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Psychophysical recovery from single-pulse forward masking in electric hearing.

Psychophysical single-pulse forward-masking (SPFM) recovery functions were measured for three electrodes in each of eight subjects with the nucleus mini-22 cochlear implant. Masker and probe stimuli were single 200-micros/phase biphasic current pulses. Recovery functions were measured at several masker levels spanning the electric dynamic range of electrodes chosen from the apical, middle, and basal regions of each subject's electrode array. Recovery functions were described by an exponential process in which threshold shift (in microA) decreased exponentially with increasing time delay between the masker and probe pulses. Two recovery processes were observed: An initial, rapid-recovery process with an average time constant of 5.5 ms was complete by about 10 ms. A second, slow-recovery process involved less masking than the rapid-recovery process but encompassed much longer time delays, sometimes as long as several hundred milliseconds. Growth-of-masking slopes for the rapid process depended upon time delay, as expected in an exponential recovery process. Unity slopes were observed at a time delay of 0 ms, whereas progressively shallower slopes were observed at time delays of 2 ms and 5 ms. Many recovery functions demonstrated nonmonotonicities or "facilitation" at very short masker-probe delays (1-2 ms). Such nonmonotonicities were usually most pronounced at low masker levels. Time constants for the rapid-recovery process did not vary systematically with masker level or with electrode location along the implanted array. Most subjects demonstrated rapid-recovery time constants less than 7 ms; however, the subject with the longest duration of deafness prior to implantation exhibited clearly prolonged time constants (9-24 ms). Time constants obtained on basal electrodes were inversely related to word recognition scores.

Adult↗

Cryptosporidium and giardia recoveries in natural waters by using environmental protection agency method 1623.

Relatively few studies have examined recoveries from source waters by using Environmental Protection Agency method 1623 with organism spike doses that are environmentally realistic and at turbidity levels commonly found in surface waters. In this study, we evaluated the filtration capacities and recovery efficiencies of the Gelman Envirochek (standard filter) and the Gelman Envirochek high-volume (HV) sampling capsules under environmental conditions. We also examined the performance of method 1623 under ambient conditions with matrix spike experiments using 10 organisms/liter. Under turbid conditions, the HV capsule filtered approximately twice the volume filtered by the standard filter, but neither could filter 10 liters without clogging. In low-turbidity waters, oocyst, but not cyst, recoveries were significantly higher when the HV capsule was used. In turbid waters, organism recoveries were lower than those in nonturbid waters and were not significantly different for the different filters. When the HV capsule was used, Cryptosporidium recoveries ranged from 36 to 75%, and Giardia recoveries ranged from 0.5 to 53%. For both organisms, recoveries varied significantly by site. Turbidity could explain variation in Giardia recoveries (r(2) = 0.80) but not variation in Cryptosporidium recoveries (r(2) = 0.16). The inconsistent recoveries across sites suggested that the background matrix of the ambient water affected recovery by method 1623. A control sample collected at the height of the winter rainy season detected one organism, highlighting the difficulty of using this method to accurately measure pathogen abundance under natural conditions. Our findings support the use of the HV filter under field conditions but suggest that designing a cost-effective and statistically valid monitoring program to evaluate sources and loads of protozoan pathogens may be difficult.

Animals↗

Time spent at a high percentage of VO2max for short intermittent runs: active versus passive recovery.

The purpose of this study was to compare the effects of recovery type (active vs. passive) on the time spent at VO(2)max and above 90 % of VO(2)max during short intermittent runs (15 s) at 120 % of maximal aerobic speed. Twelve male subjects performed a graded test and intermittent runs (15 s) alternated with 15 s of active recovery (50 % of maximal aerobic speed) or with 15 s of passive recovery to exhaustion. The time to exhaustion during the intermittent runs with active recovery (445 +/- 79 s) was significantly shorter (p < 0.001) compared with passive recovery (745 +/- 171 s). No significant difference was found between time spent at VO(2)max and above 90 % of VO(2)max for intermittent runs alternated with active recovery (180 +/- 121 s and 282 +/- 117 s, respectively ) and intermittent runs alternated with passive recovery (191 +/- 135 s and 317 +/- 132 s, respectively ). The times spent at VO(2)max (p < 0.05) and above 90 % of VO(2)max (p < 0.001), expressed in percentage of time to exhaustion, were significantly longer for intermittent runs alternated with active recovery (41 +/- 27 % and 64 +/- 24 %, respectively) than with passive recovery (25 +/- 16 % and 43 +/- 16%, respectively). In conclusion, the present study has shown that the time to exhaustion during repeated high-intensity exercise was significantly greater for passive compared with active recovery, despite no difference in absolute time spent at a high percentage of VO(2)max. However, the time spent at a high percentage of VO(2)max, expressed as a percentage of time to exhaustion, was significantly higher for active compared with passive recovery.

Adult↗

Developmental changes in time course of recovery from inactivation in L-type calcium currents of rabbit ventricular myocytes.

The mechanisms of recovery from inactivation of the L-type calcium current (I(Ca)) are not well established, and recovery is affected by many experimental conditions. Little is known about developmental changes of recovery from inactivation of I(Ca). We studied developmental changes of recovery from inactivation in I(Ca) using isolated adult and newborn (1-4 days) rabbit ventricular myocytes. We used broken-patch and perforated-patch techniques with physiological extracellular ionic concentrations of calcium and sodium and interpulse conditioning potentials of -80 or -50 mV. We also maximized I(Ca) with forskolin. We found that recovery from inactivation did not differ between adult and newborn cells when either EGTA or BAPTA was used to buffer intracellular calcium. Maximizing I(Ca) with forskolin slowed recovery from inactivation in newborn but not in adult cells. In contrast, when the intracellular buffering of the cell was left nearly intact (perforated patch), recovery from inactivation (half-time of recovery) in the newborn cells was significantly slower than for the adult cells when either a conditioning potential of -80 mV (140 +/- 9 vs. 58 +/- 4 ms, newborn vs. adult; P < 0.05) or -50 mV (641 +/- 106 vs. 168 +/- 15 ms, newborn vs. adult; P < 0.05) was used. Forskolin significantly increased half-time of recovery for both adult and newborn cells. Dialysis with no calcium buffer showed a slower recovery from inactivation in newborn cells. Intracellular dialysis with a calcium buffer masked differences in recovery from inactivation of I(Ca) between newborn and adult rabbit ventricular cells.

Aging↗

Pathophysiological characteristics of heart rate recovery in heart failure.

PURPOSE: Heart failure (HF) is associated with blunted HR recovery after exercise. The determinants of altered HR recovery in HF are unknown. The aim of this study was to investigate clinical correlates of HR recovery in HF patients. METHODS: Echocardiography, pulmonary function tests, exercise testing, and neurohormonal measurements were performed in 98 HF patients. HR recovery was calculated as the difference between heart rate at peak exercise and at 1 min into a recovery period. Study subjects were divided into three groups based on HR recovery tertiles: group 1 (HR recovery < or = 6 bpm), group 2 (7 < or = HR recovery < or = 12), and group 3 (HR recovery > or = 13). RESULTS: There were significant differences between the groups in multiple parameters. Compared with group 3, patients in group 1 had greater E/A ratios (1.81 +/- 0.26 vs 0.98 +/- 0.12, P = 0.011), shorter deceleration time (170 +/- 11 vs 223 +/- 11 ms, P = 0.016), and higher plasma atrial natriuretic peptide levels (207 +/- 32 vs 101 +/- 12 pg.mL, P = 0.008), indicating higher left ventricular filling pressures and elevated left atrial pressures. Pulmonary function tests were suggestive of greater restrictive changes in the lungs. Finally, subjects in group 1 had impaired exercise capacity, as evidenced by shorter exercise duration (5.2 +/- 0.2 vs 8.3 +/- 0.4 min, P < 0.001), lower peak VO2 (14.6 +/- 0.6 vs 22.2 +/- 1.0 mL.kg(-1).min(-1), P < 0.001), higher VE/VCO2 ratios (36.4 +/- 1.1 vs 31.1 +/- 0.9, P = 0.001), and reduced chronotropic responses to exercise (39 +/- 3 vs 69 +/- 4 bpm, P < 0.001). CONCLUSION: HR recovery may be a clinically useful index identifying HF patients with distinct echocardiographic, neurohormonal, and hemodynamic characteristics. This may have implications for our understanding of the pathophysiology of impaired HR recovery in HF as well as for the clinical evaluation of such patients.

Analysis of Variance↗

Rapid recovery following cardiac surgery: a nursing perspective.

Fast track or rapid-recovery pathways following cardiac surgery are becoming common practice in many cardiac units in order to maximize use of scarce critical care resources. Within the UK, rapid recovery generally describes same-day discharge from the initial intensive care facility to a lower-dependency unit. There are no nationally agreed protocols to help guide this practice. In a London teaching hospital a nurse-led audit was undertaken to identify which patients were selected for rapid recovery and to evaluate safety (length of hospital stay and incidences of postoperative complications) compared to a conventional recovery pathway. The study also sought to gain insight into the patients' views on rapid recovery. Data were collected on 104 patients, all patients (n = 56) who followed a rapid-recovery pathway were included. A comparison group (n = 48) was selected from patients who followed a conventional recovery but who were eligible for rapid recovery. The primary outcome, median length of hospital stay was 6 days for both groups, but the rapid-recovery group experienced significantly fewer postoperative complications. Rapid recovery as currently practised on this unit is safe for carefully selected cardiac surgical patients but barriers to rapid recovery need to be explored.

Aged↗

[Recovery from adaptation in human compound action potential following forward masking].

Recovery from adaptation was studied as changes in compound action potential (CAP) in response to clicks after broadband noise masking in volunteers with normal hearing. CAP was transtympanically elicited from the promontory using a needle electrode. Preceding masking noise and subsequent click stimuli were delivered separately from 2 loud speakers 80 cm from the tested ear. We evaluated the effect of masking noise duration and intensity on CAP recovery from adaptation as a function of delta t, defined as the interval between masking noise offset and click stimulus onset. Results were as follows: At delta t shorter than 200 ms or less, recovery from latency prolongation and amplitude decrease slowed with increasing masking noise duration and intensity. At delta t longer than 200 ms, no significant difference was seen in CAP recovery based on changes in masking noise duration or intensity. Recovery from adaptation, which depended on click intensity, took about 700 ms at a 40 dBnHL click and about 300 ms at a 60 dBnHL click. The influence of the middle ear muscle reflex on CAP recovery patterns is neglected when considering the intensity both masking noise and click stimulus. In CAP recovery, accumulated effects of the relative auditory-nerve refractory period may adversely affect recovery at very short delta t, while recovery from short-term adaptation, assumed involved in cochlear-hair cell synapse function, may be an important factor at delta t longer than 30-40 ms. Based on animal experiments showing different recovery times dependent on different auditory nerve spontaneous rates(SR), we concluded that at delta t of 200 ms or less, CAP recovery reflects high SR neuron activity, while at delta t longer than 200 ms, it mainly reflects that of low SR neurons.

Acoustic Stimulation↗

Effect of benzyladenine on recovery of cryopreserved shoot tips of grapevine and citrus cultured in vitro.

The effect of N6-benzyladenine (BA) on the recovery of cryopreserved shoot tips of the LN33 hybrid (Vitis L.) and Troyer citrange [Poncirus trifoliata (L.) Raf. x Citrus sinensis [L.] Osbeck.] cultured in vitro was examined. For the LN33 hybrid, the presence of BA in the recovery medium was essential for survival of control and cryopreserved shoot tips, although the BA concentration did not influence the survival percentage. BA at 5, 2, and 5 microM or higher induced callus formation in control, and shoot tips cryopreserved by vitrification, and by encapsulation-dehydration, respectively. While a BA concentration of 4 microM was found optimal for recovery of control shoot tips, 1 and 2-4 microM produced the best recovery of shoot tips cryopreserved by vitrification and encapsulation-dehydration, respectively. A similar pattern of effect of BA on recovery was found for 'Troyer' citrange. Low survival of control and cryopreserved shoot tips was observed with a BA-free recovery medium. The addition of BA to the recovery medium significantly increased survival. The BA concentration that induced callus formation in shoot tips cryopreserved by encapsulation-vitrification was higher than that which induced it in those cryopreserved by encapsulation-dehydration. Recovery of control shoot tips was best with an addition of 6-10 microM BA to the medium. Optimal recovery of shoot tips cryopreserved by encapsulation-vitrification and encapsulation-dehydration was achieved with 3-4 and 2 microM BA, respectively. Results from the present study suggest that an optimal BA concentration for recovery of control shoot tips may be different from that for cryopreserved shoot tips; furthermore, the optimal BA concentration for recovery of cryopreserved shoot tips may also differ among different cryogenic procedures.

Adenine↗

Corneal edema recovery dynamics in the rabbit. A useful model?

Open-eye and closed-eye recovery from contact lens-induced corneal edema was measured on the right eyes of 10 New Zealand White rabbits using ultrasound pachometry. Edema was produced by either 2 hours of eye closure (Patch Test) or 2 hours wearing of a thick hydrogel contact lens over the closed eye (Lens Test). The measured corneal edema recovery data were analyzed by both linear-regression analysis and nonlinear-regression analysis based on a previously published exponential open-eye edema recovery model. Linear-regression analysis revealed that the initial rabbit open-eye edema recovery rate of 36.3 +/- 11.9 (standard deviation) micron/hr was not significantly different (P greater than 0.25) from the initial young human open-eye edema recovery rate of 35.6 +/- 3.4 micron/hr. Similarly, the initial rabbit closed-eye edema recovery rate of 14.3 +/- 5.4 micron/hr was found to be not significantly different (P greater than 0.25) from the initial young human closed-eye edema recovery rate of 15.0 +/- 2.2 microns/hr. Corneal edema recovery indices derived using nonlinear-regression analysis also had a strong similarity between rabbit and human corneal edema recovery rates. For example, the calculated percent recovery per hour (PRPH) for rabbit open-eye corneal edema recovery of 41.4 +/- 11.3%/hr agreed well with the reported human open-eye PRPH of 34.2-58.9%/hr. The rabbit closed-eye PRPH of 25.6 +/- 10.7%/hr was also found to lie between the calculated human closed-eye PRPH values of 19.9-30.2%/hr.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Enhancement of ethylenethiourea recoveries in food analyses by addition of cysteine hydrochloride.

The effectiveness of cysteine hydrochloride (Cys-HCl) as a preservative of ethylenethiourea (ETU) in product matrixes and during analysis was studied. ETU recoveries were adversely affected by certain product matrixes when fortified directly into the product. Recoveries in 8 selected food items were 0-92% when analyzed 30 min after fortification and 0-51% when analyzed after 24 h. When Cys-HCl was added to product prior to fortification, recoveries increased to 71-95% even after frozen storage for 2-4 weeks. Cys-HCl was added during analysis of 53 untreated items. Recoveries improved an average of 15% with Cys-HCl. Without Cys-HCl, recoveries were erratic (20-98%), but with Cys-HCl, recoveries were 68-113%. Other antioxidants (sodium sulfite, butylated hydroxyanisole, butylated hydroxytoluene, and vitamins A and C) also were evaluated as ETU preservatives. When lettuce was treated first with sodium sulfite and then fortified with ETU, recoveries averaged 86%; without sodium sulfite, they averaged 1%. The other antioxidants were less effective for preserving ETU in lettuce, giving only 8-46% recoveries. The effect of oxidizers (potassium bromate, sodium hypochlorite, and hydrogen peroxide) on ETU recovery was also determined. Recovery of ETU from a baby food product (pears and pineapple) was 82%; with oxidizers, recoveries were 0-8%.

Antioxidants↗

Attenuation of disrupted hepatic active oxygen metabolism with the recovery of acute liver injury in rats intoxicated with carbon tetrachloride.

In this study, we examined how disrupted hepatic active oxygen metabolism at a progressed stage of carbon tetrachloride (CCl4)-induced acute liver injury is attenuated with the recovery of the injury in fed rats. When the progression and recovery of liver injury were assessed by measuring the activities of serum transaminases, indexes of liver cell damage, at 2, 24, 48, and 72 h after a single intraperitoneal injection of CCl4 (1.0 ml/kg body weight), an apparent liver injury was found at 2 h, the most progressed liver injury occurred at 24 h, and the progressed liver injury fairly recovered at 72 h. Hepatic superoxide dismutase and catalase activities decreased with the progression of liver injury but both decreases were maintained during the recovery of the injury. Hepatic glutathione peroxidase activity did not change with the progression and recovery of liver injury. Hepatic glutathione reductase activity decreased with the progression of liver injury and the decreased activity was returned up to the original level with the recovery of the injury. Hepatic glucose-6-phosphate dehydrogenase activity increased with the progression and recovery of liver injury but this increased activity was reduced at a late stage of the recovery. Hepatic reduced glutathione and ascorbic acid contents decreased with the progression of liver injury but both decreased contents were returned up to the original levels with the recovery of the injury. Hepatic vitamin E content decreased at an early stage of liver injury but this decreased vitamin E content increased over the original level with the progression of the injury and this increased vitamin E content was maintained during the recovery of the injury. Hepatic lipid peroxide content increased with the progression of liver injury and this increased content was returned near the original level with the recovery of the injury. These results indicate that in rats intoxicated once with CCl4, disrupted hepatic active oxygen metabolism at a progressed stage of liver injury is attenuated with the recovery of the injury mainly through the improvement of hepatic active oxygen metabolism mediated by the glutathione redox cycle and ascorbic acid.

Alanine Transaminase↗

Functional recovery after facial and sciatic nerve crush injury in the rat.

OBJECTIVES: To systematically record rat facial nerve recovery following crush injury to the main trunk with respect to ocular and vibrissial function and to compare the rates of facial and sciatic nerve recovery from crush injury in the same animals. This serves as a means of validating the functional parameters of facial nerve recovery against the well-known measure of hind limb function, the Sciatic Function Index. METHODS: The main trunk of the facial nerve and the proximal segment of the sciatic nerve were exposed in all animals. Both nerves were subjected to standardized crush injury and subsequent daily functional testing. After a plateau of functional recovery was achieved, the animals were killed, and the distances between the sites of injury and the end musculature were measured, which allowed determination and comparison of recovery rates in both systems. RESULTS: All crush injuries resulted in loss of electrical conductivity, as proven by intraoperative proximal nerve stimulation. Recovery of ocular and vibrissial motor function occurred starting at postoperative day (POD) 9 and continuing through POD 20. Hind limb function returned later (POD 14-34); however, when corrected for distance, the sciatic recovery rate (2.26 mm/d) appeared to match that of the facial nerve (1.5-2.4 mm/d). CONCLUSIONS: Recovery after facial nerve crush injury follows a predictable time course, and the rate of recovery is consistent with that of sciatic nerve injury. Return of the blink reflex, loss of vibrissial fibrillations, and return of vibrissial sweeping function appear to be internally consistent functional measures of facial recovery. These quantitative measures will be useful for future facial nerve manipulation studies.

Animals↗

Factors affecting recovery and discharge following ambulatory surgery.

PURPOSE: Recovery and discharge following ambulatory surgery are important components of the ambulatory surgery experience. This review provides contemporary perspectives on the issues of discharge criteria, fast-tracking, patient escort requirements, and driving after ambulatory anesthesia. SOURCE: A search was performed in the Cochrane Central Register for Controlled Trials, MEDLINE(R), EMBASE(R), CINAHL, and PsycINFO, to review factors delaying discharge following ambulatory surgery. The following subject headings were used: "ambulatory surgery, discharge, recovery, car driving, escort, transport, fast tracking, patient discharge, recovery, transportation of patients, hospital discharge, recovery room, patient transport, hospital discharge, recovery room, anesthetic recovery, patient transport, ambulatory surgical procedures, patient discharge, recovery of function, automobile driving, patient escort service, recovery room". Using the same search engines, the following keywords were used: "fast tracking, recovery, and discharge". PRINCIPAL FINDINGS: The current literature supports that discharge scoring systems may be useful to guide discharge following ambulatory surgery. While fast-tracking has become common in some centres, further studies are required to justify more routine implementation of this practice in the management of patients undergoing ambulatory surgery. Patients at low risk for urinary retention can be discharged home without voiding. Patients should not drive until at least 24 hr postoperatively. CONCLUSIONS: Ensuring rapid postoperative recovery and safe discharge following ambulatory surgery are important components of the ambulatory surgical program. A clearly defined process should be established for each ambulatory surgical unit to ensure the safe and timely discharge of patients after anesthesia, in accordance with current best evidence.

Ambulatory Surgical Procedures↗

Motor evoked potentials of the lower extremity in predicting motor recovery and ambulation after stroke: a cohort study.

OBJECTIVE: To assess the prognostic value of motor evoked potentials (MEPs) in the lower extremity with respect to motor recovery and functional recovery in stroke patients. DESIGN: Cohort study. SETTING: The department of neurology at a university hospital. PARTICIPANTS: Thirty-eight acute-stroke patients with complete paralysis (paralysis subgroup) or severe paresis (paresis subgroup) of the lower extremity. MEPs of the vastus medialis and the tibialis anterior muscles were recorded between days 3 and 10 after stroke onset. INTERVENTIONS: Not applicable. Main outcome measures A separate proximal leg motor score (maximum, 16 points) and crural motor score (maximum, 2 points) were defined within the lower-limb subset of the original Fugl-Meyer Motor Assessment to evaluate the motor performance at regular intervals until 6 months after stroke. The transfer item of the Barthel Index and the Functional Ambulation Categories scores were used to assess transfer and walking ability. RESULTS: For the paralysis subgroup (n=30), the follow-up was complete in 27 patients (2 patients died, 1 patient underwent above-knee amputation). At 26 weeks, 20 patients experienced proximal motor recovery (mean score +/- standard deviation, 11.70+/-4.48), and 12 of them also showed crural motor recovery (mean score, 1.40+/-.51). Nine patients (33%) could perform an independent transfer safely, and 7 (26%) had learned to walk independently. Analysis revealed significant relationships for tibialis anterior muscle MEPs and motor recovery of crural leg muscles (odds ratio [OR]=18.00; 95% confidence interval [CI], 1.31-894.40), but not for vastus medialis muscle MEPs and proximal motor recovery (OR=6.00; 95% CI,.53-303.00). We found no association between vastus medialis muscle MEPs and recovery of ambulation. However, tibialis anterior muscle MEPs seemed to provide a test with prognostic value for the ability to perform independent transfers (OR=17.50; 95% CI, 1.36-267.00), but not for walking (OR=5.25; 95% CI,.40-77.57). Patients in the paresis subgroup experienced more favorable motor and functional recovery than did those in the paralysis subgroup. CONCLUSIONS: Tibialis anterior muscle MEPs registered in subacute phase after stroke may provide important prognostic information, both for motor recovery of the crural muscles and for the ability to perform independent transfers in patients with initial complete paralysis of the lower extremity. Vastus medialis muscle MEPs were not predictive for motor and functional recovery.

Adult↗

Quantitative assessment of psychomotor recovery after sedation and analgesia for outpatient EGD.

BACKGROUND: Sedation and analgesia are routinely used to improve patient tolerance for GI endoscopy. Currently, assessment of postprocedure recovery uses cardiovascular and respiratory parameters but not psychomotor function. The two aims of this study were to determine degree of psychomotor recovery after conscious sedation for endoscopy when patients meet established discharge criteria, and to identify a sensitive method of testing psychomotor recovery, and thereby provide meaningful predictions regarding the ability of patients to return to daily activities. METHODS: Outpatients undergoing elective EGD were recruited. Four psychometric tests were used to establish baseline psychomotor function before sedation and analgesia: Critical Tracking, Manual Dexterity, Multiple-Choice Reaction Time, and Letter Cancellation. Meperidine and midazolam were administered intravenously per standard nomogram. The tests were repeated immediately after the procedure and at 15-minute intervals until patients were deemed ready for discharge by recovery room personnel. Discharge criteria included an Aldrete discharge score of 10 and the ability to ambulate unhindered and carry on a simple conversation. Recovery personnel were blinded to psychometric test results. Psychomotor scores at discharge were compared with baseline scores to determine percent recovery. RESULTS: Thirty-one patients (12 men, 19 women; mean age 43 years, range 18-72 years) were enrolled. When Aldrete discharge criteria were met, the average psychomotor recovery was only 60% to 70% compared with baseline. At the time of discharge, average psychomotor recovery was 86.5% of baseline. Letter Cancellation and Multiple-Choice Reaction Time had the highest sensitivity in detecting depression of psychomotor function versus baseline, with mean recovery of, respectively, 64% and 63% (p < 0.0001). CONCLUSIONS: Psychomotor function remains significantly impaired when patients reach an Aldrete discharge score of 10. The Letter Cancellation test was most sensitive in detecting psychomotor impairment and recovery. Incorporating psychometric tests with current discharge criteria may identify patients who are better able to resume normal daily activities without supervision.

Adolescent↗

Towards a definition of recovery of function.

In this review we consider recovery of function after spinal cord injury, and, in particular, recovery improved following intraspinal cellular transplants. Some recovery occurs spontaneously and this can be especially dramatic in neonates, supporting the notion that developing and adult spinal cord respond differently to injury. Recovery can be improved in both neonates and adults by appropriate cellular transplants into the injury site. We describe several functional tests used in animals with spinal lesions and transplants. We compare the effects of transplants of fetal tissue and genetically modified fibroblasts into neonatal and adult injury sites on recovery of motor and sensorimotor function. Fetal tissue transplants support greater recovery and elicit more regeneration in neonates than in adults. Transplants of fibroblasts modified to produce neurotrophic factors however support both recovery and axonal growth even in adults. The contribution of the transplant to recovery is shown by the loss of function that follows a second lesion just rostral to the original lesion/transplant site. The effect of the re-lesion indicates that the recovery is mediated by the presence of the transplant but the way in which transplants act to promote recovery may include a number of mechanisms, including regeneration and sprouting, neuroprotection, and modifications of organization of spared CNS structures.

Animals↗

Cerebellar hemispheric activation ipsilateral to the paretic hand correlates with functional recovery after stroke.

An experimental lesion in the primary motor or sensory cortices in monkeys leads to functional reorganization in areas surrounding the lesion or in contralateral homologous regions. In humans, task-dependent brain activation after motor stroke seems to be multifocal and bilateral. Although many active structures are seen after stroke, their roles are unclear. For instance, the uninjured primary motor cortex may play a significant role in recovery or may be associated with mirror movements. Other motor areas, particularly those outside the affected middle cerebral artery distribution, have also been thought to play such a role, including the medial pre-motor areas and both cerebellar hemispheres. The lateral pre-motor areas might also contribute but the demarcation of primary motor and pre-motor cortices is not trivial. It is not known from existing studies how brain activation relates to behavioural change over the time course of recovery. We used functional MRI (fMRI) to study 12 patients longitudinally over the first 6 months of stroke recovery. All subjects had acute stroke causing unilateral arm weakness and had some ability to move the impaired hand within 1 month. Each patient had both motor testing and fMRI during finger and wrist movements at four points during the observed period. Six of these patients showed good motor recovery, whereas the other six did not. The imaging results support a role for the cerebellum in mediating functional recovery from stroke. The data suggest that patients with good recovery have clear changes in the activation of the cerebellar hemisphere opposite the injured corticospinal tract. Patients with poor recovery do not show such changes in cerebellar activation. No other brain region had a significant correlation with recovery. Interestingly, activation in the cerebellum ipsilateral to the injury increases transiently after stroke, independently of the success of recovery. The present work suggests a possible link between cerebellar activation and behavioural recovery from hand weakness from stroke. The underlying mechanism is not known, but it could relate to haemodynamic changes such as diaschisis or to the postulated role of the cerebellum in motor skill learning.

Acute Disease↗

Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study.

OBJECTIVE: To assess the course and outcome of anorexia nervosa (AN) and bulimia nervosa (BN) at a median of 90 months of follow-up in a large cohort of women with eating disorders. METHOD: A prospective, naturalistic, longitudinal design was used to map the course of AN and BN in 246 women. Follow-up data are presented in terms of full and partial recovery, predictors of time to recovery, and rates and predictors of relapse. RESULTS: The full recovery rate of women with BN was significantly higher than that of women with AN, with 74% of those with BN and 33% of those with AN achieving full recovery by a median of 90 months of follow-up. Intake diagnosis of AN was the strongest predictor of worse outcome. No predictors of recovery emerged among bulimic subjects. Eighty-three percent of women with AN and 99% of those with BN achieved partial recovery. Approximately one third of both women with AN and women with BN relapsed after full recovery. No predictors of relapse emerged. CONCLUSIONS: The findings suggest that the course of AN is characterized by high rates of partial recovery and low rates of full recovery, while the course of BN is characterized by higher rates of both partial and full recovery.

Adolescent↗