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Overman MJ, Binns E, Milosevich ET, Demeyere N. Recovery of Visuospatial Neglect With Standard Treatment: A Systematic Review and Meta-Analysis. Stroke 2024; 55:2325-2339. [PMID: 39016005 PMCID: PMC11346719 DOI: 10.1161/strokeaha.124.046760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/05/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Visuospatial neglect is a common consequence of stroke and is characterized by impaired attention to contralesional space. Currently, the extent and time course of recovery from neglect are not clearly established. This systematic review and meta-analysis aimed to determine the recovery trajectory of poststroke neglect with standard treatment. METHODS PsycInfo, Embase, and MEDLINE were searched for articles reporting recovery rates of neglect after stroke. Time since stroke was categorized into early (0-3 months), mid (3-6 months), and late (>6 months) recovery phases. Random-effects models for pooled prevalence were generated for each phase, and potential sources of heterogeneity were explored with metaregressions. Methodological quality of each study was assessed using the Joanna Briggs Institute checklist, with low-quality studies excluded in sensitivity analyses. RESULTS The search captured 4130 articles including duplicates, and 111 full-text reviews were undertaken. A total of 27 studies reporting data from 839 stroke survivors with neglect were included for review. Meta-analyses indicated a recovery rate of 42% in the early phase, which increased to 53% in the mid-recovery phase. Additional recovery in the late phase was minimal, with an estimated 56% recovery rate. Heterogeneity of studies was high (I2>75%) in all 3 phases of recovery. Estimates were robust to sensitivity analyses. Metaregressions showed significantly greater recovery in studies that included patients with left-hemisphere lesions (β=0.275, P<0.05, I2=84%). CONCLUSIONS Most recovery from neglect occurs in the first 3 months, although additional gains can be expected up to 6 months poststroke. While a large proportion of patients recover from neglect, over 40% show persistent symptoms. Further research is needed on effective rehabilitation interventions, particularly focusing on patients most at risk of chronic visuospatial neglect. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023388763.
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Affiliation(s)
- Margot Juliëtte Overman
- Department of Experimental Psychology (M.J.O., E.B., E.T.M.), University of Oxford, United Kingdom
| | - Elena Binns
- Department of Experimental Psychology (M.J.O., E.B., E.T.M.), University of Oxford, United Kingdom
| | - Elise T. Milosevich
- Department of Experimental Psychology (M.J.O., E.B., E.T.M.), University of Oxford, United Kingdom
| | - Nele Demeyere
- Nuffield Department of Clinical Neurosciences (N.D.), University of Oxford, United Kingdom
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2
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Gallucci L, Sperber C, Monsch AU, Klöppel S, Arnold M, Umarova RM. Improving diagnostic accuracy of the Montreal Cognitive Assessment to identify post-stroke cognitive impairment. Sci Rep 2024; 14:20125. [PMID: 39209968 PMCID: PMC11362592 DOI: 10.1038/s41598-024-71184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
Given advantages in reperfusion therapy leading to mild stroke, less apparent cognitive deficits can be overseen in a routine neurological examination. Despite the widespread use of the Montreal Cognitive Assessment (MoCA), age- and education-specific cutoffs for the detection of post-stroke cognitive impairment (PSCI) are not established, hampering its valid application in stroke. We aimed to establish age- and education-specific MoCA cutoffs to better discriminate patients with and without acute PSCI. Patients with acute ischemic stroke underwent the MoCA and a detailed neuropsychological assessment. PSCI was defined as a performance < - 1.5 SD in ≥ 2 cognitive domains. As secondary data analysis, the discriminant abilities of the MoCAraw-score (not adding + 1 as correction for ≤ 12 years of education, YoE) cutoffs were automatically derived based on Youden Index and evaluated by receiver operating characteristic analyses across age- (< 55, 55-70, > 70 years old) and education-specific (≤ 12 and > 12 YoE) groups. 351 stroke patients (67.4 ± 14.1 years old; 13.1 ± 2.8 YoE) underwent the neuropsychological assessment 2.7 ± 2.0 days post-stroke. The original MoCA cutoff < 26 falsely classified 26.2% of examined patients, with poor sensitivity in younger adults (34.8% in patients < 55 years > 12 YoE) and poor specificity in older adults (55.0%, in > 70 years ≤ 12 YoE). By maximizing both sensitivity and specificity, the optimal MoCAraw cutoffs were: (i) < 28 in patients aged < 55 with > 12 YoE (sensitivity = 69.6%, specificity = 77.8%); (ii) < 22 and < 25 in patients > 70 years with ≤ 12 and > 12 YoE (sensitivity = 61.6%, specificity = 90.0%; sensitivity = 63.3%, specificity = 84.0%, respectively). In other groups the optimal MoCAraw cutoff was < 26. Age and education level should be considered when interpreting MoCA-scores. Though new age- and education-specific cutoffs demonstrated higher discriminant ability for PSCI, their performance in young stroke and adults with higher education level was low due to ceiling effects and MoCA subtests structure, and cautious interpretation in these patients is warranted.Trial registration: ClinicalTrials.gov Identifier: NCT05653141.
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Affiliation(s)
- Laura Gallucci
- Department of Neurology, University Hospital, Inselspital, University of Bern, Freiburgstr. 16, 3010, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Christoph Sperber
- Department of Neurology, University Hospital, Inselspital, University of Bern, Freiburgstr. 16, 3010, Bern, Switzerland
| | | | - Stefan Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital, Inselspital, University of Bern, Freiburgstr. 16, 3010, Bern, Switzerland
| | - Roza M Umarova
- Department of Neurology, University Hospital, Inselspital, University of Bern, Freiburgstr. 16, 3010, Bern, Switzerland.
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Kaufmann BC, Pastore-Wapp M, Bartolomeo P, Geiser N, Nyffeler T, Cazzoli D. Severity-Dependent Interhemispheric White Matter Connectivity Predicts Poststroke Neglect Recovery. J Neurosci 2024; 44:e1311232024. [PMID: 38565290 PMCID: PMC11112644 DOI: 10.1523/jneurosci.1311-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/15/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Left-sided spatial neglect is a very common and challenging issue after right-hemispheric stroke, which strongly and negatively affects daily living behavior and recovery of stroke survivors. The mechanisms underlying recovery of spatial neglect remain controversial, particularly regarding the involvement of the intact, contralesional hemisphere, with potential contributions ranging from maladaptive to compensatory. In the present prospective, observational study, we assessed neglect severity in 54 right-hemispheric stroke patients (32 male; 22 female) at admission to and discharge from inpatient neurorehabilitation. We demonstrate that the interaction of initial neglect severity and spared white matter (dis)connectivity resulting from individual lesions (as assessed by diffusion tensor imaging, DTI) explains a significant portion of the variability of poststroke neglect recovery. In mildly impaired patients, spared structural connectivity within the lesioned hemisphere is sufficient to attain good recovery. Conversely, in patients with severe impairment, successful recovery critically depends on structural connectivity within the intact hemisphere and between hemispheres. These distinct patterns, mediated by their respective white matter connections, may help to reconcile the dichotomous perspectives regarding the role of the contralesional hemisphere as exclusively compensatory or not. Instead, they suggest a unified viewpoint wherein the contralesional hemisphere can - but must not necessarily - assume a compensatory role. This would depend on initial impairment severity and on the available, spared structural connectivity. In the future, our findings could serve as a prognostic biomarker for neglect recovery and guide patient-tailored therapeutic approaches.
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Affiliation(s)
- Brigitte C Kaufmann
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
| | - Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
| | - Paolo Bartolomeo
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
| | - Nora Geiser
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern 3010, Switzerland
| | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Department of Psychology, University of Bern, Bern 3012, Switzerland
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Gouret A, Le Bars S, Porssut T, Waszak F, Chokron S. Advancements in brain-computer interfaces for the rehabilitation of unilateral spatial neglect: a concise review. Front Neurosci 2024; 18:1373377. [PMID: 38784094 PMCID: PMC11111994 DOI: 10.3389/fnins.2024.1373377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
This short review examines recent advancements in neurotechnologies within the context of managing unilateral spatial neglect (USN), a common condition following stroke. Despite the success of brain-computer interfaces (BCIs) in restoring motor function, there is a notable absence of effective BCI devices for treating cerebral visual impairments, a prevalent consequence of brain lesions that significantly hinders rehabilitation. This review analyzes current non-invasive BCIs and technological solutions dedicated to cognitive rehabilitation, with a focus on visuo-attentional disorders. We emphasize the need for further research into the use of BCIs for managing cognitive impairments and propose a new potential solution for USN rehabilitation, by combining the clinical subtleties of this syndrome with the technological advancements made in the field of neurotechnologies.
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Affiliation(s)
- Alix Gouret
- Integrative Neuroscience and Cognition Center (INCC), CNRS, Université Paris Cité, Paris, France
- Research and Innovation Department, Capgemini Engineering, Paris, France
| | - Solène Le Bars
- Integrative Neuroscience and Cognition Center (INCC), CNRS, Université Paris Cité, Paris, France
- Research and Innovation Department, Capgemini Engineering, Paris, France
| | - Thibault Porssut
- Research and Innovation Department, Capgemini Engineering, Paris, France
| | - Florian Waszak
- Integrative Neuroscience and Cognition Center (INCC), CNRS, Université Paris Cité, Paris, France
| | - Sylvie Chokron
- Integrative Neuroscience and Cognition Center (INCC), CNRS, Université Paris Cité, Paris, France
- Research and Innovation Department, Capgemini Engineering, Paris, France
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Ptak R, Bourgeois A. Disengagement of attention with spatial neglect: A systematic review of behavioral and anatomical findings. Neurosci Biobehav Rev 2024; 160:105622. [PMID: 38490498 DOI: 10.1016/j.neubiorev.2024.105622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/10/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
The present review examined the consequences of focal brain injury on spatial attention studied with cueing paradigms, with a particular focus on the disengagement deficit, which refers to the abnormal slowing of reactions following an ipsilesional cue. Our review supports the established notion that the disengagement deficit is a functional marker of spatial neglect and is particularly pronounced when elicited by peripheral cues. Recent research has revealed that this deficit critically depends on cues that have task-relevant characteristics or are associated with negative reinforcement. Attentional capture by task-relevant cues is contingent on damage to the right temporo-parietal junction (TPJ) and is modulated by functional connections between the TPJ and the right insular cortex. Furthermore, damage to the dorsal premotor or prefrontal cortex (dPMC/dPFC) reduces the effect of task-relevant cues. These findings support an interactive model of the disengagement deficit, involving the right TPJ, the insula, and the dPMC/dPFC. These interconnected regions play a crucial role in regulating and adapting spatial attention to changing intrinsic values of stimuli in the environment.
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Affiliation(s)
- Radek Ptak
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, Geneva 1206, Switzerland; Division of Neurorehabilitation, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.
| | - Alexia Bourgeois
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, Geneva 1206, Switzerland; University of Applied Sciences and Arts of Western Switzerland, School of Health Sciences, Avenue de Champel 47, Geneva 1206, Switzerland
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Wang X, Duan C, Lyu J, Han D, Cheng K, Meng Z, Wu X, Chen W, Wang G, Niu Q, Li X, Bian Y, Han D, Guo W, Yang S, Wang X, Zhang T, Bi J, Wu F, Xia S, Tong D, Duan K, Li Z, Wang R, Wang J, Lou X. Impact of the Alberta Stroke Program CT Score subregions on long-term functional outcomes in acute ischemic stroke: Results from two multicenter studies in China. J Transl Int Med 2024; 12:197-208. [PMID: 38779116 PMCID: PMC11107184 DOI: 10.2478/jtim-2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives The Alberta Stroke Program CT Score (ASPECTS) is a widely used rating system for assessing infarct extent and location. We aimed to investigate the prognostic value of ASPECTS subregions' involvement in the long-term functional outcomes of acute ischemic stroke (AIS). Materials and Methods Consecutive patients with AIS and anterior circulation large-vessel stenosis and occlusion between January 2019 and December 2020 were included. The ASPECTS score and subregion involvement for each patient was assessed using posttreatment magnetic resonance diffusion-weighted imaging. Univariate and multivariable regression analyses were conducted to identify subregions related to 3-month poor functional outcome (modified Rankin Scale scores, 3-6) in the reperfusion and medical therapy cohorts, respectively. In addition, prognostic efficiency between the region-based ASPECTS and ASPECTS score methods were compared using receiver operating characteristic curves and DeLong's test. Results A total of 365 patients (median age, 64 years; 70% men) were included, of whom 169 had poor outcomes. In the reperfusion therapy cohort, multivariable regression analyses revealed that the involvement of the left M4 cortical region in left-hemisphere stroke (adjusted odds ratio [aOR] 5.39, 95% confidence interval [CI] 1.53-19.02) and the involvement of the right M3 cortical region in right-hemisphere stroke (aOR 4.21, 95% CI 1.05-16.78) were independently associated with poor functional outcomes. In the medical therapy cohort, left-hemisphere stroke with left M5 cortical region (aOR 2.87, 95% CI 1.08-7.59) and caudate nucleus (aOR 3.14, 95% CI 1.00-9.85) involved and right-hemisphere stroke with right M3 cortical region (aOR 4.15, 95% CI 1.29-8.18) and internal capsule (aOR 3.94, 95% CI 1.22-12.78) affected were related to the increased risks of poststroke disability. In addition, region-based ASPECTS significantly improved the prognostic efficiency compared with the conventional ASPECTS score method. Conclusion The involvement of specific ASPECTS subregions depending on the affected hemisphere was associated with worse functional outcomes 3 months after stroke, and the critical subregion distribution varied by clinical management. Therefore, region-based ASPECTS could provide additional value in guiding individual decision making and neurological recovery in patients with AIS.
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Affiliation(s)
- Xinrui Wang
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Caohui Duan
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Jinhao Lyu
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Dongshan Han
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Kun Cheng
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Zhihua Meng
- Department of Radiology, Yuebei People’s Hospital, Shaoguan512000, Guangdong Province, China
| | - Xiaoyan Wu
- Department of Radiology, Anshan Changda Hospital, Anshan114000, Liaoning Province, China
| | - Wen Chen
- Department of Radiology, Shiyan Taihe Hospital, Shiyan442000, Hubei Province, China
| | - Guohua Wang
- Department of Radiology, Qingdao Municipal Hospital, Qingdao University, Qingdao266011, Shandong Province, China
| | - Qingliang Niu
- Department of Radiology, WeiFang Traditional Chinese Hospital, Weifang261053, Shandong Province, China
| | - Xin Li
- Department of Radiology, The Second Hospital of Jilin University, Jilin University, Changchun130014, Jilin Province, China
| | - Yitong Bian
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an710061, Shaanxi Province, China
| | - Dan Han
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming650032, Yunnan Province, China
| | - Weiting Guo
- Department of Radiology, Shanxi Provincial People’s Hospital, Taiyuan030012, Shanxi Province, China
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha410008, Hunan Province, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou215006, Jiangsu Province, China
| | - Tijiang Zhang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi563000, Guizhou Province, China
| | - Junying Bi
- Department of Radiology, The Third People’s Hospital of Hubei Province, Wuhan430030, Hubei Province, China
| | - Feiyun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing210029, Jiangsu Province, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Nankai University, Tianjin300190, China
| | - Dan Tong
- Department of Radiology, The First Hospital of Jilin University, Jilin University, Changchun130021, Jilin Province, China
| | - Kai Duan
- Department of Radiology, Liangxiang Hospital, Beijing102401, China
| | - Zhi Li
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming650034, Yunnan Province, China
| | - Rongpin Wang
- Department of Radiology, Guizhou Provincial People’s Hospital, Guiyang550499, Guizhou Province, China
| | - Jinan Wang
- Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen361004, Fujian Province, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
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Mazzi C, Mele S, Bagattini C, Sanchez-Lopez J, Savazzi S. Coherent activity within and between hemispheres: cortico-cortical connectivity revealed by rTMS of the right posterior parietal cortex. Front Hum Neurosci 2024; 18:1362742. [PMID: 38516308 PMCID: PMC10954802 DOI: 10.3389/fnhum.2024.1362742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Low frequency (1 Hz) repetitive transcranial stimulation (rTMS) applied over right posterior parietal cortex (rPPC) has been shown to reduce cortical excitability both of the stimulated area and of the interconnected contralateral homologous areas. In the present study, we investigated the whole pattern of intra- and inter-hemispheric cortico-cortical connectivity changes induced by rTMS over rPPC. Methods To do so, 14 healthy participants underwent resting state EEG recording before and after 30 min of rTMS at 1 Hz or sham stimulation over the rPPC (electrode position P6). Real stimulation was applied at 90% of motor threshold. Coherence values were computed on the electrodes nearby the stimulated site (i.e., P4, P8, and CP6) considering all possible inter- and intra-hemispheric combinations for the following frequency bands: delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-12Hz), low beta (12-20 Hz), high beta (20-30 Hz), and gamma (30-50 Hz). Results and discussion Results revealed a significant increase in coherence in delta, theta, alpha and beta frequency bands between rPPC and the contralateral homologous sites. Moreover, an increase in coherence in theta, alpha, beta and gamma frequency bands was found between rPPC and right frontal sites, reflecting the activation of the fronto-parietal network within the right hemisphere. Summarizing, subthreshold rTMS over rPPC revealed cortico-cortical inter- and intra-hemispheric connectivity as measured by the increase in coherence among these areas. Moreover, the present results further confirm previous evidence indicating that the increase of coherence values is related to intra- and inter-hemispheric inhibitory effects of rTMS. These results can have implications for devising evidence-based rehabilitation protocols after stroke.
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Affiliation(s)
- Chiara Mazzi
- Perception and Awareness (PandA) Laboratory, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sonia Mele
- Perception and Awareness (PandA) Laboratory, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Bagattini
- Perception and Awareness (PandA) Laboratory, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Javier Sanchez-Lopez
- Escuela Nacional de Estudios Superiores Unidad Juriquilla, Universidad Nacional Autonoma de Mexico, Santiago de Querétaro, Mexico
| | - Silvia Savazzi
- Perception and Awareness (PandA) Laboratory, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Umarova RM, Gallucci L, Hakim A, Wiest R, Fischer U, Arnold M. Adaptation of the Concept of Brain Reserve for the Prediction of Stroke Outcome: Proxies, Neural Mechanisms, and Significance for Research. Brain Sci 2024; 14:77. [PMID: 38248292 PMCID: PMC10813468 DOI: 10.3390/brainsci14010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
The prediction of stroke outcome is challenging due to the high inter-individual variability in stroke patients. We recently suggested the adaptation of the concept of brain reserve (BR) to improve the prediction of stroke outcome. This concept was initially developed alongside the one for the cognitive reserve for neurodegeneration and forms a valuable theoretical framework to capture high inter-individual variability in stroke patients. In the present work, we suggest and discuss (i) BR-proxies-quantitative brain characteristics at the time stroke occurs (e.g., brain volume, hippocampus volume), and (ii) proxies of brain pathology reducing BR (e.g., brain atrophy, severity of white matter hyperintensities), parameters easily available from a routine MRI examination that might improve the prediction of stroke outcome. Though the influence of these parameters on stroke outcome has been partly reported individually, their independent and combined impact is yet to be determined. Conceptually, BR is a continuous measure determining the amount of brain structure available to mitigate and compensate for stroke damage, thus reflecting individual differences in neural resources and a capacity to maintain performance and recover after stroke. We suggest that stroke outcome might be defined as an interaction between BR at the time stroke occurs and lesion load. BR in stroke can potentially be influenced, e.g., by modifying cardiovascular risk factors. In addition to the potential power of the BR concept in a mechanistic understanding of inter-individual variability in stroke outcome and establishing individualized therapeutic approaches, it might help to strengthen the synergy of preventive measures in stroke, neurodegeneration, and healthy aging.
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Affiliation(s)
- Roza M. Umarova
- Department of Neurology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (L.G.); (U.F.); (M.A.)
| | - Laura Gallucci
- Department of Neurology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (L.G.); (U.F.); (M.A.)
| | - Arsany Hakim
- Department of Neuroradiology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (A.H.); (R.W.)
| | - Roland Wiest
- Department of Neuroradiology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (A.H.); (R.W.)
| | - Urs Fischer
- Department of Neurology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (L.G.); (U.F.); (M.A.)
- Department of Neurology, University Hospital Basel, University of Basel, 4003 Basel, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (L.G.); (U.F.); (M.A.)
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Lunven M, Toba MN, Bartolomeo P. Prism adaptation therapy in spatial neglect: The importance of connectional anatomy. Neuropsychologia 2023; 188:108640. [PMID: 37423424 DOI: 10.1016/j.neuropsychologia.2023.108640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
The meta-analysis conducted by Székely et al. described the lack of beneficial effect of prism adaptation in neglect patients. The authors concluded that the results did "not support the routine use of prism adaptation as a therapy for spatial neglect". However, a possible nuance to this conclusion could be that the response (or lack thereof) of neglect patients to prism adaptation may actually depend on the connectional anatomy of their lesion. We develop this idea in our commentary, in order to offer a more balanced perspective on the implications of the findings obtained by Székely et al.
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Affiliation(s)
- Marine Lunven
- Département D'Etudes Cognitives, École Normale Supérieure, PSL University, 75005, Paris, France; University Paris Est Creteil, INSERM U955, Institut Mondor de Recherche Biomédicale, Equipe NeuroPsychologie Interventionnelle, F-94010, Creteil, France
| | - Monica N Toba
- Laboratory of Functional Neurosciences (UR UPJV 4559), University of Picardy Jules Verne and University Hospital of Amiens, Amiens, France; Sorbonne Université, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de La Pitié-Salpêtrière, 75013, Paris, France
| | - Paolo Bartolomeo
- Sorbonne Université, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute, ICM, Hôpital de La Pitié-Salpêtrière, 75013, Paris, France.
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10
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Ueda M, Yuri T, Ueno K, Ishii R, Naito Y. The Neurophysiological Features Associated with Unilateral Spatial Neglect Recovery: A Scoping Review. Brain Topogr 2023; 36:631-643. [PMID: 37410274 DOI: 10.1007/s10548-023-00980-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
The purpose of this scoping review is to provide updated information on the neural basis and neurophysiological features associated with unilateral spatial neglect (USN) recovery. We applied the Preferred Reporting Systems for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework and identified 16 relevant papers from the databases. Critical appraisal was performed by two independent reviewers using a standardized appraisal instrument developed by the PRISMA-ScR. We identified and categorized investigation methods for the neural basis and neurophysiological features of USN recovery after stroke using magnetic resonance imaging (MRI), functional MRI, and electroencephalography (EEG). This review found two brain-level mechanisms underlying USN recovery at the behavioral level. These include the absence of stroke-related damage to the right ventral attention network during the acute phase and compensatory recruitment of analogous areas of the undamaged opposite hemisphere and prefrontal cortex during visual search tasks in the subacute or later phases. However, the relationship between the neural and neurophysiological findings and improvements in USN-related activities of daily living remains unknown. This review adds to the growing body of evidence regarding the neural mechanisms underlying USN recovery.
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Affiliation(s)
- Masaya Ueda
- Demartment of Occupational Therapy, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan.
| | - Takuma Yuri
- Department of Occupational Therapy, Kyoto Tachibana University, Kyoto, Japan
| | - Keita Ueno
- Demartment of Occupational Therapy, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
| | - Ryouhei Ishii
- Demartment of Occupational Therapy, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
- Department of Psychiatry, Medical School, Osaka University, Osaka, Japan
| | - Yasuo Naito
- Demartment of Occupational Therapy, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
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11
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Shi S, Qie S, Wang H, Wang J, Liu T. Recombination of the right cerebral cortex in patients with left side USN after stroke: fNIRS evidence from resting state. Front Neurol 2023; 14:1178087. [PMID: 37545727 PMCID: PMC10400010 DOI: 10.3389/fneur.2023.1178087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Unilateral spatial neglect (USN) is an impaired contralesional stimulus detection, response, or action, causing functional disability. After a stroke, the right hemisphere experiences USN more noticeably, severely, and persistently than the left. However, few studies using fNIRS have been reported in cases of USN. This study aimed to confirm weaker RSFC in USN and investigate the potential inherent features in hemodynamic fluctuations that may be associated with USN. Furthermore, these features were combined into a mathematical model for more accurate classification. Methods A total of 33 stroke patients with right-sided brain damage were chosen, of whom 12 had non-USN after stroke, and 21 had USN after stroke (the USN group). Graph theory was used to evaluate the hemodynamic signals of the brain's right cerebral cortex during rest. Furthermore, a support vector machine model was built to categorize the subjects into two groups based on the chosen network properties. Results First, mean functional connectivity was lower in the USN group (0.745 ± 0.239) than in the non-USN group (0.843 ± 0.254) (t = -4.300, p < 0.001). Second, compared with the non-USN group, USN patients had a larger clustering coefficient (C) (t = 3.145, p < 0.001), local efficiency (LE) (t = 3.189, p < 0.001), and smaller global efficiency (GE) (t = 3.047, p < 0.001). Notably, there were differences in characteristic path length (L) and small worldness (σ) values between the two groups at certain thresholds, mainly as higher L (t = 3.074, p < 0.001) and lower small worldness (σ) values (t = 2.998, p < 0.001) in USN patients compared with non-USN patients. Finally, the classification accuracy of the SVM model based on AUC aC (t = -2.259, p = 0.031) and AUC aLE (t = -2.063, p = 0.048) was 85%, the sensitivity was 75%, and the specificity was 89%. Conclusion The functional network architecture of the right cerebral cortex exhibits significant topological alterations in individuals with USN following stroke, and the sensitivity index based on the small-world property AUC may be utilized to identify these patients accurately.
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Affiliation(s)
- Shanshan Shi
- Rehabilitation Clinic, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shuyan Qie
- Rehabilitation Clinic, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Hujun Wang
- Rehabilitation Clinic, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jie Wang
- Rehabilitation Clinic, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Tiejun Liu
- Department of General Surgery, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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12
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Abstract
Unilateral spatial neglect (USN) is a common and disabling cognitive consequence of stroke wherein individuals demonstrate decreased response to contralesional information. Here, we provide an updated narrative review of studies that shed light on the neural mechanisms and predictors of recovery of USN. Additionally, we report a rapid review of randomized controlled trials focusing on USN intervention, both nonpharmacological and pharmacological, published in the last 5 years. Randomized controlled trials are reviewed within the context of systematic reviews and meta-analyses of USN interventions published within the same time frame. The quality of randomized controlled trials of treatment is higher compared to quality reported in previous reviews and meta-analyses. However, remaining weaknesses in participant demographic reporting, as well as small, heterogenous samples, render generalizability and cross-study interpretation a challenge. Nevertheless, evidence regarding neural mechanisms underlying USN recovery and regarding the effectiveness of targeted USN interventions is accumulating and strengthening, setting the foundation for future investigations into patient-specific factors that may influence treatment response. We identify gaps and provide suggestions for future USN intervention research.
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Affiliation(s)
- Alexandra Zezinka Durfee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (A.Z.D., A.E.H.)
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (A.Z.D., A.E.H.).,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD (A.E.H.).,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD (A.E.H.)
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13
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Cao L, Ye L, Xie H, Zhang Y, Song W. Neural substrates in patients with visual-spatial neglect recovering from right-hemispheric stroke. Front Neurosci 2022; 16:974653. [PMID: 36061609 PMCID: PMC9434016 DOI: 10.3389/fnins.2022.974653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Visual-spatial attention disorder after stroke seriously affects recovery and quality of life in stroke patients. Previous studies have shown that some patients recovery rapidly from visual-spatial neglect (VSN), but the brain networks underlying this recovery are not well understood. Using functional magnetic resonance imaging, we aimed to identify network differences between patients who rapidly recovered from VSN and those with persistent VSN. The study included 30 patients with VSN who suffered subacute stroke. Patients were examined 2–4 weeks after stroke onset and 4 weeks after the initial assessment. At the last evaluation, patients in the persistent VSN (n = 15) and rapid recovery (n = 15) groups underwent paper-and-pencil tests. We defined the bilateral frontal eye fields, bilateral intraparietal sulcus in the dorsal attention network, and right temporoparietal junction and ventral frontal cortex areas in the ventral attention network as regions of interest (ROI) and measured whole-brain ROI-based functional connectivity (FC) and amplitude of low-frequency fluctuations (ALFF) in subacute right-hemisphere stroke patients. VSN recovery was associated with changes in the activation of multiple bilateral attentional brain regions. Specifically, persistent VSN was associated with lower FC in the right superior frontal gyrus, right inferior temporal gyrus, right medial orbitofrontal cortex, left precuneus, right inferior parietal gyrus, right medial frontal gyrus, right rectus gyrus, left superior frontal gyrus, left middle cingulate gyrus, right superior temporal pole, right postcentral gyrus, and right posterior cingulate gyrus compared to that in those with rapid recovery, whereas ALFF in the left cerebellum were decreased in patients with persistent VSN. Our results demonstrate that the DAN rather than the VAN, plays a more important role in recovery from VSN, and that the cerebellum is involved in recovery. We believe that our results supplement those of previous studies on recovery from VSN.
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Affiliation(s)
- Lei Cao
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linlin Ye
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Linlin Ye,
| | - Huanxin Xie
- Department of Orthopedics, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Yichen Zhang
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, Beijing, China
- Weiqun Song,
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14
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Imura T, Mitsutake T, Hori T, Tanaka R. Predicting the prognosis of unilateral spatial neglect using magnetic resonance imaging in patients with stroke: A systematic review. Brain Res 2022; 1789:147954. [DOI: 10.1016/j.brainres.2022.147954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
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15
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Sun R, Wong WW, Wang J, Wang X, Tong RKY. Functional brain networks assessed with surface electroencephalography for predicting motor recovery in a neural guided intervention for chronic stroke. Brain Commun 2022; 3:fcab214. [PMID: 35350709 PMCID: PMC8936428 DOI: 10.1093/braincomms/fcab214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 06/04/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022] Open
Abstract
Predicting whether a chronic stroke patient is likely to benefit from a specific intervention can help patients establish reasonable expectations. It also provides the basis for candidates selecting for the intervention. Recent convergent evidence supports the value of network-based approach for understanding the relationship between dysfunctional neural activity and motor deficits after stroke. In this study, we applied resting-state brain connectivity networks to investigate intervention-specific predictive biomarkers of motor improvement in 22 chronic stroke participants who received either combined action observation with EEG-guided robot-hand training (Neural Guided-Action Observation Group, n = 12, age: 34–68 years) or robot-hand training without action observation and EEG guidance (non-Neural Guided-text group, n = 10, age: 42–57 years). The robot hand in Neural Guided-Action Observation training was activated only when significant mu suppression (8–12 Hz) was detected from participant’s EEG signals in ipsilesional hemisphere while it was randomly activated in non-Neural Guided-text training. Only the Neural Guided-Action Observation group showed a significant long-term improvement in their upper-limb motor functions (P < 0.5). In contrast, no significant training effect on the paretic motor functions was found in the non-Neural Guided-text group (P > 0.5). The results of brain connectivity estimated via EEG coherence showed that the pre-training interhemispheric connectivity of delta, theta, alpha and contralesional connectivity of beta were motor improvement related in the Neural Guided-Action Observation group. They can not only differentiate participants with good and poor recovery (interhemispheric delta: P = 0.047, Hedges’ g = 1.409; interhemispheric theta: P = 0.046, Hedges’ g = 1.333; interhemispheric alpha: P = 0.038, Hedges’ g = 1.536; contralesional beta: P = 0.027, Hedges’ g = 1.613) but also significantly correlated with post-training intervention gains (interhemispheric delta: r = −0.901, P < 0.05; interhemispheric theta: r = −0.702, P < 0.05; interhemispheric alpha: r = −0.641, P < 0.05; contralesional beta: r = −0.729, P < 0.05). In contrast, no EEG coherence was significantly correlated with intervention gains in the non-Neural Guided-text group (all Ps>0.05). Partial least square regression showed that the combination of pre-training interhemispheric and contralesional local connectivity could precisely predict intervention gains in the Neural Guided-Action Observation group with a strong correlation between predicted and observed intervention gains (r = 0.82r=0.82) and between predicted and observed intervention outcomes (r = 0.90r=0.90). In summary, EEG-based resting-state brain connectivity networks may serve clinical decision-making by offering an approach to predicting Neural Guided-Action Observation training-induced motor improvement.
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Affiliation(s)
- Rui Sun
- The Laboratory of Neuroscience for Education, Faculty of Education, the University of Hong Kong, Pokfulam, Hong Kong, China
| | - Wan-Wa Wong
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jing Wang
- School of Mechanical Engineering, Xi'an Jiaotong University, Shaanxi, China
| | - Xin Wang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Raymond K Y Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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16
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Can music restore brain connectivity in post-stroke cognitive deficits? Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Ye LL, Xie HX, Cao L, Song WQ. Therapeutic Effects of Transcranial Magnetic Stimulation on Visuospatial Neglect Revealed With Event-Related Potentials. Front Neurol 2022; 12:799058. [PMID: 35140674 PMCID: PMC8818689 DOI: 10.3389/fneur.2021.799058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate changes in attention processing after low-frequency repetitive transcranial magnetic stimulation (rTMS) over the left posterior parietal cortex to better understand its role in visuospatial neglect (VSN) rehabilitation. The current study included 10 subacute stroke patients with VSN consecutively recruited from the inpatient stroke rehabilitation center at Xuanwu Hospital (the teaching hospital affiliated with Capital Medical University) between March and November 2019. All patients performed a battery of tasks (including line bisection, line cancellation, and star cancellation tests) two weeks before treatment and at the beginning and end of treatment; the attentive components of the test results were analyzed. In addition, low-frequency rTMS was used to stimulate the left posterior parietal cortex for 14 days and event-related potential data were collected before and after the stimulation. Participants were evaluated using a target-cue paradigm and pencil-paper tests. No significant differences were detected on the battery of tasks before rTMS. However, we found that rTMS treatment significantly improved the response times and accuracy rates of patients with VSN. After rTMS, the treatment side (left) amplitude of P300 following an event-related potential was higher than that before treatment (left target, p = 0.002; right target, p = 0.047). Thus, our findings suggest that rTMS may be an effective treatment for VSN. The observed increase in event-related potential amplitude supports the hypothesized compensational role of the contralesional hemisphere in terms of residual performance. Our results provide electrophysiological evidence that may help determine the mechanisms mediating the therapeutic effects of rTMS.
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18
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Houben M, Chettouf S, Van Der Werf YD, Stins J. Theta-burst transcranial magnetic stimulation for the treatment of unilateral neglect in stroke patients: A systematic review and best evidence synthesis. Restor Neurol Neurosci 2021; 39:447-465. [PMID: 34864705 PMCID: PMC8764600 DOI: 10.3233/rnn-211228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Unilateral neglect (UN) is a common and disabling disorder after stroke. UN is a strong and negative predictor of functional rehabilitative outcome. Non-invasive brain stimulation, such as theta-burst transcranial magnetic stimulation (TBS), is a promising rehabilitation technique for treating stroke-induced UN. OBJECTIVE To systematically review the available literature, researching whether TBS of the contra-lesional hemisphere is more effective than standard rehabilitation in improving symptoms of UN in patients with right hemisphere stroke. REVIEW METHODS A systematic review was conducted to retrieve randomized controlled trials (RCTs) that were relevant to the objective of this review. PubMed, Ovid and Cochrane Library electronic databases were comprehensively searched from inception up to February 2021. Of the included studies, methodological quality was assessed using the PEDro scale, whereafter a best evidence synthesis (BES) was conducted to summarize the results. RESULTS Nine RCTs investigating the effects of TBS on stroke-induced UN symptoms were included in this review. Seven studies assessing continuous TBS (cTBS) found significantly greater amelioration of UN symptoms in the TBS intervention group when compared to the control group; one study assessing cTBS found no such significant difference. One study assessing intermittent TBS (iTBS) found significant between-group differences in favor of the intervention. The BES yielded strong evidence in favor of cTBS, and limited evidence in favor of iTBS. CONCLUSIONS The included studies in the present review allow the conclusion that TBS can have favorable effects on UN recovery in stroke patients. Its clinical use is recommended in conjunction with cognitive rehabilitation and occupational or physical rehabilitation as needed. However, many aspects for optimal usage of TBS therapy in clinical settings, such as exact TBS protocols, number of sessions, and treatment duration, are not clear.
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Affiliation(s)
- Milan Houben
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7 Amsterdam, The Netherlands
| | - Sabrina Chettouf
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7 Amsterdam, The Netherlands
| | - Ysbrand D Van Der Werf
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117 Amsterdam, The Netherlands
| | - John Stins
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7 Amsterdam, The Netherlands
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19
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Klink PC, Aubry JF, Ferrera VP, Fox AS, Froudist-Walsh S, Jarraya B, Konofagou EE, Krauzlis RJ, Messinger A, Mitchell AS, Ortiz-Rios M, Oya H, Roberts AC, Roe AW, Rushworth MFS, Sallet J, Schmid MC, Schroeder CE, Tasserie J, Tsao DY, Uhrig L, Vanduffel W, Wilke M, Kagan I, Petkov CI. Combining brain perturbation and neuroimaging in non-human primates. Neuroimage 2021; 235:118017. [PMID: 33794355 PMCID: PMC11178240 DOI: 10.1016/j.neuroimage.2021.118017] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/07/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Brain perturbation studies allow detailed causal inferences of behavioral and neural processes. Because the combination of brain perturbation methods and neural measurement techniques is inherently challenging, research in humans has predominantly focused on non-invasive, indirect brain perturbations, or neurological lesion studies. Non-human primates have been indispensable as a neurobiological system that is highly similar to humans while simultaneously being more experimentally tractable, allowing visualization of the functional and structural impact of systematic brain perturbation. This review considers the state of the art in non-human primate brain perturbation with a focus on approaches that can be combined with neuroimaging. We consider both non-reversible (lesions) and reversible or temporary perturbations such as electrical, pharmacological, optical, optogenetic, chemogenetic, pathway-selective, and ultrasound based interference methods. Method-specific considerations from the research and development community are offered to facilitate research in this field and support further innovations. We conclude by identifying novel avenues for further research and innovation and by highlighting the clinical translational potential of the methods.
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Affiliation(s)
- P Christiaan Klink
- Department of Vision & Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, the Netherlands.
| | - Jean-François Aubry
- Physics for Medicine Paris, Inserm U1273, CNRS UMR 8063, ESPCI Paris, PSL University, Paris, France
| | - Vincent P Ferrera
- Department of Neuroscience & Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, USA
| | - Andrew S Fox
- Department of Psychology & California National Primate Research Center, University of California, Davis, CA, USA
| | | | - Béchir Jarraya
- NeuroSpin, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut National de la Santé et de la Recherche Médicale (INSERM), Cognitive Neuroimaging Unit, Université Paris-Saclay, France; Foch Hospital, UVSQ, Suresnes, France
| | - Elisa E Konofagou
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA; Department of Radiology, Columbia University, New York, NY, USA
| | - Richard J Krauzlis
- Laboratory of Sensorimotor Research, National Eye Institute, Bethesda, MD, USA
| | - Adam Messinger
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - Anna S Mitchell
- Department of Experimental Psychology, Oxford University, Oxford, United Kingdom
| | - Michael Ortiz-Rios
- Newcastle University Medical School, Newcastle upon Tyne NE1 7RU, United Kingdom; German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany
| | - Hiroyuki Oya
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa, Iowa city, IA, USA
| | - Angela C Roberts
- Department of Physiology, Development and Neuroscience, Cambridge University, Cambridge, United Kingdom
| | - Anna Wang Roe
- Interdisciplinary Institute of Neuroscience and Technology, School of Medicine, Zhejiang University, Hangzhou 310029, China
| | | | - Jérôme Sallet
- Department of Experimental Psychology, Oxford University, Oxford, United Kingdom; Univ Lyon, Université Lyon 1, Inserm, Stem Cell and Brain Research Institute, U1208 Bron, France; Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Michael Christoph Schmid
- Newcastle University Medical School, Newcastle upon Tyne NE1 7RU, United Kingdom; Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 5, CH-1700 Fribourg, Switzerland
| | - Charles E Schroeder
- Nathan Kline Institute, Orangeburg, NY, USA; Columbia University, New York, NY, USA
| | - Jordy Tasserie
- NeuroSpin, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut National de la Santé et de la Recherche Médicale (INSERM), Cognitive Neuroimaging Unit, Université Paris-Saclay, France
| | - Doris Y Tsao
- Division of Biology and Biological Engineering, Tianqiao and Chrissy Chen Institute for Neuroscience; Howard Hughes Medical Institute; Computation and Neural Systems, Caltech, Pasadena, CA, USA
| | - Lynn Uhrig
- NeuroSpin, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut National de la Santé et de la Recherche Médicale (INSERM), Cognitive Neuroimaging Unit, Université Paris-Saclay, France
| | - Wim Vanduffel
- Laboratory for Neuro- and Psychophysiology, Neurosciences Department, KU Leuven Medical School, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven Belgium; Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Melanie Wilke
- German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany; Department of Cognitive Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Igor Kagan
- German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany.
| | - Christopher I Petkov
- Newcastle University Medical School, Newcastle upon Tyne NE1 7RU, United Kingdom.
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20
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Dressing A, Kaller CP, Martin M, Nitschke K, Kuemmerer D, Beume LA, Schmidt CSM, Musso M, Urbach H, Rijntjes M, Weiller C. Anatomical correlates of recovery in apraxia: A longitudinal lesion-mapping study in stroke patients. Cortex 2021; 142:104-121. [PMID: 34265734 DOI: 10.1016/j.cortex.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study investigates the clinical course of recovery of apraxia after left-hemisphere stroke and the underlying neuroanatomical correlates for persisting or recovering deficits in relation to the major processing streams in the network for motor cognition. METHODS 90 patients were examined during the acute (4.74 ± 2.73 days) and chronic (14.3 ± 15.39 months) stage after left-hemisphere stroke for deficits in meaningless imitation, as well as production and conceptual errors in tool use pantomime. Lesion correlates for persisting or recovering deficits were analyzed with an extension of the non-parametric Brunner-Munzel rank-order test for multi-factorial designs (two-way repeated-measures ANOVA) using acute images. RESULTS Meaningless imitation and tool use production deficits persisted into the chronic stage. Conceptual errors in tool use pantomime showed an almost complete recovery. Imitation errors persisted after occipitotemporal and superior temporal lesions in the dorso-dorsal stream. Chronic pantomime production errors were related to the supramarginal gyrus, the key structure of the ventro-dorsal stream. More anterior lesions in the ventro-dorsal stream (ventral premotor cortex) were additionally associated with poor recovery of production errors in pantomime. Conceptual errors in pantomime after temporal and supramarginal gyrus lesions persisted into the chronic stage. However, they resolved completely when related to angular gyrus or insular lesions. CONCLUSION The diverging courses of recovery in different apraxia tasks can be related to different mechanisms. Critical lesions to key structures of the network or entrance areas of the processing streams lead to persisting deficits in the corresponding tasks. Contrary, lesions located outside the core network but inducing a temporary network dysfunction allow good recovery e.g., of conceptual errors in pantomime. The identification of lesion correlates for different long-term recovery patterns in apraxia might also allow early clinical prediction of the course of recovery.
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Affiliation(s)
- Andrea Dressing
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
| | - Christoph P Kaller
- Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany; Dept. of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Martin
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Kai Nitschke
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dorothee Kuemmerer
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena-A Beume
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte S M Schmidt
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mariacristina Musso
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Dept. of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
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21
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Williams NL, Suarez A, Negoita S, Hillis AE, Gottesman RF, Johansen MC. Cardiac Structure and Function Is Associated With Hemispatial Neglect Severity. Front Neurol 2021; 12:666257. [PMID: 34025570 PMCID: PMC8134693 DOI: 10.3389/fneur.2021.666257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Hemispatial neglect is a debilitating consequence of right hemispheric ischemic stroke (RIS), with evidence that patient-level factors influence neglect severity. Study objective: Determine if cardiac function is associated with presence and severity of neglect, independent of infarct size. Methods: Two hundred and eighteen non-demented, RIS with cerebral MRI and echocardiography who completed ≥1 of 4 tests evaluating neglect were included. Age- and sex- adjusted Z-scores defined neglect with severity categorized as no neglect, neglect on one or neglect on ≥2 tests. The dependent variable was presence of neglect (multivariable logistic regression), or neglect severity (multinomial logistic regression). The association with left ventricular (LV) structure/function (independent variable) was evaluated using separate nested adjustment models. Results: Patients were on average 61 yo (21–95), female (50%), black (53%), with an ejection fraction of 60% (IQR 20–75%). Fifty eight (27%) had neglect. Each 1 cm increase in LV systolic diameter was associated with a higher relative risk of having neglect on two tests compared to those with no neglect (RRR = 1.83, 95% CI 1.01–3.32), but not after adjusting for education and DWI volume (RRR = 1.68, 95% CI 0.89–3.19). Per 1 cm increase in left atrial (LA) diameter, the relative risk of having neglect on 2 tests vs. no neglect was over two times higher (95% CI 1.04–4.77), but lost significance in the final model (RRR = 1.73, 95% CI 0.76–3.94). Conclusions: We found an association between markers of diastolic dysfunction (enlarging LV, compensatory enlarging LA) and severity of neglect, suggesting that cardiac structure, and function affects not only lesion volume, but also the functional consequences of infarct volume.
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Affiliation(s)
- Nicole L Williams
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Adrian Suarez
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Serban Negoita
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Argye E Hillis
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rebecca F Gottesman
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michelle C Johansen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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22
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Adam R, Schaeffer DJ, Johnston K, Menon RS, Everling S. Structural alterations in cortical and thalamocortical white matter tracts after recovery from prefrontal cortex lesions in macaques. Neuroimage 2021; 232:117919. [PMID: 33652141 DOI: 10.1016/j.neuroimage.2021.117919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 01/04/2023] Open
Abstract
Unilateral damage to the frontoparietal network typically impairs saccade target selection within the contralesional visual hemifield. Severity of deficits and the degree of recovery have been associated with widespread network dysfunction, yet it is not clear how these behavioural and functional brain changes relate with the underlying structural white matter tracts. Here, we investigated whether recovery after unilateral prefrontal cortex (PFC) lesions was associated with changes in white matter microstructure across large-scale frontoparietal cortical and thalamocortical networks. Diffusion-weighted imaging was acquired in four male rhesus macaques at pre-lesion, week 1, and week 8-16 post-lesion when target selection deficits largely recovered. Probabilistic tractography was used to reconstruct cortical frontoparietal fiber tracts, including the superior longitudinal fasciculus (SLF) and transcallosal fibers connecting the PFC or posterior parietal cortex (PPC), as well as thalamocortical fiber tracts connecting the PFC and PPC to thalamic nuclei. We found that the two animals with small PFC lesions showed increased fractional anisotropy in both cortical and thalamocortical fiber tracts when behaviour had recovered. However, we found that fractional anisotropy decreased in cortical frontoparietal tracts after larger PFC lesions yet increased in some thalamocortical tracts at the time of behavioural recovery. These findings indicate that behavioural recovery after small PFC lesions may be supported by both cortical and subcortical areas, whereas larger PFC lesions may have induced widespread structural damage and hindered compensatory remodeling in the cortical frontoparietal network.
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Affiliation(s)
- Ramina Adam
- Graduate Program in Neuroscience, University of Western Ontario, London, Canada; Robarts Research Institute, University of Western Ontario, London, Canada; The Brain and Mind Institute, University of Western Ontario, London, Canada
| | - David J Schaeffer
- Department of Neurobiology, University of Pittsburgh, PA, United States
| | - Kevin Johnston
- The Brain and Mind Institute, University of Western Ontario, London, Canada; Department of Physiology and Pharmacology, University of Western Ontario, London, Canada
| | - Ravi S Menon
- Robarts Research Institute, University of Western Ontario, London, Canada; The Brain and Mind Institute, University of Western Ontario, London, Canada; Department of Medical Biophysics, University of Western Ontario, London, Canada
| | - Stefan Everling
- Graduate Program in Neuroscience, University of Western Ontario, London, Canada; Robarts Research Institute, University of Western Ontario, London, Canada; The Brain and Mind Institute, University of Western Ontario, London, Canada; Department of Physiology and Pharmacology, University of Western Ontario, London, Canada.
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23
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Interaction between cognitive reserve and age moderates effect of lesion load on stroke outcome. Sci Rep 2021; 11:4478. [PMID: 33627742 PMCID: PMC7904829 DOI: 10.1038/s41598-021-83927-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/01/2021] [Indexed: 01/04/2023] Open
Abstract
The concepts of brain reserve and cognitive reserve were recently suggested as valuable predictors of stroke outcome. To test this hypothesis, we used age, years of education and lesion size as clinically feasible coarse proxies of brain reserve, cognitive reserve, and the extent of stroke pathology correspondingly. Linear and logistic regression models were used to predict cognitive outcome (Montreal Cognitive Assessment) and stroke-induced impairment and disability (NIH Stroke Scale; modified Rankin Score) in a sample of 104 chronic stroke patients carefully controlled for potential confounds. Results revealed 46% of explained variance for cognitive outcome (p < 0.001) and yielded a significant three-way interaction: Larger lesions did not lead to cognitive impairment in younger patients with higher education, but did so in younger patients with lower education. Conversely, even small lesions led to poor cognitive outcome in older patients with lower education, but didn’t in older patients with higher education. We observed comparable three-way interactions for clinical scores of stroke-induced impairment and disability both in the acute and chronic stroke phase. In line with the hypothesis, years of education conjointly with age moderated effects of lesion on stroke outcome. This non-additive effect of cognitive reserve suggests its post-stroke protective impact on stroke outcome.
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24
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Baldan F, Turolla A, Rimini D, Pregnolato G, Maistrello L, Agostini M, Jakob I. Robot-assisted rehabilitation of hand function after stroke: Development of prediction models for reference to therapy. J Electromyogr Kinesiol 2021; 57:102534. [PMID: 33618325 DOI: 10.1016/j.jelekin.2021.102534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recovery of hand function after stroke represents the hardest target for clinicians. Robot-assisted therapy has been proved to be effective for hand recovery. Nevertheless, studies aimed to refer patients to the best therapy are missing. METHODS With the aim to identify which clinical features are predictive for referring to robot-assisted hand therapy, 174 stroke patients were assessed with: Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), Reaching Performance Scale (RPS), Box and Block Test (BBT), Modified Ashworth Scale (MAS), Nine Hole Pegboard Test (NHPT). Moreover, patients ability to control the robot with residual force and surface EMG (sEMG) independently, was checked. ROC curves were calculated to determine which of the measures were the predictors of the event. RESULTS sEMG control (AUC = 0.925) was significantly determined by FMA upper extremity (FMUE) (>24/66) and sensation (>23/24) sections, MAS at Flexor Carpi (<3/4) and total MAS (>4/20). Force control (AUC = 0.928) was correlated only with FMUE (>24/66). CONCLUSIONS FMUE and MAS were the best predictors of preserved ability to control the device by two different modalities. This finding opens the possibility to plan specific therapies aimed at maximizing the highest functional outcome achievable after stroke.
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Affiliation(s)
- Francesca Baldan
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy.
| | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Daniele Rimini
- Medical Physics Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Giorgia Pregnolato
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Lorenza Maistrello
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Michela Agostini
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
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25
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Bartolomeo P. Visual and motor neglect: Clinical and neurocognitive aspects. Rev Neurol (Paris) 2021; 177:619-626. [PMID: 33455830 DOI: 10.1016/j.neurol.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
Attention allows us to prioritize the processing of external information according to our goals, but also to cope with sudden, unforeseen events. Attention processes rely on the coordinated activity of large-scale brain networks. At the cortical level, these systems are mainly organized in fronto-parietal networks, with functional and anatomical asymmetries in favor of the right hemisphere. Dysfunction of these right-lateralized networks often produce severe deficit of spatial attention, such as visual neglect. Other brain-damaged patients avoid moving the limbs contralateral to their brain lesion, even in the absence of sensorimotor deficits (motor neglect). This paper first summarizes past and current evidence on brain networks of attention; then, it presents clinical and experimental findings on visual and motor neglect, and on the possible mechanisms of clinical recovery.
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Affiliation(s)
- P Bartolomeo
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France.
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26
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Umarova R, Thomalla G. Indirect connectome-based prediction of post-stroke deficits: prospects and limitations. Brain 2020; 143:1966-1970. [PMID: 32671402 DOI: 10.1093/brain/awaa186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This scientific commentary refers to ‘Post-stroke deficit prediction from lesion and indirect structural and functional disconnection’, by Salvalaggio et al. (doi:10.1093/brain/awaa156).
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Affiliation(s)
- Roza Umarova
- 1 Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Götz Thomalla
- 2 Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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27
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Mengotti P, Käsbauer AS, Fink GR, Vossel S. Lateralization, functional specialization, and dysfunction of attentional networks. Cortex 2020; 132:206-222. [PMID: 32998061 DOI: 10.1016/j.cortex.2020.08.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/20/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
The present review covers the latest findings on the lateralization of the dorsal and ventral attention systems, their functional specialization, and their clinical relevance for stroke-induced attentional dysfunction. First, the original assumption of a bilateral dorsal system for top-down attention and a right-lateralized ventral system for stimulus-driven attention is critically reviewed. The evidence for the involvement of the left parietal cortex in attentional functions is discussed and findings on putative pathways linking the dorsal and ventral network are presented. In the second part of the review, we focus on the different attentional subsystems and their lateralization, discussing the differences between spatial, feature- and object-based attention, and motor attention. We also review studies based on predictive coding frameworks of attentional functions. Finally, in the third section, we provide an overview of the consequences of specific disruption within the attention networks after stroke. The role of the interhemispheric (im)balance is discussed, and the results of new promising therapeutic approaches employing brain stimulation techniques such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) are presented.
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Affiliation(s)
- Paola Mengotti
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany.
| | - Anne-Sophie Käsbauer
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simone Vossel
- Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; Department of Psychology, Faculty of Human Sciences, University of Cologne, Cologne, Germany
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28
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Balan PF, Gerits A, Zhu Q, Kolster H, Orban GA, Wardak C, Vanduffel W. Fast Compensatory Functional Network Changes Caused by Reversible Inactivation of Monkey Parietal Cortex. Cereb Cortex 2020; 29:2588-2606. [PMID: 29901747 DOI: 10.1093/cercor/bhy128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 04/30/2018] [Accepted: 05/09/2018] [Indexed: 11/13/2022] Open
Abstract
The brain has a remarkable capacity to recover after lesions. However, little is known about compensatory neural adaptations at the systems level. We addressed this question by investigating behavioral and (correlated) functional changes throughout the cortex that are induced by focal, reversible inactivations. Specifically, monkeys performed a demanding covert spatial attention task while the lateral intraparietal area (LIP) was inactivated with muscimol and whole-brain fMRI activity was recorded. The inactivation caused LIP-specific decreases in task-related fMRI activity. In addition, these local effects triggered large-scale network changes. Unlike most studies in which animals were mainly passive relative to the stimuli, we observed heterogeneous effects with more profound muscimol-induced increases of task-related fMRI activity in areas connected to LIP, especially FEF. Furthermore, in areas such as FEF and V4, muscimol-induced changes in fMRI activity correlated with changes in behavioral performance. Notably, the activity changes in remote areas did not correlate with the decreased activity at the site of the inactivation, suggesting that such changes arise via neuronal mechanisms lying in the intact portion of the functional task network, with FEF a likely key player. The excitation-inhibition dynamics unmasking existing excitatory connections across the functional network might initiate these rapid adaptive changes.
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Affiliation(s)
- Puiu F Balan
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| | - Annelies Gerits
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium
| | - Qi Zhu
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| | - Hauke Kolster
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium
| | - Guy A Orban
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Department of Medicine and Surgery, University of Parma, via Volturno, 39E Parma, Italy
| | - Claire Wardak
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium
| | - Wim Vanduffel
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Harvard Medical School, Charlestown, MA, USA
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29
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Adam R, Johnston K, Menon RS, Everling S. Functional reorganization during the recovery of contralesional target selection deficits after prefrontal cortex lesions in macaque monkeys. Neuroimage 2020; 207:116339. [DOI: 10.1016/j.neuroimage.2019.116339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/08/2019] [Accepted: 11/05/2019] [Indexed: 01/01/2023] Open
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30
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Machner B, von der Gablentz J, Göttlich M, Heide W, Helmchen C, Sprenger A, Münte TF. Behavioral deficits in left hemispatial neglect are related to a reduction of spontaneous neuronal activity in the right superior parietal lobule. Neuropsychologia 2020; 138:107356. [PMID: 31972231 DOI: 10.1016/j.neuropsychologia.2020.107356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/21/2019] [Accepted: 01/18/2020] [Indexed: 12/24/2022]
Abstract
Focal brain lesions may induce dysfunctions in distant brain regions leading to behavioral impairments. Based on this concept of 'diaschisis', spatial neglect following stroke has been related to structural damage of the right-lateralized ventral attention network (VAN) and disrupted inter-hemispheric functional connectivity (FC) in the bilateral dorsal attention network (DAN). We questioned whether neglect-related behavioral deficits may be determined by local dysfunction of a specific region within these brain networks. We investigated acute right-hemisphere stroke patients with left hemispatial neglect using resting-state functional MRI, neuropsychological tests of spatial attention and clinical assessment of neglect-related functional disability. In addition to conventional FC analyses between different cortical regions of interest (ROIs) in the DAN/VAN, we extracted the fractional amplitude of low frequency fluctuations (fALFF) from each ROI as a marker of regional spontaneous neuronal activity. Although DAN regions (as opposed to the VAN regions) were largely spared from structural brain damage, they exhibited a significant reduction of inter-hemispheric FC. However, significant fMRI-behavior correlations were revealed specifically for the fALFF of one DAN-ROI in the right superior parietal lobule (SPL): the smaller the fALFF in the right posterior intraparietal sulcus, the more severe the patient's pathological attention bias and neglect-related functional impairment. In line with 'diaschisis', our findings confirm a crucial role of the non-lesioned but dysfunctional right SPL for the emergence of spatial neglect and its behavioral consequences. They further support targeting the SPL dysfunction by non-invasive brain stimulation in neglect rehabilitation.
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Affiliation(s)
- Björn Machner
- Department of Neurology, University of Lübeck, Lübeck, Germany.
| | | | - Martin Göttlich
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Wolfgang Heide
- Department of Neurology, General Hospital Celle, Celle, Germany
| | | | - Andreas Sprenger
- Department of Neurology, University of Lübeck, Lübeck, Germany; Department of Psychology, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany; Department of Psychology, University of Lübeck, Lübeck, Germany
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31
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Chan E, Garritsen E, Altendorff S, Turner D, Simister R, Werring DJ, Cipolotti L. Additional Queen Square (QS) screening items improve the test accuracy of the Montreal Cognitive Assessment (MoCA) after acute stroke. J Neurol Sci 2019; 407:116442. [PMID: 31677556 DOI: 10.1016/j.jns.2019.116442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is a popular cognitive screening tool used in stroke, but lacks sensitivity for detecting impairment in stroke-relevant domains of processing speed, non-verbal memory and executive functions. Our aim was to assess whether the test accuracy of the MoCA can be improved with additional tailored screening items targeting these three domains. METHODS We included 196 patients admitted to an acute stroke unit at the National Hospital for Neurology and Neurosurgery, Queen Square (QS), London. Participants completed the MoCA as well as a series of additional QS-screening items designed to assess speed of processing, non-verbal memory and executive functions. Performance on the MoCA and QS screening items was compared with performance on "gold standard" neuropsychological assessment. RESULTS In our sample, 22% of patients were classified as "cognitively intact" on the traditional MoCA alone (≥ 25). However, when tested on the QS-screening items, 40% of these patients failed on speed of processing, 56% failed on non-verbal memory and 26% failed on executive functions. Compared with neuropsychological assessment, the QS-screening items had good sensitivity (QS-Speed: 0.85; QS-Vis: 0.71; QS-EF: 0.73) and modest specificity (QS-Speed: 0.59; QS-Vis: 0.39; QS-EF: 0.54), regardless of stroke lateralisation. CONCLUSION Additional screening items detected impairments in speed of processing, non-verbal memory and executive functions over and above those captured using the standard MoCA. The use of these QS-screening items improves the detection of post-stroke cognitive deficits in domains not adequately covered by the standard MoCA.
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Affiliation(s)
- Edgar Chan
- National Hospital for Neurology and Neurosurgery, Dept. of Neuropsychology, London, United Kingdom; UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom.
| | - Eva Garritsen
- UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom
| | - Samantha Altendorff
- National Hospital for Neurology and Neurosurgery, Dept. of Neuropsychology, London, United Kingdom
| | - David Turner
- Comprehensive Stroke Service, University College London Hospital, London, United Kingdom
| | - Robert Simister
- UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom; Comprehensive Stroke Service, University College London Hospital, London, United Kingdom
| | - David J Werring
- UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom; Comprehensive Stroke Service, University College London Hospital, London, United Kingdom
| | - Lisa Cipolotti
- National Hospital for Neurology and Neurosurgery, Dept. of Neuropsychology, London, United Kingdom; UCL Queen Square Institute of Neurology, Stroke Research Centre, London, United Kingdom
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32
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Abstract
OBJECTIVES Healthy young adults often demonstrate a leftward spatial bias called "pseudoneglect" which often diminishes with aging. One hypothesis for this phenomenon is an age-related deterioration in right hemisphere functions (right hemi-aging). If true, then a greater rightward bias should be evident on all spatial attention tasks regardless of content. Another hypothesis is a decrease in asymmetrical hemispheric activation with age (HAROLD). If true, older participants may show reduced bias in all spatial tasks, regardless of leftward or rightward biasing of specific spatial content. METHODS Seventy right-handed healthy participants, 33 younger (21-40) and 37 older (60-78), were asked to bisect solid and character-letter lines as well as to perform left and right trisections of solid lines. RESULTS Both groups deviated toward the left on solid line bisections and left trisections. Both groups deviated toward the right on right trisections and character line bisections. In all tasks, the older participants were more accurate than the younger participants. CONCLUSIONS The finding that older participants were more accurate than younger participants across all bisection and trisection conditions suggests a decrease in the asymmetrical hemispheric activation of these specialized networks important in the allocation of contralateral spatial attention or spatial action intention.
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33
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Dressing A, Kaller CP, Nitschke K, Beume LA, Kuemmerer D, Schmidt CS, Bormann T, Umarova RM, Egger K, Rijntjes M, Weiller C, Martin M. Neural correlates of acute apraxia: Evidence from lesion data and functional MRI in stroke patients. Cortex 2019; 120:1-21. [DOI: 10.1016/j.cortex.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/28/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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34
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Bartolomeo P, Seidel Malkinson T. Hemispheric lateralization of attention processes in the human brain. Curr Opin Psychol 2019; 29:90-96. [DOI: 10.1016/j.copsyc.2018.12.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/21/2018] [Accepted: 12/29/2018] [Indexed: 01/06/2023]
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35
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Saj A, Cojan Y, Assal F, Vuilleumier P. Prism adaptation effect on neural activity and spatial neglect depend on brain lesion site. Cortex 2019; 119:301-311. [DOI: 10.1016/j.cortex.2019.04.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 01/07/2019] [Accepted: 04/29/2019] [Indexed: 11/27/2022]
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36
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Facchin A, Vallar G, Daini R. The Brentano Illusion Test (BRIT): An implicit task of perceptual processing for the assessment of visual field defects in neglect patients. Neuropsychol Rehabil 2019; 31:39-56. [PMID: 31438751 DOI: 10.1080/09602011.2019.1655067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In brain damaged patients with unilateral spatial neglect (USN), the differential diagnosis between the presence and absence of a unilateral visual half-field deficit (VHFD) is hampered by the similarity of their phenomenology. The absence of stimuli detection in the contralateral visual field, indeed, can be due to the co-occurrence of USN and VHFD or the sole presence of the USN. The disentangling of the two conditions is required to devise more specific rehabilitation programmes. Daini et al. [2002. Exploring the syndrome of spatial unilateral neglect through an illusion of length. Experimental Brain Research, 144(2), 224-237.] reported a difference in performance for the two conditions when the tasks required the bisection of Brentano illusory stimuli. Only when USN and VHFD co-occurred, the leftward illusory effect was disrupted. Based on previous findings, in this cross-sectional study, we developed the Brentano Illusion Test (BRIT), a clinical tool that helps the identification of VHFD in USN patients. The BRIT is a simple behavioural test of line bisection aimed at verifying the presence or absence of implicit processing in USN and thus helping the diagnosis of VHFD in USN patients; it also provides normative data for the line bisection task and the length effect.
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Affiliation(s)
- Alessio Facchin
- Department of Psychology, Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milano, Italy.,University Research Centre in Optics and Optometry, University of Milano-Bicocca (COMiB), Milano, Italy.,Institute of Research and Studies in Optics and Optometry, Vinci, Italy
| | - Giuseppe Vallar
- Department of Psychology, Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milano, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Roberta Daini
- Department of Psychology, Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milano, Italy.,University Research Centre in Optics and Optometry, University of Milano-Bicocca (COMiB), Milano, Italy
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von der Gablentz J, Könemund I, Sprenger A, Heide W, Heldmann M, Helmchen C, Machner B. Brain Activations During Optokinetic Stimulation in Acute Right-Hemisphere Stroke Patients and Hemispatial Neglect: An fMRI Study. Neurorehabil Neural Repair 2019; 33:581-592. [PMID: 31189423 DOI: 10.1177/1545968319855038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Leftward optokinetic stimulation (OKS) is a promising therapeutic approach for right-hemisphere stroke patients with left hemispatial neglect. We questioned whether the putative neural basis is an activation of frontoparietal brain regions involved in the control of eye movements and spatial attention. Methods. We used functional magnetic resonance imaging to investigate brain activations during OKS in acute right-hemisphere stroke patients (RHS, n = 19) compared with healthy control subjects (HC, n = 9). Based on neuropsychological testing we determined the ipsilesional attention bias in all RHS patients, 11 showed manifest hemispatial neglect. Results. In HC subjects, OKS in either direction led to bilateral activation of the visual cortex (V1-V4), frontal (FEF) and supplementary (SEF) eye fields, intraparietal sulcus (IPS), basal ganglia, and thalamus. RHS patients' activations were generally reduced compared with HC. Nevertheless, leftward OKS bilaterally activated the visual cortex (V1-V4), FEF, SEF, IPS, and thalamus. The neural response to OKS was negatively correlated with patients' behavioral impairment: The greater the individual attention bias/neglect the weaker the brain activations. Conclusion. In RHS patients, leftward OKS activates frontoparietal regions (FEF, IPS) that are spared from structural brain damage and functionally involved in both oculomotor control and spatial attention. This may provide a neural basis for the known therapeutic effects of OKS on hemispatial neglect. In acute stroke stages, reduced activation levels correlating with neglect severity indicate functional downregulation of the underlying dorsal attention network. Therefore, chronic RHS patients with less severe neglect after recovery of network disturbances may be more suitable candidates for OKS rehabilitation.
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Wåhlin A, Fordell H, Ekman U, Lenfeldt N, Malm J. Rehabilitation in chronic spatial neglect strengthens resting-state connectivity. Acta Neurol Scand 2019; 139:254-259. [PMID: 30427058 DOI: 10.1111/ane.13048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Rehabilitation of patients with chronic visuospatial neglect is underexplored, and little is known about neural mechanisms that can be exploited to promote recovery. In this study, we present data on resting-state functional connectivity within the dorsal attention network (DAN) in chronic neglect patients as they underwent training in a virtual reality (VR) environment that improved left-side awareness. METHODS The study included 13 patients with visuospatial neglect persisting more than six months after a right-sided stroke. The patients underwent resting-state functional magnetic resonance imaging (fMRI). Scans were collected at baseline and after five weeks of intense training. We specifically examined resting-state functional connectivity within the DAN. In addition, using spatial concordance correlation, we compared changes in the spatial topology of the DAN with that of other networks. RESULTS We found a longitudinal increase in interhemispheric functional connectivity between the right frontal eye field and the left intraparietal sulcus following training (before: 0.33 ± 0.17 [mean ± SD]; after: 0.45 ± 0.13; P = 0.004). The spatial concordance analyses indicated that training influenced the DAN connectivity more than any of the other networks. CONCLUSION Intense VR training that improved left-sided awareness in chronic stroke patients also increased sporadic interhemispheric functional connectivity within the DAN. Specifically, a region responsible for saccadic eye movement to the left became more integrated with the left posterior parietal cortex. These results highlight a mechanism that should be exploited in the training of patients with chronic visuospatial neglect.
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Affiliation(s)
- Anders Wåhlin
- Department of Radiation Sciences, Biomedical Engineering; Umeå University; Umeå Sweden
- Umeå Center for Functional Brain Imaging; Umeå University; Umeå Sweden
| | - Helena Fordell
- Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå Sweden
| | - Urban Ekman
- Umeå Center for Functional Brain Imaging; Umeå University; Umeå Sweden
- Department of Integrative Medical Biology; Umeå University; Umeå Sweden
- Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Niklas Lenfeldt
- Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå Sweden
| | - Jan Malm
- Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå Sweden
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Nyffeler T, Vanbellingen T, Kaufmann BC, Pflugshaupt T, Bauer D, Frey J, Chechlacz M, Bohlhalter S, Müri RM, Nef T, Cazzoli D. Theta burst stimulation in neglect after stroke: functional outcome and response variability origins. Brain 2019; 142:992-1008. [DOI: 10.1093/brain/awz029] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Tim Vanbellingen
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Brigitte C Kaufmann
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | | | - Daniel Bauer
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Julia Frey
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | | | | | - René M Müri
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
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Chen Q, Zhou J, Zhang H, Chen Y, Mao C, Chen X, Ni L, Zhuo Z, Zhang Y, Geng W, Yin X, Lv Y. One-step analysis of brain perfusion and function for acute stroke patients after reperfusion: A resting-state fMRI study. J Magn Reson Imaging 2018; 50:221-229. [PMID: 30569565 DOI: 10.1002/jmri.26571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/23/2018] [Accepted: 10/23/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Resting-state functional magnetic resonance imaging (rs-fMRI) can noninvasively estimate the perfusion and function of the brain. PURPOSE To investigate the perfusion and functional status using rs-fMRI in acute ischemic stroke (AIS) patients after reperfusion therapy. STUDY TYPE Prospective. SUBJECTS Twenty-five AIS patients who underwent dynamic susceptibility contrast (DSC) upon hospital admission and both rs-fMRI and DSC scans at 24 hours after reperfusion therapy. FIELD STRENGTH/SEQUENCE 3T; DSC, rs-fMRI. ASSESSMENT The time delay of the blood oxygenation level-dependent (BOLD) signal was calculated using time-shift-analysis (TSA) and compared with the time to peak (TTP) derived from the DSC. For patients who exhibited partial or complete reperfusion in the supratentorial hemisphere, we quantified the function of different regions (healthy tissue, reperfused tissue, not reperfused tissue) by using three rs-fMRI measurements (functional connectivity, the amplitude of low-frequency fluctuation [ALFF] and regional homogeneity [ReHo]). Correlations between the functional measurements and modified Rankin Scale (mRS) scores were calculated. STATISTICAL TESTS Dice coefficient (DC) analysis, two-sample t-tests, Pearson correlation coefficient. RESULTS Twelve patients who exhibited complete reperfusion on their TTP maps showed no time-delayed areas on the TSA maps. For the remaining 13 patients with partial reperfusion (5/13) or no reperfusion (8/13) on the TTP maps, the TSA detected comparable time-delayed areas. Eleven out of 13 patients showed moderate to good overlap (mean DC, 0.58 ± 0.1) between the TTP and TSA results. Fourteen patients were chosen for functional analyses and most patients (12/14) showed abnormal functional connectivity in the reperfused regions. The reperfused and not reperfused tissues had lower mean ReHo values than those of the healthy tissue (both P < 0.001). The mRS scores showed negative correlation with mean ReHo values of reperfused region (R = -0.523, P = 0.027). DATA CONCLUSION: rs-fMRI might be a useful way to estimate both the perfusion and functional status for AIS patients after reperfusion therapy. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:221-229.
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Affiliation(s)
- Qian Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hong Zhang
- Department of Radiology, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Yuchen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Cunnan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiangliang Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ling Ni
- Department of Radiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhizheng Zhuo
- Department of MR Clinical Science, Philips, Beijing, China
| | - Yingdong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen Geng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yating Lv
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
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Su W, Guo J, Zhang Y, Zhou J, Chen N, Zhou M, Li R, Chen H, He L. A Longitudinal Functional Magnetic Resonance Imaging Study of Working Memory in Patients Following a Transient Ischemic Attack: A Preliminary Study. Neurosci Bull 2018; 34:963-971. [PMID: 30128690 DOI: 10.1007/s12264-018-0270-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023] Open
Abstract
In this study, we used functional magnetic resonance imaging (fMRI) to investigate longitudinal changes in brain activation during a verbal working memory (VWM) task performed by patients who had experienced a transient ischemic attack (TIA). Twenty-five first-ever TIA patients without visible lesions in conventional MRI and 25 healthy volunteers were enrolled. VWM task-related fMRI was conducted 1 week and 3 months post-TIA. The brain activity evoked by the task and changes over time were assessed. We found that, compared with controls, patients exhibited an increased activation in the bilateral inferior frontal gyrus (IFG), right dorsolateral prefrontal cortex (DLPFC), insula, inferior parietal lobe (IPL), and cerebellum during the task performed 1 week post-TIA. But only the right IFG still exhibited an increased activation at 3 months post-TIA. A direct comparison of fMRI data between 1 week and 3 months post-TIA showed greater activation in the bilateral middle temporal gyrus, right DLPFC, IPL, cerebellum, and left IFG in patients at 1 week post-TIA. We conclude that brain activity patterns induced by a VWM task remain dynamic for a period of time after a TIA, despite the cessation of clinical symptoms. Normalization of the VWM activation pattern may be progressively achieved after transient episodes of ischemia in TIA patients.
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Affiliation(s)
- Wei Su
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China.,Department of Science and Technology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jian Guo
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yun Zhang
- Department of Neurology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Jie Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ning Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Muke Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Rong Li
- Key Laboratory for Neuroinformation of The Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Huafu Chen
- Key Laboratory for Neuroinformation of The Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Zhou RJ, Hondori HM, Khademi M, Cassidy JM, Wu KM, Yang DZ, Kathuria N, Erani FR, Dodakian L, McKenzie A, Lopes CV, Scacchi W, Srinivasan R, Cramer SC. Predicting Gains With Visuospatial Training After Stroke Using an EEG Measure of Frontoparietal Circuit Function. Front Neurol 2018; 9:597. [PMID: 30087653 PMCID: PMC6066500 DOI: 10.3389/fneur.2018.00597] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/04/2018] [Indexed: 12/17/2022] Open
Abstract
The heterogeneity of stroke prompts the need for predictors of individual treatment response to rehabilitation therapies. We previously studied healthy subjects with EEG and identified a frontoparietal circuit in which activity predicted training-related gains in visuomotor tracking. Here we asked whether activity in this same frontoparietal circuit also predicts training-related gains in visuomotor tracking in patients with chronic hemiparetic stroke. Subjects (n = 12) underwent dense-array EEG recording at rest, then received 8 sessions of visuomotor tracking training delivered via home-based telehealth methods. Subjects showed significant training-related gains in the primary behavioral endpoint, Success Rate score on a standardized test of visuomotor tracking, increasing an average of 24.2 ± 21.9% (p = 0.003). Activity in the circuit of interest, measured as coherence (20–30 Hz) between leads overlying ipsilesional frontal (motor cortex) and parietal lobe, significantly predicted training-related gains in visuomotor tracking change, measured as change in Success Rate score (r = 0.61, p = 0.037), supporting the main study hypothesis. Results were specific to the hypothesized ipsilesional motor-parietal circuit, as coherence within other circuits did not predict training-related gains. Analyses were repeated after removing the four subjects with injury to motor or parietal areas; this increased the strength of the association between activity in the circuit of interest and training-related gains. The current study found that (1) Eight sessions of training can significantly improve performance on a visuomotor task in patients with chronic stroke, (2) this improvement can be realized using home-based telehealth methods, (3) an EEG-based measure of frontoparietal circuit function predicts training-related behavioral gains arising from that circuit, as hypothesized and with specificity, and (4) incorporating measures of both neural function and neural injury improves prediction of stroke rehabilitation therapy effects.
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Affiliation(s)
- Robert J Zhou
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Hossein M Hondori
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Maryam Khademi
- Department of Informatics, University of California, Irvine, Irvine, CA, United States
| | - Jessica M Cassidy
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Katherine M Wu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Derek Z Yang
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Nikhita Kathuria
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Fareshte R Erani
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Lucy Dodakian
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Alison McKenzie
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,Department of Physical Therapy, Chapman University, Irvine, CA, United States
| | - Cristina V Lopes
- Department of Informatics, University of California, Irvine, Irvine, CA, United States
| | - Walt Scacchi
- Institute for Software Research, University of California, Irvine, Irvine, CA, United States
| | - Ramesh Srinivasan
- Department of Cognitive Sciences, University of California, Irvine, Irvine, CA, United States.,Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | - Steven C Cramer
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,Department of Anatomy & Neurobiology, University of California, Irvine, Irvine, CA, United States.,Department of Physical Medicine & Rehabilitation, University of California, Irvine, Irvine, CA, United States
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Neural correlates of visuospatial bias in patients with left hemisphere stroke: a causal functional contribution analysis based on game theory. Neuropsychologia 2018; 115:142-153. [DOI: 10.1016/j.neuropsychologia.2017.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 11/22/2022]
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44
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Hamoudi M, Schambra HM, Fritsch B, Schoechlin-Marx A, Weiller C, Cohen LG, Reis J. Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke. Neurorehabil Neural Repair 2018; 32:295-308. [PMID: 29683030 DOI: 10.1177/1545968318769164] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Motor training alone or combined with transcranial direct current stimulation (tDCS) positioned over the motor cortex (M1) improves motor function in chronic stroke. Currently, understanding of how tDCS influences the process of motor skill learning after stroke is lacking. OBJECTIVE To assess the effects of tDCS on the stages of motor skill learning and on generalization to untrained motor function. METHODS In this randomized, sham-controlled, blinded study of 56 mildly impaired chronic stroke patients, tDCS (anode over the ipsilesional M1 and cathode on the contralesional forehead) was applied during 5 days of training on an unfamiliar, challenging fine motor skill task (sequential visual isometric pinch force task). We assessed online and offline learning during the training period and retention over the following 4 months. We additionally assessed the generalization to untrained tasks. RESULTS With training alone (sham tDCS group), patients acquired a novel motor skill. This skill improved online, remained stable during the offline periods and was largely retained at follow-up. When tDCS was added to training (real tDCS group), motor skill significantly increased relative to sham, mostly in the online stage. Long-term retention was not affected by tDCS. Training effects generalized to untrained tasks, but those performance gains were not enhanced further by tDCS. CONCLUSIONS Training of an unfamiliar skill task represents a strategy to improve fine motor function in chronic stroke. tDCS augments motor skill learning, but its additive effect is restricted to the trained skill.
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Affiliation(s)
| | - Heidi M Schambra
- 2 New York University, NY, USA.,3 National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | | | | | | | - Leonardo G Cohen
- 3 National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Janine Reis
- 1 University Hospital Freiburg, Freiburg, Germany.,3 National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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45
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Adapting the concepts of brain and cognitive reserve to post-stroke cognitive deficits: Implications for understanding neglect. Cortex 2017; 97:327-338. [DOI: 10.1016/j.cortex.2016.12.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/03/2016] [Accepted: 12/04/2016] [Indexed: 01/17/2023]
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46
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Spanish Transcultural Adaptation and Validity of the Behavioral Inattention Test. Occup Ther Int 2017; 2017:1423647. [PMID: 29097959 PMCID: PMC5612745 DOI: 10.1155/2017/1423647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/16/2016] [Accepted: 11/21/2016] [Indexed: 11/17/2022] Open
Abstract
Objective To adapt, validate, and translate the Behavioral Inattention Test as an assessment tool for Spanish individuals with unilateral spatial neglect. Design A cross-sectional descriptive study. Setting University laboratories. Participants A sample of 75 Spanish stroke patients and 18 healthy control subjects. Interventions Not applicable. Main Outcome Measures The Behavioral Inattention Test. Results The Spanish version of the Behavioral Inattention Test shows a high degree of reliability both in the complete test (α = .90) and in the conventional (α = .93) and behavioral subtests (α = .75). The concurrent validity between the total conventional and behavioral scores was high (r = −.80; p < 0.001). Significant differences were found between patients with and without unilateral spatial neglect (p < 0.001). In the comparison between right and left damaged sides, differences were found in all items, except for article reading (p = 0.156) and card sorting (p = 0.117). Conclusions This measure is a useful tool for evaluating unilateral spatial neglect as it provides information on everyday problems. The BIT discriminates between stroke patients with and without unilateral spatial neglect. This measure constitutes a reliable tool for the diagnosis, planning, performance, and design of specific treatment programs intended to improve the functionality and quality of life of people with unilateral spatial neglect.
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47
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Patients’ characteristics and outcomes depending on complete or incomplete unilateral spatial neglect. Neurosurg Rev 2017; 40:643-646. [DOI: 10.1007/s10143-017-0821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
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48
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Heiss WD. Contribution of Neuro-Imaging for Prediction of Functional Recovery after Ischemic Stroke. Cerebrovasc Dis 2017; 44:266-276. [PMID: 28869961 DOI: 10.1159/000479594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/18/2017] [Indexed: 12/23/2022] Open
Abstract
Prediction measures of recovery and outcome after stroke perform with only modest levels of accuracy if based only on clinical data. Prediction scores can be improved by including morphologic imaging data, where size, location, and development of the ischemic lesion is best documented by magnetic resonance imaging. In addition to the primary lesion, the involvement of fiber tracts contributes to prognosis, and consequently the use of diffusion tensor imaging (DTI) to assess primary and secondary pathways improves the prediction of outcome and of therapeutic effects. The recovery of ischemic tissue and the progression of damage are dependent on the quality of blood supply. Therefore, the status of the supplying arteries and of the collateral flow is not only crucial for determining eligibility for acute interventions, but also has an impact on the potential to integrate areas surrounding the lesion that are not typically part of a functional network into the recovery process. The changes in these functional networks after a localized lesion are assessed by functional imaging methods, which additionally show altered pathways and activated secondary centers related to residual functions and demonstrate changes in activation patterns within these networks with improved performance. These strategies in some instances record activation in secondary centers of a network, for example, also in homolog contralateral areas, which might be inhibitory to the recovery of primary centers. Such findings might have therapeutic consequences, for example, image-guided inhibitory stimulation of these areas. In the future, a combination of morphological imaging including DTI of fiber tracts and activation studies during specific tasks might yield the best information on residual function, reserve capacity, and prospects for recovery after ischemic stroke.
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Umarova RM, Beume L, Reisert M, Kaller CP, Klöppel S, Mader I, Glauche V, Kiselev VG, Catani M, Weiller C. Distinct white matter alterations following severe stroke. Neurology 2017; 88:1546-1555. [DOI: 10.1212/wnl.0000000000003843] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/23/2017] [Indexed: 01/28/2023] Open
Abstract
Objective:To distinguish white matter remodeling directly induced by stroke lesion from that evoked by remote network dysfunction, using spatial neglect as a model.Methods:We examined 24 visual neglect/extinction patients and 17 control patients combining comprehensive analyses of diffusion tensor metrics and global fiber tracking with neuropsychological testing in the acute (6.3 ± 0.5 days poststroke) and chronic (134 ± 7 days poststroke) stroke phases.Results:Compared to stroke controls, patients with spatial neglect/extinction displayed longitudinal white matter alterations with 2 defining signatures: (1) perilesional degenerative changes characterized by congruently reduced fractional anisotropy and increased radial diffusivity (RD), axial diffusivity, and mean diffusivity, all suggestive of direct axonal damage by lesion and therefore nonspecific for impaired attention network and (2) transneuronal changes characterized by an increased RD in contralesional frontoparietal and bilateral occipital connections, suggestive of primary periaxonal involvement; these changes were distinctly related to the degree of unrecovered neglect symptoms in chronic stroke, hence emerging as network-specific alterations.Conclusions:The present data show how stroke entails global alterations of lesion-spared network architecture over time. Sufficiently large lesions of widely interconnected association cortex induce distinct, large-scale structural reorganization in domain-specific network connections. Besides their relevance to unrecovered domain-specific symptoms, these effects might also explain mechanisms of domain-general deficits in stroke patients, pointing to potential targets for therapeutic intervention.
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