MDNews - Long Island

Noninvasive Stimulation Shows Promise Stroke Recovery T HE RESEARCH, CONDUCTED at the Rehabilitation Institute of Chicago (RIC), sheds new light on possible applications of brain stimulation to target and help correct brain damage caused by stroke. Mapping the Mind The research team at RIC used TMS to map the unique location in each participant's motor cortex that con- trols upper-extremity mobility and that sustained damaged from the stroke. What they found was an imbalance of excitability — areas that were either less responsive or more responsive than normal to stimulation. "We probe the cortical system, we get output from the muscle, and we get some idea of how that connection from brain to muscle is working," says Lynn Rogers, PhD, Director of the Neuralplasticity Laboratory at RIC. "We're coming to understand that we … can actually change the system with TMS. We can The team used stereotactic MRI to guide TMS therapy to the exact point of imbalance. During thrice-weekly sessions over a six-week period, pre-functional OT was followed by repeated TMS and then by an hour of task-oriented OT. Follow-up was then conducted at one week, one month and six months. Long-term Results While researchers did observe slightly more progress in the group receiving TMS during the study and at the one- week follow-up, the difference became more pronounced as time passed. By the six-month follow-up, participants in the experimental group showed an average of 14.4 points of improvement on the upper-extremity Fugl-Meyer scale compared with 4.1 points of improvement for the control group. Rogers and her colleagues hope navi- gated TMS, as an adjunct to an existing therapeutic practice, will become part of an improved standard of post-stroke care. STROKE PATIENTS WHO RECEIVED NAVIGATED, REPETITIVE TRANSCRANIAL STIMULATION (TMS) IN ADDITION TO STANDARD OCCUPATIONAL ABLE TO REGAIN AND MAINTAIN MORE UPPER-EXTREMITY MOBILITY COMPLETED OT ALONE, A 2014 STUDY FOUND. 14 8 FEATURES CARDIOVASCULAR RESEARCH UPDATE: MORTALITY, HOSPITALIZATION AND RECOVERY IN THE MODERN ERA 6 A recent study analyzes the encouraging numbers in cardiovascular-related mortality and hospitalization rates during the past few years. Additional research points to noninvasive stimulation as a game-changer for stroke recovery. SHORT-TERM HEALTHCARE FORECAST: FAIR TO COSTLY 24 What does the new year hold for the healthcare industry? Experts predict more patient-centered uses of technology, including greater acceptance of home-based videoconferencing. Further increases in medical spending may be on the way, too. SPECIAL CLINICAL SECTION: ORTHOPEDICS WINTHROP-UNIVERSITY HOSPITAL: MULTIDISCIPLINARY ORTHOPEDIC TRAUMA CARE FOR THE AGES 14 Winthrop-University Hospital's orthopedic trauma program streamlines collaboration across specialties including emergency medicine, orthopedic surgery, anesthesia and pediatrics to successfully treat patients ranging in age from the very young to the elderly. A BRIEFER APPROACH TO CHRONIC WHIPLASH 20 A study found no significant difference in symptom resolution between chronic whiplash patients who underwent 20 intensive physical therapy sessions and those who had only one informational session and follow-up support. BREAKING DOWN ORTHOPEDICS 21 A statistics-driven snapshot of orthopedics ON THE COVER 6 DEPARTMENTS LEGAL EASE 10 PEOPLE IN THE NEWS 11 PRACTICE MANAGEMENT 23 BUSINESS OF MEDICINE 26 CME CREDITS 27 LOCAL NEWS 29 Contents | JANUARY 2015 |

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