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Meinzer M.,Universittsmedizin Berlin | Meinzer M.,University of Florida | Rodriguez A.D.,University of Florida | Rodriguez A.D.,Brain Rehabilitation Research Center | And 2 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2012

First decade of research on constrained-induced treatment approaches for aphasia rehabilitation. Approaches for treating poststroke language impairments (aphasia) based on constraint-induced (CI) principles were first introduced in 2001. CI principles as previously applied to upper extremity and locomotor retraining in stroke survivors were derived from basic neuroscience. They comprise forced-use of the affected modality, a gradual rebuilding of targeted functions using a highly intensive treatment protocol, administered in a behaviorally relevant context. CI-based approaches have stimulated considerable neurorehabilitation research interest in the past decade. The original CI aphasia treatment protocol was tailored to improve functional communication in chronic aphasia (ie, 612mo after stroke) and more recently, it has been adapted to treat language impairments in acute stroke survivors as well. Moreover, CI therapy applied to aphasia has been used as a model to assess language network plasticity in response to treatment using functional imaging techniques. In the following article, we review the first 10 years of behavioral and functional brain imaging research on CI-based approaches for aphasia rehabilitation. © 2012 American Congress of Rehabilitation Medicine.


Tester N.J.,Brain Rehabilitation Research Center | Tester N.J.,University of Florida | Fuller D.D.,University of Florida | Fromm J.S.,University of Florida | And 6 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2014

Rationale: Intermittent stimulation of the respiratory system with hypoxia causes persistent increases in respiratory motor output (i.e., long-term facilitation) in animals with spinal cord injury. This paradigm, therefore, has been touted as a potential respiratory rehabilitation strategy. Objectives: To determine whether acute (daily) exposure to intermittent hypoxia can also evoke long-term facilitation of ventilation after chronic spinal cord injury in humans, and whether repeated daily exposure to intermittent hypoxia enhances the magnitude of this response. Methods: Eight individuals with incomplete spinal cord injury (>1 yr; cervical [n = 6], thoracic [n = 2]) were exposed to intermittent hypoxia (eight 2-min intervals of 8% oxygen) for 10 days. During all exposures, end-tidal carbon dioxide levels were maintained, on average, 2 mm Hg above resting values. Minute ventilation, tidal volume, and breathing frequency were measured before (baseline), during, and 30 minutes after intermittent hypoxia. Sham protocols consisted of exposure to room air and were administered to a subset of the participants (n = 4). Measurements and Main Results: Minute ventilation increased significantly for 30 minutes after acute exposure to intermittent hypoxia (P < 0.001), but not after sham exposure. However, the magnitude of ventilatory long-term facilitation was not enhanced over 10 days of intermittent hypoxia exposures. Conclusions: Ventilatory long-term facilitation can be evoked by brief periods of hypoxia in humans with chronic spinal cord injury. Thus, intermittent hypoxia may represent a strategy for inducing respiratory neuroplasticity after declines in respiratory function that are related to neurological impairment. Clinical trial registered with www.clinicaltrials.gov (NCT01272011). Copyright © 2014 by the American Thoracic Society.


Fuller D.D.,University of Florida | Lee K.-Z.,National Sun Yat - sen University | Tester N.J.,University of Florida | Tester N.J.,Brain Rehabilitation Research Center
Respiratory Physiology and Neurobiology | Year: 2013

The prevalence of sleep disordered breathing (SDB) following spinal cord injury (SCI) is considerably greater than in the general population. While the literature on this topic is still relatively small, and in some cases contradictory, a few general conclusions can be drawn. First, while both central and obstructive sleep apnea (OSA) has been reported after SCI, OSA appears to be more common. Second, SDB after SCI likely reflects a complex interplay between multiple factors including body mass, lung volume, autonomic function, sleep position, and respiratory neuroplasticity. It is not yet possible to pinpoint a "primary factor" which will predispose an individual with SCI to SDB, and the underlying mechanisms may change during progression from acute to chronic injury. Given the prevalence and potential health implications of SDB in the SCI population, we suggest that additional studies aimed at defining the underlying mechanisms are warranted. © 2013 Elsevier B.V.


Clark D.J.,Brain Rehabilitation Research Center | Clark D.J.,University of Florida
Frontiers in Human Neuroscience | Year: 2015

Automaticity is a hallmark feature of walking in adults who are healthy and well-functioning. In the context of walking, “automaticity” refers to the ability of the nervous system to successfully control typical steady state walking with minimal use of attention-demanding executive control resources. Converging lines of evidence indicate that walking deficits and disorders are characterized in part by a shift in the locomotor control strategy from healthy automaticity to compensatory executive control. This is potentially detrimental to walking performance, as an executive control strategy is not optimized for locomotor control. Furthermore, it places excessive demands on a limited pool of executive reserves. The result is compromised ability to perform basic and complex walking tasks and heightened risk for adverse mobility outcomes including falls. Strategies for rehabilitation of automaticity are not well defined, which is due to both a lack of systematic research into the causes of impaired automaticity and to a lack of robust neurophysiological assessments by which to gauge automaticity. These gaps in knowledge are concerning given the serious functional implications of compromised automaticity. Therefore, the objective of this article is to advance the science of automaticity of walking by consolidating evidence and identifying gaps in knowledge regarding: (a) functional significance of automaticity; (b) neurophysiology of automaticity; (c) measurement of automaticity; (d) mechanistic factors that compromise automaticity; and (e) strategies for rehabilitation of automaticity. © 2015 Clark.


Troche M.S.,University of Florida | Brandimore A.E.,University of Florida | Brandimore A.E.,Brain Rehabilitation Research Center | Okun M.S.,University of Florida | And 2 more authors.
Chest | Year: 2014

BACKGROUND: Aspiration pneumonia is a leading cause of death in people with Parkinson disease (PD). The pathogenesis of these infections is largely attributed to the presence of dysphagia with silent aspiration or aspiration without an appropriate cough response. The goal of this study was to test reflex cough thresholds and associated urge-to-cough (UTC) ratings in participants with PD with and without dysphagia. METHODS: Twenty participants with PD were recruited for this study. They completed a capsaicin challenge with three randomized blocks of 0, 50, 100, and 200 μM capsaicin and rated their UTC by modified Borg scale. The concentration of capsaicin that elicited a two-cough response, total number of coughs, and sensitivity of the participant to the cough stimulus (UTC) were measured. The dysphagia severity of participants with PD was identified with the penetration-aspiration scale. RESULTS: Most participants with PD did not have a consistent two-cough response to 200 μM capsaicin. UTC ratings and total number of coughs produced at 200 μM capsaicin were significantly influenced by dysphagia severity but not by general PD severity, age, or disease duration. Increasing levels of dysphagia severity resulted in significantly blunted cough sensitivity (UTC). CONCLUSIONS: UTC ratings may be important in understanding the mechanism underlying morbidity related to aspiration pneumonia in people with PD and dysphagia. Further understanding of decreased UTC in people with PD and dysphagia will be essential for the development of strategies and treatments to address airway protection deficits in this population. © 2014 American College of Chest Physicians.


Clark D.J.,Brain Rehabilitation Research Center | Clark D.J.,University of Florida | Fielding R.A.,Tufts University
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2012

Background. Declines in skeletal muscle mass and quality are important factors contributing to age-related weakness. Neural activation of agonist and antagonist muscles may also be important contributing factors. Methods. We conducted a review of the scientific literature on older adults to determine (a) methodologies used to quantify activation, (b) the potential role of agonist and antagonist activation on weakness, and (c) some possible neurophysiological mechanisms that may underlie impaired activation. Results. The cumulative evidence indicates that agonist activation is impaired in some, but not all, older adults and that this impairment contributes to age-related weakness. It is possible that antagonist coactivation also plays a role in age-related weakness, though a definitive link has not been established. Conclusion. Future research should focus on improving quantitative measurement and mechanistic understanding of impaired activation with aging. Published by Oxford University Press on behalf of The Gerontological Society of America 2011.2012 © Published by Oxford University Press on behalf of The Gerontological Society of America 2011. © 2011 The Author.


Bowden M.G.,Brain Rehabilitation Research Center | Bowden M.G.,University of Florida | Clark D.J.,Brain Rehabilitation Research Center | Kautz S.A.,Brain Rehabilitation Research Center | Kautz S.A.,University of Florida
Neurorehabilitation and Neural Repair | Year: 2010

Background. Assessment of poststroke motor impairment has historically focused on the ability to move within and outside of abnormal synergistic motor patterns and is typically quantified by the Fugl-Meyer Assessment (FMA). However, it is unclear if the voluntary, isolated movement tasks of the FMA are appropriate for evaluating walking task-specific motor control requirements because walking is cyclical and involves considerable sensorimotor integration. Objective. The purpose of this study is to test whether the motor impairment measured by the FMA is indicative of motor dysfunction during walking in poststroke adults. Methods. Thirty-four individuals with chronic poststroke hemiparesis and 17 healthy controls walked for 60 seconds on an instrumented treadmill while recording electromyographic activity (EMG) from 8 lower extremity muscles. EMG recordings were also obtained during the FMA for those with hemiparesis to examine muscle activation patterns. Each participant was examined with a battery of walking-specific clinical and biomechanical assessment tools and stratified based on the FMA synergy (FMS) score. To further quantify muscle activation patterns during walking, a nonnegative matrix factorization (NNMF) determined the number of independent modules required to describe 90% of the total variance in the EMG patterns. Results. Stratification poorly differentiated motor activation across FMA tasks as well as EMG patterns during walking. While FMS correlated with 2 of 6 walking assessments, the number of EMG modules significantly correlated with all 6 walking performance measures. Conclusions. Voluntary, discrete activities as performed in the FMA may be inadequate to capture the complex motor behavior in walking. Conversely, walking-specific evaluations such as NNMF appear more appropriate. © The Author(s) 2010.


Shrivastav R.,University of Florida | Shrivastav R.,Brain Rehabilitation Research Center | Camacho A.,University of Florida
Journal of Voice | Year: 2010

Perception of breathy voice quality is cued by a number of acoustic changes including an increase in aspiration noise level (AH) and spectral slope. Changes in AH in a vowel may be evaluated through measures such as the harmonic-to-noise ratio, cepstral peak prominence (CPP), or via auditory measures such as the partial loudness of harmonic energy and loudness of aspiration noise. Although a number of experiments have reported high correlation between such measures and ratings of perceived breathiness, a formal model to predict breathiness of a vowel has not been proposed. This research describes two computational models to predict changes in breathiness resulting from variations in AH. One model uses auditory measures, whereas the other uses CPP as independent variables to predict breathiness. For both cases, a translated and truncated power function is required to predict breathiness. Some parameters in both of these models were observed to be pitch dependent. The "unified" model based on auditory measures was observed to be more accurate than one based on CPP. © 2010 The Voice Foundation.


Allen J.L.,University of Texas at Austin | Kautz S.A.,Brain Rehabilitation Research Center | Kautz S.A.,Medical University of South Carolina | Neptune R.R.,University of Texas at Austin
Gait and Posture | Year: 2011

Post-stroke hemiparetic subjects walk with asymmetrical step lengths that are highly variable between subjects and may be indicative of the underlying impairments and compensatory mechanisms used. The goal of this study was to determine if post-stroke hemiparetic subjects grouped by step length asymmetry have similar abnormal walking biomechanics compared to non-impaired walkers. Kinematic and ground reaction force data were recorded from 55 hemiparetic subjects walking at their self-selected speed and 21 age and speed-matched non-impaired control subjects. Hemiparetic subjects were grouped by paretic step ratio, which was calculated as the paretic step-length divided by the sum of paretic and nonparetic step-lengths, into high (>0.535), symmetric (0.535-0.465) and low (<0.465) groups. Non-parametric Wilcoxin signed-rank tests were used to test for differences in joint kinetic measures between hemiparetic groups and speed-matched control subjects during late single-leg stance and pre-swing. The paretic leg ankle moment impulse was reduced in all hemiparetic subjects regardless of their paretic step ratio. The high group had increased nonparetic leg ankle plantarflexor and knee extensor moment impulses, the symmetric group had increased hip flexor moment impulses on both the paretic and nonparetic leg and the low group had no additional significant differences in joint moment impulses. These results suggest that the direction of asymmetry can be used to identify both the degree of paretic plantarflexor impairment and the compensatory mechanisms used by post-stroke hemiparetic subjects. © 2011 Elsevier B.V.


Kautz S.A.,Medical University of South Carolina | Kautz S.A.,Ralph hnson Va Medical Center | Bowden M.G.,Medical University of South Carolina | Bowden M.G.,Ralph hnson Va Medical Center | And 2 more authors.
Neurorehabilitation and Neural Repair | Year: 2011

Background. Force-sensing split-belt treadmills (TMs) provide an alternative to the conventional overground (OG) setting and allow new avenues for analyzing the biomechanics and motor control of walking. However, walking control may differ on a TM compared with walking OG. Objective. To compare spatiotemporal, kinematic, and EMG-based measures of motor control between TM and OG walking at self-selected and fastest comfortable speeds in persons with poststroke hemiparesis. Methods. Individuals with chronic hemiparesis (56) and similarly aged healthy individuals (17) walked over an instrumented walkway and on an instrumented split-belt TM; 16 channels of EMG recorded bilateral muscle activity, and a 12-camera motion capture system collected bilateral 3D kinematics. The authors applied a nonnegative matrix factorization (NNMF) algorithm to examine the underlying patterns of motor control. Results. Self-selected walking patterns differed on the TM versus OG in controls: speed decreased, stride length decreased, stance percentage increased, and double-support percentage increased. Poststroke, responses were similar, but cadence also decreased, and step length asymmetry increased. Kinematic patterns were similar except those associated with slower walking speeds. NNMF demonstrated similar EMG variance in the 2 environments. Conclusion. Persons, both healthy and poststroke, walk with different gait parameters on the TM. Although measures of motor control were mostly similar between the 2 environments, the TM induced step length asymmetry in 30% of participants (60% of whom took longer paretic steps). TM walking, therefore, is a valid method for detecting motor control deficits. © 2011 American Society of Neurorehabilitation.

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