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Upper limb casting in stroke rehabilitation: rationale, options, and techniques

Flinn, Sharon R; Craven, Kimberly
Upper limb casts have been recommended for stroke survivors with moderate to severe spasticity. The objective of this article is to (a) review the rationale of 2 theoretical models that address spasticity and its consequences, (b) describe 4 casting options reported in the literature, (c) present the evidence for each cast type, and (d) suggest techniques that ensure safe and efficient fabrication of casts. This review underscores the critical need for high-evidence research on the efficacy of casting and the potential long-term benefits to this population. Current evidence lacks controlled research designs, robust sample sizes, and sensitive outcome measures. However, selective groups of stroke survivors have benefited from each type of casting. Future studies are required to assess the impact of casting on upper limb function, especially for those persons with wrist and hand spasticity, and to evaluate the efficacy of those casts not widely adopted in current practice such as inhibitory and drop-out casts.
PMID: 25150661
ISSN: 1074-9357
CID: 1889742

trans-1-[(2-Phenylcyclopropyl)methyl]-4-arylpiperazines: mixed dopamine D(2)/D(4) receptor antagonists as potential antipsychotic agents

Zhang, X; Hodgetts, K; Rachwal, S; Zhao, H; Wasley, J W; Craven, K; Brodbeck, R; Kieltyka, A; Hoffman, D; Bacolod, M D; Girard, B; Tran, J; Thurkauf, A
The dopaminergic receptor profile of a series of trans-1-[(2-phenylcyclopropyl)methyl]-4-arylpiperazines was examined. Aromatic substitution patterns were varied with the goal of identifying a compound having affinities for the D(2) and D(4) receptors in a ratio similar to that observed for the atypical neuroleptic clozapine. The compounds (1S, 2S)-trans-1-[(2-phenylcyclopropyl)methyl]-4-(2, 4-dichlorophenyl)piperazine (5m) and (1S, 2S)-trans-1-[(2-phenylcyclopropyl)methyl]-4-(2, 4-dimethylphenyl)piperazine (5t) were selected for functional antagonists at D(2) and D(4) receptors and had a D(2)/D(4) ratio approximating that of clozapine; they proved inactive in behavioral tests of antipsychotic activity.
PMID: 11052797
ISSN: 0022-2623
CID: 2060882

Local cerebral blood flow during the first hour following acute ligation of multiple arterioles in rat whisker barrel cortex

Wei, L; Craven, K; Erinjeri, J; Liang, G E; Bereczki, D; Rovainen, C M; Woolsey, T A; Fenstermacher, J D
The objectives are to measure the early time-course of the flows of blood, red cells, and plasma in brain tissue destined to infarct following arterial occlusion. The flux of fluorescent red blood cells (fRBCs) through venules and the arteriovenous transit times (AVTT) of fluorescein-labeled plasma albumin were periodically monitored in anesthetized adult Wistar rats before and up to 60 min after permanent ligations of several small branches of the middle cerebral artery. Of note, fRBC is a function of venular erythrocyte flow and volume, whereas AVTT is a function of plasma flow and volume in visible arteriole-capillary-venule units. In another group of anesthetized rats, local cerebral blood flow (ICBF) was measured 1 h after permanent arterial occlusion by [14C]iodoantipyrine (IAP) autoradiography. With this model of focal ischemia, the lesion is highly reproducible and involves part of the whisker barrel cortex. Infarction of this area was observed in 12 of 13 rats. From 10 to 60 min after arterial occlusion, AVTT was nearly four times longer in the ischemic barrel cortex than at the same site before ligations, and fRBC flux was 25%. Neither parameter changed appreciably over this time. After 60 min of ischemia, ICBF on the ipsilateral barrel cortex was 18% of that on the contralateral side and 15% of the sham control value for the same area of the barrel cortex. Since whole blood flow in the ischemic barrel cortex was < 20% of normal at 60 min and AVTT and fRBC flux were essentially constant from 10 to 60 min, the rates of plasma and red cell flows were similarly depressed during the first hour of arteriolar occlusion. In conclusion, such lowering of red cell, plasma, and blood flows produced consistent infarctions in the barrel cortex
PMID: 9848087
ISSN: 0969-9961
CID: 79271