.6 years), and motor impairment (Fugl-Meyer, 26.7 ± 6.5 out of 66). Both groups received therapy three times/week for 8 weeks while the experimental group included additional horizontal-plane viscous resistance. Quantitative standardized progression of the intervention was achieved using a robotic device. The primary outcomes of reaching distance and velocity under maximum abduction loading and secondary outcomes of isometric strength and a clinical battery were measured at pre-, post-, and 3 months following therapy. RESULTS: There was no difference between groups on any outcome measure. However, for combined groups, there was a significant increase in reaching distance (13.2%, effect size; d = 0.56) and velocity (13.6%, effect size; d = 0.27) at posttesting that persisted for 3 months and also a significant increase in abduction, elbow extension, and external rotation strength at posttesting that did not persist 3 months. Similarly, the clinical battery demonstrated a significant improvement in participant-reported measures of "physical problems" and "overall recovery" across all participants. CONCLUSION: The strengthening approach of incorporating horizontal-plane viscous resistance did not enhance the reaching function improvements observed in both groups. Data do not support the postulation that one can be trained to "overpower" the flexion synergy with resistance training targeting constitutive joint torques of reaching. Instead, flexion synergy must be targeted with progressive abduction loading to improve reaching function. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01548781.

Neural Plasticity in Moderate to Severe Chronic Stroke Following a Device-Assisted Task-Specific Arm/Hand Intervention.

Currently, hand rehabilitation following stroke tends to focus on mildly impaired individuals, partially due to the inability for severely impaired subjects to sufficiently use the paretic hand. Device-assisted interventions offer a means to include this more severe population and show promising behavioral results. However, the ability for this population to demonstrate neural plasticity, a crucial factor in functional recovery following effective post-stroke interventions, remains unclear. This study aimed to investigate neural changes related to hand function induced by a device-assisted task-specific intervention in individuals with moderate to severe chronic stroke (upper extremity Fugl-Meyer < 30). We examined functional cortical reorganization related to paretic hand opening and gray matter (GM) structural changes using a multimodal imaging approach. Individuals demonstrated a shift in cortical activity related to hand opening from the contralesional to the ipsilesional hemisphere following the intervention. This was driven by decreased activity in contralesional primary sensorimotor cortex and increased activity in ipsilesional secondary motor cortex. Additionally, subjects displayed increased GM density in ipsilesional primary sensorimotor cortex and decreased GM density in contralesional primary sensorimotor cortex. These findings suggest that despite moderate to severe chronic impairments, post-stroke participants maintain ability to show cortical reorganization and GM structural changes following a device-assisted task-specific arm/hand intervention. These changes are similar as those reported in post-stroke individuals with mild impairment, suggesting that residual neural plasticity in more severely impaired individuals may have the potential to support improved hand function.

Impact of Shoulder Abduction Loading on Brain-Machine Interface in Predicting Hand Opening and Closing in Individuals With Chronic Stroke.

BACKGROUND: Many individuals with moderate and severe stroke are unable to use their paretic hand. Currently, the effect of conventional therapy on regaining meaningful hand function in this population is limited. Efforts have been made to use brain-machine interfaces (BMIs) to control hand function. To date, almost all BMI classification algorithms are designed for detecting hand movements with a resting arm. However, many functional movements require simultaneous movements of the arm and hand. Arm movement will possibly affect the detection of intended hand movements, specifically for individuals with chronic stroke who have muscle synergies. The most prevalent upper-extremity synergy-flexor synergy-is expressed as an abnormal coupling between shoulder abductors and elbow/wrist/finger flexors. OBJECTIVE: We hypothesized that because of flexor synergy, shoulder abductor activity would affect the detection of the hand-opening (a movement inhibited by flexion synergy) but not the hand-closing task (a movement facilitated by the flexion synergy). METHODS: We evaluated the accuracy of a BMI classification algorithm in detecting hand-opening versus closing after reaching a target with 2 different shoulder-abduction loads in 6 individuals with stroke. RESULTS: We found a decreased accuracy in detecting hand opening when an individual with stroke intends to open the hand while activating shoulder abductors. However, such decreased accuracy with increased shoulder loading was not shown while detecting a hand-closing task. CONCLUSIONS: This study supports the idea that one should consider the effect of shoulder abduction activity when designing BMI classification algorithms for the purpose of restoring hand function in individuals with moderate to severe stroke.

Progressive abduction loading therapy targeting flexion synergy to regain reaching function in chronic stroke: Preliminary results from an RCT.

Reaching function is impaired following stroke due to abnormal coupling of shoulder abduction and elbow flexion. This phenomenon is commonly referred to as flexion synergy, loss of independent joint control, or impaired joint individuation. We have been successful in treating individuals with chronic stroke with moderate to severe motor impairments through the employment of targeted rehabilitation robotics and identified progressive abduction loading as a key element to the rehabilitation of reaching. Here we expand upon the investigation of progressive abduction loading therapy by testing two variants of the exercise in a larger sample and including a 3-month follow-up. Furthermore, we attempt to glean additional insights into the mechanisms underlying improvements by not only assessing reaching distance as a function of abduction loading but, for the first time, assessing peak reaching velocity, a combined measure of dynamic elbow and shoulder strength. Thirty-one participants with severe stroke were randomized to two intervention variants. Preliminary analysis has been performed and results are presented for blinded combined-group data. Following the intervention, there was a significant improvement in both reaching distance and peak reaching velocity. Mechanisms for improvement are briefly discussed.

Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: A case report.

This case study demonstrates the change of sensory cortical representations of the residual parts of the arm in an individual who underwent a trans-humeral amputation and subsequent targeted reinnervation (TR). As a relatively new surgical technique, TR restores a direct neural connection from amputated sensorimotor nerves to specific target muscles. This method has been successfully applied to upper-limb and lower-limb amputees, and has shown effectiveness in regaining control signals via the newly re-innervated muscles. Correspondingly, recent study results have shown that motor representations for the missing limb move closer to their original locations following TR. Besides regaining motor control signals, TR also restores the sensation in the re-innervated skin areas. We therefore hypothesize that TR causes analogous cortical sensory remapping that may return closer to their original locations. In order to test this hypothesis, cortical activity in response to sensory-level electrical stimulation in different parts of the arm was studied longitudinally in one amputated individual before and up to 2 years after TR. Our results showed that 1) before TR, the cortical response to sensory electrical stimulation in the residual limb showed a diffuse bilateral pattern without a clear focus in either the time or spatial domain; and 2) 2 years after TR, the sensory map of the reinnervated median nerve reorganized, showing predominant activity over the contralateral S1 hand area as well as moderate activity over the ipsilateral S1. Therefore, this work provides new evidence for long-term sensory cortical plasticity in the human brain after TR.

Impacto del uso de antibióticos en el valor de PSA, previo a la biopsia de prostata / Impact of antibiotic use in prostate-specific antigen levels before prostate biopsy

Existen observaciones clínicas sobre el uso empírico de antibióticos en pacientes con alto nivel de PSA, sin síntomas de infecciones del tracto urinario y con indicación de biopsia prostática. El uso indiscriminado de antibióticos puede llevar a la resistencia bacteriana y diversos efectos secundarios; pero sobre todo, esto puede ser una acción médica injustificada. El objetivo de esta investigación es determinar el impacto del uso de antibióticos en los valores de PSA antes de la biopsia prostática y en la decisión de si hacer o no una biopsia prostática en pacientes con sospecha de neoplasia prostática. Estudio de casos y controles de 63 pacientes menores de 80 años de edad, con tacto rectal normal, sin infección urinaria y los valores de PSA alterado con indicación de biopsia. El grupo de control no recibió medicamento y el grupo de casos recibió cotrimoxazol (80/400 mg) cada 12 horas durante 10 días. Quince días más tarde los niveles de PSA se evaluaron de nuevo y los resultados se analizaron estadísticamente. No se encontraron diferencias significativas entre ambos grupos en relación con la edad, tacto rectal o el valor de PSA. La variación de la PSA después del uso de la terapia con antibióticos no fue significativa (p = 0,588). El uso de la terapia antimicrobiana para disminuir los valores de PSA antes de una biopsia de próstata es controvertido y no hay evidencia científica para el tratamiento de una prostatitis asintomática que pueden estar alterando los valores de PSA. Los resultados de nuestro estudio muestran la necesidad de una investigación más compleja que puede confirmar que la terapia antimicrobiana no tiene un papel terapéutico en esta situación específica y común...

There is a clinical observation about the empiric use of antibiotics on patients with high PSA level, without symptoms of urinary tract infections and with indication for prostatic biopsy. The indiscriminate use of antibiotics may lead to bacterial resistance and various others side effects as well; but above all, this may be an unjustified medical action. The objective of this research is to determinate the impact of antibiotic use on PSA values before prostatic biopsy and on the decision whether make or not a prostatic biopsy in patients suspected of having prostatic cancer. Case and control study of 63 patients younger than 80 years old, with normal rectal tact, without symptoms of urinary tract infection and PSA values altered with biopsy indication. Control group did not receive medicament and the case group received Cotrimoxazole (80/400 mg) every 12 hours for 10 days. 15 days later PSA levels were evaluated again and the results were statistically analyzed. No significant differences were found between both groups in relation to age or PSA value. The variation of the PSA after the use of antibiotic therapy was no significant (p=0,588). The use of antimicrobial therapy to decrease the values of PSA before a prostate biopsy is controversial and there isn’t scientific evidence to treat a possible asyntomatic prostatitis that may be altering the PSA values. The results of our study shows the need of a more complex research that can confirm that the antimicrobial therapy has no therapeutic role on this specific and common situation...

Neck rotation modulates flexion synergy torques, indicating an ipsilateral reticulospinal source for impairment in stroke.

The effect of reticular formation excitability on maximum voluntary torque (MVT) generation and associated muscle activation at the shoulder and elbow was investigated through natural elicitation (active head rotation) of the asymmetric tonic neck reflex (ATNR) in 26 individuals with stroke and 9 age-range-matched controls. Isometric MVT generation at the shoulder and elbow was quantified with the head rotated (face pointing) contralateral and ipsilateral to the paretic (stroke) and dominant (control) arm. Given the dominance of abnormal torque coupling of elbow flexion with shoulder abduction (flexion synergy) in stroke and well-developed animal models demonstrating a linkage between reticular formation and ipsilateral elbow flexors and shoulder abductors, we hypothesized that constituent torques of flexion synergy, specifically elbow flexion and shoulder abduction, would increase with contralateral head rotation. The findings of this investigation support this hypothesis. Increases in MVT for three of four flexion synergy constituents (elbow flexion, shoulder abduction, and shoulder external rotation) were observed during contralateral head rotation only in individuals with stroke. Electromyographic data of the associated muscle coactivations were nonsignificant but are presented for consideration in light of a likely underpowered statistical design for this specific variable. This study not only provides evidence for the reemergence of ATNR following stroke but also indicates a common neuroanatomical link, namely, an increased reliance on ipsilateral reticulospinal pathways, as the likely mechanism underlying the expression of both ATNR and flexion synergy that results in the loss of independent joint control.

Storm sewers as larval habitats for Aedes aegypti and Culex spp. in a neighborhood of Merida, Mexico.

We report the collection of Aedes aegypti, Culex quinquefasciatus, Cx. interrogator, Cx. thriambus, Cx. coronator, and Cx. salinarius larvae from storm sewers within an endemic area for dengue transmission in Merida, Mexico, during the rainy season of 2011. This is the first record of the dengue vector Ae. aegypti breeding in storm sewers in the southeast of Mexico.

Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: a case report.

This case study demonstrates the ability of sensory cortical representations to remap following arm amputation and subsequent targeted reinnervation (TR). Previous human studies have demonstrated functional plasticity in the primary sensory cortex months or years after amputation of the upper arm, forearm, the hand or a single finger, or after subsequent replantation. Targeted reinnervation, a surgical procedure that re-routes inactive, residual sensorimotor nerves previously responsible for innervating the missing limb to alternative muscle groups and skin areas [1-3], has shown the ability to restore a subject's sensation in the reinnervated skin areas. Whether this new technique causes analogous cortical remapping in a similar timeframe as following hand replantation is still unknown. In order to answer this question, high-density electroencephalography was used to study whether the original sensory cortical territory was regained after TR. Before TR, we found that the cortical response to sensory electrical stimulation in the residual limb showed a diffuse bilateral pattern without a clear focus in either the time or spatial domain, Two years after TR, the sensory map of the reinnervated median nerve shifted back to a close-to-normal, predominantly contralateral pattern. The overall trend of TR-induced sensory remapping is similar to previous reports related to hand replantation but occurs over a slower timeframe. This relatively slower progress after TR as compared to after hand replantation could be because TR is performed months or even years after amputation, while hand replantation was performed immediately after the injury. This work provides new evidence for long term plasticity in the human brain.