Phrenic neuropathy etiologies and recovery trajectories in outpatient rehabilitation and neuromuscular medicine clinics: A retrospective analysis.

Introduction/aims: Phrenic neuropathy (PhN) impairs diaphragm muscle function, causing a spectrum of breathing disability. PhN etiologies and their natural history are ill-defined. This knowledge gap hinders informed prognosis and management decisions.

Influence of error-augmentation on the dynamics of visuomotor skill acquisition: insights from proxy-process models.

Our study addresses the critical question of how learners acquire skills without the constant crutch of feedback, using a specialized training approach with intermittent feedback. Despite recognized benefits in skill retention, the underlying mechanisms of intermittent feedback in motor control neuroscience remain elusive. Leveraging a previously published dataset from visuomotor learning experiments with intermittent feedback, we tested a wide range of proxy-process models that posit the presence of an inferred error signal even when an explicit sensory performance is not present.

The complex landscape of TMS devices: A brief overview.

The increasing application of TMS in research and therapy has spawned an ever-growing number of commercial and non-commercial TMS devices and technology development. New CE-marked devices appear at a rate of approximately one every two years, with new FDA-approved application of TMS occurring at a similar rate. With the resulting complex landscape of TMS devices and their application, accessible information about the technological characteristics of the TMS devices, such as the type of their circuitry, their pulse characteristics, or permitted protocols would be beneficial.

Can we manipulate brain connectivity? A systematic review of cortico-cortical paired associative stimulation effects.

Objective: Cortico-cortical paired associative stimulation (ccPAS) is a form of dual-site transcranial magnetic stimulation (TMS) entailing a series of single-TMS pulses paired at specific interstimulus intervals (ISI) delivered to distant cortical areas. The goal of this article is to systematically review its efficacy in inducing plasticity in humans focusing on stimulation parameters and hypotheses of underlying neurophysiology.

Methods: A systematic review of the literature from 2009-2023 was undertaken to identify all articles utilizing ccPAS to study brain plasticity and connectivity.

The Role of Surgical Prehabilitation During the COVID-19 Pandemic and Beyond.

The challenging circumstances of the COVID-19 pandemic caused a regression in baseline health of disadvantaged populations, including individuals with frail syndrome, older age, disability, and racial-ethnic minority status. These patients often have more comorbidities and are associated with increased risk of poor postoperative complications, hospital readmissions, longer length of stay, nonhome discharges, poor patient satisfaction, and mortality. There is critical need to advance frailty assessments to improve preoperative health in older populations.

Ankle Joint Angle Influences Relative Torque Fluctuation during Isometric Plantar Flexion.

The purpose of this study was to investigate the influence of changes in muscle length on the torque fluctuations and on related oscillations in muscle activity during voluntary isometric contractions of ankle plantar flexor muscles. Eleven healthy individuals were asked to perform voluntary isometric contractions of ankle muscles at five different contraction intensities from 10% to 70% of maximum voluntary isometric contraction (MVIC) and at three different muscle lengths, implemented by changing the ankle joint angle (plantar flexion of 26°-shorter muscle length; plantar flexion of 10°-neutral muscle length; dorsiflexion of 3°-longer muscle length). Surface electromyogram (EMG) signals were recorded from the skin surface over the triceps surae muscles, and rectified-and-smoothed EMG (rsEMG) were estimated to assess the oscillations in muscle activity.

Interim Safety Profile From the Feasibility Study of the BrainGate Neural Interface System.

Background And Objectives: Brain-computer interfaces (BCIs) are being developed to restore mobility, communication, and functional independence to people with paralysis. Though supported by decades of preclinical data, the safety of chronically implanted microelectrode array BCIs in humans is unknown. We report safety results from the prospective, open-label, nonrandomized BrainGate feasibility study (NCT00912041), the largest and longest-running clinical trial of an implanted BCI.

Contribution of stroke-related changes in neuromuscular factors to gear ratio during isometric contraction of medial gastrocnemius muscle: A simulation study.

Background: It is not clear which neuromuscular factors are most closely associated with the loss of variable fascicle gearing after chronic stroke. The purpose of this simulation study is to determine the effects of stroke-related changes in key neuromuscular factors on the gear ratio.

Methods: A modified Hill-type model of the medial gastrocnemius was developed to determine the gear ratio for a given muscle activation level and musculotendon length.

Relative contribution of altered neuromuscular factors to muscle activation-force relationships following chronic stroke: A simulation study.

The purpose of this study was to investigate the potential effects of key neuromuscular factors on muscle activation-force relationships, thereby helping us understand abnormal EMG-force relationships often reported in chronic stroke-impaired muscles. A modified Hill-type muscle model was developed to calculate muscle force production for a given muscle activation level and musculotendon length. Model parameters used to characterize musculotendon unit properties of medial gastrocnemius were adjusted to simulate known stroke-related changes in neuromuscular factors (e.

Interdisciplinary Management for the First Patient With Post-COVID Double-Lung Transplantation in Inpatient Rehabilitation in the United States: A Case Report.

Objective: In the setting of the COVID-19 pandemic, lung transplantation is being used as a life-saving treatment. This case report describes the rehabilitation course of the first documented individual in the United States post bilateral lung transplant for COVID-19.

Methods (case Description): The patient is a 28-year-old woman who was previously healthy and who failed all other life-saving medical interventions before undergoing bilateral lung transplantation, resulting in an extended hospital stay and significant physical debility.

Damage to the dorsolateral prefrontal cortex is associated with repetitive compulsive behaviors in patients with penetrating brain injury.

Background: Damage to cortico-striato-thalamo-cortical (CSTC) circuits is associated with the development of repetitive behaviours in animals and humans. However, the types of repetitive behaviours that are developed after injury to these structures are poorly defined. This study examines the effect of damage to separate elements of CSTC circuits sustained by veterans of the Vietnam War on obsessions, compulsions, and tics.

Reaching underserved domestic and international populations through Physical Medicine & Rehabilitation Residency training: A survey of residents and program directors.

Introduction: In 2015, the World Health Organization (WHO) reported that over 400 million individuals worldwide lack access to medical care. In addition, clinicians are more likely to treat underserved patients during their careers if they have exposure to these populations during their training.

Objectives: To analyze what forms of didactic experiences are available and which opportunities are the most valuable with domestic/international underserved populations in Physical Medicine & Rehabilitation (PM&R) residency programs in the United States.

Removing artifacts from TMS-evoked EEG: A methods review and a unifying theoretical framework.

Transcranial magnetic stimulation (TMS) combined with electroencephalography (EEG) is a technique for studying cortical excitability and connectivity in health and disease, allowing basic research and potential clinical applications. A major methodological issue, severely limiting the applicability of TMS-EEG, relates to the contamination of EEG signals by artifacts of biologic or non-biologic origin. To solve this problem, several methods, based on independent component analysis (ICA), principal component analysis (PCA), signal space projection (SSP), and other approaches, have been developed over the last decade.

Procedures for obtaining muscle physiology parameters during a gracilis free-functioning muscle transfer in adult patients with brachial plexus injury.

A complete understanding of muscle mechanics allows for the creation of models that closely mimic human muscle function so they can be used to study human locomotion and evaluate surgical intervention. This includes knowledge of muscle-tendon parameters required for accurate prediction of muscle forces. However, few studies report experimental data obtained directly from whole human muscle due to the invasive nature of these experiments.

Can Increased Locomotor Task Difficulty Differentiate Knee Muscle Forces After Anterior Cruciate Ligament Reconstruction?

Changes in knee mechanics following anterior cruciate ligament (ACL) reconstruction are known to be magnified during more difficult locomotor tasks, such as when descending stairs. However, it is unclear if increased task difficulty could distinguish differences in forces generated by the muscles surrounding the knee. This study examined how knee muscle forces differ between individuals with ACL reconstruction with different graft types (hamstring tendon and patellar tendon autograft) and "healthy" controls when performing tasks with increasing difficulty.

Direction-Specific Iterative Tuning of Motor Commands With Local Generalization During Randomized Reaching Practice Across Movement Directions.

During motor learning, people often practice reaching in variety of movement directions in a randomized sequence. Such training has been shown to enhance retention and transfer capability of the acquired skill compared to the blocked repetition of the same movement direction. The learning system must accommodate such randomized order either by having a memory for each movement direction, or by being able to generalize what was learned in one movement direction to the controls of nearby directions.

State-dependent TMS effects in the visual cortex after visual adaptation: A combined TMS-EEG study.

Objective: The impact of transcranial magnetic stimulation (TMS) has been shown to depend on the initial brain state of the stimulated cortical region. This observation has led to the development of paradigms that aim to enhance the specificity of TMS effects by using visual/luminance adaptation to modulate brain state prior to the application of TMS. However, the neural basis of interactions between TMS and adaptation is unknown.

Mechanomyogram amplitude vs. isometric ankle plantarflexion torque of human medial gastrocnemius muscle at different ankle joint angles.

The purpose of this study was to investigate the influence of changes in ankle joint angle on the mechanomyogram (MMG) amplitude of the human medial gastrocnemius (MG) muscle during voluntary isometric plantarflexion contractions. Ten healthy individuals were asked to perform voluntary isometric contractions at six different contraction intensities (from 10% to 100%) and at three different ankle joint angles (plantarflexion of 26°; plantarflexion of 10°; dorsiflexion of 3°). MMG signals were recorded from the surface over the MG muscle, using a 3-axis accelerometer.

The accuracy of needle electrode placement by trainees in selected forearm muscles using verification by neuromuscular ultrasound.

Introduction: Anatomic landmarks alone may not always be sufficient to accurately guide electromyography (EMG) electrode needle placement.

Methods: Senior residents and fellows (n = 11) targeted 4 forearm muscles with anatomic landmarks alone versus with audiovisual EMG feedback. Accuracy of EMG needle placement was verified using neuromuscular ultrasound imaging.

Systemic transplantation of adult multipotent stem cells prevents articular cartilage degeneration in a mouse model of accelerated ageing.

Background: Osteoarthritis (OA) is one of the most prevalent joint diseases of advanced age and is a leading cause of disability worldwide. Ageing is a major risk factor for the articular cartilage (AC) degeneration that leads to OA, and the age-related decline in regenerative capacity accelerates OA progression. Here we demonstrate that systemic transplantation of a unique population of adult multipotent muscle-derived stem/progenitor cells (MDSPCs), isolated from young wild-type mice, into Zmpste24 mice (a model of Hutchinson-Gilford progeria syndrome, a condition marked by accelerated ageing), prevents ageing-related homeostatic decline of AC.