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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPatients who suffer strokes experience residual symptoms in many areas. Reports in the literature indicate that 38% of patients reported major difficulty in hand function 1\u20133 months post-stroke\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eextrapyramidal \u0026amp; movement disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecerebrovascular disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EPatients who suffer strokes experience residual symptoms in many areas. Reports in the literature indicate that 38% of patients reported major difficulty in hand function 1\u20133 months post-stroke (Duncan et al. \u003Cem\u003EStroke\u003C\/em\u003E 2003), and up to 65% of patients could not use their paretic hand in daily activities 6 months post-stroke (Mayo et al. 2002). \u201cThe impact of manual function on independent living is significant\u2026this is one of the precursors of losing independent capability,\u201d said Carolee Winstein, PhD, PT, University of California, Los Angeles, CA. Different approaches are being explored to help alleviate post-stroke disability, and studies suggest that intensive, task-oriented upper limb training (TOULT) may be effective. The Stroke Arm Recovery (STAR) trial was a phase 2, unblinded, single-center study that compared TOULT, strength training (ST), and standard care (SC) on upper limb recovery. The TOULT group was significantly better than the SC group in measures of impairment (p=0.04) and strength (p=0.02). Nine months later, the less severe stroke patients outperformed the ST group in strength (p\u0026lt;0.05; Winstein et al. \u003Cem\u003EArch Phys Med Rehabil\u003C\/em\u003E 2004). In the phase 3 Extremity Constraint-Induced Therapy Evaluation (EXCITE) trial, 222 stroke patients were randomized to receive either constraint-induced movement therapy (CIMT) or SC 3\u20139 months post-stroke. Patients who received CIMT had statistically significant, clinically relevant improvements that lasted for at least one year (Wolf et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2006). \u201cThe critical elements of constraint therapy remain unresolved. Is it the task-oriented training, is it the shaping repetition, is it the forced use?\u201d commented Dr. Winstein. These questions are in need of additional research.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EElectromagnetic brain stimulation methodology and its potential effect on motor stimulation training were reviewed by Leonardo Cohen, MD, National Institutes of Health, Bethesda, MD. \u201cOne line of evidence that has been demonstrated so far\u2026is that when different forms of brain stimulation are applied over the primary motor cortex (M1), there is a resultant increase in motor cortical excitability,\u201d said Dr. Cohen. This led to the idea that stimulation may provide a synergistic effect on motor training in humans, and emerging technologies are in the proof-of-concept stage (Hummel FC, Cohen LG. \u003Cem\u003ELancet Neurology\u003C\/em\u003E 2006). The types of issues that need resolution include optimization of the stimulation site, technique optimization, characterization of the patients\/injuries\/tasks that may be helped, and the safety of the procedures (Tallelli P, Rothwell J. \u003Cem\u003ECurr Opin Neurol\u003C\/em\u003E 2006; Fregni F, Pascual-Leone A. \u003Cem\u003ECogn Behav Neurol\u003C\/em\u003E 2006).\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ECellular therapies are also being explored as a mechanism for brain repair after stroke, as discussed in an overview given by Sean Savitz, MD, University of Texas, Houston, TX. The concept arose from stem cell transplantation in cancer patients as well as transplantation in those with Parkinson disease. Promotion of lost neuronal connections and conductivity, enhancement of trophic support for neurogenesis, angiogenesis, synaptogenesis, prevention of cell death, and reduction of inflammatory responses and scar formation are some of the possible mechanisms whereby cell therapy could enhance brain recovery. Although it is an exciting idea, it is an area that is full of challenges. \u201cIs it really possible to consider that cellular therapy or cellular transplantation is going to reconstruct the complex tapestry of the infarcted brain?\u201d asked Dr. Savitz. Some of the parameters that researchers must determine are the infarct size and location, the timing of therapy, injection sites, routes of delivery, which cell types (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E), and patient safety monitoring. The search for an effective therapy to promote brain repair after stroke continues to evolve across the domains of physical therapy, brain stimulation, and cell therapy.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/1\/28\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Complexity of Cell Types.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2051943541\u0022 data-figure-caption=\u0022Complexity of Cell Types.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/1\/28\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/1\/28\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/1\/28\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11009\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EComplexity of Cell Types.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/1\/28.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmhn2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmhn2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}