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Determinants of sensorimotor recovery following stroke
Abstracts / Brain and Cognition 63 (2007) 191–196
ing psychological mechanism has become so controversial, the neural substrate associated with neglect has been challenged, as well. This talk will revisit unilateral neglect with the express goal of exploring the underlying psychological and neural mechanisms. In particular, a series of behavioral studies of patients with relatively circumscribed lesions to more superior (superior parietal lobule) versus inferior (temporo-parietal junction) regions of parietal cortex will be described and the relative contribution of these two distinct areas will be outlined. In addition, we will explore the nature of the attentional deficit in these patients by contrasting the quality and strength of activation of information appearing in the ipsilesional and contralesional fields. Finally, at the end, I will provide an analysis of the fate of the unattended information and will demonstrate under what circumstances this neglected information can still influence performance. There has been a significant paradigm shift in the domain of hemispatial neglect and the advent of more refined behavioral and imaging procedures have granted us unprecedented access to the brain–behavior relationships in individuals who suffer from this disorder. doi:10.1016/j.bandc.2006.08.014
Post-stroke depression Nathan Herrmann Professor, Department of Psychiatry, University of Toronto; Staff Psychiatrist and Head of the Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre; Associate Scientist in the Clinical and Integrative Biology Program, Toronto, Canada Almost 30 years of extensive investigation has documented that depressive symptoms and syndromes following stroke are common serious problems that significantly affect outcomes. Data from the Sunnybrook Stroke Study, a large prospective longitudinal study of patients with hemispheric stroke, suggest that 20–30% of patients experience significant depressive symptoms at 3 and 12 months following stroke. While functional status appears to be the most significant predictor of depressive symptoms, lesion location may play a role as well. The literature on the relation between depression and lesion location is inconsistent and may depend on the timing of the depression assessments. Treatment with a variety of modalities including antidepressants appears effective. There is some intriguing preliminary data which suggest that prophylactic treatment of all post-stroke patients may significantly reduce the rates of post-stroke depression and potentially improve other outcomes as well. The frequency and significance of post-stroke depression argues strongly for routine screening for depression in all stroke patients. doi:10.1016/j.bandc.2006.08.015
195
Determinants of sensorimotor recovery following stroke William McIlroy Associate Professor, Department of Physical Therapy and Graduate Department of Rehabilitation Sciences, University of Toronto; Senior Scientist and Mobility Team Leader, Toronto Rehab; Senior Scientist, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Canada Limitations in ability to walk or perform activities of daily living are frequently cited as the most important concern for many individuals after they have suffered a stroke. While considerable research and clinical effort is directed to maximizing recovery of these activities after stroke there remains many unanswered questions about critical determinants of such recovery. The presentation will provide an overview of the principles and profile of recovery of sensorimotor behavior after stroke to provide a framework for new opportunities to enhance recovery. Specific attention will be paid to the unique aspects of recovery of: (1) upper limb control (essential for recovery of activities of daily living) and (2) the lower limb control (essential for the recovery of independent mobility). The presentation will highlight the benefits and limitations of existing and emerging therapeutic techniques with an emphasis on the differential influence on neurophysiologic versus functional recovery. Details of specific treatment strategies to optimize sensorimotor recovery will be discussed with a specific focus on the important link between sensorimotor recovery and cognitive processes. doi:10.1016/j.bandc.2006.08.016
Meeting the challenges of executive functioning rehabilitation Brian Levine Senior Scientist, Rotman Research Institute, Baycrest; Associate Professor, Departments of Psychology and Medicine (Neurology), University of Toronto, Toronto, Canada Deficits in executive functioning pose significant reallife handicap in many patients with brain disease. In spite of the prevalence of executive dysfunction, there are no standardized, widely accepted methods for its rehabilitation. This problem may arise from ambiguity in the definition of executive functions. In this talk, I will review the literature on executive functioning rehabilitation and present results from a series of studies on Goal Management Training, a standardized intervention for executive function based on theoretical models of attention. doi:10.1016/j.bandc.2006.08.017
ing psychological mechanism has become so controversial, the neural substrate associated with neglect has been challenged, as well. This talk will revisit unilateral neglect with the express goal of exploring the underlying psychological and neural mechanisms. In particular, a series of behavioral studies of patients with relatively circumscribed lesions to more superior (superior parietal lobule) versus inferior (temporo-parietal junction) regions of parietal cortex will be described and the relative contribution of these two distinct areas will be outlined. In addition, we will explore the nature of the attentional deficit in these patients by contrasting the quality and strength of activation of information appearing in the ipsilesional and contralesional fields. Finally, at the end, I will provide an analysis of the fate of the unattended information and will demonstrate under what circumstances this neglected information can still influence performance. There has been a significant paradigm shift in the domain of hemispatial neglect and the advent of more refined behavioral and imaging procedures have granted us unprecedented access to the brain–behavior relationships in individuals who suffer from this disorder. doi:10.1016/j.bandc.2006.08.014
Post-stroke depression Nathan Herrmann Professor, Department of Psychiatry, University of Toronto; Staff Psychiatrist and Head of the Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre; Associate Scientist in the Clinical and Integrative Biology Program, Toronto, Canada Almost 30 years of extensive investigation has documented that depressive symptoms and syndromes following stroke are common serious problems that significantly affect outcomes. Data from the Sunnybrook Stroke Study, a large prospective longitudinal study of patients with hemispheric stroke, suggest that 20–30% of patients experience significant depressive symptoms at 3 and 12 months following stroke. While functional status appears to be the most significant predictor of depressive symptoms, lesion location may play a role as well. The literature on the relation between depression and lesion location is inconsistent and may depend on the timing of the depression assessments. Treatment with a variety of modalities including antidepressants appears effective. There is some intriguing preliminary data which suggest that prophylactic treatment of all post-stroke patients may significantly reduce the rates of post-stroke depression and potentially improve other outcomes as well. The frequency and significance of post-stroke depression argues strongly for routine screening for depression in all stroke patients. doi:10.1016/j.bandc.2006.08.015
195
Determinants of sensorimotor recovery following stroke William McIlroy Associate Professor, Department of Physical Therapy and Graduate Department of Rehabilitation Sciences, University of Toronto; Senior Scientist and Mobility Team Leader, Toronto Rehab; Senior Scientist, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Canada Limitations in ability to walk or perform activities of daily living are frequently cited as the most important concern for many individuals after they have suffered a stroke. While considerable research and clinical effort is directed to maximizing recovery of these activities after stroke there remains many unanswered questions about critical determinants of such recovery. The presentation will provide an overview of the principles and profile of recovery of sensorimotor behavior after stroke to provide a framework for new opportunities to enhance recovery. Specific attention will be paid to the unique aspects of recovery of: (1) upper limb control (essential for recovery of activities of daily living) and (2) the lower limb control (essential for the recovery of independent mobility). The presentation will highlight the benefits and limitations of existing and emerging therapeutic techniques with an emphasis on the differential influence on neurophysiologic versus functional recovery. Details of specific treatment strategies to optimize sensorimotor recovery will be discussed with a specific focus on the important link between sensorimotor recovery and cognitive processes. doi:10.1016/j.bandc.2006.08.016
Meeting the challenges of executive functioning rehabilitation Brian Levine Senior Scientist, Rotman Research Institute, Baycrest; Associate Professor, Departments of Psychology and Medicine (Neurology), University of Toronto, Toronto, Canada Deficits in executive functioning pose significant reallife handicap in many patients with brain disease. In spite of the prevalence of executive dysfunction, there are no standardized, widely accepted methods for its rehabilitation. This problem may arise from ambiguity in the definition of executive functions. In this talk, I will review the literature on executive functioning rehabilitation and present results from a series of studies on Goal Management Training, a standardized intervention for executive function based on theoretical models of attention. doi:10.1016/j.bandc.2006.08.017