Utility of delayed spinal cord injury rehabilitation: an Italian study
ABSTRACT The objective was to examine the utility of delayed spinal cord injury rehabilitation. The design was a retrospective study in the spinal unit of a large rehabilitation hospital. The participants were 117 patients at their first rehabilitation admission with an event to admission time of 90 days or more. The main outcome measures were the Barthel Index, Rivermead Mobility Index, Walking Index for Spinal Cord Injury and motor scores at admission and discharge; relative changes were examined. Patients showed a significant increase in all the outcome measures and achieved independence or assisted independence; significant neurological improvement and improvement in walking were recorded too; most of the patients were discharged home. The present data demonstrate the utility of delayed rehabilitation and highlight the importance of having rehabilitation in a specialised setting.
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ABSTRACT: Neuromotor systems have the capacity for functional recovery following damage to the central nervous system. This recovery can be enhanced by rehabilitative training. Animal studies in which artificial damage is induced in a specific region of the brain or spinal cord of rodents or monkeys have contributed to our understanding of the effects of rehabilitative training. In this article, I provide an overview of recent studies in which experimental animals were used to investigate the effects of rehabilitative training on motor recovery and brain plasticity. A study from my group in the macaque monkey reported the effects of hand motor training on motor recovery after lesioning of the primary motor cortex (M1) or the corticospinal tract at the cervical level. In monkeys that had undergone extensive post-lesion training, manual dexterity recovered to previous levels. Rehabilitative training was more effective in promoting recovery of manual dexterity when initiated immediately after the corticospinal tract lesion rather than 1 month later. Both functional brain imaging and gene expression analyses suggest that functional and structural changes may occur in undamaged motor areas during recovery of hand function after M1 or corticospinal tract lesions.Neuroscience Research 09/2013; DOI:10.1016/j.neures.2013.09.008 · 2.15 Impact Factor
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ABSTRACT: OBJECTIVE: Best practice is a practice that, on rigorous evaluation, demonstrates success, has had an impact, and can be replicated. It is differentiated from its constituent parts, evidence-based practice and knowledge translation, by its general meaning and global purview. The purpose of this clinical review is to provide transparency to the concept and achievement of best practice in the context of rehabilitation medicine. The authors will review and analyze the roles of evidence-based practice and knowledge translation in rehabilitation medicine as they work to support best practice. Challenge areas will be discussed, including an evidential hierarchy in need of update, a lack of "high-level" research evidence, and delays in translating evidence to practice. Last, the authors will argue that rehabilitation medicine is well-positioned to effect change by promoting inclusion of emerging research methodologies and analytic techniques that better capture context-specific rehabilitation evidence, into the evidential hierarchy. Achieving best practice is dependent on this, as well as alignment of all key stakeholders, ranging from the patient, researchers and clinicians, to policymakers, payers, and others.PM&R 09/2009; 1(10):941-50. DOI:10.1016/j.pmrj.2009.06.001 · 1.66 Impact Factor
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ABSTRACT: Migraine is a neurological disorder that affects the central nervous system causing painful attacks of headache. A genetic vulnerability and exposure to environmental triggers can influence the migraine phenotype. Migraine interferes in many facets of people's daily life including employment commitments and their ability to look after their families resulting in a reduced quality of life. Identification of the biological processes that underlie this relatively common affliction has been difficult because migraine does not have any clearly identifiable pathology or structural lesion detectable by current medical technology. Theories to explain the symptoms of migraine have focused on the physiological mechanisms involved in the various phases of headache and include the vascular and neurogenic theories. In relation to migraine pathophysiology the trigeminovascular system and cortical spreading depression have also been implicated with supporting evidence from imaging studies and animal models. The objective of current research is to better understand the pathways and mechanisms involved in causing pain and headache to be able to target interventions. The genetic component of migraine has been teased apart using linkage studies and both candidate gene and genome-wide association studies, in family and case-control cohorts. Genomic regions that increase individual risk to migraine have been identified in neurological, vascular and hormonal pathways. This review discusses knowledge of the pathophysiology and genetic basis of migraine with the latest scientific evidence from genetic studies.Current Genomics 08/2013; 14(5):300-315. DOI:10.2174/13892029113149990007 · 2.87 Impact FactorThis article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.