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Find video protocols related to scientific articles indexed in Pubmed.
The next revolution in stroke care.
Expert Rev Neurother
PUBLISHED: 10-22-2014
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Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the burden of stroke have largely focused on prevention and acute care strategies. Despite considerable resources and attention, the focus on prevention and acute care has not been successful in changing the clinical trajectory for the majority of stroke patients. While efforts to prevent strokes will continue to have an impact, the total burden of stroke will increase due to the aging population and decreased mortality rates. There is strong evidence for the effectiveness of rehabilitation in better managing stroke and its related disabilities. The time has come to shift the attention in stroke care and research from prevention and cure to a greater focus and investment in the rehabilitation and quality of life of stroke survivors. The rebalancing of stroke care and research initiatives requires a reinvestment in rehabilitation and community reintegration of stroke survivors.
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Psychometrics of the Wrist Stability and Hand Mobility Subscales of the Fugl-Meyer Assessment in Moderately Impaired Stroke.
Phys Ther
PUBLISHED: 09-04-2014
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There remains a need for a quickly administered, stroke-specific, bedside measure of active wrist and finger movement for the expanding stroke population. The wrist stability and hand mobility scales of the upper extremity Fugl-Meyer Assessment (w/h UE FM) constitute a valid, reliable measure of paretic UE impairment in patients with active wrist and finger movement.
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Relationship between touch sensation of the affected hand and performance of valued activities in individuals with chronic stroke.
Top Stroke Rehabil
PUBLISHED: 08-25-2014
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To investigate the association between touch sensation of the affected hand and performance and satisfaction with performance of valued activities in individuals with chronic stroke.
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Speech language pathologists' opinions of constraint-induced language therapy.
Top Stroke Rehabil
PUBLISHED: 08-25-2014
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Constraint-induced language therapy (CILT) has received recent attention as a possible intervention to improve expressive language in people with nonfluent aphasia. Difficulties have been reported with the practical implementation of constraint-induced movement therapy due to its intensive treatment parameters. It remains unknown whether similar challenges may exist with CILT.
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Modified constraint-induced movement therapy for upper extremity recovery post stroke: what is the evidence?
Top Stroke Rehabil
PUBLISHED: 08-25-2014
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Constraint-induced movement therapy (CIMT) is an effective treatment for upper extremity (UE) recovery post stroke. Difficulties implementing a traditional CIMT approach have led to development of protocols featuring varying practice schedules, including a 10-week, 3 times per week intervention, termed modified CIMT (mCIMT). To date, systematic reviews of CIMT have grouped the various protocols, precluding the ability to ascertain the level of evidence (LOE) of specific CIMT protocols. Knowing the LOE for various protocols and their relative effectiveness may facilitate decision making regarding which protocol to implement.
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Examining the use of constraint-induced movement therapy in canadian neurological occupational and physical therapy.
Physiother Can
PUBLISHED: 04-11-2014
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To investigate the use of constraint-induced movement therapy (CIMT) in Canadian neurological occupational and physical therapy.
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The professional occupational therapy doctoral degree: why do it?
Am J Occup Ther
PUBLISHED: 03-04-2014
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This article presents a rationale for the development of professional occupational therapy doctorate (OTD) programs. As more universities transition to the entry-level OTD degree, opportunities are becoming available to advance the profession and increase benefits to clients. We analyzed the current health care environment and developed the following proposed outcomes for doctoral-trained practitioners: (1) Demonstrate advanced clinical skills; (2) attain proficiency in outcomes measurement and analysis and synthesis of outcomes data; (3) routinely use standardized evidence-based practice clinical guidelines that translate research into practice; (4) develop, implement, and lead health promotion services; and (5) excel as partners in interprofessional teams.
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Stroke Survivors Scoring Zero on the NIH Stroke Scale Score Still Exhibit Significant Motor Impairment and Functional Limitation.
Stroke Res Treat
PUBLISHED: 02-05-2014
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Objective. To determine the National Institutes of Health Stroke Scale's (NIHSS's) association with upper extremity (UE) impairment and functional outcomes. Design. Secondary, retrospective analysis of randomized controlled trial data. Setting. Not applicable. Participants. 146 subjects with stable, chronic stroke-induced hemiparesis. Intervention. The NIHSS, the UE Fugl-Meyer (FM), and the Arm Motor Ability Test (AMAT) were administered prior to their participation in a multicenter randomized controlled trial. Main Outcome Measures. The NIHSS, FM, and AMAT. Results. The association between the NIHSS and UE impairment was statistically significant (P = -0.204; p = 0.014) but explained less than 4% of the variance among UE FM scores. The association between NIHSS total score and function as measured by the AMAT was not statistically significant (P = -0.141; p = 0.089). Subjects scoring a "zero" on the NIHSS exhibited discernible UE motor deficits and varied scores on the UE FM and AMAT. Conclusion. While being used in stroke trials, the NIHSS may have limited ability to discriminate between treatment responses, even when only a relatively narrow array of impairment levels exists among patients. Given these findings, NIHSS use should be restricted to acute stroke studies and clinical settings with the goal of reporting stroke severity.
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Periprocedural stroke risk in patients undergoing catheter ablation for atrial fibrillation on uninterrupted warfarin.
J. Cardiovasc. Electrophysiol.
PUBLISHED: 01-07-2014
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Catheter ablation is an effective treatment for symptomatic individuals with atrial fibrillation (AF) but is associated with a risk of periprocedual stroke. Recent data suggest that this risk may be abolished if catheter ablation is performed with uninterrupted warfarin (UW). We sought to compare the incidence, severity and timing of periprocedural stroke between 2 periprocedural anticoagulation protocols: bridging low-molecular-weight heparin (LMWH) and UW.
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Ethinyl estradiol and other human pharmaceutical estrogens in the aquatic environment: a review of recent risk assessment data.
AAPS J
PUBLISHED: 01-02-2014
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Interest in pharmaceuticals in the environment has increased substantially in recent years. Several studies in particular have assessed human and ecological risks from human pharmaceutical estrogens, such as 17?-ethinyl estradiol (EE2). Regulatory action also has increased, with the USA and other countries developing rules to address estrogens and other pharmaceuticals in the environment. Accordingly, the Center for Drug Evaluation and Research at the US Food and Drug Administration has conducted a review and analysis of current data on the long-term ecological exposure and effects of EE2 and other estrogens. The results indicate that mean-flow long-term predicted environmental concentrations (PECs) of EE2 in approximately 99% or more of US surface water segments downstream of wastewater treatment plants are lower than a predicted no-effect concentration (PNEC) for aquatic chronic toxicity of 0.1 ng/L. Exceedances are expected to be primarily in localized, effluent-dominated water segments. The median mean-flow PEC is more than two orders of magnitude lower than this PNEC. Similar results exist for other pharmaceutical estrogens. Data also suggest that the contribution of EE2 more broadly to total estrogenic load in the environment from all sources (including other human pharmaceutical estrogens, endogenous estrogens, natural environmental estrogens, and industrial chemicals), while highly uncertain and variable, appears to be relatively low overall. Additional data and a more comprehensive approach for data collection and analysis for estrogenic substances in the environment, especially in effluent-dominated water segments in sensitive environments, would more fully characterize the risks.
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Ischemic ventricular tachycardia presenting as a narrow complex tachycardia.
Indian Pacing Electrophysiol J
PUBLISHED: 01-01-2014
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This report describes a patient presenting with a narrow complex tachycardia in the context of prior myocardial infarction and impaired ventricular function. Electrophysiological studies confirmed ventricular tachycardia and activation and entrainment mapping demonstrated a critical isthmus within an area of scar involving the His-Purkinje system accounting for the narrow QRS morphology. This very rare case shares some similarities with upper septal ventricular tachycardia seen in patients with structurally normal hearts, but to our knowledge has not been seen previously in patients with ischemic heart disease.
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A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial).
Circ Arrhythm Electrophysiol
PUBLISHED: 01-01-2014
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Restoring sinus rhythm in patients with heart failure (HF) and atrial fibrillation (AF) may improve left ventricular (LV) function and HF symptoms. We sought to compare the effect of a catheter ablation strategy with that of a medical rate control strategy in patients with persistent AF and HF.
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Effect of Overground Training Augmented By Mental Practice On Gait Velocity in Chronic, Incomplete Spinal Cord Injury.
Arch Phys Med Rehabil
PUBLISHED: 11-22-2013
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To compare efficacy of a regimen combining mental practice (MP) with overground training with the efficacy of a regimen comprised of overground training only on gait velocity and lower extremity motor outcomes in individuals with chronic (> 12 months post injury), incomplete, spinal cord injury (SCI).
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Minimal depression: how does it relate to upper-extremity impairment and function in stroke?
Am J Occup Ther
PUBLISHED: 08-24-2013
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OBJECTIVE. We sought to determine the association between minimal depression, upper-extremity (UE) impairment, and UE motor function in a cohort of participants with subacute stroke. METHOD. We conducted a retrospective, secondary analysis of an interventional study. Correlational analyses were performed using the following outcome measures: the UE section of the Fugl-Meyer Assessment (FM), the functional ability section of the Arm Motor Ability Test (AMAT), and the Beck Depression Inventory (BDI-II). RESULTS. We found a negative correlation between BDI-II and both the FM (-.120, p = .196) and the AMAT (-.110, p = .275); however, this correlation was not statistically significant. Women exhibited higher depression scores (8.75 ± 0.78) than men (6.29 ± 0.46; p = .008). CONCLUSION. Low levels of depression are not associated with UE motor impairment and function in people with minimal to moderate UE disability levels. Poststroke depression occurs more frequently in women, warranting additional research on sex-specific differences. Given the proliferation of UE therapies targeting this group, this information is important for effective therapy planning and implementation.
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Balance is associated with quality of life in chronic stroke.
Top Stroke Rehabil
PUBLISHED: 07-30-2013
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To investigate the association between balance and quality of life (QOL) in chronic stroke survivors by (1) examining the associations between balance and QOL scores; (2) identifying the frequency of balance impairment and poststroke falls; and (3) determining the differences in QOL scores between persons with and those without balance impairment.
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Vagal afferent NMDA receptors modulate CCK-induced reduction of food intake through synapsin I phosphorylation in adult male rats.
Endocrinology
PUBLISHED: 05-28-2013
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Vagal afferent nerve fibers transmit gastrointestinal satiation signals to the brain via synapses in the nucleus of the solitary tract (NTS). Despite their pivotal role in energy homeostasis, little is known about the cellular mechanisms enabling fleeting synaptic events at vagal sensory endings to sustain behavioral changes lasting minutes to hours. Previous reports suggest that the reduction of food intake by the satiation peptide, cholecystokinin (CCK), requires activation of N-methyl-D-aspartate-type glutamate receptors (NMDAR) in the NTS, with subsequent phosphorylation of ERK1/2 (pERK1/2) in NTS vagal afferent terminals. The synaptic vesicle protein synapsin I is phosphorylated by pERK1/2 at serines 62 and 67. This pERK1/2-catalyzed phosphorylation increases synaptic strength by increasing the readily releasable pool of the neurotransmitter. Conversely, dephosphorylation of serines 62 and 67 by calcineurin reduces the size of the readily releasable transmitter pool. Hence, the balance of synapsin I phosphorylation and dephosphorylation can modulate synaptic strength. We postulated that CCK-evoked activation of vagal afferent NMDARs results in pERK1/2-catalyzed phosphorylation of synapsin I in vagal afferent terminals, leading to the suppression of food intake. We found that CCK injection increased the phosphorylation of synapsin I in the NTS and that this increase is abolished after surgical or chemical ablation of vagal afferent fibers. Furthermore, fourth ventricle injection of an NMDAR antagonist or the mitogen-activated ERK kinase inhibitor blocked CCK-induced synapsin I phosphorylation, indicating that synapsin phosphorylation in vagal afferent terminals depends on NMDAR activation and ERK1/2 phosphorylation. Finally, hindbrain inhibition of calcineurin enhanced and prolonged synapsin I phosphorylation and potentiated reduction of food intake by CCK. Our findings are consistent with a mechanism in which NMDAR-dependent phosphorylation of ERK1/2 modulates satiation signals via synapsin I phosphorylation in vagal afferent endings.
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Recruitment, retention, and blinding in clinical trials.
Am J Occup Ther
PUBLISHED: 02-26-2013
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The recruitment and retention of participants and the blinding of participants, health care providers, and data collectors present challenges for clinical trial investigators. This article reviews challenges and alternative strategies associated with these three important clinical trial activities. Common recruiting pitfalls, including low sample size, unfriendly study designs, suboptimal testing locations, and untimely recruitment are discussed together with strategies for overcoming these barriers. The use of active controls, technology-supported visit reminders, and up-front scheduling is recommended to prevent attrition and maximize retention of participants. Blinding is conceptualized as the process of concealing research design elements from key players in the research process. Strategies for blinding participants, health care providers, and data collectors are suggested.
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Protocol development, treatment fidelity, adherence to treatment, and quality control.
Am J Occup Ther
PUBLISHED: 02-26-2013
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Occupational therapy leaders have emphasized the importance of intervention effectiveness research. The CONSORT and TREND checklists have been suggested as useful tools for reporting the results of randomized and nonrandomized studies, respectively. Despite such recommendations, research protocols and reports continue to underutilize the available tools, a situation reflecting limited resources for and experience with the conduct of effectiveness research. To address this issue, and using the CONSORT statement to structure the analysis, this article discusses strategies for optimization of protocol development, treatment fidelity, adherence to treatment, and quality control. We recommend several approaches to increase the quality of research throughout these various processes. Examples of implementation from our laboratory provide evidence of the utility of these strategies.
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What are the "ingredients" of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations.
Restor. Neurol. Neurosci.
PUBLISHED: 02-12-2013
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Modified constraint induced movement therapy (mCIT) increases paretic upper extremity use and movement in all phases of stroke. Although fundamental to its appropriate implementation, specific details on day to day implementation on this promising family of therapies have not heretofore been published. Consequently, some integral behavioral facets of mCIT may be overlooked, while other approaches may be easily mistaken to constitute mCIT, during attempts to implement the therapy. The purpose of this paper is to review mCIT, and to provide the clinician-reader with a detailed description of the "ingredients" of mCIT and their rationale, including clinical examples of these components. It is expected that a more complete understanding of the components comprising this promising approach will overcome knowledge barriers associated with its appropriate use, and encourage better patient management in clinical practice.
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Size doesnt matter: cortical stroke lesion volume is not associated with upper extremity motor impairment and function in mild, chronic hemiparesis.
Arch Phys Med Rehabil
PUBLISHED: 01-06-2013
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To determine (1) the relationship between lesion volume and upper extremity (UE) motor impairment using the UE section of the Fugl-Meyer (FM) assessment; and (2) the relationship between lesion volume and UE functional outcomes using the Arm Motor Ability Test (AMAT) Functional Ability (FA) and Time scales.
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Affected upper-extremity movement ability is retained 3 months after modified constraint-induced therapy.
Am J Occup Ther
PUBLISHED: 10-27-2011
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The practicality and patient compliance of constraint-induced movement therapy limit its application in many clinical environments. For more than a decade, the principal investigators laboratory has shown efficacy of an outpatient, modified constraint-induced therapy (mCIT). The current study examined whether participants administered mCIT retained motor changes 3 mo after intervention. The upper-extremity section of the Fugl-Meyer Impairment Scale (FM) and the Action Research Arm Test (ARA) were administered directly after mCIT intervention. Thirteen patients poststroke were tracked prospectively from directly after intervention concluded to 3 mo after intervention, at which time the FM and ARA were readministered. Three months after intervention, 25 of the 26 scores on the FM and ARA increased between the time after intervention and 3 months after intervention, reflecting continued increases in affected extremity movement ability. It is believed that the continued motor changes were caused by the comparatively larger number of extremity-use opportunities during the 10-wk mCIT intervention period. These opportunities encourage habitual extremity use even after the intervention period has concluded, leading to the changes observed.
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Retention of motor changes in chronic stroke survivors who were administered mental practice.
Arch Phys Med Rehabil
PUBLISHED: 04-20-2011
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To determine retention of motor changes 3 months after participation in a regimen consisting of mental practice (MP) combined with repetitive task-specific (RTP) practice.
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Portable neurorobotics for the severely affected arm in chronic stroke: a case study.
J Neurol Phys Ther
PUBLISHED: 04-09-2011
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Few motor therapies increase active movement in the severely impaired arm of individuals with chronic stroke. Existing robotic devices to address this need are large and expensive. This case study describes the application and reports outcomes associated with a repetitive task-specific training (RTP) program incorporating a portable robotic device. We assessed outcomes related to affected arm impairment, ability to perform valued activities, satisfaction with movement performance, and quality of life in a participant with chronic stroke exhibiting severe arm hemiparesis.
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Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study.
Arch Phys Med Rehabil
PUBLISHED: 03-23-2011
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To assess balance recovery and quality of life after tongue-placed electrotactile biofeedback training in patients with stroke.
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Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial.
Clin Rehabil
PUBLISHED: 03-22-2011
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To evaluate and compare efficacy of 20-, 40-, and 60-minute mental practice sessions on affected upper extremity impairment and functional limitation.
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Computer-based rhythm and timing training in severe, stroke-induced arm hemiparesis.
Am J Occup Ther
PUBLISHED: 02-12-2011
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We pilot tested the efficacy of computer-based training implementing rhythm and timing in chronic, severe, stroke-induced hemiparesis.
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Regulation of CCL2 expression by an upstream TALE homeodomain protein-binding site that synergizes with the site created by the A-2578G SNP.
PLoS ONE
PUBLISHED: 02-07-2011
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CC Chemokine Ligand 2 (CCL2) is a potent chemoattractant produced by macrophages and activated astrocytes during periods of inflammation within the central nervous system. Increased CCL2 expression is correlated with disease progression and severity, as observed in pulmonary tuberculosis, HCV-related liver disease, and HIV-associated dementia. The CCL2 distal promoter contains an A/G polymorphism at position -2578 and the homozygous -2578 G/G genotype is associated with increased CCL2 production and inflammation. However, the mechanisms that contribute to the phenotypic differences in CCL2 expression are poorly understood. We previously demonstrated that the -2578 G polymorphism creates a TALE homeodomain protein binding site (TALE binding site) for PREP1/PBX2 transcription factors. In this study, we identified the presence of an additional TALE binding site 22 bp upstream of the site created by the -2578 G polymorphism and demonstrated the synergistic effects of the two sites on the activation of the CCL2 promoter. Using chromatin immunoprecipitation (ChIP) assays, we demonstrated increased binding of the TALE proteins PREP1 and PBX2 to the -2578 G allele, and binding of IRF1 to both the A and G alleles. The presence of TALE binding sites that form inverted repeats within the -2578 G allele results in increased transcriptional activation of the CCL2 distal promoter while the presence of only the upstream TALE binding site within the -2578 A allele exerts repression of promoter activity.
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Reliability of frames of reference used for tibial component rotation in total knee arthroplasty.
Comput. Aided Surg.
PUBLISHED: 02-04-2011
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This study evaluated seven different frames of reference used for tibial component rotation in total knee arthroplasty (TKA) to determine which ones showed good reliability between bone specimens. An optoelectronic system based around a computer-assisted surgical navigation system was used to measure and locate 34 individual anatomical landmarks on 40 tibias. Each particular frame of reference was reconstructed from a group of data points taken from the surface of each bone. The transverse axis was used as the baseline to which the other axes were compared, and the differences in angular rotation between the other six reference frames and the transverse axis were calculated. There was high variability in the tibial rotational alignment associated with all frames of reference. Of the references widely used in current TKA procedures, the tibial tuberosity axis and the anterior condylar axis had lower standard deviations (6.1° and 7.3°, respectively) than the transmalleolar axis and the posterior condylar axis (9.3° for both). In conclusion, we found high variability in the frames of reference used for tibial rotation alignment. However, the anterior condylar axis and transverse axis may warrant further tests with the use of navigation. Combining different frames of reference such as the tibial tuberosity axis, anterior condylar axis and transverse axis may reduce the range of errors found in all of these measurements.
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A pilot study of rhythm and timing training as a supplement to occupational therapy in stroke rehabilitation.
Top Stroke Rehabil
PUBLISHED: 01-02-2011
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Stroke is the leading cause of disability. A need exists for an effective intervention to enhance upper extremity (UE) motor abilities and activities of daily living (ADL) performance.
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Game-based, portable, upper extremity rehabilitation in chronic stroke.
Top Stroke Rehabil
PUBLISHED: 01-02-2011
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This case series pilot study evaluates the efficacy of the Core:Tx gaming device on 2 chronic stroke survivors.
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Chronometry of mentally versus physically practiced tasks in people with stroke.
Am J Occup Ther
PUBLISHED: 12-07-2010
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The purpose of this study was to determine whether chronometry is appropriate for monitoring engagement in mental practice by comparing the time taken for people with chronic stroke to mentally and physically practice five tasks.
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Combined bracing, electrical stimulation, and functional practice for chronic, upper-extremity spasticity.
Am J Occup Ther
PUBLISHED: 11-16-2010
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Conventional methods for managing upper-extremity (UE) spasticity are invasive, usually require readministration after a certain time period, and do not necessarily increase UE function. This study examined efficacy of combining two singularly efficacious modalities-UE bracing and electrical stimulation-with functional training to reduce UE spasticity and improve function.
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Catheter ablation for atrial fibrillation on uninterrupted warfarin: can it be done without echo guidance?
J. Cardiovasc. Electrophysiol.
PUBLISHED: 10-06-2010
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Catheter ablation for atrial fibrillation is an effective treatment for symptomatic patients who have failed drug therapy. Recent studies using intracardiac echocardiography have demonstrated that ablation can be performed safely on uninterrupted warfarin and may be superior to bridging low molecular weight heparin (LMWH). We sought to assess the safety of an uninterrupted warfarin protocol using a simplified ablation protocol in a prospective controlled study.
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Impact of variant pulmonary vein anatomy and image integration on long-term outcome after catheter ablation for atrial fibrillation.
Europace
PUBLISHED: 09-07-2010
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To investigate the impact of variant pulmonary vein (PV) anatomy and the use of three-dimensional image integration (3D-II) on long-term efficacy of catheter ablation for atrial fibrillation (AF).
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Orthotic functional electrical stimulation following botulinum toxin for a young adult with severe hand impairment due to childhood stroke.
Physiother Theory Pract
PUBLISHED: 04-20-2010
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ABSTRACT This case report describes the outcomes of a task-specific training protocol using functional electrical stimulation for a young adult with severe hand impairment from a childhood stroke who had a history of tendon transfer and a recent botulinum toxin injection. A 22-year-old female who had a hemorrhagic stroke at age 5, a tendon transfer at 18, and a botulinum toxin injection 6 weeks before study entry, participated in a home- and clinic-based task-specific training program using a functional electrical stimulation orthosis. Training was 30-90 minutes per day, 4 days per week, for 4 weeks. Stroke-specific outcomes were measured before and after intervention. Increases occurred in the following scores: Action Research Arm Test, Stroke Impact Scale Hand Function Domain, and Canadian Occupational Performance Measure. A task-specific training protocol using orthotic functional electrical stimulation appears to have increased hand function and quality of life for an adult with chronic, childhood-onset stroke. To our knowledge, this is the first study to investigate the efficacy of functional electrical stimulation for such an individual.
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Telerehabilitation and electrical stimulation: an occupation-based, client-centered stroke intervention.
Am J Occup Ther
PUBLISHED: 02-06-2010
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We examined the efficacy of a remotely based arm rehabilitation regimen. A 62-year-old man participated in occupation-based, task-specific practice of activities of daily living (ADLs) >3 years after stroke. The entire regimen was administered over the Internet using personal computer-based cameras and free network meeting software.
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Permethrin spot-on intoxication of cats Literature review and survey of veterinary practitioners in Australia.
J. Feline Med. Surg.
PUBLISHED: 02-04-2010
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SURVEY AIMS: A questionnaire was sent to veterinarians in Australia to determine the approximate number of cats presenting for permethrin spot-on (PSO) intoxication over a 2-year period.
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Affected arm use and cortical change in stroke patients exhibiting minimal hand movement.
Neurorehabil Neural Repair
PUBLISHED: 01-29-2010
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Conventional electrical stimulation modalities are limited by their lack of opportunities for motor learning and, consequently, their impact on function. Other rehabilitative regimens necessitate affected hand and wrist movement for patients to be included, making them implausible for most patients. In light of these challenges, the current study examined the efficacy of a repetitive task-specific training (RTP) regimen using an electrical stimulation neuroprosthesis in stroke patients exhibiting no affected wrist or hand movement.
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Poststroke aphasia recovery assessed with functional magnetic resonance imaging and a picture identification task.
J Stroke Cerebrovasc Dis
PUBLISHED: 01-12-2010
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Stroke patients often display deficits in language function, such as correctly naming objects. Our aim was to evaluate the reliability and the patterns of poststroke language recovery using a picture identification task during functional magnetic resonance imaging (fMRI) at 4 T. Four healthy subjects and 4 subjects with left middle cerebral artery stroke with chronic (>1 year) aphasia were enrolled in the study. In each subject, 10 fMRI scans were performed over a 10-week period using a picture-identification task. The active condition involved presenting subject with a panel of 4 figures (eg, drawings of 4 animals) every 6 seconds and asking the subject to indicate which figure matched the written name in the center. The control condition was a same/different judgment task with pairs of geometric figures (squares, octagons, or combination) presented every 6 seconds. Thirty-second active/control blocks were repeated 5 times each, and responses were recorded. The stoke subjects and controls had similar demographic characteristics, including age (46 vs 53 years), personal handedness (Edinburg Handedness Inventory, 89 vs 95), familial handedness (93 vs 95), and years of education (14.3 vs 14.8). For the active condition, the controls performed better than the stroke subjects (97.7% vs 89.1%; P < .001); the 2 groups performed similarly for the control condition (99.5% vs 98.8%; P = .23). On fMRI, the controls exhibited bilateral, L > R positive blood oxygenation level-dependent (BOLD) activations in frontal and temporal language areas and symmetric retrosplenial and posterior cingulate areas and symmetric negative BOLD activations in bilateral frontotemporal language networks. In contrast, the stroke subjects exhibited positive BOLD activations predominantly in peristroke areas and negative BOLD activations in the unaffected (right) hemisphere. Both groups displayed high activation reliability (as measured by the intraclass correlation coefficient [ICC]) in the left frontal and temporal language areas, although in the stroke subjects the ICC in the frontal regions was spread over a much larger peristroke area. This study documents the utility of the picture-identification task for poststroke language recovery evaluation. Our data suggest that adult stroke patients use functional peristroke areas to perform language functions.
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Activity-based electrical stimulation training in a stroke patient with minimal movement in the paretic upper extremity.
Neurorehabil Neural Repair
PUBLISHED: 09-19-2009
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Existing task-specific practice interventions do not increase movement in stroke patients exhibiting minimal distal movement in the paretic upper extremity. Although often used, an important limitation of conventional electrical stimulation is that it does not involve task-specific practice.
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Modified constraint-induced therapy combined with mental practice: thinking through better motor outcomes.
Stroke
PUBLISHED: 02-21-2009
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Modified constraint-induced therapy (mCIT) is an outpatient therapy encouraging repetitive, task-specific practice with the affected arm. mCIT has shown efficacy in all stages poststroke. Given its efficacy when combined with other therapy regimens, the current study examined the efficacy of mental practice when combined with mCIT versus mCIT only using randomized, controlled methods.
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Cortical plasticity following motor skill learning during mental practice in stroke.
Neurorehabil Neural Repair
PUBLISHED: 01-20-2009
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and purpose. Mental practice (MP), which involves cognitive rehearsal of physical movements, is a noninvasive, inexpensive method of enabling repetitive, task-specific practice (RTP). Recent, randomized controlled data suggest that MP, when combined with an RTP therapy program, increases affected arm use and function significantly more than RTP only. As a next step, this 10-subject case series examined the possibility that cortical plasticity is a mechanism underlying the treatment effect of MP when combined with RTP.
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Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial.
Clin Rehabil
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To compare the efficacy of a repetitive task-specific practice regimen integrating a portable, electromyography-controlled brace called the Myomo versus usual care repetitive task-specific practice in subjects with chronic, moderate upper extremity impairment.
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Epicardial catheter ablation for ventricular tachycardia in heparinized patients.
Europace
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In patients undergoing epicardial catheter ablation of ventricular tachycardia (VT), current guidelines recommend obtaining pericardial access prior to heparinization to minimize bleeding complications. Consequently, access is obtained before endocardial mapping (leading to unnecessary punctures) or during an additional procedure. We present our experience of obtaining pericardial access during the index procedure in heparinized patients.
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A novel Myosin essential light chain mutation causes hypertrophic cardiomyopathy with late onset and low expressivity.
Biochem Res Int
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Hypertrophic cardiomyopathy (HCM) is caused by mutations in genes encoding sarcomere proteins. Mutations in MYL3, encoding the essential light chain of myosin, are rare and have been associated with sudden death. Both recessive and dominant patterns of inheritance have been suggested. We studied a large family with a 38-year-old asymptomatic HCM-affected male referred because of a murmur. The patient had HCM with left ventricular hypertrophy (max WT?21?mm), a resting left ventricular outflow gradient of 36?mm?Hg, and left atrial dilation (54?mm). Genotyping revealed heterozygosity for a novel missense mutation, p.V79I, in MYL3. The mutation was not found in 300 controls, and the patient had no mutations in 10 sarcomere genes. Cascade screening revealed a further nine heterozygote mutation carriers, three of whom had ECG and/or echocardiographic abnormalities but did not fulfil diagnostic criteria for HCM. The penetrance, if we consider this borderline HCM the phenotype of the p.V79I mutation, was 40%, but the mean age of the nonpenetrant mutation carriers is 15, while the mean age of the penetrant mutation carriers is 47. The mutation affects a conserved valine replacing it with a larger isoleucine residue in the region of contact between the light chain and the myosin lever arm. In conclusion, MYL3 mutations can present with low expressivity and late onset.
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Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke.
Arch Phys Med Rehabil
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There is a need for time-efficient, valid measures of distal paretic upper extremity (UE) movement. The purposes of this study were to (1) determine the psychometric properties of the wrist stability and mobility and wrist/hand scale of the upper extremity Fugl-Meyer (w/h UE FM) as a "stand-alone" measure of distal UE movement; and (2) provide detailed instructions on w/h UE FM administration and scoring. The upper extremity Fugl Meyer (UE FM) and Action Research Arm Test (ARAT) were administered on 2 separate occasions to each of 29 subjects exhibiting stable, mild UE hemiparesis (23 men; mean age ± SD, 60.8±12.3 y; mean time since stroke onset for subjects in the sample, 36.0 mo). Fifty-eight observations were collected on each measure. w/h UE FM internal consistency levels (measured by Cronbach ?) were high (.90 and .88 for first and second testing sessions, respectively). The intraclass correlation coefficient for the UE FM was .98, while the intraclass correlation coefficient for the w/h UE FM was .97. Concurrent validity measured by Spearman correlation was moderately high between the w/h UE FM and ARAT (.72, P<.001). From these data, it appears that the w/h UE FM is a promising tool to measure distal UE movement in minimally impaired stroke, although more research with a larger sample is needed. A standardized approach to UE test administration is critical to accurate score interpretation across patients and trials. Thus, the article also provides instructions and pictures for w/h UE FM administration and scoring.
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Paretic upper extremity movement gains are retained 3 months after training with an electrical stimulation neuroprosthesis.
Arch Phys Med Rehabil
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To determine retention of upper extremity (UE) motor changes 3 months after participation in a regimen in which subjects with moderate UE hemiparesis engaged in repetitive task-specific training using an electrical stimulation neuroprosthesis (ESN).
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Opinions of constraint-induced movement therapy among therapists in southwestern Ohio.
Top Stroke Rehabil
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To determine the opinions of therapists about constraint-induced movement therapy (CIMT).
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Improved electrogram attenuation during ablation of paroxysmal atrial fibrillation with the Hansen robotic system.
Pacing Clin Electrophysiol
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Robotic catheter ablation aims to improve outcomes after ablation of atrial fibrillation (AF) through improved lesion quality. This study examined electrogram attenuation as a measure of efficacy in response to robotic (ROB) and manual (MAN) ablation.
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Optimizing terminology for stroke motor rehabilitation: recommendations from the American Congress of Rehabilitation Medicine Stroke Movement Interventions Subcommittee.
Arch Phys Med Rehabil
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As knowledge and interest in stroke motor rehabilitation continue to increase, consistent terminologies that are specific to this discipline must be established. Such language is critical to effective rehabilitative team communication, and is important to facilitating communication among the diverse groups interested in the science and practice of stroke motor rehabilitation. The purpose of this article is to provide operational definitions for 3 concepts that are common-and commonly mislabeled-attributes of stroke motor rehabilitation interventions: intensity, duration, and frequency. In developing these guidelines, conceptual frameworks used in the pharmaceutical, exercise, and rehabilitative therapy realms were used. Implications of these definitions for research and clinical practice are also discussed.
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Dynamics of walking adaptation aftereffects induced in static images of walking actors.
Vision Res.
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Visual adaptation to walking actions results in subsequent aftereffects that bias perception of static images of walkers in different postures so that they are interpreted as walking in the opposite direction to the adapting actor. It is not clear, however, if the walking aftereffect is comparable to other well studied low- and high-level visual aftereffects. We therefore measured the dynamics of the walking aftereffect in order to assess the characteristics of the adapting mechanism. We found that walking aftereffects showed similar characteristic dynamics as for face aftereffects and some motion aftereffects. Walking aftereffects could be induced in a broad range of different static images of walking actors and were not restricted to images of actors in any particular posture. Walking aftereffects increased with adapting stimulus repetition and declined over time. The duration of the aftereffect was dependent upon time spent observing the adapting stimulus and could be well modelled by a power-law function that characterises this relationship in both face and motion aftereffects. Increasing the speed of the adapting stimulus by increasing actor walk speed increased aftereffect magnitude, as seen for some motion aftereffects. The nature of the aftereffects induced by observing walking actors indicates that they behave like traditional high-level visual aftereffects.
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Thinking About Better Speech: Mental Practice for Stroke-Induced Motor Speech Impairments.
Aphasiology
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BACKGROUND: Mental practice (MP) is a mind-body technique in which physical movements are cognitively rehearsed. It has shown efficacy in reducing the severity of a number of neurological impairments. AIMS: In the present review, we highlight recent developments in MP research, and the basis for MP use after stroke-induced motor speech disorders. MAIN CONTRIBUTION: In this review, we: (a) propose a novel conceptual model regarding the development of learned nonuse in people with motor speech impairments; (b) review the rationale and efficacy of MP for reducing the severity of stroke-induced impairments; (c) review evidence demonstrating muscular and neural activations during and following MP use; (d) review evidence showing that MP increases skill acquisition, use, and function in stroke; (e) review literature regarding neuroplasticity after stroke, including MP-induced neuroplasticity and the neural substrates underlying motor and language reacquisition; and (f) based on the above, review the rationale and clinical application of MP for stroke-induced motor speech impairments. CONCLUSIONS: Support for MP use includes decades of MP neurobiological and behavioral efficacy data in a number of populations. Most recently, these data have expanded to the application of MP in neurological populations. Given increasingly demanding managed care environments, efficacious strategies that can be easily administered are needed. We also encounter clinicians who aspire to use MP, but their protocols do not contain several of the elements shown to be fundamental to effective MP implementation. Given shortfalls of some conventional aphasia and motor speech rehabilitative techniques, and uncertainty regarding optimal MP implementation, this paper introduces the neurophysiologic bases for MP, the evidence for MP use in stroke rehabilitation, and discusses its applications and considerations in patients with stroke-induced motor speech impairments.
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Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke.
Arch Phys Med Rehabil
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To examine and compare efficacy of 30-, 60-, and 120-minute repetitive task-specific practice (RTP) sessions incorporating use of an electrical stimulation neuroprosthesis (ESN) on affected upper-extremity (UE) movement.
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Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke.
Phys Ther
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The upper-extremity portion of the Fugl-Meyer Scale (UE-FM) is one of the most established and commonly used outcome measures in stroke rehabilitative trials. Empirical work is needed to determine the amount of change in UE-FM scores that can be regarded as important and clinically meaningful for health professionals, patients, and other stakeholders.
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Cardiac myosin binding protein-C mutations in families with hypertrophic cardiomyopathy: disease expression in relation to age, gender, and long term outcome.
Circ Cardiovasc Genet
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Small selected cohort studies suggest that mutations in the cardiac myosin binding protein-C (MYBPC3) gene cause late-onset, clinically benign hypertrophic cardiomyopathy (HCM). The aim of this study was to test this hypothesis in a large series of families with HCM associated with MYBPC3 mutations.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.