Physician Articles
The Impact of a Web-Based Caregiver Intervention on the Reasons Stroke Survivors Use Health Care Services During the First Year Post Treatment
Victoria Steiner, Linda L. Pierce, Felicia Windnagel, Kelly Martincin, Rosalyn Pawlak, and Diane Salvador
Purpose: A Web-based education/support intervention for caregivers of stroke survivors was developed. A prospective, descriptive design was used to identify caregivers’ reported reasons for stroke survivors’ health care service use (i.e., health care provider and emergency department visits, hospital readmissions) during the fi rst year after initial treatment. Method: Caregivers were recruited in the Midwest and randomized into an experimental (Web users, n = 36) or control (non-Web users, n = 37) group. Telephone interviews were conducted with the caregivers every 2 weeks. Reported reasons were organized by group and time period in which the service occurred (i.e., Months 1–6 or 7–12; 1-year totals). Content analysis and descriptive statistics were used to analyze these data. Results: Two themes emerged: wellness- and problem-oriented reasons for health care service use. Web users reported a large percentage of visits for rehabilitations reasons, which may have subsequently contributed to the musculoskeletal issues of this group. Laboratory work and testing was considered by both groups as a primary reason for provider visits. Non-Web users reported that medication adjustment was a common reason for provider visits. They also had more emergency department visits and hospital admissions for cardiology or pulmonology reasons. Conclusion: This study informs professionals about the care and needs of stroke survivors and provides direction for education and supportive interactions with caregivers and survivors. Read the paper
Key words: caregivers, health services, health utilization, stroke, stroke patients
Translational Research Stimulation Award
Progress Report for 1st year (January 2008 – December 2008)
Title: MRI of Human Cortex after Limb Loss
UT Research Group: J. Wall (PI)1, W. Bauer1, N. Chiaia1, M. Dennis2, J. Kane3, R. Lane1, R. Mooney1, and X. Wang1,4; UT Departments of Neurosciences1, Radiology2, Orthopedics3, and Psychiatry4
1. Brief overview, specific aims, and long term objectives
Overview.
The University of Toledo (UT) Translational Research Stimulation Award (TRSA) program was designed to develop new translational research at UT, including generation of pilot data for seeking new extramural funding. Our TRSA funded studies involve a translational research project aimed at doing pilot tests of cortical structural changes in humans who have lost a limb. As stated in the timetable for our original proposal, our goal is to recruit, scan, and analyze 15 amputee and 15 age/gender matched control subjects within 1½ years of the January 2008 starting date. The final ½ year will be used to complete the planned analyses, explore unplanned analyses that may be prompted from the results, and prepare applications for external funding. Our studies to date follow this timetable. Read the complete paper
The Brain in Chronic CRPS Pain:
Abnormal Gray-White Matter Interactions
in Emotional and Autonomic Regions
Paul Y. Geha,1 Marwan N. Baliki,1 R. Norman Harden,2 William R. Bauer,6 Todd B. Parrish,3 and A. Vania Apkarian1,4,5,*
1Department of Physiology
2Rehabilitation Institute
3Department of Radiology
4Department of Anesthesia
5Department of Surgery
Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
6Department of Neuroscience, University of Toledo, 3000 Arlington Avenue, Toledo OH 43614-2598, USA
*Correspondence: a-apkarian@northwestern.edu
DOI 10.1016/j.neuron.2008.08.022
SUMMARY
Chronic complex regional pain syndrome (CRPS) is
a debilitating pain condition accompanied by autonomic
abnormalities. We investigated gray matter
morphometry and white matter anisotropy in CRPS
patients and matched controls. Patients exhibited
a disrupted relationship between whitematter anisotropy
and whole-brain gray matter volume; gray matter
atrophy in a single cluster encompassing right
insula, right ventromedial prefrontal cortex (VMPFC),
and right nucleus accumbens; and a decrease in fractional
anisotropy in the left cingulum-callosal bundle.
Reorganization of white matter connectivity in these
regionswas characterized by branching pattern alterations,
as well as increased (VMPFC to insula) and
decreased (VMPFC to basal ganglion) connectivity.
While regional atrophy differentially related to pain
intensity and duration, the strength of connectivity
between specific atrophied regions related to anxiety.
These abnormalities encompass emotional,
autonomic, and pain perception regions, implying
that they likely play a critical role in the global clinical
picture of CRPS.
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Longitudinal MRI evaluations of human global cortical thickness over minutes to weeks.
Xin Wang, William Bauer, Nicolas Chiaia, Michael Dennis, Mischka Gerken, Jacob Hummel, John Kane, Cynthia Kenmuir, Sadik Khuder, Richard Lane, Richard Mooney, Peter Bazeley, Vania Apkarian, John Wall
Department of Neuroscience, University of Toledo Medical Center, Toledo, OH 43614, United States; Department of Psychiatry, University of Toledo Medical Center, Toledo, OH 43614, United States.
Magnetic resonance imaging (MRI) was used to evaluate within-subject variability in global mean cortical thickness over test-retest intervals of minutes-weeks in five healthy adults. Within-subject measures of global mean thickness were consistent over these intervals. Test-retest assessments of absolute thickness differences and percent thickness differences indicated variations of, respectively, </=0.05-0.06mm and </=+/-1.9-2.3%. There have been few evaluations of normal within-subject variations in cortical thickness. The present results suggest that within-subject variability in global mean cortical thickness can be low over test-retest intervals of minutes-weeks, and that longitudinal scans can establish useful baseline estimates of variability from which to assess changes due to injury, disease, or other experiences.
Prenatal development of the receptive
fields of individual trigeminal ganglion cells in the rat
N. L. Chiaia, W. R. Bauer and R. W. Rhoades
Department of Anatomy, Medical College of Ohio, Toledo 43699.
1. Extracellular single-unit recording and receptive-field mapping techniques were used to evaluate the response characteristics of trigeminal (V) ganglion cells in unanesthetized, decerebrate, fetal rats between the ages of embryonic (E-) day 15 and E-20 (E-0 is the day of conception).
2. The receptive-field properties of the cells (n = 282) recorded at all of these ages except E-15 were remarkably similar; V primary afferents were generally silent in the absence of peripheral stimulation (94.3%) and gave rapidly adapting responses to innocuous tactile stimuli (97.5%). Rapid response decrements to repeated stimuli were observed in 9 of the 14 cells (64%) tested.
3. None of the cells recorded were activated by either heat or cold. No attempt was made to evaluate responses to noxious mechanical stimuli.
4. Particular attention was paid to neurons whose receptive fields involved mystacial vibrissae follicles. At all ages, neurons were recorded that responded to indentation of the skin at the base of the vibrissae, but vibrissa deflection was not an adequate stimulus for any of the cells tested. At all ages, nearly all (89.0%) of the 127 cells with vibrissa-related receptive fields responded to indentation of one and only one follicle.
5. These results indicate that the response properties (e.g., adaptation characteristics, ability to respond to repeated stimuli) of V primary afferents in fetal rats differ substantially from those of V ganglion cells in adult animals, but that the receptive-field size for these neurons in prenatal rats is, with very rare exceptions, adult-like from the earliest age at which they can be recorded.
6. These results, when considered together with the results of previous retrograde tracing experiments in fetal animals, suggest that the initial projections of V primary afferents to their peripheral targets may be quite accurate.
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