Consider The Evidence: Med/Peds Journal Roundup

November 9, 2006

SIDS breakthrough? Mittens for stroke rehab

Filed under: JAMA, SIDS, stroke — medblog @ 11:26 am

JAMA (11/1)- An article in last weeks issue by Paterson, et al. is showing up in many news reports as a major advance in the understanding of sudden infant death syndrome (SIDS). The investigators explored the role of seritonergic(5-HT) neurons in the pathogenesis of the syndrome. Frankly, alot of it was basic science gobledygook to me but I got the idea that 1.) seretonin neurons in the medulla oblongata are involved with autonomic and respiratory function, 2.) postmortem exams of the brains of SIDS victims show significant differences in the number and location of 5-HT neurons, as well as lower relative density of seritonin transport protein. With 35% of the SIDS samples coming from premature babies, and the number of controls that were premature not being reported – I was left wondering if this was all confounded by normal developmental differences?

In a more immediately applicable study, Wolf et al. took about 200 stroke patients with hemiparesis and and had half of them put a restraining mitt on their good hand. Its called constraint-induced movement therapy (CIMT). The idea was to reinforce the connections to the affected limb by restricting use of the other limb. The subjects were 3 to 9 months out from the stroke. The CIMT group were supposed to wear the mitt during 90% of waking hours for 2 weeks. In addition they had daily task practice sessions with the paretic limb. The control group had usual care stroke rehab. In the end, the CIMT group had significantly better motor function that persisted at 1 year after therapy.


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