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Rehabilitation of an Aged Hemiplegic Patient  [cached]
Esma Ceceli
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2009,
Abstract: The incidence of hemiplegia due to cerebrovascular accident is increasing with aging and hemiplegia is the primary cause of long-term disability among the aged population. Comorbid diseases in aged patients have a negative influence on the therapy course. In this review comorbid problems and rehabilitation methods for aged hemiplegic patients were investigated. Turk J Phys Med Rehab 2009; 55 Suppl 2: 90-1.
Acupuncture treatment programs for post-stroke motor rehabilitation in community hospitals: study protocol of a multicenter, randomized, controlled trial  [cached]
Qin-hui Fu,Jian Pei
Zhong Xi Yi Jie He Xue Bao , 2012,
Abstract: BACKGROUND: Stroke is responsible for increasingly high rates of mortality and disability worldwide. Approximately two million people suffer from stroke for the first time in China each year. The high incidence (50%) of post-stroke disability brings a heavy burden to patients and their caregivers. Acupuncture has been widely used in the communities for post-stroke rehabilitation in China. The objective of this trial is to apply our acupuncture research achievement to treatment and evaluation of post-stroke hemiplegic patients in community.METHODS AND DESIGN: A multicenter, randomized, controlled trial will be performed in Longhua Hospital and a number of community health service centers in Shanghai. A total of 124 patients (estimated sample size) with post-stroke hemiplegia will be randomly divided into an acupuncture group and a control group. The patients undergoing randomization should be stratified according to National Institutes of Health Stroke Scale score at baseline. Within the acupuncture group, different acupuncture protocols are administered to patients with flaccid paralysis or spastic paralysis based on the Ashworth Scale. Patients in the acupuncture group will also be treated with comprehensive rehabilitation therapy. The control group will be treated with comprehensive rehabilitation therapy only. The primary outcome measures are the Simplified Fugl-Meyer Motor Scale, the Modified Barthel Index, and the Burden of Stroke Scale. Secondary outcome measures are the modified Rankin Scale, the modified Ashworth Scale and the Stroke Scale of Traditional Chinese Medicine. Outcome measures will be performed after 4 and 8 weeks of treatment. The patients will be followed up after 6 months.DISCUSSION: The results of this study are expected to demonstrate that our standardized acupuncture protocol for treating and evaluating post-stroke hemiplegic patients will improve motor function and lessen the burden of post-stroke patients within the communities. This will provide the evidence to support successful translation of acupuncture therapy for post-stroke hemiplegic patients in community hospital use.TRIAL REGISTRATION: This trial was registered in Chinese Clinical Trial Registry with the registration number ChiCTR-TRC-11001347.
Parallel organization of contralateral and ipsilateral prefrontal cortical projections in the rhesus monkey
Helen Barbas, Claus C Hilgetag, Subhash Saha, Caterina R Dermon, Joanna L Suski
BMC Neuroscience , 2005, DOI: 10.1186/1471-2202-6-32
Abstract: Commissural projection neurons constituted less than one third of the ipsilateral. Nevertheless, projections from the two hemispheres were strongly correlated in topography and relative density. We investigated to what extent the distribution of contralateral projections depended on: (a) geographic proximity of projection areas to the area homotopic to the injection site; (b) the structural type of the linked areas, based on the number and neuronal density of their layers. Although both measures were good predictors, structural type was a comparatively stronger determinant of the relative distribution and density of projections. Ipsilateral projection neurons were distributed in the superficial (II-III) and deep (V-VI) layers, in proportions that varied across areas. In contrast, contralateral projection neurons were found mostly in the superficial layers, but still showed a gradient in their distribution within cortical layers that correlated significantly with cortical type, but not with geographic proximity to the homotopic area.The organization of ipsilateral and contralateral prefrontal projections is similar in topography and relative density, differing only by higher overall density and more widespread laminar origin of ipsilateral than contralateral projections. The projections on both sides are highly correlated with the structural architecture of the linked areas, and their remarkable organization is likely established by punctuated development of distinct cortical types. The preponderance of contralateral projections from layer III may be traced to the late development of the callosal system, whose function may be compromised in diseases that have their root late in ontogeny.The primate cerebral cortex constitutes a vast communication network of ipsilateral and contralateral corticocortical connections. Although fewer in number, contralateral projection neurons, which course through the corpus callosum and the anterior commissure, have elaborate dendritic
Response of SII cortex to ipsilateral, contralateral and bilateral flutter stimulation in the cat
Mark Tommerdahl, Stephen B Simons, Joannellyn S Chiu, Vinay Tannan, Oleg Favorov, Barry Whitsel
BMC Neuroscience , 2005, DOI: 10.1186/1471-2202-6-11
Abstract: Optical intrinsic signal imaging was used to evaluate the response of primary somatosensory cortex (SI and SII in the same hemisphere) to 25 Hz sinusoidal vertical skin displacement stimulation ("skin flutter") applied contralaterally, ipsilaterally, and bilaterally to the central pads of the forepaws. A localized increase in absorbance in both SI and SII was evoked by both contralateral and bilateral flutter stimulation. Ipsilateral flutter stimulation evoked a localized increase in absorbance in SII, but not in SI. The SII region that responded with an increase in absorbance to ipsilateral stimulation was posterior to the region in which absorbance increased maximally in response to stimulation of the contralateral central pad. Additionally, in the posterior SII region that responded maximally to ipsilateral stimulation of the central pad, bilateral central pad stimulation approximated a linear summation of the SII responses to independent stimulation of the contralateral and ipsilateral central pads. Conversely, in anterior SII (the region that responded maximally to contralateral stimulation), bilateral stimulation was consistently less than the response evoked from the contralateral central pad.The results indicate that two regions located at neighboring, but distinctly different A-P levels of the anterior ectosylvian gyrus process input from opposite sides of the body midline in very different ways. The results suggest that the SII cortex, in the cat, can be subdivided into at least two functionally distinct regions and that these functionally distinct regions demonstrate a laterality preference within SII.There is general agreement that in cats and monkeys (and presumably in humans) the spike discharge activity a mechanical stimulus sets up in rapidly adapting (RA), slowly adapting (SA), and Pacinian (PC) skin mechanoreceptors is projected centrally, at short latency and with relatively minor transformation, to primary somatosensory cortex (both SI and SII) i
System Identification Algorithm Analysis of Acupuncture Effect on Mean Blood Flux of Contralateral Hegu Acupoint
Guangjun Wang,Jianguo Han,Gerhard Litscher,Weibo Zhang
Evidence-Based Complementary and Alternative Medicine , 2012, DOI: 10.1155/2012/951928
Abstract: Background. Acupoints (belonging to 12 meridians) which have the same names are symmetrically distributed on the body. It has been proved that acupoints have certain biological specificities different from the normal parts of the body. However, there is little evidence that acupoints which have the same name and are located bilaterally and symmetrically have lateralized specificity. Thus, researching the lateralized specificity and the relationship between left-side and right-side acupuncture is of special importance. Methodology and Principal Findings. The mean blood flux (MBF) in both Hegu acupoints was measured by Moor full-field laser perfusion imager. With the method of system identification algorithm, the output distribution in different groups was acquired, based on different acupoint stimulation and standard signal input. It is demonstrated that after stimulation of the right Hegu acupoint by needle, the output value of MBF in contralateral Hegu acupoint was strongly amplified, while after acupuncturing the left Hegu acupoint, the output value of MBF in either side Hegu acupoint was amplified moderately. Conclusions and Significance. This paper indicates that the Hegu acupoint has lateralized specificity. After stimulating the ipsilateral Hegu acupoint, symmetry breaking will be produced in contrast to contralateral Hegu acupoint stimulation.
Response of SI cortex to ipsilateral, contralateral and bilateral flutter stimulation in the cat
Mark Tommerdahl, Stephen B Simons, Joannellyn S Chiu, Oleg Favorov, Barry Whitsel
BMC Neuroscience , 2005, DOI: 10.1186/1471-2202-6-29
Abstract: Optical intrinsic signal imaging was used to evaluate the response of SI and SII in the same hemisphere to 25 Hz sinusoidal vertical skin displacement stimulation ("skin flutter") applied contralaterally, ipsilaterally, and bilaterally (simultaneously) to the central pads of the forepaws. A localized increase in absorbance in both SI and SII occurred in response to both contralateral and bilateral flutter stimulation. Ipsilateral flutter stimulation evoked a localized increase in absorbance in SII, but little or no change in SI absorbance. In the forepaw representational region of SI, however, bilateral stimulation of the central pads evoked a response substantially smaller (approximately 30–35% smaller) than the response to flutter stimulation of the contralateral central pad.The finding that the response of SI cortex to bilateral central pad flutter stimulation is substantially smaller than the response evoked by a contralateral flutter stimulus, together with the recently published observation that a region located posteriorly in SII responds with a substantially larger response to a bilateral flutter stimulus than the response evoked from the contralateral central pad, lead us to propose that the SI activity evoked by contralateral skin stimulation is suppressed/inhibited (via corticocortical connections between SII and SI in the same hemisphere) by the activity a simultaneous ipsilateral skin stimulus evokes in posterior SII.It is established that multiple fields/areas in each cerebral hemisphere are activated at short latency by stimuli that trigger spike discharge activity in skin mechanoreceptive afferents. Of these the most extensively studied is SI – a region which most investigators have come to regard as responsive solely (the major exception being the face region of SI) to tactile stimuli delivered to contralateral skin sites. In contrast, SII has long been known to be activated at short latency by mechanical stimulation of skin sites on both sides of t
Ipsilateral and Contralateral Auditory Brainstem Response Reorganization in Hemispherectomized Patients  [PDF]
Ning Yao,Hui Qiao,Ping Li,Yang Liu,Liang Wu,Xiaofeng Deng,Zide Wang,Daxing Chen,Xianzeng Tong,Yuan Liu,Chenlong Yang,Yulun Xu
Neural Plasticity , 2013, DOI: 10.1155/2013/832473
Abstract: Background. Cortical hemispherectomy leads to degeneration of ipsilateral subcortical structures, which can be observed long term after the operation. Therefore, reorganization of the brainstem auditory pathway might occur. The aim of this study was to assess reorganization of brainstem auditory pathways by measuring the auditory brainstem response (ABR) in long-term hemispherectomized patients. Methods. We performed bilateral monaural stimulation and measured bilateral ABR in 8 patients ~20 years after hemispherectomy and 10 control subjects. Magnetic resonance imaging (MRI) was performed in patients to assess structural degeneration. Results. All patients showed degenerated ipsilateral brainstem structures by MRI but no significant differences in bilateral recording ABR wave latencies. However, nonsurgical-side stimulation elicited significantly longer wave V latencies compared to surgical-side stimulation. Differences in bilateral ABR were observed between hemispherectomized patients and control subjects. Waves III and V latencies elicited by nonsurgical-side stimulation were significantly longer than those in control subjects; surgical-side stimulation showed no significant differences. Conclusions. (1) Differences in ABR latency elicited by unilateral stimulation are predominantly due to bilateral brainstem auditory pathway activity rather than to changes in brainstem volume; (2) ABR Waves III and V originate predominantly in the contralateral brainstem; and (3) subcortical auditory pathways appear to reorganize after long term hemispherectomy. 1. Introduction Hemispherectomy is commonly performed for the surgical management of pediatric patients with medically refractory epilepsy [1]. Specific types of hemispherectomy, such as anatomic and functional hemispherectomy, involve removal of diverse areas of the hemisphere. In particular, anatomic hemispherectomy involves complete removal of the cortex from the hemisphere in which the seizures originate [2]. Many studies indicate that reorganization, particularly in the sensorimotor cortex, occurs in the remaining hemisphere [3], leading to recovery of function, depending on how early during postnatal development hemispherectomy is performed. Reorganization of the auditory pathway has also been reported in hemispherectomized patients [4]. Although subcortical structures are left intact in hemispherectomy, degenerative changes can take place and remain long after surgery. In 1966, Oppenheimer and Griffith [5] published an autopsy report of a patient with hemispherectomy, noting degeneration of the
The Refinement of Ipsilateral Eye Retinotopic Maps Is Increased by Removing the Dominant Contralateral Eye in Adult Mice  [PDF]
Spencer L. Smith,Joshua T. Trachtenberg
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0009925
Abstract: Shortly after eye opening, initially disorganized visual cortex circuitry is rapidly refined to form smooth retinotopic maps. This process asymptotes long before adulthood, but it is unknown whether further refinement is possible. Prior work from our lab has shown that the retinotopic map of the non-dominant ipsilateral eye develops faster when the dominant contralateral eye is removed. We examined whether input from the contralateral eye might also limit the ultimate refinement of the ipsilateral eye retinotopic map in adults. In addition, we examined whether the increased refinement involved the recruitment of adjacent cortical area.
Análise dos resultados estéticos na reconstru??o mamária com TRAM ipsilateral vs. contralateral
Matos, Juliana Régia Furtado;Dias, Iana Silva;Pessoa, Breno Bezerra Gomes de Pinho;Pessoa, Salustiano Gomes de Pinho;
Revista Brasileira de Cirurgia Plástica , 2012, DOI: 10.1590/S1983-51752012000200017
Abstract: background: breast reconstruction by using the rectus abdominis muscle (transverse rectus abdominis myocutaneous, tram) flaps is a common procedure that has been performed since the 1990s. ipsilateral tram flaps were proven to be as safe as contralateral flaps for breast reconstruction. however, studies comparing the aesthetic outcomes of the two procedures are poorly described in the literature. the aim of this study was to compare the cosmetic outcomes of ipsilateral and contralateral pedicled flaps. methods: we prospectively evaluated 29 cases of immediate reconstruction with ipsilateral (group 1) or contralateral (group 2) tram flaps. the aesthetic outcomes were analyzed and the two groups were compared. results: the average age of the patients was 43 ± 7 years. in group 1 (ipsilateral tram), 91.7% of the patients presented a well-defined inframammary fold, as compared to 52.9% of the patients in group 2 (contralateral tram). in group 1, 8.3% of patients showed xiphoid bulges, whereas they were observed in 23.5% of patients in group 2. the difference in the overall shape of the reconstructed breast was not significant; symmetry was observed in 66.7% and 70.6% of patients in groups 1 and 2, respectively. conclusions: ipsilateral tram flaps allow better preservation of the inframammary fold and cause less xiphoid bulge. however, the overall shape of the breast and the projection of its lower pole were similar between the two groups.
The Effect of Cutaneous Mechanical Stimulations of Medial Plantar Surface on the Excitability of Ipsilateral and Contralateral Motoneurons
MR Hadian,A Bastani,S Talebian,GR Olyaei
Modern Rehabilitation , 2007,
Abstract: Background and Aim: Mechanoreceptors from the foot sole likely contribute in the reflex regulations. Stimulation of these receptors in the medial aspect of the foot is corresponded to the medial plantar nerve divisions in the tibial nerve. Therefore, it was hypothesized that repetitive low threshold afferents stimulation would have an inhibitory effect on the soleus H-reflexes.Materials and Methods : sixteen normal subjects voluntarily, participated in the study. Subjects were remained in prone position. The Cutaneous Mechanical Pressure (CMP) (equal to 50% of leg and foot weight) was applied to the ipsilateral medial plantar surface by a designed instrument through a square plate (30 x 30 mm). H reflex as an indicator for excitability of motoneurones was bilaterally elicited before and after the application of the CMP.Results: The amplitude of H reflex and H/M ratio showed significant differences before and after the Ipsilateral CMP stimulation of the medial side of the foot (p<0.05); furthermore, the latency of& H reflex was also increased (p<0.05). In addition, the effect of CMP stimulation of the IPS stimulation showed more difference than the Contralateral side.Discussion: The results highlights the modulatory effects of natural stimulation of cutaneous afferents on excitability of Ipsilateral and contralateral motoneurones. This in respect may have practical application in the management of muscle tone disorders in brain and spinal cord injuries.
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