"The learn'd is happy, nature to explore,

The fool is happy that he knows no more." - Alexander Pope (1733) An Essay on Man, Epistle 2, l.263-4.

When these poignant words1 were penned more than 280 years ago, they echoed a philosophic truth that helped to distinguish those with the resources to learn from those who lacked them. To some extent that differentiation still persists today, but the consequences resulting from embracing ignorance are dire. The rate of information accessibility has increased exponentially in just the last decade. Undoubtedly, advances in science and technology have fueled both our quest for knowledge and the mechanisms available to obtain and retrieve it. One manifestation derived from these discoveries has been our ability to engage new ways of exploring our nervous system. This engagement has been pursued by many physical therapists and their scientific colleagues through the development of the Frontiers in Rehabilitation Science and Technology initiative, briefly discussed previously in this journal.2 The Frontiers in Rehabilitation Science and Technology was a derivative from the Physical Therapy and Society Summit,3 at which time an external review of our profession by an interdisciplinary panel concluded that, among other initiatives, we embrace scientific and technological advances that will impact our knowledge base and service delivery opportunities.

This special issue exposes us to some of these discoveries and advances. As neurologic physical therapists who are dedicated to improving the care of our patients through the assimilation of information and with it, revelations from new procedures to unmask the potential within our dynamic nervous system, we are inevitably faced with 2 options-absorb or abhor. We can embrace some of the new technologies and genomic discoveries while asking ourselves some leading questions upon which to reflect. Will I ever be actively using these procedures? Might I be collaborating in a team effort to implement them with other scientists or professionals? What knowledge do I need to acquire that I did not receive in my formal education or supplemental courses/workshops? How will the discoveries extracted from these presentations impact future practice? Alternatively, one might conclude that this information is irrelevant and has no bearing on what one does or will do and has no place in neurologic physical therapy. We can only hope that the blinders symbolically defining this attitude no longer have a place in our profession.

Insights into how cortical provocation, elicited either volitionally or through electrical stimulation, can augment movement in patients with spinal cord injury or following stroke are embedded within the 3 research articles and the clinical point of view article. For all articles, the authors have provided specific commentary on implications for practice. The novelty of much of that narrative should engender many thought-provoking ideas.

Vuckovic et al4 provide some initial data on how motor imagery can summon sensory-motor rhythms to drive functional electrical stimulation for hand opening and closing. With the growing interest in brain-computer interfaces,5 this paper represents a direct link between this exciting concept and a potential treatment option for patients with spinal cord injuries. Goh et al6 provide evidence that noninvasive brain stimulation using either transcranial direct current stimulation or high frequency (5 Hz) repetitive transcranial magnetic stimulation can both elicit corticospinal responses in the same participants with chronic stroke, thus raising the possibility that either approach can drive motor output and could be used interchangeably on the basis of the preference of the patient or the availability of equipment as part of a protocol to enhance movement potential. Finally, the research article by Gomes-Osman and Field-Fote7 makes use of repetitive transcranial magnetic stimulation at 10 Hz in a group of participants with cervical spinal cord injury to demonstrate that when combined (interleaved) with repetitive task practice, greater function in both the trained and untrained hands as well as greater grasp strength in the trained hand can be achieved. As Stewart and Flach8 point out in their commentary, work such as this highlights the potential for additive effects when noninvasive cortical stimulation is combined with concurrent or subsequent volitional activity. This notion raises the interesting possibility of combining such stimulation with tasks or components of them in an effort to induce functional plasticity at the cortical level and/or other levels of the neuraxis.

In the first of 3 special interest papers, Stoykov and Madhavan9 build the concept of approximating noninvasive stimulus or context-relevant activity with a meaningful and often volitional movement that, in combination, can be considered "priming." This concept is particularly interesting in fostering functionally relevant movement and has been the source of intense investigation (see, eg, the work of Stinear et al10). Borich et al11 review the underpinnings of electroencephalography, a measurement tool infrequently encountered by neurologic physical therapists, and how it might be used in combination with noninvasive cortical stimulation to unveil brain function among individuals with stroke. Although appearing somewhat extraneous at first, the Borich group makes a compelling argument for its use in delineating changes in brain behavior that could result from therapeutic interventions. Such revelations have the potential to define mechanisms of cortical plasticity that result from our present or future therapies. This paper is a departure from other content; the overview on genomics provided by Goldberg et al12 awaken us to stellar examples of how knowledge of our clients' genetic makeup can inform us about the value of physical therapies, how their dosages might be modified, or how frequent discoveries of polymorphisms or genetic sequencing can impact our mode of delivery or herald the advent of new therapies. The very fact that we now have access to our own genetic profile may well serve as a prime example of "personalized medicine" to which we will become increasing exposed.

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