Restorative Neurology and Neuroscience - Volume 33, issue 4

Authors: Dundon, Neil M. | Làdavas, Elisabetta | Maier, Martin E. | Bertini, Caterina

Article Type: Research Article

Abstract: Purpose: Lateralised lesions can disrupt inhibitory cross-callosal fibres which maintain interhemispheric equilibrium in attention networks, with a consequent attentional bias towards the ipsilesional field. Some evidence of this imbalance has also been found in hemianopic patients (Tant et al., 2002 ). The aim of the present study was to reduce this attentional bias in hemianopic patients by using multisensory stimulation capable of activating subcortical structures responsible for orienting attention, such as the superior colliculus. Methods: Eight hemianopic patients underwent a course of multisensory stimulation treatment for two weeks and their behavioural and electrophysiological performance was …tested at three time intervals: baseline 1 (before treatment), control baseline 2 (two weeks after baseline 1 and immediately before treatment as a control for practice effects) and finally after treatment. Results: The results show improvements on various clinical measures, on orienting responses in the hemianopic field, and a reduction of electrophysiological activity (P3 amplitude) in response to stimuli presented in the intact visual field. Conclusions: These results suggest that the primary visual deficit in hemianopic patients might be accompanied by an ipsilesional attentional bias which might be reduced by multisensory stimulation. Show more

Keywords: P3, hemianopia, interhemispheric imbalance, multisensory integration, visual rehabilitation

DOI: 10.3233/RNN-140457

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 405-419, 2015

Authors: Brunetti, Maddalena | Morkisch, Nadine | Fritzsch, Claire | Mehnert, Jan | Steinbrink, Jens | Niedeggen, Michael | Dohle, Christian

Article Type: Research Article

Abstract: Background: Mirror therapy (MT) was found to improve motor function after stroke. However, there is high variability between patients regarding motor recovery. Objectives: The following pilot study was designed to identify potential factors determining this variability between patients with severe upper limb paresis, receiving MT. Methods: Eleven sub-acute stroke patients with severe upper limb paresis participated, receiving in-patient rehabilitation. After a set of pre-assessments (including measurement of brain activity at the primary motor cortex and precuneus during the mirror illusion, using near-infrared spectroscopy as described previously), four weeks of MT were applied, …followed by a set of post-assessments. Discriminant group analysis for MT responders and non-responders was performed. Results: Six out of eleven patients were defined as responders and five as non-responders on the basis of their functional motor improvement. The initial motor function and the activity shift in both precunei (mirror index) were found to discriminate significantly between responders and non-responders. Conclusions: In line with earlier results, initial motor function was confirmed as crucial determinant of motor recovery. Additionally, activity response to the mirror illusion in both precunei was found to be a candidate for determination of the efficacy of MT. Show more

Keywords: Mirror therapy, stroke, motor recovery, fNIRS, precuneus

DOI: 10.3233/RNN-140421

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 421-434, 2015

Authors: Khedr, Eman M. | Elbeh, Khaled A. | Abdel Baky, Ahmed | Abo-Elfetoh, Noha | El-Hammady, Dina H. | Korashy, Fatma

Article Type: Research Article

Abstract: Purpose: Purpose of this study was to evaluate the long term efficacy of repetitive sacral root magnetic stimulation (rSMS) in patients with monosymptomatic nocturnal enuresis (MNE). Methods: Forty four patients were randomized to receive either sham or real repetitive sacral root magnetic stimulation (rSMS; 15 Hz with a total of 1500 pulses/session) for 10 sessions. Evaluation was performed before starting treatment, immediately after the 5th and 10th treatment session, and 1 month later, using frequency of enuresis/week, visual analogue scale (VAS) and quality of life as outcome measures. Resting and active motor thresholds of gastrocnemius muscles were …measured before and after the end of sessions. Results: Both treatment and control groups were comparable for baseline measures of frequency of enuresis, and VAS. The mean number of wet nights/week was significantly reduced in patients who received real rSMS. This improvement was maintained 1 month after the end of treatment. Patients receiving real-rSMS also reported an improvement in VAS ratings and quality of life. A significant reduction of resting motor threshold was recorded after rSMS in the real group while no such changes were observed in the sham group. Conclusion: These findings suggest that rSMS has potential as an adjuvant treatment for MNE and deserves further study. Show more

Keywords: Nocturnal enuresis, quality of life, targeted electrical or magnetic sacral root stimulation, repetitive sacral root magnetic stimulation

DOI: 10.3233/RNN-150507

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 435-445, 2015

Authors: Naro, Antonino | Leo, Antonino | Filoni, Serena | Bramanti, Placido | Calabrò, Rocco Salvatore

Article Type: Research Article

Abstract: Purpose: The unresponsive wakefulness syndrome (UWS) is characterized by either a profound unawareness or an impairment of large-scale cortico/subcortical connectivity. Nevertheless, some individuals with UWS could show residual markers of consciousness and cognition. In this study, we applied an electrophysiological approach aimed to identify the residual visuomotor connectivity patterns that are thought to be linked to awareness, in patients with chronic disorder of consciousness (DOC). Methods: We measured some markers of visuomotor and premotor-motor integration in 14 patients affected by DOC, before and after the application of transcranial direct current stimulation, delivered over the dorsolateral …prefrontal cortex and the parieto-occipital area, paired to transorbital alterning current stimulation. Results: Our protocol induced a potentiation of the electrophysiological markers of visuomotor and premotor-motor connectivity, paired to a clinical improvement, in all of the patients with minimally conscious state and in one individual affected by UWS. Conclusions: Our protocol could be a promising approach to potentiate the functional connectivity within large-scale visuomotor networks, thus allowing identifying the patients suffering from a functional locked-in syndrome (i.e. individuals showing an extreme behavioral motor dysfunction although with somehow preserved cognitive functions that can be identified only through para-clinical tests) within individuals with UWS. Show more

Keywords: DLPFC, functional connectivity, MCS, parieto-occipital area, tDCS, UWS, visuomotor integration

DOI: 10.3233/RNN-150525

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 447-460, 2015

Authors: Noguchi, Takashi | Ohta, Souichi | Kakinoki, Ryosuke | Ikeguchi, Ryosuke | Kaizawa, Yukitoshi | Oda, Hiroki | Matsuda, Shuichi

Article Type: Research Article

Abstract: Purpose: The rapid death of many spinal motor neurons after nerve root avulsion injury results in limited functional recovery following replantation surgery of avulsed nerves into the spinal cord. Therefore, we investigated the neuroprotective effect of erythropoietin (EPO) on motor neurons after nerve root avulsion injury using a rat model. Methods: After C6 nerve root avulsion injury, EPO (2680 U/kg) was injected subcutaneously once a day for 3 consecutive days with various starting time points. At 28 and 56 days after injury, histological and immunohistological investigations were performed. Results: EPO-treated rats showed …a significant increase in the number of surviving motor neurons at day 28 when the initial dose was started within 96 h after injury. In EPO-treated rats, superoxide formation in the motor neurons and proliferation of microglia were markedly suppressed in the acute phase. GAP-43-positive surviving motor neurons were significantly increased in EPO-treated rats at day 28. However, at 56 days after surgery, EPO-treated rats showed a much greater decrease of surviving motor neurons compared with those at day 28. Conclusion: The neuroprotective effect of EPO is not long lasting, but may prolong the time before replantation surgery. Show more

Keywords: Nerve root avulsion injury, oxidative stress, rat, motor neurons, erythropoietin

DOI: 10.3233/RNN-140481

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 461-470, 2015

Authors: Hadanny, A. | Golan, H. | Fishlev, G. | Bechor, Y. | Volkov, O. | Suzin, G. | Ben-Jacob, E. | Efrati, S.

Article Type: Research Article

Abstract: Purpose: Cognitive impairment may occur in 42–50% of cardiac arrest survivors. Hyperbaric oxygen therapy (HBO2 ) has recently been shown to have neurotherapeutic effects in patients suffering from chronic cognitive impairments (CCI) consequent to stroke and mild traumatic brain injury. The objective of this study was to assess the neurotherapeutic effect of HBO2 in patients suffering from CCI due to cardiac arrest. Methods: Retrospective analysis of patients with CCI caused by cardiac arrest, treated with 60 daily sessions of HBO2 . Evaluation included objective computerized cognitive tests (NeuroTrax), Activity of Daily Living (ADL) …and Quality of life questionnaires. The results of these tests were compared with changes in brain activity as assessed by single photon emission computed tomography (SPECT) brain imaging. Results: The study included 11 cases of CCI patients. Patients were treated with HBO2 , 0.5–7.5 years (mean 2.6 ± 0.6 years) after the cardiac arrest. HBO2 was found to induce modest, but statistically significant improvement in memory, attention and executive function (mean scores) of 12% , 20% and 24% respectively. The clinical improvements were found to be well correlated with increased brain activity in relevant brain areas as assessed by computerized analysis of the SPECT imaging. Conclusions: Although further research is needed, the results demonstrate the beneficial effects of HBO2 on CCI in patients after cardiac arrest, even months to years after the acute event. Show more

Keywords: Anoxic brain damage, rehabilitation, cognitive symptoms, hyperbaric oxygen therapy, SPECT

DOI: 10.3233/RNN-150517

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 471-486, 2015

Authors: Iodice, Rosa | Dubbioso, Raffaele | Ruggiero, Lucia | Santoro, Lucio | Manganelli, Fiore

Article Type: Research Article

Abstract: Purpose: To assess whether anodal transcranial direct current stimulation (tDCS) is effective in modulating lower limb spasticity in MS patients. Previously, anodal tDCS has been shown to improve motor deficits in several neurological diseases and, recently, it has been proposed as effective in decreasing spasticity after stroke. However, the effect of anodal tDCS on spasticity is not examined in MS. Methods: We performed a single-centre randomized, double-blind, sham-controlled study to investigate efficacy of anodal vs sham tDCS in 20 relapsing-remitting MS patients. Ten patients received anodal tDCS stimulation to the primary motor cortex of the …more affected side, 20 minutes/day for 5 consecutive days. Ten patients received sham tDCS stimulation. Spasticity was assessed by using the modified Ashworth scale (MAS), the self-scoring MSSS-88 (Multiple Sclerosis Spasticity Scale) and Multiple Sclerosis Walking Scale (MSWS-12) at baseline and at the end of protocol stimulation. Results: No side effects were detected during either anodal tDCS or sham. In both groups, there was no significant improvement in MAS, MSSS-88 and MSWS-12 scores. Moreover the comparison between anodal tDCS and sham showed no difference. Conclusions: Five-daily sessions of anodal tDCS to the primary motor cortex does do not improve lower limb spasticity in MS patients. Show more

Keywords: Multiple sclerosis, anodal transcranial direct current stimulation, lower limb spasticity

DOI: 10.3233/RNN-150495

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 487-492, 2015

Authors: Huang, Qijuan | Chen, Bing | Wang, Fuxin | Huang, Heng | Milner, Richard | Li, Longxuan

Article Type: Research Article

Abstract: Purpose: We previously demonstrated that 7 days post-ischemia, angiogenic vessels in the ischemic penumbra show strong upregulation of fibronectin (Fn) and its receptors, α5β1 and αvβ3 integrins. The aim of the current study was to precisely define the time-course of angiogenic responses and glial activation following experimental ischemia in the mouse. Methods: Male C57Bl/6 mice were subject to 90 minutes of ischemia by temporary occlusion of the middle cerebral artery followed by reperfusion. Vascular remodeling and glial activation were then examined in the brains of these mice after 0, 1, 2, 4, 7 and 14 …days post-ischemia. Results: Immunofluorescent studies demonstrated that in the ischemic penumbra, blood vessel density increased up to day 14. In contrast, within the ischemic core, vessel density declined, reaching a low point at day 4, but then started to increase. In the penumbra, expression of Fn and the α5 and β3 integrins peaked at day 7, and this coincided exactly with maximal endothelial proliferation. Conclusions: Our results suggest that upregulation of the Fn-α5β1/αVβ3 integrin axis on blood vessels stimulates BEC proliferation at an early stage of angiogenesis post-ischemia. This could form the basis of novel therapeutic strategies aimed at promoting angiogenesis following cerebral ischemia. Show more

Keywords: Cerebral ischemia, angiogenesis, endothelial proliferation, integrin, fibronectin, glia

DOI: 10.3233/RNN-140491

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 493-507, 2015

Authors: Marquez, Jodie | Conley, Alexander | Karayanidis, Frini | Lagopoulos, Jim | Parsons, Mark

Article Type: Research Article

Abstract: Purpose: Research popularity and scope for the application of transcranial direct current stimulation have been steadily increasing yet many fundamental questions remain unanswered. We sought to determine if anodal stimulation of either hemisphere leads to improved performance of the contralateral hand and/or altered function of the ipsilateral hand, or affects movement preparation, in older subjects. Method: In this cross-over, double blind, sham controlled study, 34 healthy aged participants (age range 40– 86) were randomised to receive 20 minutes of stimulation to either the dominant or non-dominant motor cortex. The primary outcome was functional performance of …both upper limbs measured by the Jebsen Taylor Test and hand grip strength. Additionally, we measured motor preparation using electrophysiological (EEG) recordings. Results: Anodal stimulation resulted in statistically significantly improved performance of the non-dominant hand (p  <  0.01) but did not produce significant changes in the dominant hand on any measure (p  >  0.05). This effect occurred irrespective of the hemisphere stimulated. Stimulation did not produce significant effects on measures of gross function, grip strength, reaction times, or electrophysiological measures on the EEG data. Conclusion: This study demonstrated that the hemispheres respond differently to anodal stimulation and the response appears to be task specific but not mediated by age. Show more

Keywords: tDCS, upper limb function, transcranial direct current stimulation, ageing

DOI: 10.3233/RNN-140490

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 509-519, 2015

Authors: Kim, Min Su | Chang, Won Hyuk | Cho, Jin Whan | Youn, Jinyoung | Kim, Yun Kwan | Kim, Sun Woong | Kim, Yun-Hee

Article Type: Research Article

Abstract: Purpose: Freezing of gait (FOG) affects mobility and balance seriously. Few reports have investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on FOG in Parkinson’s disease (PD). We investigated the efficacy of high-frequency rTMS for the treatment of FOG in PD. Methods: Seventeen patients diagnosed with PD were recruited in a randomized, double-blinded, cross-over study. We applied high frequency rTMS (90% of resting motor threshold, 10 Hz, 1,000 pulses) over the lower leg primary motor cortex of the dominant hemisphere (M1-LL) for five sessions in a week. We also administered alternative sham stimulation with a …two-week wash out period. The primary outcomes were measured before, immediately after, and one week after the intervention using the Standing Start 180° Turn Test (SS-180) with video analysis and the Freezing of Gait Questionnaire (FOG-Q). The secondary outcome measurements consisted of Timed Up and Go (TUG) tasks and the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Motor cortical excitability was also evaluated. Results: There were significant improvements in the step required to complete the SS-180 and FOG-Q in the rTMS condition compared to the sham condition, and the effects continued for a week. The TUG and UPDRS-III also showed significant ameliorations over time in the rTMS condition. The MEP amplitude at 120% resting motor threshold and intracortical facilitation also increased after real rTMS condition. Conclusions: High frequency rTMS over the M1-LL may serve as an add-on therapy for improving FOG in PD. Show more

Keywords: Freezing of gait, brain stimulation, Parkinson’s disease, transcranial magnetic stimulation, gait

DOI: 10.3233/RNN-140489

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 521-530, 2015

Authors: Shen, Cong | Sun, Fang-ling | Zhang, Ru-yi | Zhang, Li | Li, Ya-li | Zhang, Lan | Li, Lin

Article Type: Research Article

Abstract: Purpose: To investigate the effects of 2,3,5,4′ -tetrahydroxystilbene-2-O-β-D-glucoside (TSG) on the memory and movement functions and its mechanisms related to synapses and α-synuclein in aged mice. Methods: The memory ability of mice was detected by step-through passive avoidance task. The movement function was measured by the pole test and rotarod test. Transmission electron microscopy was used to observe the synaptic ultrastructure. Western blotting was applied to measure the expression of synapse-related proteins and α-synuclein. Results: Intragastrical administration of TSG for 3 months significantly improved the memory and movement functions in aged mice. …TSG treatment obviously protected the synaptic ultrastructure and increased the number of synaptic connections in the hippocampal CA1 region and striatum; enhanced the expression of synaptophysin, phosphorylated synapsin I and postsynaptic density protein 95 (PSD95), elevated phosphorylated calcium/calmodulin-dependent protein kinase II (p-CaMKII) expression, and inhibited the overexpression and aggregation of α-synuclein in the hippocampus, striatum and cerebral cortex of aged mice. Conclusion: TSG improved the memory and movement functions in aged mice through protecting synapses and inhibiting α-synuclein overexpression and aggregation in multiple brain regions. The results suggest that TSG may be beneficial to the treatment of ageing-related neurodegenerative diseases. Show more

Keywords: Tetrahydroxystilbene glucoside, memory ability, movement function, synapse, α-synuclein, hippocampus, striatum, aging

DOI: 10.3233/RNN-150514

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 531-541, 2015

Authors: Mateo, Sébastien | Di Rienzo, Franck | Reilly, Karen T. | Revol, Patrice | Delpuech, Claude | Daligault, Sébastien | Guillot, Aymeric | Jacquin-Courtois, Sophie | Luauté, Jacques | Rossetti, Yves | Collet, Christian | Rode, Gilles

Article Type: Research Article

Abstract: Purpose: Grasp recovery after C6-C7-spinal cord injury (SCI) requires learning “tenodesis grasp” whereby active wrist extension elicits passive thumb-to-forefinger and finger-to-palm flexion. Evidence that motor imagery (MI) promotes upper limb function after tetraplegia is growing, but whether MI potentiates grasp recovery in C6-C7-SCI individuals who have successfully learned the “tenodesis grasp” remains unknown. Methods: Six chronic stable C6-C7-SCI inpatients and six healthy control participants were included. C6-C7-SCI participants imagined grasping movements and controls visualized geometric forms for 45 minutes, three times a week for five weeks. Three separate measures taken over a five week period …before the intervention formed the baseline. Intervention effects were assessed immediately after the intervention and eight weeks later. Each testing session consisted of kinematic recordings during reach-to-grasp and magnetoencephalographic (MEG) recordings during wrist extension. Results: During baseline, kinematic wrist extension angle during “tenodesis grasp” and MEG contralateral sensorimotor cortex (cSMC) activity during wrist extension were stable. Moreover, SCI participants exhibited a greater number of voxels within cSMC than controls. After MI sessions, wrist extension angle increased during “tenodesis grasp” and the number of voxels within cSMC during wrist extension decreased and became similar to controls. Conclusion: These findings provide further support for the use of MI to reinforce a compensatory grasping movement (tenodesis) and induce brain plasticity. Show more

Keywords: Motor imagery, C6-C7 tetraplegia, “tenodesis grasp”, rehabilitation, brain plasticity, kinematic, magnetoencephalography

DOI: 10.3233/RNN-140466

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 543-555, 2015

Authors: Bates, Kristyn Alissa | Rodger, Jennifer

Article Type: Research Article

Abstract: Repeated sessions of transcranial magnetic stimulation (rTMS) are capable of changing and modulating neural activity beyond the period of stimulation. Because many neurological disorders are thought to involve abnormal or dysfunctional neuronal activity, it is hypothesised that the therapeutic action of rTMS may occur through modulating and reversing abnormal activity and facilitating neuroplasticity. Numerous clinical studies have investigated the safety and efficacy of rTMS treatment for a wide variety of conditions including depression, anxiety disorders including obsessive compulsive disorder, Parkinson’s disease, stroke, tinnitus, affective disorders, schizophrenia and chronic pain. Despite some promising results, rTMS is not currently widely used …to assist in recovery from neurotrama. In this review, we argue that the therapeutic promise of rTMS is limited because the mechanisms of action of rTMS are not completely understood and therefore it is difficult to determine which treatment protocols are appropriate for specific neurological conditions. We use the application of rTMS in motor functional recovery from cerebral ischemic stroke to illustrate the difficulties in interpreting and assessing the therapeutic potential of rTMS for neurotrauma in terms of the presumed mechanisms of action of rTMS. Future directions for research will also be discussed. Show more

Keywords: Repetitive transcranial magnetic stimulation, brain plasticity, stroke, neuroprotection

DOI: 10.3233/RNN-130359

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 557-569, 2015

Authors: Monaco, Gina N. | Brown, Todd J. | Burgette, Ryan C. | Fargo, Keith N. | Akst, Lee M. | Jones, Kathryn J. | Foecking, Eileen M.

Article Type: Research Article

Abstract: Objective: This study investigated the effects of a combinatorial treatment, consisting of a brief period of nerve electrical stimulation (ES) and systemic supraphysiologic testosterone, on functional recovery following a crush of the recurrent laryngeal nerve (RLN). Study design: Prospective, controlled animal study. Methods: After a crush of the left RLN, adult male Sprague-Dawley rats were divided into four treatment groups: 1) no treatment, 2) ES, 3) testosterone propionate (TP), and 4) ES + TP. Each group was subdivided into 1, 2, 3, or 4 weeks post-operative survival time points. Groups had an …n of 4– 9. Recovery of vocal fold mobility (VFM) was assessed. Results: Brief ES of the proximal nerve alone or in combination with TP accelerated the initiation of functional recovery. TP administration by itself also produced increased VFM scores compared to controls, but there were no statistical differences between the ES-treated and TP-treated animals. Treatment with brief ES alone was sufficient to decrease the time required to recover complete VFM. Animals with complete VFM were seen in treatment groups as early as 1 week following injury; in the untreated group, this was not observed until at least 3 weeks post-injury, translating into a 66% decrease in time to complete recovery. Conclusions: Brief ES, alone or in combination with TP, promise to be effective therapeutic interventions for promoting regeneration following RLN injury. Show more

Keywords: Axotomy, regeneration, androgen, electrical stimulation, rat, recurrent laryngeal nerve, functional recovery, vocal fold

DOI: 10.3233/RNN-130334

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 571-578, 2015

Authors: Lowrance, S.A. | Fink, K.D. | Crane, A. | Matyas, J. | Dey, N.D. | Matchynski, J.J. | Thibo, T. | Reinke, T. | Kippe, J. | Hoffman, C. | Sandstrom, M. | Rossignol, J. | Dunbar, G.L.

Article Type: Research Article

Abstract: Purpose: Stroke is the third leading cause of death and permanent disability in the United States, often producing long-term cognitive impairments, which are not easily recapitulated in animal models. The goals of this study were to assess whether: (1) the endothelin-1 (ET-1) model of chronic stroke produced discernable cognitive deficits; (2) a spatial operant reversal task (SORT) would accurately measure memory deficits in this model; and (3) bone-marrow-derived mesenchymal stem cells (BMMSCs) could reduce any observed deficits. Methods: Rats were given unilateral intracerebral injections of vehicle or ET-1, a stroke-inducing agent, near the middle cerebral …artery. Seven days later, they were given intrastriatal injections of BMMSCs or vehicle, near the ischemic penumbra. The cognitive abilities of the rats were assessed on a novel SORT, which was designed to efficiently distinguish cognitive deficits from potential motoric confounds. Results: Rats given ET-1 had significantly more cognitive errors at six weeks post-stroke on the SORT, and that these deficits were attenuated by BMMSC transplants. Conclusions: These findings indicate that: (1) the ET-1 model produces chronic cognitive deficits; (2) the SORT efficiently measures cognitive deficits that are not confounded by motoric impairment; and (3) BMMSCs may be a viable treatment for stroke-induced cognitive dysfunction. Show more

Keywords: Endothelin-1, mesenchymal stem cells, stroke, operant conditioning, cognitive dysfunction

DOI: 10.3233/RNN-130329

Citation: Restorative Neurology and Neuroscience, vol. 33, no. 4, pp. 579-588, 2015