2 results for Ackerley, SJ
Stimulating stimulation: Can we improve motor recovery following stroke using repetitive transcranial magnetic stimulation?
Ackerley, SJ; Stinear, Cathy (2010)
The University of Auckland Library
Background: Ongoing impairment of the upper limb is common after stroke, despite neurorehabilitation. This impairment has a significant impact on an individual???s activity and participation in life roles. It is essential to explore new ways to optimize motor recovery. Objectives: This narrative review describes repetitive transcranial magnetic stimulation (rTMS), which is a non-invasive electrophysical technique, currently being investigated in the laboratory setting. It considers the role rTMS might play in the future of stroke rehabilitation. Major findings: In the research setting, rTMS can be used to safely increase the excitability of descending motor pathways that innervate the paretic hand. When applied to the primary motor cortex (M1) of the lesioned or non-lesioned hemisphere, rTMS can temporarily improve motor behaviour of the paretic hand. Preliminary research supports the use of rTMS in conjunction with therapy, but repeated sessions are probably required to induce longer lasting changes that have a functionally meaningful effect for the patient. Conclusions: The use of rTMS to improve motor recovery following stroke appears promising, especially to prime the brain for a better response to subsequent therapy. Further research is required before the use of rTMS can move from the laboratory to the clinic.View record details
Stinear, Cathy; Byblow, Winston; Ackerley, SJ; Barber, Peter; Smith, Marie-Claire (2017-04)
The University of Auckland Library
Background and Purpose-Several clinical measures and biomarkers are associated with motor recovery after stroke, but none are used to guide rehabilitation for individual patients. The objective of this study was to evaluate the implementation of upper limb predictions in stroke rehabilitation, by combining clinical measures and biomarkers using the Predict Recovery Potential (PREP) algorithm. Methods-Predictions were provided for patients in the implementation group (n=110) and withheld from the comparison group (n=82). Predictions guided rehabilitation therapy focus for patients in the implementation group. The effects of predictive information on clinical practice (length of stay, therapist confidence, therapy content, and dose) were evaluated. Clinical outcomes (upper limb function, impairment and use, independence, and quality of life) were measured 3 and 6 months poststroke. The primary clinical practice outcome was inpatient length of stay. The primary clinical outcome was Action Research Arm Test score 3 months poststroke. Results-L ength of stay was 1 week shorter for the implementation group (11 days; 95% confidence interval, 9-13 days) than the comparison group (17 days; 95% confidence interval, 14-21 days; P=0.001), controlling for upper limb impairment, age, sex, and comorbidities. Therapists were more confident (P=0.004) and modified therapy content according to predictions for the implementation group (P < 0.05). The algorithm correctly predicted the primary clinical outcome for 80% of patients in both groups. There were no adverse effects of algorithm implementation on patient outcomes at 3 or 6 months poststroke. Conclusions-PREP algorithm predictions modify therapy content and increase rehabilitation efficiency after stroke without compromising clinical outcome.View record details