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Chow CHT, Yu C, Yu W, Yeung K, Schmidt LA, Buckley N. Risk and protective factors in predicting pediatric acute postsurgical pain: A systematic review and meta-analysis. Health Psychol 2023; 42:723-734. [PMID: 37261750 DOI: 10.1037/hea0001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Acute postsurgical pain (APSP), defined as pain within 3 months after surgery, is reported in most surgical pediatric patients, and a significant number of patients experience pain interfering with their daily life activities. We aimed to identify perioperative and psychosocial factors associated with APSP severity in pediatric patients undergoing surgery. METHOD MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and CENTRAL were searched from database inception to October 2021. Studies that reported an association between risk or protective factors and acute pain in children were included. The primary outcome was the magnitude of association between identified factors and APSP, as measured by standardized effect sizes. RESULTS Thirty-eight studies (7,936 participants aged 1-18 years) were included. Meta-analysis of 12 studies (1,192 participants) revealed child preoperative pain, pain immediately after surgery, anticipated pain, temperament, pain catastrophizing, age, preoperative anxiety, parent pain catastrophizing, and parent preoperative anxiety were positively associated with APSP. Child pain coping efficacy was protective against APSP. We identified several modifiable child and parent psychosocial factors as predictors of APSP severity. CONCLUSION Given the small degree of association between identified factors and postsurgical pain, there is value in pursuing other factors that may better explain the variability in pain. Recognizing patients at risk for moderate to severe APSP enables early implementation of interventions to minimize pain burden. Interventions to enhance coping, an adaptive characteristic, may also help to reduce APSP. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Chow CHT, Poole KL, Xu RY, Sriranjan J, Van Lieshout RJ, Buckley N, Moffat G, Schmidt LA. Children's Shyness, Frontal Brain Activity, and Anxiety in the Perioperative Context. Behav Sci (Basel) 2023; 13:766. [PMID: 37754044 PMCID: PMC10525976 DOI: 10.3390/bs13090766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Although preoperative anxiety affects up to 75% of children undergoing surgery each year and is associated with many adverse outcomes, we know relatively little about individual differences in how children respond to impending surgery. We examined whether patterns of anterior brain electrical activity (i.e., a neural correlate of anxious arousal) moderated the relation between children's shyness and preoperative anxiety on the day of surgery in 70 children (36 girls, Mage = 10.4 years, SDage = 1.7, years, range 8 to 13 years) undergoing elective surgery. Shyness was assessed using self-report approximately 1 week prior to surgery during a preoperative visit (Time 1), preoperative anxiety was assessed using self-report, and regional EEG (left and right frontal and temporal sites) was assessed using a dry sensory EEG headband on the day of surgery (Time 2). We found that overall frontal EEG alpha power moderated the relation between shyness and self-reported preoperative anxiety. Shyness was related to higher levels of self-reported anxiety on the day of surgery for children with lower average overall frontal alpha EEG power (i.e., higher cortical activity) but not for children with higher average overall frontal alpha EEG power (i.e., lower cortical activity). These results suggest that the pattern of frontal brain activity might amplify some shy children's affective responses to impending surgery. Findings also extend prior results linking children's shyness, frontal brain activity, and anxiety observed in the laboratory to a real-world, ecologically salient environment.
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Sriranjan J, Chow CHT, Poole KL, Hassan R, Mirabelli J, Buckley N, Van Lieshout RJ, Schmidt LA. Children's shyness and frontal electroencephalogram delta-beta correlation in the pediatric surgical setting. Dev Psychobiol 2022; 64:e22275. [PMID: 35452540 DOI: 10.1002/dev.22275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 02/07/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022]
Abstract
The prospect of surgery is a unique psychologically threatening context for children, often leading to experiences of preoperative anxiety. Recent research suggests that individual differences in children's temperament may influence responses to the surgical setting. In the present study, we examined whether individual differences in shyness were related to differences in frontal electroencephalogram (EEG) delta-beta correlation, a proposed neural correlate of emotion regulation and dysregulation, among children anticipating surgery. Seventy-one children (36 boys, Mage = 10.3 years, SDage = 1.7 years) undergoing elective surgery self-reported on their own shyness, and their parents also reported on their child's shyness. Using a mobile, dry sensor EEG headband, frontal EEG measures were collected and self- and observer-reported measures of state anxiety were obtained at the children's preoperative visit (Time 1) and on the day of surgery (Time 2). A latent cluster analysis derived classes of low shy (n = 37) and high shy (n = 34) children using the child- and parent-reported shyness measures. We then compared the two classes on frontal EEG delta-beta correlation using between- and within-subjects analyses. Although children classified as high versus low in shyness had higher self- and observer-reported state anxiety across both time periods, frontal EEG delta-beta correlation increased from T1 to T2 only among low shy children using a between-subjects delta-beta correlation measure. We discuss the interpretation of a relatively higher delta-beta correlation as a correlate of emotion regulatory versus dysregulatory strategies for some children in a "real-world," surgical context.
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Chow CHT, Schmidt LA, Buckley DN. The role of anxiety and related states in pediatric postsurgical pain. Can J Pain 2020; 4:26-36. [PMID: 33987517 PMCID: PMC7942768 DOI: 10.1080/24740527.2020.1847600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 10/25/2020] [Accepted: 11/04/2020] [Indexed: 11/22/2022]
Abstract
Background: Nearly 20% of children and adolescents have pain with disability 1 year after surgery, and they experience poor sleep, school absence, and decreased activities. Negative clinical, psychological, and developmental effects include greater pain medication use, longer recovery, and fear of future medical care. Research has found psychological and family influences (i.e., child and parental anxiety) on pediatric chronic postsurgical pain (CPSP), but a better understanding of the role of perioperative anxiety and its related states in predicting pediatric postsurgical pain is needed. The poor understanding of the causes of child CPSP can lead to misdiagnosis and inadequate treatment, with significant short- and long-term effects. Objectives: The aim of this review was to summarize the literature on children's perioperative anxiety and parental anxiety in relation to acute postsurgical pain, CPSP, and pain trajectories. We also examined other related psychological factors (i.e., anxiety sensitivity, catastrophizing, pain anxiety, and fear of pain) in relation to pediatric acute and chronic postsurgical pain. Lastly, we discuss the interventions that may be effective in reducing children's and parents' preoperative anxiety. Conclusions: Our findings may improve the understanding of the causes of CPSP and highlight the gaps in research and need for further study.
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Chow CHT, Rizwan A, Xu R, Poulin L, Bhardwaj V, Van Lieshout RJ, Buckley N, Schmidt LA. Association of Temperament With Preoperative Anxiety in Pediatric Patients Undergoing Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e195614. [PMID: 31173131 PMCID: PMC6563582 DOI: 10.1001/jamanetworkopen.2019.5614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Preoperative anxiety is associated with poor behavioral adherence during anesthetic induction and adverse postoperative outcomes. Research suggests that temperament can affect preoperative anxiety and influence its short- and long-term effects, but these associations have not been systematically examined. OBJECTIVE To examine the associations of temperament with preoperative anxiety in young patients undergoing surgery. DATA SOURCES Studies from MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched from database inception to June 2018. STUDY SELECTION All prospective studies reporting associations of temperament with preoperative anxiety were included. Overall, 43 of 5451 identified studies met selection criteria. DATA EXTRACTION AND SYNTHESIS Using the PRISMA guidelines, reviewers independently read 43 full-text articles, extracted data on eligible studies, and assessed the quality of each study. Data were pooled using the Lipsey and Wilson random-effects model. MAIN OUTCOMES AND MEASURES Primary outcome was the association of temperament with preoperative anxiety in patients undergoing surgery. RESULTS A total of 23 studies, with 4527 participants aged 1 to 18 years, were included in this review. Meta-analysis of 12 studies including 1064 participants revealed that emotionality (r = 0.11; 95% CI, 0.04 to 0.19), intensity of reaction (r = 0.29; 95% CI, 0.11 to 0.46), and withdrawal (r = 0.40; 95% CI, 0.23 to 0.55) were positively associated with preoperative anxiety, whereas activity level (r = -0.23; 95% CI, -0.31 to -0.16) was negatively correlated with preoperative anxiety. Impulsivity was not significantly associated with preoperative anxiety. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis provided evidence suggesting that temperament may help identify pediatric patients at risk of preoperative anxiety and guide the design of prevention and intervention strategies. Future studies should continue to explore temperament and other factors influencing preoperative anxiety and their transactional effects to guide the development of precision treatment approaches and to optimize perioperative care.
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Furtado M, Chow CHT, Owais S, Frey BN, Van Lieshout RJ. Risk factors of new onset anxiety and anxiety exacerbation in the perinatal period: A systematic review and meta-analysis. J Affect Disord 2018; 238:626-635. [PMID: 29957480 DOI: 10.1016/j.jad.2018.05.073] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/29/2018] [Accepted: 05/28/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Even though more than 20% of women meet diagnostic criteria for an anxiety disorder during the perinatal period, very little is known about the predictors of these problems. As a result, we systematically reviewed the literature on risk factors for new onset anxiety and maternal anxiety exacerbation in the perinatal period. METHODS PubMed, MEDLINE, PsycINFO, CINAHL, Ovid, ProQuest Portal, and Web of Science were searched for studies assessing risk factors for the development of new onset anxiety or anxiety worsening in women during pregnancy and the postpartum period. RESULTS 11,759 citations were identified, with 11 studies meeting eligibility criteria. New onset anxiety was assessed in 7 studies, anxiety worsening in 3, and 1 assessed both. Lower educational attainment, living with extended family members, multiparity, a family history of psychiatric disorders, hyperemesis gravidarum, comorbid sleep disorders, and prenatal oxytocin exposure were risk factors for new onset perinatal anxiety, while presence of comorbid psychiatric disorders and prenatal oxytocin were risk factors for anxiety worsening. LIMITATIONS Studies not explicitly stating whether participants had pre-existing anxiety disorders were excluded. As a result, meta-analysis was not possible for several risk factors. CONCLUSIONS Risk factors for new onset anxiety and anxiety worsening during the perinatal period include psychological, social, and biological exposures. Given the lack of studies differentiating women with and without pre-existing anxiety disorders, additional research is required in order to determine whether these factors differ from the non-puerperal population, as well as from each other.
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Owais S, Chow CHT, Furtado M, Frey BN, Van Lieshout RJ. Non-pharmacological interventions for improving postpartum maternal sleep: A systematic review and meta-analysis. Sleep Med Rev 2018; 41:87-100. [PMID: 29449122 DOI: 10.1016/j.smrv.2018.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/04/2018] [Accepted: 01/17/2018] [Indexed: 12/29/2022]
Abstract
Evidence suggests that poor postpartum sleep quality is a risk factor for the development of postpartum depression. As such, non-pharmacological interventions have been developed to help improve sleep in the postpartum period. The primary aims of this systematic review and meta-analysis were to determine if non-pharmacological interventions improved maternal sleep and to compare the effectiveness of different intervention types. Secondary aims included examining effects on maternal mood and infant sleep. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from their inceptions to September 2017 and found 15 eligible studies. Non-pharmacological sleep interventions were found to improve subjective reports of maternal sleep (Cohen's d = -0.54, 95%CI = -0.88 to -0.19). Massage (Cohen's d = -1.07 95%CI = -1.34 to -0.79) and exercise (Cohen's d = -0.82 95%CI = -1.28 to -0.37) interventions had the largest impact on maternal sleep quality. Positive effects on nocturnal infant sleep were found for interventions overall (Cohen's d = -0.27 95%CI = -0.52 to -0.02) but not for maternal depression (Cohen's d = -0.08 95%CI = -0.28 to 0.12). Despite evidence suggesting improvements in subjective maternal sleep, more research must be conducted on the durability of effects of non-pharmacological interventions using objective measures of sleep quality.
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Chow CHT, Wan S, Pope E, Meng Z, Schmidt LA, Buckley N, Van Lieshout RJ. Audiovisual interventions for parental preoperative anxiety: A systematic review and meta-analysis. Health Psychol 2018; 37:746-758. [PMID: 30024230 DOI: 10.1037/hea0000627] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To systematically review and meta-analyze studies assessing the effectiveness of audiovisual (AV) interventions aimed at reducing anxiety in parents whose children are undergoing elective surgery. METHODS A comprehensive search of multiple electronic databases was performed. A narrative synthesis of findings and random-effects meta-analyses were used to summarize the results. Our primary outcome was parental anxiety. Secondary outcomes included children's preoperative anxiety and postoperative outcomes; parental satisfaction, knowledge, and need for anesthesia information. Risk of bias was appraised within and across studies. RESULTS Our search yielded 723 studies and 11 were included. A Standardized Mean Difference (SMD) of -0.53 (95% CI [-0.91, -0.15], p < .01) was found between parental anxiety scores in AV interventions and control groups. In terms of children's preoperative anxiety, there was a SMD of -0.59 (95% CI [-1.11, -0.07], p < .05) between children's anxiety scores in AV intervention and nonintervention participants. Furthermore, AV interventions were shown to shorten the recovery time for children undergoing surgery (SMD = -0.21; 95% CI [-0.39, -0.02], p = .03) but did not lead to improvements on other postoperative outcomes. CONCLUSIONS These findings suggest that AV interventions have modest, positive effects on both parental and children's preoperative anxiety. Although a statistically significant medium size effect was detected, the clinical significance of this finding requires further exploration. Further research aimed at developing better AV interventions to help guide future practice is warranted. (PsycINFO Database Record
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Mathewson KJ, Chow CHT, Dobson KG, Pope EI, Schmidt LA, Van Lieshout RJ. Mental health of extremely low birth weight survivors: A systematic review and meta-analysis. Psychol Bull 2017. [PMID: 28191983 DOI: 10.1037/bu10000091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Although individuals born at extremely low birth weight (ELBW; < 1,000 g) are the most vulnerable of all preterm survivors, their risk for mental health problems across the life span has not been systematically reviewed. The primary objective of this systematic review and meta-analysis was to ascertain whether the risk for mental health problems is greater for ELBW survivors than their normal birth weight (NBW) peers in childhood, adolescence, and adulthood. Forty-one studies assessing 2,712 ELBW children, adolescents, and adults and 11,127 NBW controls were reviewed. Group differences in mental health outcomes were assessed using random effects meta-analyses. The impacts of birthplace, birth era, and neurosensory impairment on mental health outcomes were assessed in subgroup analyses. Children born at ELBW were reported by parents and teachers to be at significantly greater risk than NBW controls for inattention and hyperactivity, internalizing, and externalizing symptoms. ELBW children were also at greater risk for conduct and oppositional disorders, autistic symptoms, and social difficulties. Risks for parent-reported inattention and hyperactivity, internalizing, and social problems were greater in adolescents born at ELBW. In contrast, ELBW teens self-reported lower inattention, hyperactivity, and oppositional behavior levels than their NBW peers. Depression, anxiety, and social difficulties were elevated in ELBW survivors in adulthood. Group differences were robust to region of birth, era of birth, and the presence of neurosensory impairments. The complex needs faced by children born at ELBW continue throughout development, with long-term consequences for psychological and social well-being. (PsycINFO Database Record
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Mathewson KJ, Chow CHT, Dobson KG, Pope EI, Schmidt LA, Van Lieshout RJ. Mental health of extremely low birth weight survivors: A systematic review and meta-analysis. Psychol Bull 2017; 143:347-383. [DOI: 10.1037/bul0000091] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dobson KG, Chow CHT, Morrison KM, Van Lieshout RJ. Associations Between Childhood Cognition and Cardiovascular Events in Adulthood: A Systematic Review and Meta-analysis. Can J Cardiol 2016; 33:232-242. [PMID: 27956044 DOI: 10.1016/j.cjca.2016.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The success of behavioural interventions to optimize cardiovascular health is dependent on adequate cognitive functioning beginning in early life. In this study we aimed to systematically review studies that examined associations between childhood cognition and cardiovascular disease (CVD) events in adulthood. METHODS This study followed the Meta-analysis Of Observational Studies in Epidemiology guidelines to systematically examine associations between childhood cognition and adult CVD, coronary heart disease, and stroke hospitalization or mortality events. Literature was retrieved from EMBASE, MEDLINE, PsycInfo, and CINAHL. RESULTS Five longitudinal studies that examined links between childhood cognition and CVD in adulthood were included. Pooled estimates of unadjusted CVD events indicated a relative risk of 1.23 (95% confidence interval, 1.12-1.34) per standard deviation decrease in childhood IQ, whereas the pooled estimate adjusted for biopsychosocial confounding factors indicated an overall relative risk of 1.16 (95% confidence interval, 1.07-1.26). CONCLUSIONS Lower childhood IQ is associated with an increased risk of cardiovascular events in adulthood, even after adjustment for confounding variables. Future research should examine the behavioural mechanisms by which these risks are mediated to optimize cardiovascular health.
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Chow CHT, Van Lieshout RJ, Schmidt LA, Dobson KG, Buckley N. Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery. J Pediatr Psychol 2015; 41:182-203. [PMID: 26476281 DOI: 10.1093/jpepsy/jsv094] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 09/11/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery. METHODS A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children's preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed. RESULTS In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies. CONCLUSIONS This systematic review suggests that AV interventions can be effective in reducing children's preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice.
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de Leon RD, See PA, Chow CHT. Differential effects of low versus high amounts of weight supported treadmill training in spinally transected rats. J Neurotrauma 2011; 28:1021-33. [PMID: 21476782 DOI: 10.1089/neu.2010.1699] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intensive weight-supported treadmill training (WSTT) improves locomotor function following spinal cord injury. Because of a number of factors, undergoing intensive sessions of training may not be feasible. Whether reduced amounts of training are sufficient to enhance spinal plasticity to a level that is necessary for improving function is not known. The focus of the present study was to assess differences in recovery of locomotor function and spinal plasticity as a function of the amount of steps taken during WSTT in a rodent model of spinal cord injury. Rats were spinally transected at 5 days of age. When they reached 28 days of age, a robotic system was used to implement a weight-supported treadmill training program of either 100 or 1000 steps/training session daily for 4 weeks. Antibodies for brain-derived neurotrophic factor (BDNF), TrkB, and the pre-synaptic marker, synaptophysin, were used to examine the expression of these proteins in the ventral horn of the lumbar spinal cord. Rats that received weight-supported treadmill training performed better stepping relative to untrained rats, but only the rats that received 1000 steps/training session recovered locomotor function that resembled normal patterns. Only the rats that received 1000 steps/training session recovered normal levels of synaptophysin immunoreactivity around motor neurons. Weight-supported treadmill training consisting of either 100 or 1000 steps/training session increased BDNF immunoreactivity in the ventral horn of the lumbar spinal cord. TrkB expression in the ventral horn was not affected by spinal cord transection or weight-supported treadmill training. Synaptophysin expression, but not BDNF or TrkB expression was correlated with the recovery of stepping function. These findings suggested that a large amount of weight-supported treadmill training was necessary for restoring synaptic connections to motor neurons within the locomotor generating circuitry. Although a large amount of training was best for recovery, small amounts of training were associated with incremental gains in function and increased BDNF levels.
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