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Research paper thumbnail of Halothane Changes the Domain Structure of a Binary Lipid Membrane

X-ray and neutron diffraction studies of a binary lipid membrane demonstrate that halothane at ph... more X-ray and neutron diffraction studies of a binary lipid membrane demonstrate that halothane at physiological concentrations produces a pronounced redistribution of lipids between domains of different lipid types identified by different lamellar d-spacings and isotope composition. In contrast, dichlorohexafluorocyclobutane (F6), a halogenated nonanesthetic, does not produce such significant effects. These findings demonstrate a specific effect of inhalational anesthetics on mixing phase equilibria of a lipid mixture.

Research paper thumbnail of Translational issues in neurorehabilitation

Research paper thumbnail of Brain-computer interface technology: A review of the second international meeting

Over the past decade, many laboratories have begun to explore brain-computer interface (BCI) tech... more Over the past decade, many laboratories have begun to explore brain-computer interface (BCI) technology as a radically new communication option for those with neuromuscular impairments that prevent them from using conventional augmentative communication methods. BCI's provide these users with communication channels that do not depend on peripheral nerves and muscles. This article summarizes the first international meeting devoted to BCI research and development. Current BCI's use electroencephalographic (EEG) activity recorded at the scalp or single-unit activity recorded from within cortex to control cursor movement, select letters or icons, or operate a neuroprosthesis. The central element in each BCI is a translation algorithm that converts electrophysiological input from the user into output that controls external devices. BCI operation depends on effective interaction between two adaptive controllers, the user who encodes his or her commands in the electrophysiological input provided to the BCI, and the BCI which recognizes the commands contained in the input and expresses them in device control. Current BCI's have maximum information transfer rates of 5-25 b/min. Achievement of greater speed and accuracy depends on improvements in signal processing, translation algorithms, and user training. These improvements depend on increased interdisciplinary cooperation between neuroscientists, engineers, computer programmers, psychologists, and rehabilitation specialists, and on adoption and widespread application of objective methods for evaluating alternative methods. The practical use of BCI technology depends on the development of appropriate applications, identification of appropriate user groups, and careful attention to the needs and desires of individual users. BCI research and development will also benefit from greater emphasis on peer-reviewed publications, ).

Research paper thumbnail of Home and Community-Based Long-Term Care: Lessons From Denmark

Purpose: Denmark is cited as a model in the develop- ment of home- and community-based systems fo... more Purpose: Denmark is cited as a model in the develop- ment of home- and community-based systems for the frail elderly population. We examined the results of this natural experiment and considered implications for U.S. policy. Design and Methods: We used international comparative policy analysis, including site visits and semi- structured interviews with Danish leadership in conjunc- tion with a review

Research paper thumbnail of Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model

Neurorehabilitation and Neural Repair, 2009

Objective-To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercis... more Objective-To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.

Research paper thumbnail of Community-Based Exercise for Chronic Disease Management: An Italian Design for the United States?

Neurorehabilitation and Neural Repair, 2014

Although only a small proportion of older adults in the United States engage in recommended amoun... more Although only a small proportion of older adults in the United States engage in recommended amounts of physical exercise, the health benefits of exercise for this population and the potential for lowering health care costs are substantial. However, access to regular exercise programs for the frail elderly and individuals with disabilities remains limited. In the context of health reform and emerging opportunities in developing integrated systems of care, the experience in Tuscany in implementing a community-based program of exercise for the elderly should be of interest.

Research paper thumbnail of Community-Based Exercise for Upper Limb Paresis: A Controlled Trial With Telerehabilitation

Neurorehabilitation and Neural Repair, 2014

Arm paresis remains a major impairment after stroke despite the best conventional rehabilitation.... more Arm paresis remains a major impairment after stroke despite the best conventional rehabilitation. Randomized, controlled trials of intensive exercise programs have demonstrated improvements in arm function for patients with chronic stroke. However, the gains achieved have been relatively modest for the large investments in patient and therapist time. To evaluate the safety, acceptance, adherence, and effectiveness of a community-based exercise program for upper limb paresis in patients with chronic stroke and the effects of telerehabilitation monitoring in kiosks distributed through the community. Longitudinal cohort with geographic control group. The experimental group received devices needed for a home exercise program based on the Carr and Shepherd "Motor Learning Program" and were instructed to practice the exercises at least twice a week at the kiosk and at least 3 more days a week at home. The control group received usual care. Compared with the control group, patients in the experimental group demonstrated significant gains in arm function as measured by the Wolf Motor Function Test, 9-Hole Peg Test, Motricity Index, and Nottingham Extended Activities of Daily Living Questionnaire. The intervention received high satisfaction ratings and produced no adverse events. Only 30% of the subjects attended kiosks regularly. Outcomes for this group did not differ significantly from those who only practiced at home. Home- and community-based exercise for arm paresis is safe and effective. Telerehabilitation interventions will need additional enhancements to improve effectiveness. The optimal upper extremity exercise prescription poststroke remains to be established.

Research paper thumbnail of Toward Neurotechnology Innovation: Report from the 2005 Neural Interfaces Workshop. An NIH-Sponsored Event

Neuromodulation: Technology at the Neural Interface, 2006

innovation and elucidate the sites and mecha nisms of action of DBS.The purpose of this report is... more innovation and elucidate the sites and mecha nisms of action of DBS.The purpose of this report is to highlight scientific presentations and dis

Research paper thumbnail of Adaptive physical activity improves mobility function and quality of life in chronic hemiparesis

The Journal of Rehabilitation Research and Development, 2008

This study investigated the effects of an adaptive physical activity (APA) program on mobility fu... more This study investigated the effects of an adaptive physical activity (APA) program on mobility function and quality of life (QOL) in chronic stroke patients. Twenty subjects with chronic hemiparesis completed a 2-month, combined group, class-home exercise regimen that emphasized mobility training. APA improved Berg Balance Scale scores (35 +/− 2 vs 45 +/− 2, p = 0.001), 6-minute walk distances (114 +/− 15 vs 142 +/− 7 m, p < 0.001), and Short Physical Performance Battery scores (3.2 +/− 0.4 vs 5.2 +/− 0.6, p < 0.001). Barthel Index scores increased (75 +/− 4 vs 84 +/− 4, p < 0.001), but Lawton scores were unchanged. Geriatric Depression Scale (p < 0.01) and Stroke Impact Scale (SIS), Mobility, Participation, and Recovery improved with APA (p < 0.03). APA has the potential to improve gait, balance, and basic but not instrumental activities of daily living profiles in individuals with chronic stroke. Improved depression and SIS scores suggest APA improves stroke-specific outcomes related to QOL.

Research paper thumbnail of Methodological issues in monitoring health services and outcomes for stroke survivors: A case study

Disability and Health Journal, 2010

Background-Obtaining comprehensive health outcomes and health services utilization data on stroke... more Background-Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the NIH and the ISS (its Italian equivalent) to foster collaborative research on rehabilitation.

Research paper thumbnail of Timing, Intensity, and Duration of Rehabilitation for Hip Fracture and Stroke: Report of a Workshop at the National Center for Medical Rehabilitation Research

Neurorehabilitation & Neural Repair, 2004

This article summarizes the proceedings of an NIH workshop on timing, intensity, and duration of ... more This article summarizes the proceedings of an NIH workshop on timing, intensity, and duration of rehabilitation for acute stroke and hip fracture. Participants concentrated on methodological issues facing investigators and suggested priorities for future research in this area.

Research paper thumbnail of Halothane Changes the Domain Structure of a Binary Lipid Membrane

X-ray and neutron diffraction studies of a binary lipid membrane demonstrate that halothane at ph... more X-ray and neutron diffraction studies of a binary lipid membrane demonstrate that halothane at physiological concentrations produces a pronounced redistribution of lipids between domains of different lipid types identified by different lamellar d-spacings and isotope composition. In contrast, dichlorohexafluorocyclobutane (F6), a halogenated nonanesthetic, does not produce such significant effects. These findings demonstrate a specific effect of inhalational anesthetics on mixing phase equilibria of a lipid mixture.

Research paper thumbnail of Translational issues in neurorehabilitation

Research paper thumbnail of Brain-computer interface technology: A review of the second international meeting

Over the past decade, many laboratories have begun to explore brain-computer interface (BCI) tech... more Over the past decade, many laboratories have begun to explore brain-computer interface (BCI) technology as a radically new communication option for those with neuromuscular impairments that prevent them from using conventional augmentative communication methods. BCI's provide these users with communication channels that do not depend on peripheral nerves and muscles. This article summarizes the first international meeting devoted to BCI research and development. Current BCI's use electroencephalographic (EEG) activity recorded at the scalp or single-unit activity recorded from within cortex to control cursor movement, select letters or icons, or operate a neuroprosthesis. The central element in each BCI is a translation algorithm that converts electrophysiological input from the user into output that controls external devices. BCI operation depends on effective interaction between two adaptive controllers, the user who encodes his or her commands in the electrophysiological input provided to the BCI, and the BCI which recognizes the commands contained in the input and expresses them in device control. Current BCI's have maximum information transfer rates of 5-25 b/min. Achievement of greater speed and accuracy depends on improvements in signal processing, translation algorithms, and user training. These improvements depend on increased interdisciplinary cooperation between neuroscientists, engineers, computer programmers, psychologists, and rehabilitation specialists, and on adoption and widespread application of objective methods for evaluating alternative methods. The practical use of BCI technology depends on the development of appropriate applications, identification of appropriate user groups, and careful attention to the needs and desires of individual users. BCI research and development will also benefit from greater emphasis on peer-reviewed publications, ).

Research paper thumbnail of Home and Community-Based Long-Term Care: Lessons From Denmark

Purpose: Denmark is cited as a model in the develop- ment of home- and community-based systems fo... more Purpose: Denmark is cited as a model in the develop- ment of home- and community-based systems for the frail elderly population. We examined the results of this natural experiment and considered implications for U.S. policy. Design and Methods: We used international comparative policy analysis, including site visits and semi- structured interviews with Danish leadership in conjunc- tion with a review

Research paper thumbnail of Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model

Neurorehabilitation and Neural Repair, 2009

Objective-To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercis... more Objective-To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.

Research paper thumbnail of Community-Based Exercise for Chronic Disease Management: An Italian Design for the United States?

Neurorehabilitation and Neural Repair, 2014

Although only a small proportion of older adults in the United States engage in recommended amoun... more Although only a small proportion of older adults in the United States engage in recommended amounts of physical exercise, the health benefits of exercise for this population and the potential for lowering health care costs are substantial. However, access to regular exercise programs for the frail elderly and individuals with disabilities remains limited. In the context of health reform and emerging opportunities in developing integrated systems of care, the experience in Tuscany in implementing a community-based program of exercise for the elderly should be of interest.

Research paper thumbnail of Community-Based Exercise for Upper Limb Paresis: A Controlled Trial With Telerehabilitation

Neurorehabilitation and Neural Repair, 2014

Arm paresis remains a major impairment after stroke despite the best conventional rehabilitation.... more Arm paresis remains a major impairment after stroke despite the best conventional rehabilitation. Randomized, controlled trials of intensive exercise programs have demonstrated improvements in arm function for patients with chronic stroke. However, the gains achieved have been relatively modest for the large investments in patient and therapist time. To evaluate the safety, acceptance, adherence, and effectiveness of a community-based exercise program for upper limb paresis in patients with chronic stroke and the effects of telerehabilitation monitoring in kiosks distributed through the community. Longitudinal cohort with geographic control group. The experimental group received devices needed for a home exercise program based on the Carr and Shepherd &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Motor Learning Program&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and were instructed to practice the exercises at least twice a week at the kiosk and at least 3 more days a week at home. The control group received usual care. Compared with the control group, patients in the experimental group demonstrated significant gains in arm function as measured by the Wolf Motor Function Test, 9-Hole Peg Test, Motricity Index, and Nottingham Extended Activities of Daily Living Questionnaire. The intervention received high satisfaction ratings and produced no adverse events. Only 30% of the subjects attended kiosks regularly. Outcomes for this group did not differ significantly from those who only practiced at home. Home- and community-based exercise for arm paresis is safe and effective. Telerehabilitation interventions will need additional enhancements to improve effectiveness. The optimal upper extremity exercise prescription poststroke remains to be established.

Research paper thumbnail of Toward Neurotechnology Innovation: Report from the 2005 Neural Interfaces Workshop. An NIH-Sponsored Event

Neuromodulation: Technology at the Neural Interface, 2006

innovation and elucidate the sites and mecha nisms of action of DBS.The purpose of this report is... more innovation and elucidate the sites and mecha nisms of action of DBS.The purpose of this report is to highlight scientific presentations and dis

Research paper thumbnail of Adaptive physical activity improves mobility function and quality of life in chronic hemiparesis

The Journal of Rehabilitation Research and Development, 2008

This study investigated the effects of an adaptive physical activity (APA) program on mobility fu... more This study investigated the effects of an adaptive physical activity (APA) program on mobility function and quality of life (QOL) in chronic stroke patients. Twenty subjects with chronic hemiparesis completed a 2-month, combined group, class-home exercise regimen that emphasized mobility training. APA improved Berg Balance Scale scores (35 +/− 2 vs 45 +/− 2, p = 0.001), 6-minute walk distances (114 +/− 15 vs 142 +/− 7 m, p < 0.001), and Short Physical Performance Battery scores (3.2 +/− 0.4 vs 5.2 +/− 0.6, p < 0.001). Barthel Index scores increased (75 +/− 4 vs 84 +/− 4, p < 0.001), but Lawton scores were unchanged. Geriatric Depression Scale (p < 0.01) and Stroke Impact Scale (SIS), Mobility, Participation, and Recovery improved with APA (p < 0.03). APA has the potential to improve gait, balance, and basic but not instrumental activities of daily living profiles in individuals with chronic stroke. Improved depression and SIS scores suggest APA improves stroke-specific outcomes related to QOL.

Research paper thumbnail of Methodological issues in monitoring health services and outcomes for stroke survivors: A case study

Disability and Health Journal, 2010

Background-Obtaining comprehensive health outcomes and health services utilization data on stroke... more Background-Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the NIH and the ISS (its Italian equivalent) to foster collaborative research on rehabilitation.

Research paper thumbnail of Timing, Intensity, and Duration of Rehabilitation for Hip Fracture and Stroke: Report of a Workshop at the National Center for Medical Rehabilitation Research

Neurorehabilitation & Neural Repair, 2004

This article summarizes the proceedings of an NIH workshop on timing, intensity, and duration of ... more This article summarizes the proceedings of an NIH workshop on timing, intensity, and duration of rehabilitation for acute stroke and hip fracture. Participants concentrated on methodological issues facing investigators and suggested priorities for future research in this area.