Assuntos
Axônios , Infecções por Campylobacter/complicações , Campylobacter jejuni , Neurônios Motores , Degeneração Neural/etiologia , Condução Nervosa , Doenças do Sistema Nervoso Periférico/microbiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Autoanticorpos/sangue , Feminino , Gangliosídeo G(M1)/imunologia , Humanos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/imunologiaRESUMO
BACKGROUND: The mechanisms behind motor recovery from stroke are not clearly understood. Functional imaging studies have demonstrated task-related brain activation in several motor areas, but few studies have attempted to correlate this with stroke outcome. Moreover, these studies have focused on how motor areas may individually contribute to compensation. Here, the authors investigate whether different cortical areas interact to form dynamic assemblies that may then compensate for disability. METHODS: The authors investigated corticocortical coherence in 16 healthy subjects and 25 patients with chronic stroke involving one cerebral hemisphere and having varying degrees of motor recovery. Scalp EEG was recorded at rest and while right-handed subjects performed a unimanual grip task. The degree of functional recovery after stroke was assessed using a range of outcome measures. RESULTS: Compared with healthy subjects, hand-related asymmetries in task-related EEG-EEG coherence were increased between mesial and lateral frontal regions of the affected hemisphere, over mesial frontal regions, and over lateral frontal areas of the unaffected hemisphere when patients with stroke gripped with their affected hand. Mesial hand-related asymmetries in task-related power and coherence were negatively correlated with recovery. CONCLUSION: Increases in task-related coupling between cortical areas may dynamically compensate for brain damage after stroke. Some of this increased coupling, particularly that over mesial frontal areas, decreases as patients make a functional recovery.
Assuntos
Córtex Cerebral/fisiopatologia , Rede Nervosa/fisiopatologia , Paresia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Doença Crônica , Dominância Cerebral , Eletroencefalografia , Eletromiografia , Feminino , Lobo Frontal/fisiopatologia , Força da Mão , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/fisiopatologia , Infarto da Artéria Cerebral Média/reabilitação , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Plasticidade Neuronal , Paresia/etiologia , Paresia/reabilitação , Desempenho Psicomotor , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral , Resultado do TratamentoRESUMO
In 1999 a report from the Royal College of Surgeons of England drew attention to the fact that, in the UK, there is little structured acute inpatient rehabilitation for patients admitted after traumatic brain injury (TBI). This paper reports the results of a retrospective study of acute inpatient rehabilitation (AR) after TBI, comparing aspects of resource use in 92 patients who received structured unit-based multidisciplinary AR with 97 patients who received usual practice. About 10% of patients admitted via casualty after TBI required AR after neurosurgical consultation or care. These patients remained in AR for a mean of 20.5 days; length of stay in an acute bed was not prolonged compared with patients in usual practice. Sixty per cent of patients discharged home from unit-based care were referred to community-based rehabilitation on discharge compared with no patients discharged home from neurosurgical care. There is an urgent need to discuss and plan at national level the structured secondary provision of acute rehabilitation after acquired brain injury.
