Schwab Rehabilitation Hospital

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal

A central fatigue factor (satiation of orientation) is proposed to account for reversals of the Necker cube. During viewing, the figure process mediating one orientation becomes satiated, a threshold level is reached and a reversal is reported. The conception places no special importance on retinal locus of the figure since it is not any one part of the central process that satiates but rather the process mediating one particular orientation. To support this analysis, the cube was presented tachistoscopically so that growth of satiation would be interrupted before threshold was reached. When presented repetitively, the satiation summated with residual satiation generated by preceding exposures until the threshold was reached and a reversal was reported. When, however, the interval between successive exposures of the cube was lengthened to permit the satiative processes to decay to a minimal value after each exposure, then no summation took place, the threshold was never reached and reversals were never reported.

One innovation currently influencing physical medicine and rehabilitation is brain-computer interface (BCI) technology. BCI systems used for motor control record neural activity associated with thoughts, perceptions, and motor intent; decode brain signals into commands for output devices; and perform the user's intended action through an output device. BCI systems used for sensory augmentation transduce environmental stimuli into neural signals interpretable by the central nervous system. Both types of systems have potential for reducing disability by facilitating a user's interaction with the environment. Investigational BCI systems are being used in the rehabilitation setting both as neuroprostheses to replace lost function and as potential plasticity-enhancing therapy tools aimed at accelerating neurorecovery. Populations benefitting from motor and somatosensory BCI systems include those with spinal cord injury, motor neuron disease, limb amputation, and stroke. This article discusses the basic components of BCI for rehabilitation, including recording systems and locations, signal processing and translation algorithms, and external devices controlled through BCI commands. An overview of applications in motor and sensory restoration is provided, along with ethical questions and user perspectives regarding BCI technology.

Daily seminal discharges were observed when individually caged male rats were prevented from grooming the genital region orally.

MOTIVATION: Simple sequence repeats (SSRs) or microsatellite repeats are found abundantly in many prokaryotic and eukaryotic genomes. Among SSRs, triplet repeats are of special significance because some of them have been linked to various genetic disorders. The objective of the study is to analyze the triplet repeats of complete human genome and to identify the genes that contain the triplet repeats in their coding region. The analysis will help us to identify the candidate genes that have potential for repeat expansion. RESULTS: We have analyzed triplet repeats in the complete human genome from the publicly available sequences. Our analysis revealed that AGC and CCG repeat were predominantly present in the coding regions of the genome while UTRs and the upstream sequences contained CCG repeats in relative abundance. Analysis of density of triplet repeats (bp/Mb) revealed that AAT and AAC were the abundant repeats whereas ACT and ACG were the rare repeats found in human genome. We could identify about 2135 known or predicted genes that were associated with at least one of the triplet repeat types. A large proportion of putative transcripts that were identified by gene finding programs were found to be associated with triplet repeats. These transcripts will be the candidate genes for analysis of triplet repeat expansion and a possible association with disease phenotypes. Identification of 171 genes which contain a minimum of ten repeat units will be of particular interest in future in correlating their association with any disease phenotype due to the expansion potential of repeats present in them. The list of genes and other details of analysis are given in the online supplementary data (http://www.ingenovis.com/tripletrepeats).

Physiologic recordings of palmar resistance, respiration rate, heart rate, blood pressure, and muscle action potentials in seven different skeletal muscles were recorded among psychiatric patients and normal persons during a resting state and in response to a white noise. Results showed that these patients, all in the early stages of illness, responded at physiologic levels which were at least as high as those of the normals. Psychotic and depressive disorders were two types of mal-adjustment characterized by exaggerated physiologic responses. This was particularly true for the skeletal muscles in response to the auditory stimulus.

PURPOSE: This qualitative study explored mothers' perceptions of their children's communication disabilities, emergent literacy development, and speech-language therapy programs. METHOD: Participants were 14 Mexican immigrant mothers and their children (age 17-47 months) who were receiving center-based services from an early childhood intervention program, located in a large urban city in the Midwestern United States. Mother interviews composed the primary source of data. A secondary source of data included children's therapy files and log notes. Following the analysis of interviews through the constant comparative method, grounded theory was generated. RESULTS: The majority of mothers perceived their children as exhibiting a communication delay. Causal attributions were diverse and generally medical in nature (i.e., ear infections, seizures) or due to familial factors (i.e., family history and heredity, lack of extended family). Overall, mothers seemed more focused on their children's speech intelligibility and/or expressive language in comparison to emergent literacy abilities. CONCLUSIONS: To promote culturally responsive intervention, mothers recommended that professionals speak Spanish, provide information about the therapy process, and use existing techniques with Mexican immigrant families.

The effects of Systematic Motivational Counseling (SMC) on adults following traumatic brain injury (TBI) were assessed. The sample comprised 40 participants in the SMC Group who received 12 individual SMC sessions and 54 participants in the Comparison Group who received no motivational or substance-abuse treatment. Both groups received rehabilitation for their brain injuries. The SMC additionally focused on participants' personal goals and concerns in various areas of their lives, and helped them to formulate and execute concrete and realistic plans for resolving their concerns. To assess changes across time in the SMC Group, motivational structure, positive and negative affect, and substance use were measured at baseline, immediately after the intervention (mean of 10.2 months from baseline), and at a follow-up (mean of 9.1 months later). Because the comparison group had no SMC intervention, only two assessments were taken: at baseline and at a follow-up (mean of 12.8 months later). Across time, the SMC Group showed significant improvements in motivational structure and a significant reduction in negative affect and the use of substances of abuse. There were no corresponding changes in the Comparison Group. The results indicate that SMC improves motivational indices and may help to moderate substance use; hence they suggest a potential role for SMC in the rehabilitation of patients with TBI.

In this paper we present the first patient-based results for a micro computer-based EMG signature-controlled functional electrical stimulation (FES) system, for restoring walker-supported and brace-free primitive walking to complete paraplegics, at the patients own command. Stimulation is thus controlled directly by the patient's own EMG signatures, generated by him at will, and which are produced by him at his erector spinae back muscles (while activating these muscles more or less as he would during normal walking, had the person not been a paraplegic). In this manner a switch-free simplistic but reliable information-gap is produced across the paraplegic's lesion, such that the above lesion's relatively normal EMG provides the control command to electrical stimulation of paralyzed peripheral (lower limb) nerves, to provide the basic functions of standing up, sitting-down and walking. The FES signals are at pulse rates close to the average ones occurring naturally at the corresponding nerves. The paper reports actual patient results for 3 paraplegics, two at T-9 (one complete, one with only residual sensation) and one T-6 complete paraplegic, who all subsequently achieved walking between parallel bars and two even with a walker (no braces in all cases), using the FES system, this walking being, to our knowledge the first hand-switch-free patient-controlled FES walking reported ever. The EMG signature-discrimination for control is as previously developed by D. Graupe for artificial-limb control, and it depends only on the EMG signature temporal parameters, while completely ignoring EMG power (amplitude) level. Whereas all 3 patients produced EMG parameters in the range reported below, adequate for controlling all functions involved, only one, a T-6 complete paraplegic, has so far (due to time limitations) achieved EMG controlled walking between parallel bars and by now also a few steps with a walker. One T-9 complete paraplegic, injured 5 years before coming to our program, was however able, within 4 weeks, to walk via FES with a walker, though with manual control. Note that the present approach is valid only for upper motor neuron paralysis situations (intact peripheral nerves and muscles). We are thus also attempting to apply this approach to certain hemiplegics and quadraplegics, for restoring some upper limb functions, using EMG signals from the trapezius (shoulder) level.

The primary motor (M1) and somatosensory (S1) cortices play critical roles in motor control but the signaling between these structures is poorly understood. To fill this gap, we recorded - in three participants in an ongoing human clinical trial (NCT01894802) for people with paralyzed hands - the responses evoked in the hand and arm representations of M1 during intracortical microstimulation (ICMS) in the hand representation of S1. We found that ICMS of S1 activated some M1 neurons at short, fixed latencies consistent with monosynaptic activation. Additionally, most of the ICMS-evoked responses in M1 were more variable in time, suggesting indirect effects of stimulation. The spatial pattern of M1 activation varied systematically: S1 electrodes that elicited percepts in a finger preferentially activated M1 neurons excited during that finger's movement. Moreover, the indirect effects of S1 ICMS on M1 were context dependent, such that the magnitude and even sign relative to baseline varied across tasks. We tested the implications of these effects for brain-control of a virtual hand, in which ICMS conveyed tactile feedback. While ICMS-evoked activation of M1 disrupted decoder performance, this disruption was minimized using biomimetic stimulation, which emphasizes contact transients at the onset and offset of grasp, and reduces sustained stimulation.

Lesions to the olfactory stalk, medial olfactory area, and hippocampus were produced in rats at 3–19 days of age. Delayed puberty occurred in the females with bilateral olfactory stalk and medial olfactory area lesions. Unilateral lesions of the olfactory stalk were also effective in delaying vaginal opening. Deficiencies in growth and smaller endocrine organs occurred in both sexes with a variety of lesions. Early handling affected final body and adrenal weights in both operated and control rats.

Tactile feedback from brain-controlled bionic hands can be partially restored via intracortical microstimulation (ICMS) of the primary somatosensory cortex. In ICMS, the location of percepts depends on the electrode’s location and the percept intensity depends on the stimulation frequency and amplitude. Sensors on a bionic hand can thus be linked to somatotopically appropriate electrodes, and the contact force of each sensor can be used to determine the amplitude of a stimulus. Here we report a systematic investigation of the localization and intensity of ICMS-evoked percepts in three participants with cervical spinal cord injury. A retrospective analysis of projected fields showed that they were typically composed of a focal hotspot with diffuse borders, arrayed somatotopically in keeping with their underlying receptive fields and stable throughout the duration of the study. When testing the participants’ ability to rapidly localize a single ICMS presentation, individual electrodes typically evoked only weak sensations, making object localization and discrimination difficult. However, overlapping projected fields from multiple electrodes produced more localizable and intense sensations and allowed for a more precise use of a bionic hand. An analysis of the localization and intensity of intracortical microstimulation in three participants with cervical spinal cord injury shows that overlapping projected fields from multiple electrodes produce sensations that are more easily localizable.

KEPECS, JOSEPH G. M.D.; ROBIN, MILTON M.D.; BRUNNER, MATTHEW J. M.D. Author Information

The sociocultural framework highlights the contributions of children's cultural and linguistic contexts to early language and literacy development. To collaborate with parents in early intervention programs, including speech—language therapy, there must be a sincere commitment to the development of cultural competence. Hispanics are one of the largest and fastest growing minority groups within the United States. The goal of this study was to identify Mexican immigrant mothers' perceptions and beliefs about language development, their children's disabilities, and therapy activities. Additionally, it explored how these perceptions and beliefs inform culturally responsive speech— language therapy with families of Mexican descent.

Previous literature has suggested that reflex sympathetic dystrophy, also known as complex regional pain syndrome (CRPS) type 1, is a relatively common finding after a stroke. However, much of this data was obtained before patients routinely received early intensive inpatient rehabilitation. The purpose of this study is to reevaluate the incidence of CRPS type 1 following an acute first stroke. Subjects admitted to an acute rehabilitation setting for stroke with no other concomitant neurologic or orthopedic injuries between October 1, 1996, and May 31, 1997, were studied. At admission and once a week until discharge, subjects were evaluated for shoulder pain, decreased passive range of motion of the shoulder, wrist/hand pain, edema, and skin changes. If three of these five criteria were positive, the subjects underwent a triple-phase bone scan (TPBS). Bone scan findings consistent with CRPS type 1 were taken as confirming the diagnosis. Of 64 subjects, 13 underwent bone scans, with only one positive result. Thus our study revealed a 1.56 percent incidence of CRPS type 1 following a first stroke. This incidence is much lower than the historically accepted 12.5 percent. We speculate that this low figure is related to early comprehensive rehabilitation that included proper upper extremity positioning and early mobilization with sensory stimulation.

Institute for Psychosomatic and Psychiatric Research and Training of the Michael Reese Hospital, Chicago, Illinois *Michigan State College Received October 24, 1949

Manual interactions with objects are supported by tactile signals from the hand. This tactile feedback can be restored in brain-controlled bionic hands via intracortical microstimulation (ICMS) of somatosensory cortex (S1). In ICMS-based tactile feedback, contact force can be signaled by modulating the stimulation intensity based on the output of force sensors on the bionic hand, which in turn modulates the perceived magnitude of the sensation. In the present study, we gauged the dynamic range and precision of ICMS-based force feedback in three human participants implanted with arrays of microelectrodes in S1. To this end, we measured the increases in sensation magnitude resulting from increases in ICMS amplitude and participant's ability to distinguish between different intensity levels. We then assessed whether we could improve the fidelity of this feedback by implementing "biomimetic" ICMS-trains, designed to evoke patterns of neuronal activity that more closely mimic those in natural touch, and by delivering ICMS through multiple channels at once. We found that multi-channel biomimetic ICMS gives rise to stronger and more distinguishable sensations than does its single-channel counterpart. Finally, we implemented biomimetic multi-channel feedback in a bionic hand and had the participant perform a compliance discrimination task. We found that biomimetic multi-channel tactile feedback yielded improved discrimination over its single-channel linear counterpart. We conclude that multi-channel biomimetic ICMS conveys finely graded force feedback that more closely approximates the sensitivity conferred by natural touch.

Kittens sustaining bilateral amygdalectomy failed to show behavioral changes seen in the adult after subjection to similar lesions. No growth deficits or hypopituitarism occurred in the kittens. A certain level of neuroendocrine maturation may be necessary for the effects of amygdalectomy to be manifested.

A 17-year-old dual personality was treated with techniques derived from hypnotherapy and adapted for use without hupnosis induction. The mechanism of hypnotically induced dissociation is thought to be identical with that of dissociation in multiple personality. Like the hypnotic subject, the second personality usually has access to material not available to ordinary consciousness. Therapists are cautioned against showing too much interest in the dissociated personality as this subtly reinforces the dramatic aspects of this condition. Hypnosis, while commonly used in such cases for contact with the dissociated personality, is thought to be counterindicated for the same reason, and also because it may be interpreted by the patient as a sanction of the dissociative process. The result tends to be a further splitting off of personality fragments. However, a working knowledge of the dynamics of hypnosis and of hypnotherapeutic techniques can make a unique contribution to the therapy of dual or multiple personalities

Early intervention programs are developed on the premise that parents or primary caregivers generalize treatment strategies within naturalistic environments. The diverse characteristics of children within early language intervention reinforce the urgency for services that consider the needs of each child within his or her broader social, cultural, and familial context. Furthermore, effective language interventions require the integration of many factors including cognitive, linguistic, and cultural influences. This article presents strategies for implementing collaborative, family-centered language intervention with Hispanic parents and their children with communication disabilities. General strategies include establishing a trusting relationship, valuing parents as experts of their children, creating mutually constructed goals, accommodating families’ schedules and roles, individualizing intervention in the home language, and encouraging parental education and advocacy. The intent of this article is to guide understanding of communication disabilities among young Hispanic children and provide speech-language pathologists with information on implementing evidence-based practices.