A film projecting system as a diagnostic and training technique for eye movements of cerebral palsied children

Theoretical and Practical Considerations in the Restoration of Function After Stroke

Recovery of function after stroke appears to include elements of both restoration and compensation. The brain is highly plastic, which allows reorganization after damage. Stroke produces permanent damage to the brain, so recovery must be based on activity in surviving cells that are either adjacent, contralateral, or in a different region. Furthermore, representation of a particular function in the brain is usually not limited to a single brain region. Multiple representation provides the opportunity for brain reorganization; functions are assumed by surviving brain structures. Compensation can be the initial response in the recovery phase and may persist through later phases because of the new habits formed (as the restraint therapy studies of Taub and others would suggest), because the damage to the brain is extensive and hinders restoration, because of secondary pathology, such as tendon shortening and muscle wasting, that does not allow brain reorganization to be translated into functional recovery, or because of inadequate (especially late) rehabilitation.

Computer-Assisted Motivating Rehabilitation (CAMR) for Institutional, Home, and Educational Late Stroke Programs

Based on our results during the last 25 years, we are developing late stroke computer-assisted motivating rehabilitation (CAMR) for the upper extremity. Evidence has been accumulating that functional gains are possible even many years after the damage. However, postacute rehabilitation must be motivating and related to real-life functional activities, or it may fail to enlist active participation. With CAMR programs, such as briefly reported here, instead of exercise, the patient is engaged in a game (e.g., ping-pong); instead of concentrating on the specific movements, he/she is concentrating on the game and the movements become subconscious. Patients, even those who initially consider that they cannot accomplish the task, show interest and improvement, and functional recovery appears to be extended beyond the specific movements that are being practiced. CAMR is also suitable for late functional reorganization programs in an educational model.

Spontaneous improvement in oculomotor function of children with cerebral palsy

Eye movements are essential to get a clear vision of moving objects. In the present study, we assessed quantitatively the oculomotor deficits of children with cerebral palsy (CP). We recorded eye movements of 51 children with cerebral palsy (aged 5-16 years) with relatively mild motor impairment and compared their performance with age-matched control and premature children. Overall eye movements of children with CP are unexpectedly close to those of controls even though some oculomotor parameters are biased by the side of hemiplegia. Importantly, the difference in performance between children with CP and controls decreases with age, demonstrating that the oculomotor function of children with CP develops as fast as or even faster than controls for some visual tracking parameters. That is, oculomotor function spontaneously improves over the course of childhood. This evolution highlights the ability of lesioned brain of children with CP to compensate for impaired motor function beyond what would be achieved by normal development on its own.

Late postacute neurologic rehabilitation: neuroscience, engineering, and clinical programs

This lecture highlights my career in rehabilitation research. My principal efforts in rehabilitation have been to study (1) mechanisms of brain plasticity related to reorganization of the brain and recovery of function; (2) late postacute rehabilitation; (3) sensory substitution; and (4) rehabilitation engineering. A principal goal has been to aid in the development of a strong scientific base in rehabilitation.

Visual motor rehabilitation in children with cerebral palsy

Cerebral palsied (CP) children were given intensive visuo-oculomotor training in order to improve their visuo-oculomotor control, using children's films as a visual stimulus. A comparative study was conducted on a group of normal children of the same age. Results showed that training does improve visuo-oculomotor system control as illustrated by (1) a marked increase in smooth pursuit precision and maximum velocity, (2) an improvement of saccadic movement precision and stability, and (3) a shortening of the saccadic reaction time. The highest performance was observed under conditions in which the child pointed at and followed the visuo-acoustic target with his arm extended.

Rehabilitation following brain damage: some neurophysiological mechanisms. The effects of repetitive stimulation in recovery from damage to the central nervous system

There is a growing body of evidence that the central nervous system (CNS), even in the adult animal, is capable of adaptation and reorganization not only as a result of partial damage to the CNS but also in response to stimulation. Environmental stimulation produces changes including expansion of visual cortex, increases in dendritic branching, glia and cholinesterase. Environmental stimulation also produces behavioural changes. Experimental electrical stimulation produces changes in synapse size, synaptic vesicle change, dendritic branching and changes in synaptic transmission. In man, repetitive electrical stimulation via epidural electrodes increases plasma levels of norepinephrine, epinephrine, and dopamine, and CSF levels of norepinephrine. Repetitive electrical stimulation in man dates back to 1967 and has been used for the control of pain, to improve spasticity, bladder control, motor deficit and the autonomic hyperreflexia of spinal cord injury. In addition, improvement has been reported in epilepsy, cerebral palsy, torticollis and peripheral vascular diseases. The best controlled studies are in multiple sclerosis and peripheral vascular disease, and these results will be presented in more detail.