Structural and Functional Neuroplasticity Following Bilateral Vestibular Loss: A Longitudinal [18F]-UCB-H/[18F]-FDG Dual Tracer Rat Study

Neuronal lesions trigger mechanisms of structural and functional neuroplasticity, which can support recovery. However, the temporal and spatial appearance of structure-function changes and their interrelation remain unclear. The current study aimed to directly compare serial whole-brain in vivo measurements of functional plasticity (by [18F]-FDG-PET) and structural synaptic plasticity (by [18F]-UCB-H-PET) before and after bilateral labyrinthectomy in rats and investigate the effect of locomotor training. Complex structure-function changes were found after bilateral labyrinthectomy: in brainstem-cerebellar circuits, regional cerebral glucose metabolism (rCGM) decreased early, followed by reduced synaptic density. In the thalamus, increased [18F]-UCB-H binding preceded a higher rCGM uptake. In frontal-basal ganglia loops, an increase in synaptic density was paralleled by a decrease in rCGM. In the group with locomotor training, thalamic rCGM and [18F]-UCB-H binding increased following bilateral labyrinthectomy compared to the no training group. Rats with training had relatively fewer body rotations. In conclusion, combined [18F]-FDG/[18F]-UCB-H dual tracer imaging reveals that adaptive neuroplasticity after bilateral vestibular loss is not a uniform process but is composed of complex spatial and temporal patterns of structure-function coupling in networks for vestibular, multisensory, and motor control, which can be modulated by early physical training.

The Experience of Locomotor Training From the Perspectives of Therapists and Parents of Children With Cerebral Palsy

Objective: The objective of this study was to explore the experiences of intensive locomotor training from the perspective of therapists and parents of children with cerebral palsy.Design: A qualitative study using semi-structured interviews was employed to capture perspectives following an intensive locomotor training intervention. Data were analyzed thematically, systematically coding and interpreted by grouping information into themes and sub-theme categories.Participants: Five therapists and seven parents of children with high daily physical assistance and equipment needs participated in the study.Setting: A pediatric tertiary hospital.Results: Experiences of locomotor training were described with relation to the suitability of locomotor training with sub-themes of intervention length and time, engagement within sessions, the importance of support, and the utility of locomotor training beyond a research context. Motivation for participating in locomotor training was described in relation to the enjoyment of movement and for increasing activity level. The barriers and facilitators who participated in locomotor training provided environmental and personal factor subthemes. Finally, the outcomes from the intervention were related to improvements in physical health, sleep, affect and emotion, and ambulation in daily activities.Conclusion: The experience of intensive locomotor training from the perspectives of parents of children who have high physical assistance and equipment needs and the therapists providing the intervention was described. Future studies should consider outcome measures beyond motor capacity to quantify the perceived outcomes of interventions that are meaningful to families.

Robotic walking for recovery of functional capacity in individuals with incomplete spinal cord injury: A randomized pilot trial

Objective: Activity-based Training (ABT) represents the current standard of neurological rehabilitation. Robotic Locomotor Training (RLT) is an innovative technique that aims to enhance rehabilitation outcomes, however, its efficacy in SCI rehabilitation, particularly within a low-middle income setting, is currently unclear. The primary aim of this study was to determine the feasibility of a locomotor training program within XX, in terms of recruitment, attendance, drop-out rates and safety. Secondary aims were to determine the effects of RLT compared to ABT on functional capacity in people with chronic SCI. Design: Participants with chronic traumatic motor incomplete tetraplegia (n = 16) were recruited. Each intervention involved 60-minute sessions, 3x per week, over 24-weeks. RLT involved walking in the Ekso GTTM suit. ABT involved a combination of resistance, cardiovascular and weight-bearing exercise. Primary feasibility outcomes included recruitment rate, adherence rate, and adverse events. Validated tests were performed at baseline, 6, 12 and 24-weeks to assess the secondary outcomes of functional capacity. Results: Out of 110 individuals who expressed interest in participating in the study, 17 initiated the program (recruitment rate = 15.4 %). Of these, 16 individuals completed the program (drop-out rate = 5.8 %) and attended sessions (attendance rate = 93.9%). There were no significant differences between the intervention groups for lower or upper extremity motor scores (UEMS effect size (ES) = 0.09; LEMS ES = 0.05), back strength (ES = 0.14) and abdominal strength (ES = 0.13) after training. However, both groups showed a significant increase of 2.00 points in UEMS and a significant increase in abdominal strength from pre- to post intervention. Only the RLT group showed a significant change in LEMS, with a mean increase of 3.00 [0.00; 16.5] points over time. Distance walked in the Functional Ambulatory Inventory (SCI-FAI) increased significantly (p = 0.02) over time only for the RLT group. Conclusions: Recruitment, attrition and adherence rates of the intervention and outcomes justify a subsequent powered RCT comparing RLT to ABT as an effective rehabilitation tool for potentially improving functional strength and walking capacity in people with incomplete SCI.

A Controlled Clinical Study of Intensive Neurorehabilitation in Post-Surgical Dogs with Severe Acute Intervertebral Disc Extrusion

This retrospective controlled clinical study aimed to verify if intensive neurorehabilitation (INR) could improve ambulation faster than spontaneous recovery or conventional physiotherapy and provide a possible therapeutic approach in post-surgical paraplegic deep pain perception-positive (DPP+) (with absent/decreased flexor reflex) and DPP-negative (DDP−) dogs, with acute intervertebral disc extrusion. A large cohort of T10-L3 Spinal Cord Injury (SCI) dogs (n = 367) were divided into a study group (SG) (n = 262) and a control group (CG) (n = 105). The SG was based on prospective clinical cases, and the CG was created by retrospective medical records. All SG dogs performed an INR protocol by the hospitalization regime based on locomotor training, electrical stimulation, and, for DPP−, a combination with pharmacological management. All were monitored throughout the process, and measuring the outcome for DPP+ was performed by OFS and, for the DPP−, by the new Functional Neurorehabilitation Scale (FNRS-DPP−). In the SG, DPP+ dogs had an ambulation rate of 99.4% (n = 167) and, in DPP−, of 58.5% (n = 55). Moreover, in DPP+, there was a strong statistically significant difference between groups regarding ambulation (p < 0.001). The same significant difference was verified in the DPP– dogs (p = 0.007). Furthermore, a tendency toward a significant statistical difference (p = 0.058) regarding DPP recovery was demonstrated between groups. Of the 59 dogs that did not recover DPP, 22 dogs achieved spinal reflex locomotion (SRL), 37.2% within a maximum of 3 months. The progressive myelomalacia cases were 14.9% (14/94). Therefore, although it is difficult to assess the contribution of INR for recovery, the results suggested that ambulation success may be improved, mainly regarding time.

IMPACT OF LOCOMOTOR TRAINING IN IMPROVING FUNCTION AFTER STROKE

Stroke is among the world's leading causes of death, disability and functional inability for adults. The incidence of stroke currently exceeds that of Western developed nations in India. Increased understanding of the risk factors for stroke is hoped to lessen the future prevalence. Recurrence rates of stroke are high. The incidence and ability of individuals to recover varies widely. Stroke affects health by affecting the functioning system resulting in disabilities, physical problems, and a lower quality of life. Physiotherapy is instrumental to restore lost sensations and motor skills and to deal with patient's emotional needs. This case report describes a case of A 66 year old male retired PWD worker, who was referred to physiotherapy with complaints of weakness in left upper and lower extremities and inability to perform movements of left side. He had a sudden loss of power in the left side one day prior and was diagnosed with stroke along straightening of the dorso-lumbar spine and disc bulges at C2-C6, L4-S1 levels on X-ray and MRI scan. Physiotherapy rehabilitation was started with bed mobility and transfer activities with further progress to sitting and standing activity. As the transfers improved, we progressed to balance training, lower limb strengthening, and gait training in which task specific training was focused. Later, we concluded that balance and locomotor training has a great impact on functional recovery post-stroke.