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Purpose: Survivors of childhood stroke incur lifelong physical disability. Treatment options are limited, however, models of motor reorganization after stroke are revealing cortical targets for neuromodulation. Transcranial direct-current stimulation (tDCS) enhances motor learning and may improve motor recovery in adult stroke, but remains uninvestigated in childhood-onset stroke. Here we documented the feasibility and safety of tDCS in an adolescent with chronic stroke-induced hemiparesis.Materials and methods: Over 10 days, the participant underwent occupational therapy paired with contralesional, primary motor cortex-targeting, cathodal tDCS. Clinical motor outcomes, and safety and tolerability measures were completed.Results: tDCS was well-tolerated with no adverse events. Motor outcomes did not regress post-intervention, with clinically significant changes still evident at 6 months.Conclusions: Application of controlled trials of non-invasive neuromodulation are safe and tolerability in childhood-onset stroke.

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BACKGROUND: Perinatal stroke is the most common cause of unilateral cerebral palsy. Mechanisms of post-stroke developmental plasticity in children are poorly understood. To better understand the relationship between functional connectivity and disability, we used resting-state fMRI to compare sensorimotor connectivity with clinical dysfunction. METHODS: School-aged children with periventricular venous infarction (PVI) and unilateral cerebral palsy were compared to controls. Resting-state BOLD signal was acquired on 3 T MRI and analyzed using CONN in SPM12. Functional connectivity was computed between S1, M1, supplementary motor area (SMA), and thalamus of the left/non-lesioned and right/lesioned hemisphere. Primary outcome was connectivity expressed as a Fisher-transformed correlation coefficient. Motor function was measured using the Assisting Hand Assessment (AHA), and Melbourne Assessment (MA). Proprioceptive function was measured using a robotic position matching task (VarXY). RESULTS: Participants included 15 PVI and 21 controls. AHA and MA in stroke patients were negatively correlated with connectivity (increased connectivity = poorer performance). Position sense was inversely correlated with connectivity (increased connectivity = improved performance) between the non-lesioned S1 and thalamus/SMA. In controls, VarXY was positively correlated with connectivity between the thalamus and bilateral sensorimotor regions. CONCLUSIONS: Resting state fMRI measures of sensorimotor connectivity are associated with clinical sensorimotor function in children with unilateral cerebral palsy secondary to PVI. Greater insight into understanding reorganization of brain networks following perinatal stroke may facilitate personalized rehabilitation.

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BACKGROUND: The human motor cortex can be mapped safely and painlessly with transcranial magnetic stimulation (TMS) to explore neurophysiology in health and disease. Human error likely contributes to heterogeneity of such TMS measures. Here, we aimed to use recently pioneered robotic TMS technology to develop an efficient, reproducible protocol to characterize cortical motor maps in a pediatric population. NEW METHOD: Magnetic resonance imaging was performed on 12 typically developing children and brain reconstructions were paired with the robotic TMS system. The system automatically aligned the TMS coil to target sites in 3 dimensions with near-perfect coil orientation and real-time head motion correction. Motor maps of 4 forelimb muscles were derived bilaterally by delivering single-pulse TMS at predefined, uniformly spaced trajectories across a 10 × 10 grid (7 mm spacing) customized to the participant's MRI. RESULTS: Procedures were well tolerated with no adverse events. Two male, eight-year-old participants had high resting motor thresholds that precluded mapping. The mean hotspot coordinate and centre of gravity coordinate were determined in each hemisphere for four forelimb muscles bilaterally. Average mapping time was 14.25 min per hemisphere. COMPARISON WITH EXISTING METHODS: Traditional manual TMS methods of motor mapping are time intensive, technically challenging, prone to human error, and arduous for use in pediatrics. This novel TMS robot approach facilitates improved efficiency, tolerability, and precision in derived, high-fidelity motor maps. CONCLUSIONS: Robotic TMS opens new avenues to explore motor map neurophysiology and its influence on developmental plasticity and therapeutic neuromodulation. Our findings provide evidence that TMS robotic motor mapping is feasible in young participants.

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The snapping scapula syndrome is an infrequently described source of shoulder discomfort characterized by painful, audible, and/or palpable abnormal scapulothoracic motion. The syndrome may be caused by skeletal or soft-tissue abnormalities that interfere with articulation between the scapula and the rib cage. Often, no obvious source of the snapping can be identified with imaging studies. Three new cases with electrodiagnostic and imaging studies are presented. For the first time a critical analysis and review by diagnoses, gender, age, treatment, and outcome of 89 reported cases is presented. Accurate recognition of the syndrome may lead to prompt and long-term relief of symptoms by conservative or surgical treatment.

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Various crops were tested in greenhouse and field trials for their potential utility in the rotation sequence in the potato cropping system in Meloidogyne chitwoodi-infested soils of the Klamath Basin in northeastern California and southern Oregon. Two Solarium accessions from the International Potato Center in Peru were potential sources of resistance to M. chitwoodi. Cultivars of barley, oat, rye, wheat, and white lupine were maintenance hosts, supporting the nematode population at its current level without substantial increase or decline. Poor to nonhosts to race 1 of the nematode included cultivars of alfalfa, amaranth, oilseed radish, oilseed rape, and safflower. These crops have potential for inclusion in the cropping system but are subject to various constraints, including frost sensitivity and availability of markets. Sugarbeet, a new crop in the area, is a maintenance or better host of M. chitwoodi. Potato, tomato, and sunflower are excellent hosts.

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Field trials were conducted with a chitin-urea soil amendment and several other nematicides on four crop-nematode combinations: tomato-Meloidogyne incognita; potato-Meloidogyne chitwoodi; walnut-Pratylenchus vulnus; and brussels sprouts-Heterodera schachtii. Significant (P

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