Clinical Neurophysiology Symposium: Fill & Download for Free

Absolutely. There is tremendous scientific evidence of the capacity of meditation to effect many aspects of brain functioning in a positive manner. Here is just a fraction of evidence available.Because many here are quick to dismiss the value of such techniques, I have taken pains to offer ample sources of these pieces of information:Stanford University: A meta-analysis of 146 independent studies found that the Transcendental Meditation technique is effective in reducing trait anxiety. Reference:Journal of Clinical Psychology, 45 (1989): 957–974.published, peer-reviewed research is finding that the Transcendental Meditation technique also has a profound effect on enhancing wellness and reducing health care spending.This study measured the change in payments for physicians’ services over 14 years among 1,418 people in Canada who learned the Transcendental Meditation technique, in comparison to 1,418 controls randomly selected from individuals of the same age, gender, and region. After learning the TM technique, individuals showed a significant annual decline of 13.8 per cent in payments for physicians’ services. Reference:American Journal of Health Promotion 14:Alterations in Brain and Immune Function Produced by Mindfulness MeditationAlterations in Brain and Immune Function Produced by Mindfulness MeditationAbstractOBJECTIVE: The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well-known and widely used 8-week clinical training program in mindfulness meditation applied in a work environment with healthy employees.METHODS: We measured brain electrical activity before and immediately after, and then 4 months after an 8-week training program in mindfulness meditation. Twenty-five subjects were tested in the meditation group. A wait-list control group (N = 16) was tested at the same points in time as the meditators. At the end of the 8-week period, subjects in both groups were vaccinated with influenza vaccine.RESULTS: We report for the first time, significant increases in left-sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group. Finally, the magnitude of increase in left-sided activation predicted the magnitude of antibody titer rise to the vaccine.CONCLUSIONS: These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.Meditation practices have various health benefits including the possibility of preserving cognition and preventing dementia. While the mechanisms remain investigational, studies show that meditation may affect multiple pathways that could play a role in brain aging and mental fitness.For example, meditation may reduce stress-induced cortisol secretion and this could have neuroprotective effects potentially via elevating levels of brain derived neurotrophic factor (BDNF). Meditation may also potentially have beneficial effects on lipid profiles and lower oxidative stress, both of which could in turn reduce the risk for cerebrovascular disease and age-related neurodegeneration.Further, meditation may potentially strengthen neuronal circuits and enhance cognitive reserve capacity. These are the theoretical bases for how meditation might enhance longevity and optimal health. Evidence to support a neuroprotective effect comes from cognitive, electroencephalogram (EEG), and structural neuroimaging studies. In one cross-sectional study, meditation practitioners were found to have a lower age-related decline in thickness of specific cortical regions. However, the enthusiasm must be balanced by the inconsistency and preliminary nature of existing studies as well as the fact that meditation comprises a heterogeneous group of practices. Key future challenges include the isolation of a potential common element in the different meditation modalities, replication of existing findings in larger randomized trials, determining the correct “dose,” studying whether findings from expert practitioners are generalizable to a wider population, and better control of the confounding genetic, dietary and lifestyle influences.Scientific evidence that Transcendental Meditation works“TM dramatically reduces high blood pressure. It also reduces cholesterol, atherosclerosis, obesity, risk of stroke—even lowers death rates due to cardiovascular disease. But this is just the tip of the iceberg. There are so many other benefits to mind and body.”—Mehmet Oz, M.D., Emmy Award-winning host of The Dr. Oz ShowHundreds of scientific studies have been conducted on the benefits of the Transcendental Meditation program at more than 200 independent universities and research institutions worldwide over the past 40 years. The National Institutes of Health have awarded over $26 million to research the effectiveness of TM for reducing stress and stress-related illness with a focus on cardiovascular disease. Findings have been published in leading, peer-reviewed scientific journals, including The American Journal of Cardiology and the American Heart Association’s Hypertension and Stroke.Research Summary http://...Benefits to EducationFindings:10% improvement in test scores and GPAEducation 131: 556–565, 201186% reduction in suspensions over two yearsSan Francisco Unified School District65% decrease in violent conflict over two yearsJohn O'Connell High School dataReduced ADHD symptoms and symptoms of other learning disordersMind & Brain: The Journal of Psychiatry 2 (1): 73-81, 2011Highly effective for increasing creativityIntelligence 29: 419-440, 200140% reduction in psychological distress, including stress, anxiety and depressionAmerican Journal of Hypertension 22(12): 1326-1331, 2009http://...Benefits to Veterans40-55% reduction in symptoms of PTSD and depressionMilitary Medicine 176 (6): 626-630, 201142% decrease in insomniaJournal of Counseling and Development 64: 212-215, 198525% reduction in plasma cortisol levelsHormones and Behavior 10: 54–60, 1978Decreased high blood pressure–on par with first-line antihypertensivesAmerican Journal of Hypertension 21: 310–316, 200847% reduced risk of cardiovascular-related mortalityCirculation: Cardiovascular Quality and Outcomes 5: 750-758, 201230% improvement in satisfaction with quality of lifeMilitary Medicine 176 (6): 626-630, 2011http://...Benefits to Abused Women and GirlsReduced flashbacks and bad memoriesMilitary Medicine 176 (6): 626-630, 2011Greater resistance to stressPsychosomatic Medicine 35: 341–349, 1973Twice the effectiveness of conventional approaches for reducing alcoholism and substance abuseAlcoholism Treatment Quarterly 11: 13-87, 199442% decrease in insomniaJournal of Counseling and Development 64: 212-215, 1985Twice as effective as other relaxation techniques for decreasing trait anxietyJournal of Clinical Psychology 45(6): 957–974, 1989Improved quality of lifeMilitary Medicine 176 (6): 626-630, 2011Universities and Medical SchoolsResearch has been conducted on the Transcendental Meditation program at 250 independent universities and medical schools, including:Harvard Medical SchoolYale Medical SchoolUniversity of Virginia Medical CenterUniversity of Michigan Medical SchoolUniversity of Chicago Medical SchoolUniversity of Southern California Medical SchoolUCLA Medical SchoolUCSF Medical SchoolStanford Medical SchoolUniversity of Connecticut:At-risk adolescents reduce stress, anxiety and hyperactivity through Transcendental MeditationThis newly completed study found that 106 at-risk adolescents in three high schools reduced their levels of stress, anxiety, hyperactivity and emotional problems when practicing the Transcendental Meditation technique for four months at school, as compared with controls.Robert Colbert, Ph.D., Assistant Professor of Educational Psychology, University of ConnecticutAnnual Meeting of the Society for Behavioral Medicine, March 2008American University:Transcendental Meditation produces positive effects on health, brain functioning and cognitive development in studentsThis two-year study of 250 students attending American University and surrounding colleges in Washington, D.C., found that the TM program produced beneficial effects for health, brain functioning and cognitive development compared to controls.David Haaga, Ph.D., Professor and Director of the James J. Gray Psychotherapy Training Clinic, American UniversityAmerican Journal of Hypertension, 2009International Journal of Psychophysiology, 2009Cedars-Sinai Medical Center–Los Angeles:Transcendental Meditation reduces hypertension, obesity and diabetes in patients with coronary heart diseaseThis study of 103 people with coronary heart disease found that individuals practicing Transcendental Meditation for four months had significantly lower blood pressure, improved blood glucose and insulin levels (which signify reduced insulin resistance), and more stable functioning of the autonomic nervous system compared to controls.C. Noel Bairey Merz, M.D., Director of the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center; Professor of Medicine at the UCLA Medical SchoolAmerican Medical Association’s Archives of Internal Medicine, June 2006Medical University of Georgia:Reduced high blood pressure among high school studentsThis eight-month study of 156 hypertensive African American high school students found that the Transcendental Meditation program reduced high blood pressure among the meditating students as compared with little or no change in the control group (twenty percent of African American teenagers suffer from high blood pressure).Vernon Barnes, Ph.D., physiologist and research scientist, Georgia Prevention Institute, Medical College of GeorgiaAmerican Journal of Hypertension, April 2004University of Michigan:Transcendental Meditation reduces stress and increases happiness among middle school studentsTwo studies on 60 sixth-graders at two middle schools found the practice of Transcendental Meditation over four months positively affected emotional development in early adolescent children in a school setting. Meditating students also had significantly higher scores on affectivity, self-esteem and emotional competence.Rita Benn, Ph.D., Director of Education, Complementary & Alternative Medicine Research Center, University of MichiganNational Institutes of Health in Bethesda, Maryland, April 2003University of California at Irvine:Transcendental Meditation reduces the brain’s reaction to stressIn this pilot study, 12 subjects practicing Transcendental Meditation for 30 years showed a 40–50% lower brain response to stress and pain compared to 12 healthy controls. Further, when the controls then learned and practiced Transcendental Meditation for five months, their brain responses to stress and pain also decreased by a comparable 40–50%.David Orme-Johnson, Ph.D., study director, Neuroimaging Laboratory, University of California at IrvineNeuroReport, August 2006Bibliography of the research findingsrelevant to educationImproved Brain FunctioningHuman Physiology 25 (1999) 171-180.Psychophysiology 31 Abstract (1994) S67.Psychophysiology 27 Supplement (1990) 4A.Psychophysiology 26 (1989) 529.International Journal of Neuroscience 15 (1981) 151-157.International Journal of Neuroscience 14: (1981) 147–151.International Journal of Neuroscience 13: (1981) 211-217.Psychosomatic Medicine 46: (1984) 267–276.Increased Blood Flow to the BrainPhysiology & Behavior, 59(3) (1996): 399-402 .American Journal of Physiology 235(1)(1978): R89–R92.Psychophysiology 13 (1976): 168.The Physiologist 21 (1978): 60.Increased Flexibility of Brain FunctioningBiological Psychology, 55 (2000): 41-55.Psychophysiology 14 (1977): 293–296.Increased Efficiency of Information Transfer in the BrainMotivation, Motor and Sensory Processes of the Brain, Progress in Brain Research 54 (1980): 447–453.International Journal of Neuroscience 10 (1980): 165–170.Psychophysiology 26 (1989): 529.Mobilization of the Latent Reserves of the BrainProceedings of the International Symposium: Physiological and Biochemical Basis of Brain Activity, St. Petersburg, Russia, (June 22–24, 1994).Increased Intelligence in Secondary and College StudentsIntelligence 29/5 (2001): 419-440.Journal of Personality and Individual Differences 12 (1991): 1105–1116.Perceptual and Motor Skills 62 (1986): 731–738.College Student Journal 15 (1981): 140–146.Journal of Clinical Psychology 42 (1986): 161–164.Gedrag: Tijdschrift voor Psychologie [Behavior: Journal of Psychology] 3 (1975): 167–182.Dissertation Abstracts International 38(7) (1978): 3372B–3373B.Higher Education Research and Development 15 (1995): 73–82.Increased CreativityJournal of Personality and Social Psychology 57 (1989) 950-964.The Journal of Creative Behavior 19 (1985) 270-275.Dissertation Abstracts International 38(7): 3372B–3373B, 1978.Improved MemoryMemory and Cognition 10 (1982): 207–215.Improved Academic PerformanceEducation 107 (1986): 49–54.Education 109 (1989): 302–304.British Journal of Educational Psychology 55 (1985): 164–166.Benefits in Special EducationJournal of Clinical Psychiatry 42 (1981) 35-36.Journal of Biomedicine 1 (1980) 73-88.Increased Integration of PersonalityIncreased Self-Confidence and Self-ActualizationJournal of Social Behavior and Personality 6 (1991): 189–247.Higher Stages of Human Development: Perspectives on Adult Growth (New York: Oxford University Press, 1990), 286–341.British Journal of Psychology 73 (1982) 57-68.College Student Journal 15 (1981): 140–146.Journal of Counseling Psychology 20 (1973): 565-566.Journal of Counseling Psychology 19 (1972): 184–187.Improved PerceptionPerceptual and Motor Skills 49 (1979): 270.Perceptual and Motor Skills 64 (1987): 1003–1012.Increased Efficiency of Perception and MemoryMemory and Cognition 10 (1982): 207–215.Orientation Towards Positive ValuesPerceptual and Motor Skills 64 (1987): 1003–1012.Improved Problem-Solving AbilityPersonality and Individual Differences 12 (1991): 1105–1116.Dissertation Abstracts International 38(7): 3372B–3373B, 1978.Decreased HostilityCriminal Justice and Behavior 5 (1978): 3–20.Criminal Justice and Behavior 6 (1979): 13–21.Improved Left Hemispheric Functioning—Improved Verbal and Analytical ThinkingThe Journal of Creative Behavior 13 (1979): 169–180.The Journal of Creative Behavior 19 (1985): 270–275.Perceptual and Motor Skills 62 (1986): 731–738.Improved Right Hemispheric Functioning—Improved Synthetic and Holistic ThinkingThe Journal of Creative Behavior 13 (1979): 169–180.Journal of Clinical Psychology 42 (1986): 161–164.Biofeedback and Self-Regulation 2 (1977): 407–415.Increased Field Independence—Increased Resistance to Distraction and Social PressurePerceptual and Motor Skills 39 (1974): 1031–1034.Perceptual and Motor Skills 65 (1987): 613–614.Perceptual and Motor Skills 59 (1984): 999-1000.Dissertation Abstracts International 38(7) (1978): 3372B–3373B.Reduced AnxietyJournal of Clinical Psychology 45 (1989) 957-974.Anxiety, Stress and Coping: An International Journal 6 (1993) 245-262.Journal of Clinical Psychology 33 (1977) 1076-1078.Dissertation Abstracts International 38(7) (1978): 3372B–3373B.Hospital & Community Psychiatry 26 (1975): 156–159.Decreased DepressionJournal of Counseling and Development 64 (1986): 212–215.Journal of Humanistic Psychology 16(3)(1976): 51–60.Gedrag: Tijdschrift voor Psychologie [Behavior: Journal of Psychology] 4 (1976): 206–218.Improved School-Related BehaviorReduction of Anger, Absenteeism, Disciplinary Infractions and SuspensionsAnnals of Behavioral Medicine 23 (2001) S100.Health and Quality of Life Outcomes 1 (2003): 10.Increased ToleranceThe Journal of Psychology 99 (1978): 121-127.International Journal of the Addictions 26 (1991): 293-325.Dissertation Abstracts International 38(7) (1978): 3372B–3373B.Reduced Substance AbuseAlcoholism Treatment Quarterly 11 (1994) 1-524.Bulletin of the Society of Psychologists in Addictive Behaviors 2 (1983) 28-33.The International Journal of the Addictions 12 (1977) 729-754.Journal of Offender Rehabilitation 36 (2003): 127–160.American Journal of Psychiatry 132 (1975): 942–945.American Journal of Psychiatry 131 (1974): 60–63.Accelerated Cognitive Development in ChildrenPerceptual and Motor Skills 65 (1987): 613–614Journal of Social Behavior and Personality 17 (2005): 65–91.Journal of Social Behavior and Personality 17 (2005): 47–64.Greater Interest in Academic ActivitiesWestern Psychologist 4 (1974): 104–111.Improved HealthPhysiological RestAmerican Physiologist 42 (1987) 879-881.Science 167 (1970) 1751-1754.American Journal of Physiology 221 (1971) 795-799.Increased Muscle RelaxationElectroencephalography and Clinical Neurophysiology 35 (1973): 143–151.Psychopathométrié 4 (1978): 437–438.Faster ReactionsPersonality and Individual Differences 12 (1991): 1106–1116.Perceptual and Motor Skills 38 (1974): 1263–1268.Perceptual and Motor Skills 46 (1978): 726.Motivation, Motor and Sensory Processes of the Brain, Progress in Brain Research 54 (1980): 447–453.L’Encéphale [The Brain] 10 (1984): 139–144.Decreased Stress Hormone (Plasma Cortisol)Hormones and Behavior 10(1)(1978): 54–60.Journal of Biomedicine 1 (1980): 73–88.Clinical and Experimental Pharmacology and Physiology 7 (1980): 75–76.Experientia 34 (1978): 618–619.Increased Stability of the Autonomic Nervous SystemPsychosomatic Medicine 35 (1973): 341–349.Psychosomatic Medicine 44 (1982): 133–153.Healthier Response to StressPsychosomatic Medicine 35 (1973): 341–349.Journal of Counseling and Development 64 (1986): 212–215.Psychosomatic Medicine 49 (1987): 212–213.Journal of Psychosomatic Research 33 (1989): 29–33.Psychosomatic Medicine 44 (1982): 133-153.International Journal of Neuroscience 46 (1989): 77-86.Reduced Blood Pressure in AdolescentsAnnals of Behavioral Medicine 22 (2000) S133.American Journal of Hypertension (2004).Decreased Blood Pressure in Hypertensive SubjectsHypertension 26 (1995): 820-827.Journal of Personality and Social Psychology 57 (1989): 950–964.Decreased InsomniaThe New Zealand Family Physician 9 (1982): 62–65.Journal of Counseling and Development 64 (1986): 212–215.Japanese Journal of Public Health 37 (1990): 729.Healthier Family LifePsychological Reports 51 (1982): 887–890.Journal of Counseling and Development 64 (1986): 212–215Lower Health Insurance Utilization RatesPsychosomatic Medicine 49 (1987) 493-507.American Journal of Health Promotion 10 (1996) 208-216.Improved Mind-Body CoordinationJournal of Clinical Psychology 42 (1986) 161-164.Perceptual and Motor Skills 46 (1978) 726.Perceptual and Motor Skills 38 (1974) 1263-1268.

Thanks for the A2A.It has laid the perfect foundation for my future education in Medicine.My experience :Our college started on 1st July. We were the first batch to be taught according to the new curriculum. It was a boon because we had 6 weeks of foundation course.Foundation course stressed on medical outlook, language and communications, sensitization to medical research. It was fun. We had outings and visits to Rural health centres and museums. I enjoyed it as it was like an extended vacation.The actual classes in Anatomy, Physiology and Biochemistry started on 16th August.So our curriculum was cut short to 8 months. It was divided into 4 modules. Every module was of 6 weeks. First was about Locomotion, second about CVS, third about Digestion , Absorption and Hormones and the last was about Neural Coordination.The portions were covered in fast paced manner, which many of us were unable to follow properly. The classes were followed by dissection for 2 hours. Practicals were held in afternoon.I found the dissection hours particularly useful and very interesting as it helped to visualize, touch and feel the structures taught in the class.Anatomy was taking much of my study time initially but I balanced the timings equally for the 3 subjects by September end. It had the most workload and had the many nuances to cover. I found embryology and the regional anatomy interesting. Upper and lower limbs, Thorax and Abdomen were very well thought. There was very less time to cover Head, neck and neuroanatomy.Physiology was my favourite and mostIP interesting subject as far as first year is concerned. It requires very Less mnemonics and memory but more understanding of concepts and application skills. Particularly I found Cardiovascular physiology and Neurophysiology very interesting.Biochemistry was good and it had mostly what we learnt in high school. I found it a bit boring as there was no means to correlate with clinics in many chapters.Finally we had an afternoon of clinical exposure every Friday. It helped us to correlate things we learnt clinically. We were taken to Surgery, Cardiology etc.Also with fun came the big burden.Tests.Every Saturday was an assessment day. I used to be planning to evade them most of the time but to no avail. Take my word, They were very useful.Also we had major tests at the end of every module.Apart from academics we had Spandan, the UG fest of Jipmer in mid August. It was good though I did not attend Most of the events.From a Marathon to Eatathon, name an event and it was there. It is a sign of what Jipmerites could accomplish.Also there was the first ever UG academic conference in the country - Conaissance. Again we were lucky to attend as first years. We came to know how those paper presentations and symposiums go about.OK I can go on writing but I stop it now.Tomorrow I am going to start my Second year of MBBS.

Is there any scientific evidence that suggests exoskeleton systems (e.g. Rewalk, Cyberdyne) regenerate neurons to help stroke or paralysis victims regain control of extremities?To date, there are no studies that address the direct effect of robotic exoskeleton systems on neurogenesis. But, if what is really being asked is whether robotic exoskeleton systems influence neural repair and remodeling (where neurogenesis is just one component) then there is at least one indirect evidence (read further).I. Neural repair and remodeling after brain injury.Self-repair after brain injury, such as stroke (brain infarction), is an inherent property of brain tissue. Post-stroke neural repair mechanisms include regeneration of neurons (neurogenesis), regeneration of neuronal elements (axonal sprouting, synaptogenesis), regeneration of glial cells (gliogenesis), and regeneration of blood vessels (angiogenesis) [1]. With more time—and with repetitive stimulation of neural circuits—brain remodeling takes place with restoration or improvement of function .Post-stroke neurogenesis has only been recognized recently. Multipotent stem cells located in the subventricular zone proliferate after a stroke and differentiate into immature neurons (neuroblasts). Angiogenic vessels release chemokines and growth factors that simulate neuroblasts to migrate to injured areas adjacent to the infarct where they differentiate into mature neurons with local synaptic connections and long-distance projections [2-4]. Ablation of newly derived immature neurons after stroke causes reduced recovery [5]. Post-stroke neurogenesis has been reported in human stroke, by utilizing tissue staining for protein markers of immature neurons in autopsy material [6-8].Post-stroke gliogenesis is much more well established than neurogenesis. Stem cells differentiate into oligodendrocyte progenitor cells which divide adjacent to the lesion [9,10]. However, these progenitor cells do not appear to differentiate into fully mature oligodendrocytes after stroke (unlike in multiple sclerosis). Damage to myelinated fiber tracts after white matter stroke is worse in aged animals [11]. Stroke induces proliferation of astrocytes adjacent to the lesion, [12,13] and a large number of new astrocytes are generated from progenitor cells that migrate from the subventricular zone [14,15] Reactive gliosis, the response of astrocytes to brain injury, may be a defensive reaction for limiting tissue damage and restoring homeostasis but it may also inhibit adaptive neuroplasticity mechanisms underlying recovery of function [1].Neuroplasticity is the ability of neurons to produce stable and lasting changes in synaptic and non-synaptic function in response to activation by extrinsic or intrinsic stimuli [16]. It is the basis of memory, learning, and brain remodeling—both during development and after brain injury (e.g. stroke). Our understanding of synaptic plasticity, motor learning, and functional recovery after brain injury has grown significantly in recent years. Brain plasticity is crucial for neural repair and remodeling which can lead to partial or complete recovery of function.Post-stroke remodeling involves reorganization of surviving brain areas, reconnection of disrupted circuits, and/or creation of new compensatory circuits. The mechanisms underlying remodeling are regeneration, growth, migration, and neuroplasticity. In adult humans, post-stroke cortical remodeling of neural circuits may result in any of the following: (1) change in interhemispheric lateralization, (2) alteration in the activity of brain regions (e.g. association cortices) that are linked to the injured zones, (3) reorganization of cortical representational maps, and/or (4) adoption of a bilateral function by the intact contralateral hemisphere [17]. Brain remodeling involves both regenerative changes in gray matter (neurogenesis, gliogenesis, synaptogenesis) and white matter (axonal sprouting, oligodendrogenesis, and remyelination).Brain remodeling can be adaptive or maladaptive. In a perfect world, remodeling results in complete restoration of lost networks and complete recovery of lost function. More often than not, remodeling is incomplete with partial sensorimotor, cognitive and behavioral recovery. Remodeling may also result in maladaptive function when aberrant connections are formed. For example, maladaptive remodeling after a thalamic stroke may result in overactive pain pathways (thalamic pain syndrome) and maladaptive motor remodeling may result in aberrant circuits which, when activated, produce movements that do not fit the repertoire (motor dyssynergia).II. Motor rehabilitation after brain injuryThe goals of post-stroke rehabilitation are functional recovery and functional adaptation. Functional recovery aims to maximize return of lost function, minimize the functional deficits from the stroke, and prevent further functional loss from secondary complications (e.g. contractures can lead to more functional impairment). This goal tends to be emphasized a lot. Thus, rehabilitative strategies are often evaluated on how fast they speed up functional recovery. Functional adaptation emphasizes strategies and techniques that help the person adapt to the impaired function and to develop new skills to compensate for the deficits incurred from the stroke; e.g. learning to use the unaffected hand to carry out two-handed tasks in a single-handed fashion. Good adaptive techniques and equipment do not only minimize the physical impact of the deficits—they also protect against the adverse psychological and social effects of the deficits. The ultimate goal of rehabilitation is improving the quality of life of the handicapped person.Motor rehabilitation influences neuroplasticity and remodeling in animals. Research in animals showed that rehabilitation (via exercise and training) modifies and boost neuroplasticity in animals. Motor learning and cortical stimulation alter intracortical inhibitory circuits and induce cortical remodeling [18-22]. Some researchers demonstrated increased protein synthesis, gene activation, and synaptogenesis in the lesioned hemisphere with motor practice of the paretic limb [21-24] .Motor rehabilitation influences neuroplasticity and remodeling in humans. Studies showed that individuals with better functional recovery of their upper extremity activate primarily the lesioned hemisphere when using the paretic arm [25-29] supporting the argument that targeted upper extremity therapy post-stroke can facilitate engagement of the lesioned hemisphere during movements of the paretic arm. Evidence that rehabilitation enhances neuroplasticity and brain remodeling in humans is indirect at best and is, by and large, based on neuroimaging and neurophysiological studies. A meta-analysis of motor rehabilitation targeting the paretic upper extremity in humans who suffered a stroke showed increased recruitment or engagement in the sensorimotor cortex of the affected hemisphere. There is an expansion in the area of the brain subserving the movements of the paretic arm and an enhancement in TMS, fMRI, PET, or SPECT signal intensity of the particular brain region [30]. Inspired by the concept of post-stroke neuroplasticity, new techniques continue to emerge. A meta-analysis was performed on 66 studies of upper limb rehabilitation in stroke patients. The main therapeutic strategies employed in the studies are: (1) activation of the ipsilesional motor cortex, (2) inhibition of the contralesional motor cortex, and (3) modulation of the sensory afferents by distal cutaneous electrostimulation, anesthesia of the healthy limb, mirror therapy, or virtual reality. The authors found that intensified rehabilitation(by increasing the total hours rehabilitating the paretic limb via repetitive movements and proprioceptive stimulation) improved the arm function significantly when performed in the subacute period (< 6 months post-stroke) [31]. Interestingly, the studies employed different techniques for intense rehabilitation including robots inactive-assisted mode, neuromuscular electrostimulation, and bilateral task training. Another interesting finding is the improvement of the paretic hand dexterity with contralesional neurostimulation or anesthesia of the healthy hand. This has been attributed to a decrease of transcallosal inhibition. Another review focused on the use of cortical stimulation in animals and humans with stroke-related hemiplegia. EMG-controlled electrical muscle stimulation was found to improve the motor function of the hemiparetic arm and hand. Near-infrared spectroscopy (NIRS) studies found that the cerebral blood flow in the injured sensory-motor cortex area is greatest during EMG-controlled functional electrical stimulation(FES). The authors argued that optimal rehabilitation requires timing of interventions to coincide with defined plastic time windows [17].III. Robotic exoskeleton for motor rehabilitationDo robotic exoskeleton systems work? In a recent review of 43 robotic systems for lower-limb rehabilitation [32], the authors concluded that: (1) more than half have not yet been marketed and some systems available in the market are not yet ready for home application because of expense, lack of clinical evidence, therapy protocol, or assessment criteria, and because some systems intended for mobile use are bulky and have short battery life, (2) the robotic systems allows precise measurement of movement parameters which can be used for assessing patient recovery and progress but there are no standardized protocols for reliable assessment of data, (3) clinical studies conducted show little evidence for superior effectiveness of robotic systems compared to manually assisted training for locomotor recovery and (4) the robotic systems have a clear benefit in terms of reduced therapist effort, time, and costs [32].REX-FES hybrid systems. Hybrid exoskeletons were first introduced in 1978 [33], though actual physical construction and preliminary results were not reported until 1989 [34]. In a recent review of hybrid exoskeletons [35]—robotic exoskeleton (REX) with functional electrical stimulation (FES)—to restore gait following spinal cord injury(SCI), the authors recognized the following: (1) FES advantage—natural muscles are the actuators of gait provide functional and psychological benefits, (2) FES disadvantages—early appearance of muscle fatigue and control of joint trajectories, (3) REX advantage—provides joint movement compensation or substitution to the body during walking, and (4) REX disadvantage—technology is not mature yet because of many limitations related to physical and cognitive interaction, portability, and energy-management issues, (5) REX-FES hybrid technology brings together technologies, methods,and rehabilitation principles that can overcome the drawbacks of each individual approach, and (6) studies are difficult to interpret and generalize due to subject variability (e.g. the location of the muscles affected, muscular atrophy in the chronic phase of the injury, impaired sensation and decreased physical capacity are different and require specific clinical evaluation in patients with SCI), lack of data on the testing method [36-38], insufficient number of subjects [34, 39-43], and the considerable variability in the metrics used to evaluate hybrid exoskeletons. Although the hybrid systems are functional there are no criteria regarding the optimum balance between the exoskeleton and muscle joint torque [35].Do robotic exoskeleton systems influence neuroplasticity and remodeling? Intuitively—yes! By definition, neuroplasticity and remodeling are driven by sensory activation. Movement is always sensory and motor—not only motor. Every time you move,proprioceptive information from the muscles and joints are sent to the brain.Every time the foot touches the ground or the hands manipulate an object proprioceptive and tactile information are sent to the brainstem, to the thalamus, to the cerebral cortex, and to the motor control circuits of the cerebellum and basal ganglia. All of these structures are involved with neuroplasticity and remodeling. Activating the appropriate circuits regularly and frequently (as in intensified rehabilitation; see above) guarantees neuroplasticity and remodeling. But there’s one caveat: the ingredients for achieving this should be available. If the part of the brain damaged is large then neuroplasticity and remodeling cannot occur in that big hole filled with CSF (called encephalomalacia). However, other parts can still compensate and participate in remodeling.Almost all studies on robotic exoskeleton (discussed earlier) address measurable effects on function (e.g. gait), optimal technical parameters, and safety issues but not neuroplasticity or brain modeling. For example, a recent paper reports that H2 robotic exoskeleton for gait rehabilitation after stroke is a robust and safe system for assisting a stroke patient perform an overground walking task [44].Only a few studies directly address the effect of robot-mediated therapy on neuroplasticity. In a review of spinal plasticity in robot-mediated therapy for the lower limbs, the authors found essentially no evidence for the mechanisms underlying functional improvements in humans (particularly in terms of neuroplasticity or remodeling in the spinal cord) and they ended up proposing methods for measuring spinal plasticity using robotic devices [45]. Thus far, the only article linking hybrid assistive limb (HAL) exoskeleton training to neuroplasticity and cortical reorganization is based on indirect evidence—changes in somatosensory evoked potentials (SEP) [46]. Based on the previous reports of reorganization in the sensorimotor cortex accompanied by increased excitability and enlarged body representations in spinal cord injury (SCI) patients, the author hypothesized that HAL-assisted body weight supported treadmill training induces cortical reorganization and improves walking function. Paired-pulse somatosensory evoked potentials (ppSEP) was performed in 11 SCI patients by stimulation above the level of injury before and after 3 months of HAL-assisted training and the SEP amplitude ratios (amplitude following double pulses) were assessed and compared to that of 11 healthy controls. PpSEPs were significantly increased in SCI patients as compared to controls at baseline. Following training, ppSEPs were increased from baseline and no longer significantly differed from controls. Walking parameters also showed significant improvements, yet there was no significant correlation between ppSEP measures and walking parameters [46].IV. The ultimate goal of rehabilitationImprovement in the quality of life through functional recovery, functional adaptation, or both is the ultimate goal of any rehabilitation program. Rehabilitation measures that have no significant effects on neuroplasticity and brain remodeling—and therefore do not guarantee functional recovery—can still improve the quality of life by increasing a person’s ability to adapt to a new lifestyle physically, psychologically, and socially. Adaptive physical activity, a community-based exercise program for chronic stroke survivors, has proved to be effective in improving physical functioning and psychological well-being for the long haul [47].REFERENCESCarmichael ST. Emergent properties of neural repair: Elemental biology to therapeutic concepts. Ann Neurol. 2016 Apr 4. doi: 10.1002/ana.24653.Ohab JJ, Carmichael ST. Poststroke neurogenesis: emerging principles of migration and localization of immature neurons. Neuroscientist 2008;14:369–380.Hermann DM, Chopp M. Promoting brain remodelling and plasticity for stroke recovery: therapeutic promise and potential pitfalls of clinical translation. Lancet Neurol 2012;11:369–380.Kahle MP, Bix GJ. Neuronal restoration following ischemic stroke: influences, barriers, and therapeutic potential. Neurorehabil Neural Repair 2013;27:469–478.Jin K, Wang X, Xie L, et al. Transgenic ablation of doublecortin-expressing cells suppresses adult neurogenesis and worsens stroke outcome in mice. Proc Natl Acad Sci U S A 2010;107:7993–7998.Jin K, Wang X, Xie L, et al. Evidence for stroke-induced neurogenesis in the human brain. Proc Natl Acad Sci U S A 2006;103:13198–13202.Macas J, Nern C, Plate KH, Momma S. Increased generation of neuronal progenitors after ischemic injury in the aged adult human forebrain. J Neurosci 2006;26:13114–13119.Ekonomou A, Johnson M, Perry RH, et al. Increased neural progenitors in individuals with cerebral small vessel disease. Neuropathol Appl Neurobiol 2012;38:344–353.Sozmen EG, Kolekar A, Havton LA, Carmichael ST. A white matter stroke model in the mouse: axonal damage, progenitor responses and MRI correlates. J Neurosci Methods 2009;180:261–272.Miyamoto N, Maki T, Shindo A, et al. Astrocytes promote oligodendrogenesis after white matter damage via brain-derived neurotrophic factor. J Neurosci 2015;35:14002–14008.Rosenzweig S, Carmichael ST. Age-dependent exacerbation of white matter stroke outcomes: a role for oxidative damage and inflammatory mediators. Stroke 2013;44:2579–2586.Barreto GE, Sun X, Xu L, Giffard RG. Astrocyte proliferation following stroke in the mouse depends on distance from the infarct. PLoS One 2011;6:e27881.Shimada IS, Borders A, Aronshtam A, Spees JL. Proliferating reactive astrocytes are regulated by Notch-1 in the peri-infarct area after stroke. Stroke 2011;42:3231–3237.Benner EJ, Luciano D, Jo R, et al. Protective astrogenesis from the SVZ niche after injury is controlled by Notch modulator Thbs4. Nature 2013;497:369–373.Faiz M, Sachewsky N, Gascón S, et al. Adult neural stem cells from the subventricular zone give rise to reactive astrocytes in the cortex after stroke. Cell Stem Cell 2015;17:624–634.Fuchs E, Flügge G. Adult neuroplasticity: more than 40 years of research. Neural Plasticity. 2014; 2014:541870.Hara Y. Brain plasticity and rehabilitation in stroke patients. J Nippon Med Sch. 2015;82(1):4-13.Nudo RJ, Milliken GW, Jenkins WM, Merzenich MM. Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys. J Neurosci. 1996;16(2):785–807.Black JE, Isaacs KR, Anderson BJ, Alcantara AA, Greenough WT. Learning causes synaptogenesis, whereas motor activity causes angiogenesis, in cerebellar cortex of adult rats. Proc Natl Acad Sci U S A. 1990;87(14):5568–5572.Comery TA, Stamoudis CX, Irwin SA, Greenough WT. Increased density of multiple-head dendritic spines on medium-sized spiny neurons of the striatum in rats reared in a complex environment.Neurobiol Learn Mem. 1996;66(2):93–96.Jones TA, Chu CJ, Grande LA, Gregory AD. Motor skills training enhances lesion-induced structural plasticity in the motor cortex of adult rats. J Neurosci. 1999;19(22):10153–10163.Plautz EJ, Milliken GW, Nudo RJ. Effects of repetitive motor training on movement representations in adult squirrel monkeys: role of use versus learning. Neurobiol Learn Mem. 2000;74(1):27–55.Kleim JA, Lussnig E, Schwarz ER, Comery TA, Greenough WT. Synaptogenesis and Fos expression in the motor cortex of the adult rat after motor skill learning. J Neurosci. 1996;16(14):4529–4535.Kleim JA, Vij K, Ballard DH, Greenough WT. Learning-dependent synaptic modifications in the cerebellar cortex of the adult rat persist for at least four weeks. J Neurosci. 1997;17(2):717–721.Calautti C, Leroy F, Guincestre JY, Baron JC. Dynamics of motor network overactivation after striatocapsular stroke: a longitudinal PET study using a fixed-performance paradigm. Stroke. 2001 Nov;32(11):2534-2542.Marshall RS, Perera GM, Lazar RM, Krakauer JW, Constantine RC, DeLaPaz RL. Evolution of cortical activation during recovery from corticospinal tract infarction. Stroke. 2000 Mar;31(3):656-661.Traversa R, Cicinelli P, Bassi A, Rossini PM, Bernardi G. Mapping of motor cortical reorganization after stroke. A brain stimulation study with focal magnetic pulses. Stroke. 1997 Jan;28(1):110-7.Traversa R, Cicinelli P, Pasqualetti P, Filippi M, Rossini PM. Follow-up of interhemispheric differences of motor evoked potentials from the 'affected' and 'unaffected' hemispheres in human stroke. Brain Res. 1998 Aug 24;803(1-2):1-8.Turton A, Wroe S, Trepte N, Fraser C, Lemon RN. Contralateral and ipsilateral EMG responses to transcranial magnetic stimulation during recovery of arm and hand function after stroke. Electroencephalogr Clin Neurophysiol. 1996 Aug;101(4):316-28.Richards LG, Stewart KC, Woodbury ML, Senesac C, Cauraugh JH. Movement-Dependent Stroke Recovery: A Systematic Review and Meta-Analysis of TMS and fMRI Evidence. Neuropsychologia. 2008;46(1):3-11.24. Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med. 2009 Apr;52(3):269-293.Iñaki Díaz, Jorge Juan Gil, and Emilio Sánchez, “Lower-Limb Robotic Rehabilitation: Literature Review and Challenges,” Journal of Robotics, vol. 2011, Article ID 759764, 11 pages, 2011.Tomovic R. Hybrid actuators for orthotic systems: hybrid assistive systems. Advances in External Control of Human Extremities: Proceedings of 4th International Symposium on External Control of Human Extremities; 1972 Aug 28–Sep 2; Dubrovnik, Croatia; Dubrovnik (Croatia): Yugoslav Comittee for Electronics and Automation; 1973. p. 73.Popovic D, Tomovi R, Schwirtlich L. Hybrid assistive system—the motor neuroprosthesis. IEEE Trans Biomed Eng. 1989;36(7):729–737.del-Ama AJ, Koutsou AD, Moreno JC, de-los-Reyes A, Gil-Agudo A, Pons JL. Review of hybrid exoskeletons to restore gait following spinal cord injury. J Rehabil Res Dev. 2012;49(4):497-514.Audu ML, To CS, Kobetic R, Triolo RJ. Gait evaluation of a novel hip constraint orthosis with implication for walking in paraplegia. IEEE Trans Neural Syst Rehabil Eng. 2010; 18(6):610–618.Farris RJ, Quintero HA, Withrow TJ, Goldfarb M. Design of a joint-coupled orthosis for FES-aided gait. 2009 IEEE 11th International Conference on Rehabilitation Robotics; 2009 Jun 23–26; Kyoto, Japan. Piscataway (NJ): IEEE; 2009. p. 246–252.Farris RJ, Quintero HA, Withrow TJ, Goldfarb M. Design and simulation of a joint-coupled orthosis for regulating FES-aided gait. 2009 IEEE 11th International Conference on Rehabilitation Robotics; 2009 Jun 23–26; Kyoto, Japan. Piscataway (NJ): IEEE; 2009. p. 1916–1922.Kobetic R, Marsolais EB, Triolo RJ, Davy DT, Gaudio R, Tashman S. Development of a hybrid gait orthosis: a case report. J Spinal Cord Med. 2003;26(3):254–258.Kobetic R, To CS, Schnellenberger JR, Audu ML, Bulea TC, Gaudio R, Pinault G, Tashman S, Triolo RJ. Development of hybrid orthosis for standing, walking, and stair climbing after spinal cord injury. J Rehabil Res Dev. 2009; 46(3):447–62.Durfee WK, Goldfarb M. Design of a controlled-brake orthosis for regulating FES-aided gait. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, vol. 14; 1992 Oct 29–Nov 1; Paris, France. Piscataway (NJ): IEEE; 1992. p. 1337–1338.Goldfarb M, Korkowski K, Harrold B, Durfee W. Preliminary evaluation of a controlled-brake orthosis for FES-aided gait. IEEE Trans Neural Syst Rehabil Eng. 2003; 11(3):241-248.Stauffer Y, Allemand Y, Bouri M, Fournier J, Clavel R, Metrailler P, Brodard R, Reynard F. The WalkTrainer—a new generation of walking reeducation device combining orthoses and muscle stimulation. IEEE Trans Neural Syst Rehabil Eng. 2009;17(1):38-45.Bortole M, Venkatakrishnan A, Zhu F, Moreno JC, Francisco GE, Pons JL, Contreras-Vidal JL. The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study. J Neuroeng Rehabil. 2015 Jun 17;12:54.Stevenson AJ, Mrachacz-Kersting N, van Asseldonk E, Turner DL, Spaich EG. Spinal plasticity in robot-mediated therapy for the lower limbs. J Neuroeng Rehabil. 2015 Sep 17;12:81.Sczesny-Kaiser M, Höffken O, Aach M, Cruciger O, Grasmücke D, Meindl R, Schildhauer TA, Schwenkreis P, Tegenthoff M. HAL® exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients. J Neuroeng Rehabil. 2015 Aug 20;12:68.Calugi S, Taricco M, Rucci P, Fugazzaro S, Stuart M, Dallolio L, Pillastrini P, Fantini MP. Effectiveness of adaptive physical activity combined with therapeutic patient education in stroke survivors at twelve months: a non-randomized parallel group study. Eur J Phys Rehabil Med. 2016 Feb;52(1):72-80.A2A by: Sabrina Ali