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Giannopapas V, Smyrni V, Kitsos DK, Chasiotis AK, Stavrogianni K, Papagiannopoulou G, Tsivgoulis G, Voumvourakis K, Giannopoulos S, Bakalidou D. Tibial nerve stimulation in the management of primary sexual dysfunction in patients with multiple sclerosis: a pilot randomized control trial. Neurol Sci 2024:10.1007/s10072-024-07687-2. [PMID: 39009893 DOI: 10.1007/s10072-024-07687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/04/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Sexual dysfunction (SD) is a common symptom that affects 40-90% of patients with multiple sclerosis (MS). Previous studies have highlighted the negative impact of sexual dysfunction in the mental health status and overall quality of life in patients with MS. METHODS The aim of this study was to examine the effects of transcutaneous tibial nerve stimulation (TTNS) in the primary SD symptoms in patients with MS. A total of 40 participants were randomized (1:1 ratio) to either TTNS or Sham group and received three 20 min sessions over the course of two months. Pre and post intervention SD was evaluated using the Multiple Sclerosis Intimacy Questionnaire (MISQ-15). RESULTS Statistically significant improvements in the aspects of primary sexual dysfunction were observed in the TTNS group pre-post intervention (specifically erectile function (for males)/vaginal lubrication (for females) (p < .001), orgasm quality and satisfaction for both male and female patients (p < .001), sexual desire (p < .05) and bladder related symptomatology (p < .005). In the sham group pre-post intervention, the only observed improvement was in the sexual desire aspect (p < .05). Post intervention the groups significantly differed erectile function/vaginal lubrication and orgasm quality and satisfaction (p < .05). CONCLUSIONS Our findings underline the efficacy of TTNS in improving primary SD symptoms as well as bladder problems in both male and female patients with MS. TTNS demonstrated significant improvement in the following domains: erectile function, vaginal lubrication, orgasm quality, satisfaction, bladder-related symptoms, and sexual desire.
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Affiliation(s)
- Vasileios Giannopapas
- Second Department of Neurology, University of Athens, Athens, Greece
- Department of Physical Therapy, University of West Attica, Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece
| | - Vassiliki Smyrni
- Second Department of Neurology, University of Athens, Athens, Greece
| | | | - Athanasios K Chasiotis
- Second Department of Neurology, University of Athens, Athens, Greece
- Department of Physical Therapy, University of West Attica, Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece
| | - Konstantina Stavrogianni
- Second Department of Neurology, University of Athens, Athens, Greece
- Department of Physiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | | | | | | | | | - Daphne Bakalidou
- Department of Physical Therapy, University of West Attica, Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece
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Keriven H, Sánchez Sierra A, González de-la-Flor Á, García-Arrabé M, Bravo-Aguilar M, de la Plaza San Frutos M, Garcia-Perez-de-Sevilla G, Tornero-Aguilera JF, Clemente-Suarez VJ, Domínguez-Balmaseda D. Effects of combined treatment with transcranial and peripheral electromagnetic stimulation on performance and pain recovery from delayed onset muscle soreness induced by eccentric exercise in young athletes. A randomized clinical trial. Front Physiol 2023; 14:1267315. [PMID: 37900951 PMCID: PMC10603222 DOI: 10.3389/fphys.2023.1267315] [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: 07/26/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background: There is a common interest in finding a common consensus in the approach of athletes suffering from DOMS with the aim of accelerating recovery and thereby enhancing performance. The objective of this study was to observe the effects of a paired-associative transcranial and peripheral electromagnetic stimulation on young athletes suffering from DOMS, induced by 1 h of eccentric and plyometric exercises. Methods: Forty-eight young athletes participated in this randomized control trial: 13 were assigned to the peripheral group (P); 12 were in the control group (Cont); 11 were assigned to the transcranial group (T) and 12 were included in the paired-associative group (Comb). The Visual Analogue Scale (VAS) of pain perception and the mechanical Pressure Pain Threshold (PPT) were the tools used to analyze the symptoms of DOMS. On the other hand, the Half Squat (HS) test evaluated with an accelerometer, and the 30 m sprint velocity (30-mSP) test were used to observe the evolution of the sports performance of the lower limbs. All evaluations were performed before and after the eccentric exercise session that caused DOMS, as well as at 24-48, and 72 h afterward. Results: The AS group improved the symptoms of the induced DOMS, since significant positive differences were observed in the VAS and PPT compared to the other groups (p < 0.001). In addition, the AS group showed a significant improvement in the HS and the 30-mSP tests (p < 0.001). Based on the results a treatment with both peripheral and transcranial electromagnetic stimulation improves recovery and performance in athletes at 72 h, although these data would need to be verified in future research with a larger sample size. Conclusion: Paired-associative electromagnetic stimulation improved DOMS symptomatology, velocity, and sports performance in the lower limbs.
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Affiliation(s)
- Hugo Keriven
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Alberto Sánchez Sierra
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Faculty of Phisioterapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- Toledo Physiotherapy Research Group (GIFTO), Madrid, Spain
| | - Ángel González de-la-Flor
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - María García-Arrabé
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - María Bravo-Aguilar
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Marta de la Plaza San Frutos
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Research Group on Exercise Therapy and Functional Rehabilitation, Faculty of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Guillermo Garcia-Perez-de-Sevilla
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Jose Francisco Tornero-Aguilera
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Vicente Javier Clemente-Suarez
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Diego Domínguez-Balmaseda
- Department of Physiotherapy, Faculty of Sports Sciences, Therapeutic Exercise and Fucntional Rehabiltiation Research Group, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Masmicrobiota Group, Faculty of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
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Fadli RA, Yamanouchi Y, Jovanovic LI, Popovic MR, Marquez-Chin C, Nomura T, Milosevic M. Effectiveness of motor and prefrontal cortical areas for brain-controlled functional electrical stimulation neuromodulation. J Neural Eng 2023; 20:056022. [PMID: 37714143 DOI: 10.1088/1741-2552/acfa22] [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: 03/23/2023] [Accepted: 09/15/2023] [Indexed: 09/17/2023]
Abstract
Objective. Brain-computer interface (BCI)-controlled functional electrical stimulation (FES) could excite the central nervous system to enhance upper limb motor recovery. Our current study assessed the effectiveness of motor and prefrontal cortical activity-based BCI-FES to help elucidate the underlying neuromodulation mechanisms of this neurorehabilitation approach.Approach. The primary motor cortex (M1) and prefrontal cortex (PFC) BCI-FES interventions were performed for 25 min on separate days with twelve non-disabled participants. During the interventions, a single electrode from the contralateral M1 or PFC was used to detect event-related desynchronization (ERD) in the calibrated frequency range. If the BCI system detected ERD within 15 s of motor imagery, FES activated wrist extensor muscles. Otherwise, if the BCI system did not detect ERD within 15 s, a subsequent trial was initiated without FES. To evaluate neuromodulation effects, corticospinal excitability was assessed using single-pulse transcranial magnetic stimulation, and cortical excitability was assessed by motor imagery ERD and resting-state functional connectivity before, immediately, 30 min, and 60 min after each intervention.Main results. M1 and PFC BCI-FES interventions had similar success rates of approximately 80%, while the M1 intervention was faster in detecting ERD activity. Consequently, only the M1 intervention effectively elicited corticospinal excitability changes for at least 60 min around the targeted cortical area in the M1, suggesting a degree of spatial localization. However, cortical excitability measures did not indicate changes after either M1 or PFC BCI-FES.Significance. Neural mechanisms underlying the effectiveness of BCI-FES neuromodulation may be attributed to the M1 direct corticospinal projections and/or the closer timing between ERD detection and FES, which likely enhanced Hebbian-like plasticity by synchronizing cortical activation detected by the BCI system with the sensory nerve activation and movement related reafference elicited by FES.
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Affiliation(s)
- Rizaldi A Fadli
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama, Toyonaka 560-8531, Japan
- Department of Biomedical Engineering, University of Miami College of Engineering, 1251 Memorial Drive, Coral Gables, FL 33146, United States of America
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL 33136, United States of America
| | - Yuki Yamanouchi
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama, Toyonaka 560-8531, Japan
| | - Lazar I Jovanovic
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto. 550 University Avenue, Toronto, Ontario M5G 2A2, Canada
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto. 550 University Avenue, Toronto, Ontario M5G 2A2, Canada
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama, Toyonaka 560-8531, Japan
| | - Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama, Toyonaka 560-8531, Japan
- Department of Biomedical Engineering, University of Miami College of Engineering, 1251 Memorial Drive, Coral Gables, FL 33146, United States of America
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL 33136, United States of America
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Qi F, Nitsche MA, Ren X, Wang D, Wang L. Top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation: a perspective. Front Neurol 2023; 14:1156987. [PMID: 37497013 PMCID: PMC10367110 DOI: 10.3389/fneur.2023.1156987] [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: 02/03/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Stroke is a central nervous system disease that causes structural lesions and functional impairments of the brain, resulting in varying types, and degrees of dysfunction. The bimodal balance-recovery model (interhemispheric competition model and vicariation model) has been proposed as the mechanism of functional recovery after a stroke. We analyzed how combinations of motor observation treatment approaches, transcranial electrical (TES) or magnetic (TMS) stimulation and peripheral electrical (PES) or magnetic (PMS) stimulation techniques can be taken as accessorial physical therapy methods on symptom reduction of stroke patients. We suggest that top-down and bottom-up stimulation techniques combined with action observation treatment synergistically might develop into valuable physical therapy strategies in neurorehabilitation after stroke. We explored how TES or TMS intervention over the contralesional hemisphere or the lesioned hemisphere combined with PES or PMS of the paretic limbs during motor observation followed by action execution have super-additive effects to potentiate the effect of conventional treatment in stroke patients. The proposed paradigm could be an innovative and adjunctive approach to potentiate the effect of conventional rehabilitation treatment, especially for those patients with severe motor deficits.
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Affiliation(s)
- Fengxue Qi
- Sports, Exercise and Brain Sciences Laboratory, Beijing Sport University, Beijing, China
| | - Michael A. Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Xiping Ren
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Duanwei Wang
- Shandong Mental Health Center, Shandong University, Jinan, Shandong, China
| | - Lijuan Wang
- Key Laboratory of Exercise and Physical Fitness, Ministry of Education, Beijing Sport University, Beijing, China
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
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Keriven H, Sánchez-Sierra A, Miñambres-Martín D, González de la Flor Á, García-Pérez-de-Sevilla G, Domínguez-Balmaseda D. Effects of peripheral electromagnetic stimulation after an eccentric exercise-induced delayed-onset muscle soreness protocol in professional soccer players: a randomized controlled trial. Front Physiol 2023; 14:1206293. [PMID: 37465698 PMCID: PMC10351376 DOI: 10.3389/fphys.2023.1206293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction: To examine the effects of peripheral electromagnetic stimulation in male professional soccer players on markers of Delayed Onset Muscular Soreness (DOMS), induced by a protocol of exercise (60 min of eccentric and plyometric). Methods: A randomized controlled trial with fourty-five professional soccer players aged 22.33 ± 4.82 years participated in the study. Twenty-three participants were assigned to the experimental group with peripheral electromagnetic stimulation (5 stimulations of 5 s at 100 HZ with 55 s of rest for a total of 5 min of treatment) and the remaining 22 participants were assigned to the control group. Pain pressure threshold (PPT) of the vastus medialis, the Visual Analogue Scale-Fatigue (VAS-F), half squat (HS) test and the maximum voluntary contraction of the quadriceps were assessed. All evaluations were performed before and after 1 h of the eccentric exercise induced DOMS, as well as at post 24-48, and 72 h. Results: Group-by-time interaction was observed in PPT of the vastus medialis (p = 0.040) with a medium effect size (η2 p = 0.069). From 48 to 72 h the experimental group showed an increase of PPT compared to control group (p = 0.015). There was no group-by-time interaction for HS, quadriceps strength and VAS-F (p > 0.05). Discussion: Peripheral electromagnetic stimulation in male professional soccer players did not produce significant improvements in the power and strength of the lower limbs but decreased the peripheral sensitization of the vastus medialis after eccentric exercise protocol. Clinical Trial Registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384050&isReview=true, Identifier: ACTRN12622000841774.
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Affiliation(s)
- Hugo Keriven
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Alberto Sánchez-Sierra
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Faculty of Phisioterapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
- Toledo Physiotherapy Research Group (GIFTO), Toledo, Spain
| | | | | | | | - Diego Domínguez-Balmaseda
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Masmicrobiota Group, Faculty of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
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Suzuki M, Saito K, Maeda Y, Cho K, Iso N, Okabe T, Suzuki T, Yamamoto J. Effects of Paired Associative Stimulation on Cortical Plasticity in Agonist–Antagonist Muscle Representations. Brain Sci 2023; 13:brainsci13030475. [PMID: 36979285 PMCID: PMC10046224 DOI: 10.3390/brainsci13030475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Paired associative stimulation (PAS) increases and decreases cortical excitability in primary motor cortex (M1) neurons, depending on the spike timing-dependent plasticity, i.e., long-term potentiation (LTP)- and long-term depression (LTD)-like plasticity, respectively. However, how PAS affects the cortical circuits for the agonist and antagonist muscles of M1 is unclear. Here, we investigated the changes in the LTP- and LTD-like plasticity for agonist and antagonist muscles during PAS: 200 pairs of 0.25-Hz peripheral electric stimulation of the right median nerve at the wrist, followed by a transcranial magnetic stimulation of the left M1 with an interstimulus interval of 25 ms (PAS-25 ms) and 10 ms (PAS-10 ms). The unconditioned motor evoked potential amplitudes of the agonist muscles were larger after PAS-25 ms than after PAS-10 ms, while those of the antagonist muscles were smaller after PAS-25 ms than after PAS-10 ms. The γ-aminobutyric acid A (GABAA)- and GABAB-mediated cortical inhibition for the agonist and antagonist muscles were higher after PAS-25 ms than after PAS-10 ms. The cortical excitability for the agonist and antagonist muscles reciprocally and topographically increased and decreased after PAS, respectively; however, GABAA and GABAB-mediated cortical inhibitory functions for the agonist and antagonist muscles were less topographically decreased after PAS-10 ms. Thus, PAS-25 ms and PAS-10 ms differentially affect the LTP- and LTD-like plasticity in agonist and antagonist muscles.
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Affiliation(s)
- Makoto Suzuki
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
- Faculty of Systems Design, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji City 192-0397, Tokyo, Japan
- Correspondence: ; Tel.: +81-42-955-6074
| | - Kazuo Saito
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
| | - Yusuke Maeda
- School of Health Sciences at Odawara, International University of Health and Welfare, 1-2-25 Shiroyama, Odawara City 250-8588, Kanagawa, Japan
| | - Kilchoon Cho
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
| | - Naoki Iso
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
| | - Takuhiro Okabe
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1 Inariyama, Sayama City 350-1398, Saitama, Japan
| | - Takako Suzuki
- School of Health Sciences, Saitama Prefectural University, 820 Sannomiya, Koshigaya City 343-8540, Saitama, Japan
| | - Junichi Yamamoto
- Faculty of Systems Design, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji City 192-0397, Tokyo, Japan
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Hehl M, Swinnen SP, Van Malderen S, Cuypers K. No evidence for a difference in lateralization and distinctiveness level of transcranial magnetic stimulation-derived cortical motor representations over the adult lifespan. Front Aging Neurosci 2022; 14:971858. [PMID: 36313026 PMCID: PMC9608504 DOI: 10.3389/fnagi.2022.971858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to investigate the presence and patterns of age-related differences in TMS-based measures of lateralization and distinctiveness of the cortical motor representations of two different hand muscles. In a sample of seventy-three right-handed healthy participants over the adult lifespan, the first dorsal interosseus (FDI) and abductor digiti minimi (ADM) cortical motor representations of both hemispheres were acquired using transcranial magnetic stimulation (TMS). In addition, dexterity and maximum force levels were measured. Lateralization quotients were calculated for homolog behavioral and TMS measures, whereas the distinctiveness between the FDI and ADM representation within one hemisphere was quantified by the center of gravity (CoG) distance and cosine similarity. The presence and patterns of age-related changes were examined using linear, polynomial, and piecewise linear regression. No age-related differences could be identified for the lateralization quotient of behavior or cortical motor representations of both intrinsic hand muscles. Furthermore, no evidence for a change in the distinctiveness of the FDI and ADM representation with advancing age was found. In conclusion this work showed that lateralization and distinctiveness of cortical motor representations, as determined by means of TMS-based measures, remain stable over the adult lifespan.
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Affiliation(s)
- Melina Hehl
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Stephan P. Swinnen
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Shanti Van Malderen
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Koen Cuypers
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Belgium
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek, Belgium
- Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
- *Correspondence: Koen Cuypers,
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Lin YN, Huang SW, Kuan YC, Chen HC, Jian WS, Lin LF. Hybrid robot-assisted gait training for motor function in subacute stroke: a single-blind randomized controlled trial. J Neuroeng Rehabil 2022; 19:99. [PMID: 36104706 PMCID: PMC9476570 DOI: 10.1186/s12984-022-01076-6] [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: 09/27/2021] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Robot-assisted gait training (RAGT) is a practical treatment that can complement conventional rehabilitation by providing high-intensity repetitive training for patients with stroke. RAGT systems are usually either of the end-effector or exoskeleton types. We developed a novel hybrid RAGT system that leverages the advantages of both types. Objective This single-blind randomized controlled trial evaluated the beneficial effects of the novel RAGT system both immediately after the intervention and at the 3-month follow-up in nonambulatory patients with subacute stroke. Methods We recruited 40 patients with subacute stroke who were equally randomized to receive conventional rehabilitation either alone or with the addition of 15 RAGT sessions. We assessed lower-extremity motor function, balance, and gait performance by using the following tools: active range of motion (AROM), manual muscle test (MMT), the Fugl–Meyer Assessment (FMA) lower-extremity subscale (FMA-LE) and total (FMA-total), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), Tinetti Performance-Oriented Mobility Assessment (POMA) balance and gait subscores, and the 3-m and 6-m walking speed and Timed Up and Go (TUG) tests. These measurements were performed before and after the intervention and at the 3-month follow-up. Results Both groups demonstrated significant within-group changes in the AROM, MMT, FMA-LE, FMA-total, PASS, BBS, POMA, TUG, and 3-m and 6-m walking speed tests before and after intervention and at the 3-month follow-up (p < 0.05). The RAGT group significantly outperformed the control group only in the FMA-LE (p = 0.014) and total (p = 0.002) assessments. Conclusion Although the novel hybrid RAGT is effective, strong evidence supporting its clinical effectiveness relative to controls in those with substantial leg dysfunction after stroke remains elusive. Trial registration The study was registered with an International Standard Randomized Controlled Trial Number, ISRCTN, ISRCTN15088682. Registered retrospectively on September 16, 2016, at https://www.isrctn.com/ISRCTN15088682
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Schranz C, Vatinno A, Ramakrishnan V, Seo NJ. Neuroplasticity after upper-extremity rehabilitation therapy with sensory stimulation in chronic stroke survivors. Brain Commun 2022; 4:fcac191. [PMID: 35938072 PMCID: PMC9351980 DOI: 10.1093/braincomms/fcac191] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/19/2022] [Accepted: 07/21/2022] [Indexed: 01/16/2023] Open
Abstract
This study investigated the effect of using subthreshold vibration as a peripheral sensory stimulation during therapy on cortical activity. Secondary analysis of a pilot triple-blinded randomized controlled trial. Twelve chronic stroke survivors underwent 2-week upper-extremity task-practice therapy. Half received subthreshold vibratory stimulation on their paretic wrist (treatment group) and the other half did not (control). EEG connectivity and event-related de-/resynchronization for the sensorimotor network during hand grip were examined at pre-intervention, post-intervention and follow-up. Statistically significant group by time interactions were observed for both connectivity and event-related spectral perturbation. For the treatment group, connectivity increased at post-intervention and decreased at follow-up. Event-related desynchronization decreased and event-related resynchronization increased at post-intervention, which was maintained at follow-up. The control group had the opposite trend for connectivity and no change in event-related spectral perturbation. The stimulation altered cortical sensorimotor activity. The findings complement the clinical results of the trial in which the treatment group significantly improved gross manual dexterity while the control group did not. Increased connectivity in the treatment group may indicate neuroplasticity for motor learning, while reduced event-related desynchronization and increased event-related resynchronization may indicate lessened effort for grip and improved inhibitory control. EEG may improve understanding of neural processes underlying motor recovery.
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Affiliation(s)
- Christian Schranz
- Correspondence to: Christian Schranz, PhD 77 President Street, Charleston SC 29425, USA E-mail:
| | - Amanda Vatinno
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Na Jin Seo
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA,Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29425, USA,Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USA
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Seo NJ, Ramakrishnan V, Woodbury ML, Bonilha L, Finetto C, Schranz C, Scronce G, Coupland K, Blaschke J, Baker A, Howard K, Meinzer C, Velozo CA, Adams RJ. Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke. Trials 2022; 23:262. [PMID: 35382902 PMCID: PMC8981199 DOI: 10.1186/s13063-022-06241-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors’ abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone. Methods A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication. Discussion This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden. Trial registration NCT04569123. Registered on September 29, 2020
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Affiliation(s)
- Na Jin Seo
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA. .,Ralph H. Johnson VA Medical Center, Charleston, SC, USA. .,Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA.
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Charleston, SC, 29425, USA
| | - Michelle L Woodbury
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC, 29425, USA
| | - Christian Finetto
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Christian Schranz
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Gabrielle Scronce
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Kristen Coupland
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Jenna Blaschke
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA
| | - Adam Baker
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Keith Howard
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Caitlyn Meinzer
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Charleston, SC, 29425, USA
| | - Craig A Velozo
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC, 29425, USA
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11
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Cansever L, Sezen CB, Yaran OV, Duman S, Seyrek Y, Hatipoğlu M, Öneş K, Bedirhan MA. The effect of transcutaneous electric nerve stimulation on chronic postoperative pain and long-term quality of life. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2021; 29:496-502. [PMID: 35096447 PMCID: PMC8762903 DOI: 10.5606/tgkdc.dergisi.2021.19800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/10/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aims to investigate the effects of transcutaneous electrical nerve stimulation on early-stage postoperative pain and long-term quality of life in patients undergoing thoracotomy. METHODS Between January 2019 and September 2019, a total of 100 patients (76 males, 24 females; mean age: 57.9±11.9 years; range, 51 to 79 years) who underwent thoracotomy due to benign or malignant lesions were included. The patients were divided into two groups: 50 patients who received transcutaneous electrical nerve stimulation (Group 1) and a control group of 50 patients who did not receive transcutaneous electrical nerve stimulation (Group 2). The Short Form-36 life quality scale was used to evaluate patients' quality of life at one month before and after surgery. RESULTS The mean length of hospital stay was 4.9±3.1 days in Group 1 and 6.2±4.6 days in Group 2 (p=0.008). There were no statistically significant differences in early-stage postoperative pain scores between the groups (p>0.05). Compared to Group 2, Group 1 had significantly lower pain scores and higher life quality scores pre- and postoperatively (p<0.05). CONCLUSION Transcutaneous electrical nerve stimulation is an effective method to manage chronic pain in the postoperative period. On the other hand, it does not effectively reduce early-stage postoperative pain or affect complication rates. The prevention of chronic postoperative pain by transcutaneous electrical nerve stimulation improves long-term quality of life of patients.
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Affiliation(s)
- Levent Cansever
- Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Celal Buğra Sezen
- Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Onur Volkan Yaran
- Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Salih Duman
- Department of Thoracic Surgery, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Yunus Seyrek
- Department of Thoracic Surgery, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Merve Hatipoğlu
- Department of Thoracic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Kadriye Öneş
- Department of Thoracic Surgery, University of Health Sciences, Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ali Bedirhan
- Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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12
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Endo N, Ishii D, Ishibashi K, Yamamoto S, Takeda K, Kohno Y. A study on the immediate effects of neuromuscular electrical stimulation on the corticospinal tract excitability of the infraspinatus muscle. J Back Musculoskelet Rehabil 2021; 34:631-637. [PMID: 33646142 DOI: 10.3233/bmr-200298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rotator cuff muscles are structurally and functionally different from other upper-limb muscles because they are responsible for glenohumeral joint stability. Neuromuscular electrical stimulation (NMES) induces excitability changes (increase or decrease) of the corticospinal tract (CST) in the peripheral muscles, such as those of the finger. However, it remains unclear whether similar results are obtained when targeting the infraspinatus muscle, which has properties that differ from other muscles, in healthy subjects. OBJECTIVE We investigated the immediate effects of NMES on the corticospinal excitability of the infraspinatus muscle, a rotator cuff muscle, in healthy subjects. METHODS Thirteen healthy right-handed men (mean age: 26.77 ± 2.08 years) participated in this study. The motor evoked potentials (MEPs) and the maximum compound muscle action potential (Mmax) were recorded before NMES to the right infraspinatus and within 15 minutes after the end of the NMES. RESULTS NMES on the infraspinatus muscle significantly increased its MEP amplitude (Pre: 0.45 mV [0.33-0.48]; Post: 0.54 mV [0.46-0.60] (median [lower quartile to higher quartile]); p= 0.005) but had no effect on Mmax (Pre: 2.95 mV [2.59-4.71]; Post: 3.35 mV [2.76-4.72]; p= 0.753). CONCLUSIONS NMES application to the infraspinatus muscle increases CST excitability without producing immediate changes in the neuromuscular junction or muscle hypertrophy.
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Affiliation(s)
- Naoto Endo
- Yumemino Orthopedic Clinic, Toride-shi, Ibaraki 302-0039, Japan
| | - Daisuke Ishii
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Inashiki-gun, Ibaraki 300-0394, Japan.,Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba-shi, Chiba 260-8670, Japan
| | - Kiyoshige Ishibashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Satoshi Yamamoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Kotaro Takeda
- Faculty of Rehabilitation, School of Healthcare, Fujita Health University, Toyoake-shi, Aichi 470-1192, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Inashiki-gun, Ibaraki 300-0394, Japan
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13
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Cruz E, Miller C, Zhang W, Rogers K, Lee HJ, Wells Y, Cloud GC, Lannin NA. Does non-implanted electrical stimulation reduce post-stroke urinary or fecal incontinence? A systematic review with meta-analysis. Int J Stroke 2021; 17:378-388. [PMID: 33724094 DOI: 10.1177/17474930211006301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Urinary and fecal incontinence are disabling impairments after stroke that can be clinically managed with electrical stimulation. AIM The purpose of this systematic review was to determine the effectiveness of non-implanted electrical stimulation to reduce the severity of post-stroke incontinence. SUMMARY OF REVIEW Clinical trials of non-implanted electrical stimulation applied for the purposes of treating post-stroke incontinence were searched in MEDLINE, EMBASE, CINAHL, PEDro, and CENTRAL. From a total of 5043 manuscripts, 10 trials met the eligibility criteria (n = 894 subjects). Nine trials reported urinary incontinence severity outcomes enabling meta-analysis of transcutaneous electrical nerve stimulation (TENS; five trials) and electroacupuncture (four trials). Studies provide good-to-fair quality evidence that TENS commenced <3 months post-stroke has a large effect on urinary continence (SMD = -3.40, 95% CI -4.46 to -2.34) and a medium effect when commenced >3 months after stroke (SMD = -0.67, 95% CI -1.09 to -0.26). Electroacupuncture has a large effect when administered >5 times a week (SMD = -2.32, 95% CI -2.96 to -1.68) and a small effect when administered five times a week (SMD = -0.44, 95% CI -0.69 to -0.18). Only one trial reported the effect of non-implanted electrical stimulation on post-stroke fecal incontinence. CONCLUSIONS Published trials evaluating the effect of non-implanted electrical stimulation on post-stroke incontinence are few and heterogenous. Synthesized trials suggest that early and frequent treatment using electrical stimulation is probably more effective than sham or no treatment. Further trials measuring incontinence in an objective manner are required.
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Affiliation(s)
- Enrique Cruz
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Charne Miller
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - WenWen Zhang
- Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Austin Health, Melbourne, Australia
| | | | | | - Yvonne Wells
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Geoffrey C Cloud
- Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Natasha A Lannin
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,John Walsh Centre for Rehabilitation Research, Kolling Institute, The University of Sydney, Sydney, Australia
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14
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Electroacupuncture-Induced Plasticity between Different Representations in Human Motor Cortex. Neural Plast 2020; 2020:8856868. [PMID: 32855632 PMCID: PMC7443218 DOI: 10.1155/2020/8856868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/18/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022] Open
Abstract
Somatosensory stimulation can effectively induce plasticity in the motor cortex representation of the stimulated body part. Specific interactions have been reported between different representations within the primary motor cortex. However, studies evaluating somatosensory stimulation-induced plasticity between different representations within the primary motor cortex are sparse. The purpose of this study was to investigate the effect of somatosensory stimulation on the modulation of plasticity between different representations within the primary motor cortex. Twelve healthy volunteers received both electroacupuncture (EA) and sham EA at the TE5 acupoint (located on the forearm). Plasticity changes in different representations, including the map volume, map area, and centre of gravity (COG) were evaluated by transcranial magnetic stimulation (TMS) before and after the intervention. EA significantly increased the map volume of the forearm and hand representations compared to those of sham EA and significantly reduced the map volume of the face representation compared to that before EA. No significant change was found in the map volume of the upper arm and leg representations after EA, and likewise, no significant changes in map area and COG were observed. These results suggest that EA functions as a form of somatosensory stimulation to effectively induce plasticity between different representations within the primary motor cortex, which may be related to the extensive horizontal intrinsic connectivity between different representations. The cortical plasticity induced by somatosensory stimulation might be purposefully used to modulate human cortical function.
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15
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Swallowing Outcomes and Discharge Destinations in Acute Stroke Tube-Feeding Dependent Dysphagia Patients Treated With Neuromuscular Electrical Stimulation During Inpatient Rehabilitation. Am J Phys Med Rehabil 2020; 99:487-494. [DOI: 10.1097/phm.0000000000001353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Hehl M, Swinnen SP, Cuypers K. Alterations of hand sensorimotor function and cortical motor representations over the adult lifespan. Aging (Albany NY) 2020; 12:4617-4640. [PMID: 32160591 PMCID: PMC7093194 DOI: 10.18632/aging.102925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/02/2020] [Indexed: 12/14/2022]
Abstract
Using a cross sectional design, we aimed to identify the effect of aging on sensorimotor function and cortical motor representations of two intrinsic hand muscles, as well as the course and timing of those changes. Furthermore, the link between cortical motor representations, sensorimotor function, and intracortical inhibition and facilitation was investigated. Seventy-seven participants over the full adult lifespan were enrolled. For the first dorsal interosseus (FDI) and abductor digiti minimi (ADM) muscle, cortical motor representations, GABAA-mediated short-interval intracortical inhibition (SICI), and glutamate-mediated intracortical facilitation (ICF) were assessed using transcranial magnetic stimulation over the dominant primary motor cortex. Additionally, participants' dexterity and force were measured. Linear, polynomial, and piecewise linear regression analyses were conducted to identify the course and timing of age-related differences. Our results demonstrated variation in sensorimotor function over the lifespan, with a marked decline starting around the mid-thirties. Furthermore, an age-related reduction in cortical motor representation volume and maximal MEP of the FDI, but not for ADM, was observed, occurring mainly until the mid-forties. Area of the cortical motor representation did not change with advancing age. Furthermore, cortical motor representations, sensorimotor function, and measures of intracortical inhibition and facilitation were not interrelated.
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Affiliation(s)
- Melina Hehl
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Leuven, Belgium
| | - Stephan P. Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Leuven, Belgium
- KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Koen Cuypers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Heverlee, Leuven, Belgium
- REVAL Research Institute, Hasselt University, Agoralaan, Diepenbeek, Belgium
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17
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Houde F, Harvey MP, Tremblay Labrecque PF, Lamarche F, Lefebvre A, Leonard G. Combining Transcranial Direct Current Stimulation and Transcutaneous Electrical Nerve Stimulation to Relieve Persistent Pain in a Patient Suffering from Complex Regional Pain Syndrome: A Case Report. J Pain Res 2020; 13:467-473. [PMID: 32184651 PMCID: PMC7060070 DOI: 10.2147/jpr.s226616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Complex regional pain syndrome (CRPS) is a rare neuropathic pain condition characterized by sensory, motor and autonomic alterations. Previous investigations have shown that transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) can alleviate pain in various populations, and that a combination of these treatments could provide greater hypoalgesic effects. In the present case report, we describe the effect of tDCS and TENS treatment on pain intensity and unpleasantness in a patient suffering from chronic CRPS. RESULTS The patient was a 37-year-old woman, suffering from left lower limb CRPS (type I) for more than 5 years. Despite medication (pregabalin, tapentadol, duloxetine), rehabilitation treatments (sensorimotor retraining, graded motor imagery) and spinal cord stimulation (SCS), the participant reported moderate to severe pain. Treatments of tDCS alone (performed with SCS turned off during tDCS application, 1 session/day, for 5 consecutive days) did not significantly decrease pain. Combining tDCS with TENS (SCS temporarily turned off during tDCS, 1 session/day, for 5 consecutive days) slightly reduced pain intensity and unpleasantness. DISCUSSION Our results suggest that combining tDCS and TENS could be a therapeutic strategy worth investigating further to relieve pain in chronic CRPS patients. Future studies should examine the efficacy of combined tDCS and TENS treatments in CRPS patients, and other chronic pain conditions, with special attention to the cumulative and long-term effects and its effect on function and quality of life.
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Affiliation(s)
- Francis Houde
- Research Center on Aging, CIUSSS de l'Estrie - CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), CIUSSS de l'Estrie - CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada
| | - Marie-Philippe Harvey
- Research Center on Aging, CIUSSS de l'Estrie - CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada
| | - Pierre-François Tremblay Labrecque
- Research Center on Aging, CIUSSS de l'Estrie - CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada
| | - Francis Lamarche
- Research Center on Aging, CIUSSS de l'Estrie - CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada
| | - Alexandra Lefebvre
- Research Center on Aging, CIUSSS de l'Estrie - CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada
| | - Guillaume Leonard
- Research Center on Aging, CIUSSS de l'Estrie - CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada
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18
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Suzuki T, Suzuki M, Kanemura N, Hamaguchi T. Differential Effect of Visual and Proprioceptive Stimulation on Corticospinal Output for Reciprocal Muscles. Front Integr Neurosci 2019; 13:63. [PMID: 31736723 PMCID: PMC6829117 DOI: 10.3389/fnint.2019.00063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
This study investigated the corticospinal excitability of reciprocal muscles during tasks involving sensory difference between proprioceptive and visual inputs. Participants were instructed to relax their muscles and to observe a screen during vibratory stimulation. A video screen was placed on the board covering the right hand and forearm. Participants were randomly tested in four conditions: resting, control, static, and dynamic. The resting condition involved showing a black screen, the control condition, a mosaic patterned static videoclip; the static condition, a static videoclip of wrist flexion 0°; and the dynamic condition, a videoclip that corresponded to each participant's closely-matched illusory wrist flexion angle and speed by vibration. Vibratory stimulation (frequency 80 Hz and duration 4 s) was applied to the distal tendon of the dominant right extensor carpi radialis (ECR) using a tendon vibrator in the control, static, and dynamic conditions. Four seconds after the vibratory stimulation (end of vibration), the primary motor cortex at the midpoint between the centers of gravity of the flexor carpi radialis (FCR) and ECR muscles was stimulated by transcranial magnetic stimulation (TMS). The ECR motor evoked potential (MEP) amplitudes significantly increased in the control condition compared to the resting condition, whereas the FCR MEP amplitudes did not change between the resting and control conditions. In addition, the ECR MEP amplitudes significantly increased in the static condition compared to the dynamic condition. However, the FCR MEP amplitudes significantly increased in the dynamic condition compared to the static condition. These results imply that the difference between visuo-proprioceptive information had an effect on corticospinal excitability for the muscle. In conclusion, we found that proprioceptive and visual information differentially altered the corticospinal excitability of reciprocal muscles.
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Affiliation(s)
- Takako Suzuki
- School of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Makoto Suzuki
- Department of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Naohiko Kanemura
- School of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Toyohiro Hamaguchi
- School of Health Sciences, Saitama Prefectural University, Saitama, Japan
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19
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Seo NJ, Enders LR, Fortune A, Cain S, Vatinno AA, Schuster E, Ramakrishnan V, Feng W. Phase I Safety Trial: Extended Daily Peripheral Sensory Stimulation Using a Wrist-Worn Vibrator in Stroke Survivors. Transl Stroke Res 2019; 11:204-213. [PMID: 31444692 DOI: 10.1007/s12975-019-00724-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
Peripheral sensory stimulation augments post-stroke upper extremity rehabilitation outcomes. Most sensory stimulations interfere with natural hand tasks and the stimulation duration is limited. We developed TheraBracelet, low-level random-frequency vibration applied via a wristwatch, to enable stimulation during hand tasks and potentially extend stimulation durations. To determine safety of prolonged exposure to TheraBracelet. Single-site double-blind crossover randomized controlled trial. Chronic stroke survivors were instructed to wear a device on the affected wrist for > 8 h/day everyday for 2 months while coming to the laboratory weekly for evaluations, with a 2-week break between each month. The device applied vibration at 60% and 1% of the sensory threshold for the real and sham month, respectively. The order of the real and sham months was randomized/balanced. Adverse events (AEs) were assessed weekly, including worsening of hand sensation, dexterity, grip strength, pain, or spasticity and occurrence of skin irritation or swelling. Device-related AE rates were compared between the real and sham month. Twenty-five participants completed the study. Six participants (24%) experienced mild AEs involving worsened sensory scores that may be related to the intervention with reasonable possibility. Two experienced them in the real stimulation month only, 3 in the sham month only, and 1 in both months. Therefore, less participants experienced device-related AEs in the real than sham month. Daily stimulation using the device for a month is safe for chronic stroke survivors. Future studies examining the efficacy of pairing TheraBracelet with therapy for increasing neurorehabilitation outcomes are a logical next step. Trial registration: NCT03318341.
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Affiliation(s)
- Na Jin Seo
- Division of Occupational Therapy, Department of Health Professions, Department of Health Sciences and Research, Medical University of South Carolina (MUSC), Charleston, SC, USA.
| | | | - Andrew Fortune
- Department of Health Sciences and Research, MUSC, Charleston, SC, USA
| | - Shannon Cain
- Division of Occupational Therapy, Department of Health Professions, MUSC, Charleston, SC, USA
| | - Amanda A Vatinno
- Department of Health Sciences and Research, MUSC, Charleston, SC, USA
| | - Eli Schuster
- Department of Health Professions, MUSC, Charleston, SC, USA
| | | | - Wuwei Feng
- Department of Health Sciences and Research, MUSC, Charleston, SC, USA
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
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20
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Lopez-Rosado R, Kimalat A, Bednarczyk M, Sullivan JE. Sensory Amplitude Electrical Stimulation via Sock Combined With Standing and Mobility Activities Improves Walking Speed in Individuals With Chronic Stroke: A Pilot Study. Front Neurosci 2019; 13:337. [PMID: 31040763 PMCID: PMC6477056 DOI: 10.3389/fnins.2019.00337] [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: 09/27/2018] [Accepted: 03/22/2019] [Indexed: 11/18/2022] Open
Abstract
Objective: To determine if sensory amplitude electrical stimulation (SES) delivered via sock electrode combined with standing and mobility activities improved gait speed, sensation, balance, and participation in chronic stroke. It was hypothesized that SES would enhance the effectiveness of exercise, resulting in reduced impairment and improved function. Design: Case Series. Setting: Home-based intervention. Participants: Thirteen adults (56.5 + 7.84 years old) with chronic stroke (8.21 + 4.36 years post) and hemiparesis completed the study. Participants were community ambulators. Intervention: Participants completed 6 weeks of self-administered SES delivered via sock electrode concurrent with standing and mobility activities for a minimum of 5 days/week for 30-min, twice daily. Outcome Measures: Berg Balance Scale (BBS), Stroke Rehabilitation Assessment of Movement—LE subscale (STREAM), 10 Meter Walk Test (10 MWT), Activities-Specific Balance Confidence Scale (ABC), Stroke Impact Scale (SIS), Perceptual Threshold of Electrical Stimulation (PTTES), and Monofilament testing were administered at pre-test, post-test, and 3-month follow up. Results: Baseline sensory scores and change scores on functional outcomes were analyzed using Pearson Product-Movement Correlation Coefficients, Friedman test, and Linear mixed models. There was a significant change with 10 MWT self-selected pace (Friedman's p = 0.038). Pre-post intervention changes in other outcome measures were not significant. According to the Cohen's effect size classification, there were medium effect sizes for both the STREAM-LE and Monofilaments. Conclusion: The use of home-based SES via sock electrode combined with standing and mobility activities may contribute to improve gait speed in chronic stroke.
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Affiliation(s)
- Roberto Lopez-Rosado
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Andrea Kimalat
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Jane E Sullivan
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Trudgen A, Cirillo J, Byblow WD. Somatosensory and transcranial direct current stimulation effects on manual dexterity and motor cortex function: A metaplasticity study. Brain Stimul 2019; 12:938-947. [PMID: 30850217 DOI: 10.1016/j.brs.2019.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/08/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Non-invasive neuromodulation may provide treatment strategies for neurological deficits affecting movement, such as stroke. For example, weak electrical stimulation applied to the hand by wearing a "mesh glove" (MGS) can transiently increase primary motor cortex (M1) excitability. Conversely, transcranial direct current stimulation with the cathode over M1 (c-tDCS) can decrease corticomotor excitability. OBJECTIVE/HYPOTHESIS We applied M1 c-tDCS as a priming adjuvant to MGS and hypothesised metaplastic effects would be apparent in improved motor performance and modulation of M1 inhibitory and facilitatory circuits. METHODS Sixteen right-handed neurologically healthy individuals participated in a repeated measures cross-over study; nine minutes of sham- or c-tDCS followed by 30 min of suprasensory threshold MGS. Dexterity of the non-dominant (left) hand was assessed using the grooved pegboard task, and measures of corticomotor excitability, intracortical facilitation, short-latency afferent inhibition (SAI), short-interval intracortical inhibition (SICI), and SAI in the presence of SICI (SAIxSICI), were obtained at baseline, post-tDCS, and 0, 30 and 60 min post-MGS. RESULTS There was a greater improvement in grooved pegboard completion times with c-tDCS primed MGS than sham + MGS. There was also more pronounced disinhibition of SAI. However, disinhibition of SAI in the presence of SICI was less and rest motor threshold higher compared to sham + MGS. CONCLUSIONS The results indicate a metaplastic modulation of corticomotor excitability with c-tDCS primed MGS. Further studies are warranted to determine how various stimulation approaches can induce metaplastic effects on M1 neuronal circuits to boost functional gains obtained with motor practice.
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Affiliation(s)
- Anita Trudgen
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - John Cirillo
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand; Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Winston D Byblow
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand; Centre for Brain Research, University of Auckland, Auckland, New Zealand.
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Seo NJ, Lakshminarayanan K, Lauer AW, Ramakrishnan V, Schmit BD, Hanlon CA, George MS, Bonilha L, Downey RJ, DeVries W, Nagy T. Use of imperceptible wrist vibration to modulate sensorimotor cortical activity. Exp Brain Res 2019; 237:805-816. [PMID: 30607471 PMCID: PMC6613561 DOI: 10.1007/s00221-018-05465-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/21/2018] [Indexed: 11/24/2022]
Abstract
Peripheral sensory stimulation has been used as a method to stimulate the sensorimotor cortex, with applications in neurorehabilitation. To improve delivery modality and usability, a new stimulation method has been developed in which imperceptible random-frequency vibration is applied to the wrist concurrently during hand activity. The objective of this study was to investigate effects of this new sensory stimulation on the sensorimotor cortex. Healthy adults were studied. In a transcranial magnetic stimulation (TMS) study, resting motor threshold, short-interval intracortical inhibition, and intracortical facilitation for the abductor pollicis brevis muscle were compared between vibration on vs. off, while subjects were at rest. In an electroencephalogram (EEG) study, alpha and beta power during rest and event-related desynchronization (ERD) for hand grip were compared between vibration on vs. off. Results showed that vibration decreased EEG power and decreased TMS short-interval intracortical inhibition (i.e., disinhibition) compared with no vibration at rest. Grip-related ERD was also greater during vibration, compared to no vibration. In conclusion, subthreshold random-frequency wrist vibration affected the release of intracortical inhibition and both resting and grip-related sensorimotor cortical activity. Such effects may have implications in rehabilitation.
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Affiliation(s)
- Na Jin Seo
- Department of Health Professions, Medical University of South Carolina, 151B Rutledge Ave., Charleston, SC, 29425, USA.
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Kishor Lakshminarayanan
- Department of Industrial and Manufacturing Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, 53201, USA
| | - Abigail W Lauer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, 53233, USA
| | - Colleen A Hanlon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Mark S George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Ryan J Downey
- Department of Health Professions, Medical University of South Carolina, 151B Rutledge Ave., Charleston, SC, 29425, USA
| | - Will DeVries
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Tibor Nagy
- Department of Chemistry, Appalachian State University, Boone, NC, 28608, USA
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Seo NJ, Woodbury ML, Bonilha L, Ramakrishnan V, Kautz SA, Downey RJ, Dellenbach BHS, Lauer AW, Roark CM, Landers LE, Phillips SK, Vatinno AA. TheraBracelet Stimulation During Task-Practice Therapy to Improve Upper Extremity Function After Stroke: A Pilot Randomized Controlled Study. Phys Ther 2019; 99:319-328. [PMID: 30690609 PMCID: PMC6383710 DOI: 10.1093/ptj/pzy143] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/13/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Peripheral sensory stimulation has been used in conjunction with upper extremity movement therapy to increase therapy-induced motor gains in patients with stroke. The limitation is that existing sensory stimulation methods typically interfere with natural hand tasks and thus are administered prior to therapy, requiring patients' time commitment. To address this limitation, we developed TheraBracelet. This novel stimulation method provides subthreshold (ie, imperceptible) vibratory stimulation to the wrist and can be used during hand tasks/therapy without interfering with natural hand tasks. OBJECTIVE The objective was to determine the feasibility of using TheraBracelet during therapy to augment motor recovery after stroke. DESIGN The design was a triple-blinded pilot randomized controlled trial. METHODS Twelve chronic stroke survivors were assigned to the treatment or control group. All participants completed 2-hour task practice therapy sessions thrice weekly for 2 weeks. Both groups wore a small vibrator on the paretic wrist, which was turned on to provide TheraBracelet stimulation for the treatment group and turned off for the control group to provide sham stimulation. Outcome measures (Box and Block Test [BBT] and Wolf Motor Function Test [WMFT]) were obtained at baseline, 6 days after therapy, and at follow-up 19 days after therapy. RESULTS The intervention was feasible with no adverse events. The treatment group significantly improved their BBT scores after therapy and at follow-up compared with baseline, whereas the control group did not. For WMFT, the group × time interaction was short of achieving significance. Large effect sizes were obtained (BBT d = 1.43, WMFT d = 0.87). No indication of desensitization to TheraBracelet stimulation was observed. LIMITATIONS The limitation was a small sample size. CONCLUSIONS TheraBracelet could be a promising therapy adjuvant for upper extremity recovery after stroke.
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Affiliation(s)
- Na J Seo
- Division of Occupation Therapy, Department of Health Professions, Department of Health Sciences and Research, Medical University of South Carolina, 151B Rutledge Ave, Charleston, SC 29425 (USA)
| | - Michelle L Woodbury
- Department of Health Sciences and Research, Medical University of South Carolina
| | | | | | - Steven A Kautz
- Department of Health Sciences and Research, Medical University of South Carolina
| | - Ryan J Downey
- Department of Health Professions, Medical University of South Carolina
| | - Blair H S Dellenbach
- Department of Health Sciences and Research, Medical University of South Carolina
| | - Abigail W Lauer
- Department of Public Health Sciences, Medical University of South Carolina
| | - Caroline M Roark
- Division of Occupational Therapy, Medical University of South Carolina
| | - Lauren E Landers
- Division of Occupational Therapy, Medical University of South Carolina
| | - Sarah K Phillips
- Division of Occupational Therapy, Medical University of South Carolina
| | - Amanda A Vatinno
- College of Health Professions, Medical University of South Carolina
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Pelletier R, Bourbonnais D, Higgins J. Nociception, pain, neuroplasticity and the practice of Osteopathic Manipulative Medicine. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Suzuki M, Hamaguchi T, Matsunaga A. Nonequivalent modulation of corticospinal excitability by positive and negative outcomes. Brain Behav 2018; 8:e00862. [PMID: 29568678 PMCID: PMC5853642 DOI: 10.1002/brb3.862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/25/2017] [Accepted: 09/25/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The difference between positive and negative outcomes is important in trial-and-error decision-making processes and affects corticospinal excitability. This study investigated corticospinal excitability during the performance of trial-and-error decision-making tasks with varying competing behavioral outcomes. METHODS Each trial began with one of five colored circles presented as a cue. Each color represented a different reward probability, ranging from 10% to 90%. The subjects were instructed to decide whether to perform wrist flexion in response to the cue. Two seconds after the presentation of the cue, a reward stimulus (picture of a coin) or penalty stimulus (mauve circle) was randomly presented to the subject. If the picture of a coin appeared, the subjects received the coin after the experiment if they had performed wrist flexion, but not if they had not performed wrist flexion. If a mauve circle appeared, a coin was deducted from the total reward if the subjects had performed wrist flexion, but not if they had not performed wrist flexion. One second after the reward or penalty stimulus, transcranial magnetic stimulation was delivered to the primary motor cortex at the midpoint between the centers of gravity of the flexor carpi radialis (agonist) and extensor carpi radialis (antagonist) muscles. RESULTS Cumulative wrist flexions were positively correlated with reward probabilities. Motor evoked potential (MEP) amplitudes in agonist muscles were significantly higher when wrist flexion incurred a penalty than when it incurred a reward, but there was no difference in the MEP amplitudes of antagonist muscles. CONCLUSION Positive and negative behavioral outcomes differentially altered behavior and corticospinal excitability, and unexpected penalties had a stronger effect on corticospinal excitability for agonist muscles.
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Affiliation(s)
- Makoto Suzuki
- School of Health Sciences Saitama Prefectural University Saitama Japan
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Lin LF, Huang SW, Chang KH, Ouyang JH, Liou TH, Lin YN. A novel Robotic Gait Training System (RGTS) may facilitate functional recovery after stroke: A feasibility and safety study. NeuroRehabilitation 2017; 41:453-461. [DOI: 10.3233/nre-162137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (ROC)
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei City, Taiwan (ROC)
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (ROC)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan (ROC)
| | - Kwang-Hwa Chang
- Department of Physical Medicine and Rehabilitation, Wan Fang Medical Center, Taipei Medical University, Taipei City, Taiwan (ROC)
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan (ROC)
| | - Jin-Han Ouyang
- Department of Physical Medicine and Rehabilitation, Wan Fang Medical Center, Taipei Medical University, Taipei City, Taiwan (ROC)
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (ROC)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan (ROC)
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan (ROC)
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan Fang Medical Center, Taipei Medical University, Taipei City, Taiwan (ROC)
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan (ROC)
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Automatized set-up procedure for transcranial magnetic stimulation protocols. Neuroimage 2017; 153:307-318. [DOI: 10.1016/j.neuroimage.2017.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/03/2017] [Accepted: 04/01/2017] [Indexed: 12/15/2022] Open
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Chai G, Zhang D, Zhu X. Developing Non-Somatotopic Phantom Finger Sensation to Comparable Levels of Somatotopic Sensation through User Training With Electrotactile Stimulation. IEEE Trans Neural Syst Rehabil Eng 2017; 25:469-480. [DOI: 10.1109/tnsre.2016.2580905] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders. Phys Ther 2015; 95:1582-91. [PMID: 25953594 DOI: 10.2522/ptj.20140575] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/01/2015] [Indexed: 11/17/2022]
Abstract
Present interventions utilized in musculoskeletal rehabilitation are guided, in large part, by a biomedical model where peripheral structural injury is believed to be the sole driver of the disorder. There are, however, neurophysiological changes across different areas of the peripheral and central nervous systems, including peripheral receptors, dorsal horn of the spinal cord, brain stem, sensorimotor cortical areas, and the mesolimbic and prefrontal areas associated with chronic musculoskeletal disorders, including chronic low back pain, osteoarthritis, and tendon injuries. These neurophysiological changes appear not only to be a consequence of peripheral structural injury but also to play a part in the pathophysiology of chronic musculoskeletal disorders. Neurophysiological changes are consistent with a biopsychosocial formulation reflecting the underlying mechanisms associated with sensory and motor findings, psychological traits, and perceptual changes associated with chronic musculoskeletal conditions. These changes, therefore, have important implications in the clinical manifestation, pathophysiology, and treatment of chronic musculoskeletal disorders. Musculoskeletal rehabilitation professionals have at their disposal tools to address these neuroplastic changes, including top-down cognitive-based interventions (eg, education, cognitive-behavioral therapy, mindfulness meditation, motor imagery) and bottom-up physical interventions (eg, motor learning, peripheral sensory stimulation, manual therapy) that induce neuroplastic changes across distributed areas of the nervous system and affect outcomes in patients with chronic musculoskeletal disorders. Furthermore, novel approaches such as the use of transcranial direct current stimulation and repetitive transcranial magnetic stimulation may be utilized to help renormalize neurological function. Comprehensive treatment addressing peripheral structural injury as well as neurophysiological changes occurring across distributed areas of the nervous system may help to improve outcomes in patients with chronic musculoskeletal disorders.
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Sullivan J, Girardi M, Hensley M, Rohaus J, Schewe C, Whittey C, Hansen P, Muir K. Improving arm function in chronic stroke: a pilot study of sensory amplitude electrical stimulation via glove electrode during task-specific training. Top Stroke Rehabil 2015; 22:169-75. [PMID: 26084321 DOI: 10.1179/1074935714z.0000000007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To investigate the effects of sensory amplitude electrical stimulation (SES) delivered by glove electrode during task-specific exercise on arm movement, function, and sensation in chronic stroke. METHODS The design was an intervention pilot study, pre-test, post-test, follow-up design. The settings used were a university research laboratory and home-based intervention. Participants comprised of 11 individuals with chronic stroke (7.2 ± 4.1 years post onset) and moderate arm paresis, 10.82/20 ± 2.27 on the Stroke Rehabilitation Assessment of Movement (STREAM) - Arm Subscale. Participants were seven males and four females (mean age: 59 years). Participants were recruited from university-based database. Intervention- Participants engaged in task-specific training at home for 30 min, twice daily, for 5 weeks, while receiving SES via glove electrode. Participants received supervised task practice at least twice during intervention period for 1 hour. Main outcome measures- Jebsen-Taylor Hand Function Test (JTHFT), STREAM - Arm Subscale, Motor Activity Log-14 (MAL-14) - Amount and Quality Subscales, and Nottingham Stereognosis Assessment (NSA). RESULTS Significant changes were found in group mean pre- and post-test comparisons on the NSA (P = 0.042), MAL amount subscale (P = 0.047), and JTHFT (with writing item 29 excluded) (P = 0.003) and in pre-test to follow-up comparisons on NSA (P = 0.027) and JTHFT (writing item excluded) (P = 0.009). There was no significant change on the STREAM (P = 1.0). Individuals with a greater baseline motor capacity determined by STREAM scores (P = 0.048) and more recent stroke (P = 0.014) had significantly greater improvements. CONCLUSION Combining task-specific training with glove-based SES in chronic stroke resulted in changes in arm sensation and function that were maintained at 3-month follow-up.
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McDonnell MN, Hillier SL, Opie GM, Nowosilskyj M, Haberfield M, Todd G. Continuous passive movement does not influence motor maps in healthy adults. Front Hum Neurosci 2015; 9:230. [PMID: 25972802 PMCID: PMC4413560 DOI: 10.3389/fnhum.2015.00230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/10/2015] [Indexed: 11/19/2022] Open
Abstract
Hand weakness following stroke is often associated with a reduced representation of the hand in the primary motor cortex. Meaningful sensory input can induce sensorimotor reorganization in the brain, but the after-effect of continuous passive motion (CPM) on the cortical representation is unknown. The purpose of this study was to determine whether repeated sessions of continuous passive movement of the thumb induce a lasting increase in the motor cortical representation of a thumb muscle in healthy adults. Thirteen right-handed healthy adults (mean age 24.3 ± 4.3 years) participated in the study. Single-pulse Transcranial Magnetic Stimulation (TMS) was delivered over the motor area of the target muscle (abductor pollicis brevis) before and/or after a thirty minute session of thumb CPM administered on three consecutive days. TMS was also delivered 5 days after cessation of the CPM intervention. The response to TMS (motor evoked potential) was recorded in the target muscle with surface EMG. Resting motor threshold (RMT), motor evoked potential amplitude at a specified intensity, and the area and volume of the cortical representation of the target muscle were measured. Thumb CPM had no significant effect on TMS parameters (p > 0.05 all measures) and performance of an attention task remained unchanged within and across CPM sessions. The results suggest that three sessions of repetitive passive thumb movement is not sufficient to induce a change in the cortical representation of the thumb and is unlikely to reverse the decreased representation of the affected hand following stroke.
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Affiliation(s)
- Michelle N McDonnell
- International Centre for Allied Health Evidence, Sansom Institute for Health Research, School of Health Sciences, University of South Australia Adelaide, Australia
| | - Susan L Hillier
- International Centre for Allied Health Evidence, Sansom Institute for Health Research, School of Health Sciences, University of South Australia Adelaide, Australia
| | - George M Opie
- Department of Physiology, The University of Adelaide Adelaide, Australia
| | - Matthew Nowosilskyj
- International Centre for Allied Health Evidence, Sansom Institute for Health Research, School of Health Sciences, University of South Australia Adelaide, Australia
| | - Miranda Haberfield
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia Adelaide, Australia
| | - Gabrielle Todd
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia Adelaide, Australia
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van de Ruit M, Perenboom MJL, Grey MJ. TMS brain mapping in less than two minutes. Brain Stimul 2014; 8:231-9. [PMID: 25556004 DOI: 10.1016/j.brs.2014.10.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) corticospinal excitability maps are a valuable tool to study plasticity in the corticospinal tract. Traditionally, data acquisition for a single map is time consuming, limiting the method's applicability when excitability changes quickly, such as during motor learning, and in clinical investigations where assessment time is a limiting factor. OBJECTIVE To reduce the time needed to create a reliable map by 1) investigating the minimum interstimulus interval (ISI) at which stimuli may be delivered, and 2) investigating the minimum number of stimuli required to create a map. METHOD Frameless stereotaxy was used to monitor coil position as the coil was moved pseudorandomly within a 6 × 6 cm square. Maps were acquired using 1-4 s ISIs in 12 participants. The minimum number of stimuli was determined by randomly extracting data and comparing the resulting map to the original data set. To confirm validity, the pseudorandom walk method was compared against a traditional mapping method. RESULTS Reliable maps could be created with 63 stimuli recorded with a 1 s ISI. Maps created acquiring data using the pseudorandom walk method were not significantly different from maps acquired following the traditional method. CONCLUSIONS To account for inter-participant variability, outliers, coil positioning errors and, most importantly, participant comfort during data acquisition, we recommend creating a map with 80 stimuli and a 1.5 s ISI. This makes it possible to acquire TMS maps in 2 min, making mapping a more feasible tool to study short- and long-term changes in cortical organization.
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Affiliation(s)
- Mark van de Ruit
- NIHR Surgical Reconstruction and Microbiology Research Centre, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston B15 2TT, UK; MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston B15 2TT, UK
| | - Matthijs J L Perenboom
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Michael J Grey
- NIHR Surgical Reconstruction and Microbiology Research Centre, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston B15 2TT, UK; MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston B15 2TT, UK; Department of Neuroscience and Pharmacology, Panum Institute, University of Copenhagen, Copenhagen, Denmark.
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Gomes-Osman J, Field-Fote EC. Cortical vs. afferent stimulation as an adjunct to functional task practice training: a randomized, comparative pilot study in people with cervical spinal cord injury. Clin Rehabil 2014; 29:771-82. [PMID: 25381344 DOI: 10.1177/0269215514556087] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess single-session effects of three different types of stimuli known to increase cortical excitability when combined with functional task practice. DESIGN Randomized cross-over trial. PARTICIPANTS A total of 24 participants with chronic cervical spinal cord injury. INTERVENTIONS One 30-minute session of each, applied concurrently with functional task practice: transcranial direct current stimulation, vibration, and transcutaneous electrical nerve stimulation. MEASUREMENTS Nine-hole Peg Test, pinch force, visuomotor tracking, and cortical excitability were collected at pretest, posttest and late posttest (30 minutes after). Early effects (posttest minus pretest) and short-term persistence (late posttest minus pretest) were assessed using a general linear mixed model. Magnitude of effect size was assessed using the Cohen's d. RESULTS Transcutaneous electrical nerve stimulation was associated with moderate, significant early effects and short-term persistence on Nine-hole Peg Test performance (1.8 ±1.8, p = 0.003, d = 0.59; 2.0 ±2.5, p < 0.001, Cohen's d = 0.65, respectively). Transcranial direct current stimulation (1.8 ±2.5, p = 0.003, Cohen's d = 0.52) was also associated with significant short-term persistence of moderate size on Nine-hole Peg Test performance (1.8 ±2.5, p = 0.003, Cohen's d = 0.52) and visuomotor tracking performance (p = 0.05, d = 0.51). Early effects on corticomotor excitability were significant for transcutaneous electrical nerve stimulation (p = 0.003), approached significance for transcranial direct current stimulation (p = 0.07), and only vibration was associated with significant short-term persistence (p = 0.006). CONCLUSIONS Meaningful improvements in aspects of hand-related function that persisted at least 30 minutes after intervention were observed with transcutaneous electrical nerve stimulation and transcranial direct current stimulation, when combined with functional task practice.
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Affiliation(s)
- Joyce Gomes-Osman
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edelle C Field-Fote
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA
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Kafri M, Laufer Y. Therapeutic effects of functional electrical stimulation on gait in individuals post-stroke. Ann Biomed Eng 2014; 43:451-66. [PMID: 25316590 DOI: 10.1007/s10439-014-1148-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
Functional electrical stimulation (FES) to lower extremity (LE) muscles is used by individuals post-stroke as an alternative to mechanical orthotic devices during gait or as a training modality during rehabilitation. Technological developments which improve the feasibility, accessibility and effectiveness of FES systems as orthotic and training devices, highlight the potential of FES for rehabilitating LE function in individuals post-stroke. This study presents a systematic review of the carryover effects of LE FES to motor performance when stimulation is not applied (therapeutic effects) in subjects post-stroke. A description of advances in FES technologies, with an emphasis on systems designed to promote LE function is included, and mechanisms that may be associated with the observed therapeutic effects are discussed. Eligible studies were reviewed for methodological quality, population, intervention and outcome characteristics. Therapeutic effects of FES were consistently demonstrated at the body function and activity levels when it was used as a training modality. Compared to matched treatments that did not incorporate FES, no definite conclusions can be drawn regarding the superiority of FES. When FES was used as an alternative to an orthotic device, it had no superior therapeutic effects at the activity level, yet patients still seemed to prefer it.
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Affiliation(s)
- Michal Kafri
- Department of Physical Therapy Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa, 3498838, Israel,
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Suzuki M, Kirimoto H, Sugawara K, Oyama M, Yamada S, Yamamoto JI, Matsunaga A, Fukuda M, Onishi H. Motor cortex-evoked activity in reciprocal muscles is modulated by reward probability. PLoS One 2014; 9:e90773. [PMID: 24603644 PMCID: PMC3948372 DOI: 10.1371/journal.pone.0090773] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 02/05/2014] [Indexed: 12/02/2022] Open
Abstract
Horizontal intracortical projections for agonist and antagonist muscles exist in the primary motor cortex (M1), and reward may induce a reinforcement of transmission efficiency of intracortical circuits. We investigated reward-induced change in M1 excitability for agonist and antagonist muscles. Participants were 8 healthy volunteers. Probabilistic reward tasks comprised 3 conditions of 30 trials each: 30 trials contained 10% reward, 30 trials contained 50% reward, and 30 trials contained 90% reward. Each trial began with a cue (red fixation cross), followed by blue circle for 1 s. The subjects were instructed to perform wrist flexion and press a button with the dorsal aspect of middle finger phalanx as quickly as possible in response to disappearance of the blue circle without looking at their hand or the button. Two seconds after the button press, reward/non-reward stimulus was randomly presented for 2-s duration. The reward stimulus was a picture of Japanese 10-yen coin, and each subject received monetary reward at the end of experiment. Subjects were not informed of the reward probabilities. We delivered transcranial magnetic stimulation of the left M1 at the midpoint between center of gravities of agonist flexor carpi radialis (FCR) and antagonist extensor carpi radialis (ECR) muscles at 2 s after the red fixation cross and 1 s after the reward/non-reward stimuli. Relative motor evoked potential (MEP) amplitudes at 2 s after the red fixation cross were significantly higher for 10% reward probability than for 90% reward probability, whereas relative MEP amplitudes at 1 s after reward/non-reward stimuli were significantly higher for 90% reward probability than for 10% and 50% reward probabilities. These results implied that reward could affect the horizontal intracortical projections in M1 for agonist and antagonist muscles, and M1 excitability including the reward-related circuit before and after reward stimulus could be differently altered by reward probability.
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Affiliation(s)
- Makoto Suzuki
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
- * E-mail:
| | - Hikari Kirimoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kazuhiro Sugawara
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mineo Oyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sumio Yamada
- Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | | | - Atsuhiko Matsunaga
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Michinari Fukuda
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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Cuypers K, Thijs H, Meesen RLJ. Optimization of the transcranial magnetic stimulation protocol by defining a reliable estimate for corticospinal excitability. PLoS One 2014; 9:e86380. [PMID: 24475111 PMCID: PMC3901672 DOI: 10.1371/journal.pone.0086380] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/11/2013] [Indexed: 11/19/2022] Open
Abstract
The goal of this study was to optimize the transcranial magnetic stimulation (TMS) protocol for acquiring a reliable estimate of corticospinal excitability (CSE) using single-pulse TMS. Moreover, the minimal number of stimuli required to obtain a reliable estimate of CSE was investigated. In addition, the effect of two frequently used stimulation intensities [110% relative to the resting motor threshold (rMT) and 120% rMT] and gender was evaluated. Thirty-six healthy young subjects (18 males and 18 females) participated in a double-blind crossover procedure. They received 2 blocks of 40 consecutive TMS stimuli at either 110% rMT or 120% rMT in a randomized order. Based upon our data, we advise that at least 30 consecutive stimuli are required to obtain the most reliable estimate for CSE. Stimulation intensity and gender had no significant influence on CSE estimation. In addition, our results revealed that for subjects with a higher rMT, fewer consecutive stimuli were required to reach a stable estimate of CSE. The current findings can be used to optimize the design of similar TMS experiments.
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Affiliation(s)
- Koen Cuypers
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Motor Control Laboratory, Research Center for Movement Control and Neuroplasticity, Department of Biomedical Kinesiology, Group Biomedical Sciences, K.U. Leuven, Heverlee, Belgium
| | - Herbert Thijs
- I-BioStat, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
- I-BioStat, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Leuven University, Leuven, Belgium
| | - Raf L. J. Meesen
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Motor Control Laboratory, Research Center for Movement Control and Neuroplasticity, Department of Biomedical Kinesiology, Group Biomedical Sciences, K.U. Leuven, Heverlee, Belgium
- * E-mail:
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Suzuki M, Kirimoto H, Sugawara K, Watanabe M, Shimizu S, Ishizaka I, Yamada S, Matsunaga A, Fukuda M, Onishi H. Induction of cortical plasticity for reciprocal muscles by paired associative stimulation. Brain Behav 2014; 4:822-32. [PMID: 25365805 PMCID: PMC4212109 DOI: 10.1002/brb3.280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/27/2014] [Accepted: 08/18/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Paired associative stimulation (PAS) is widely used to induce plasticity in the human motor cortex. Although reciprocal inhibition of antagonist muscles plays a fundamental role in human movements, change in cortical circuits for reciprocal muscles by PAS is unknown. METHODS We investigated change in cortical plasticity for reciprocal muscles during PAS. PAS consisted of 200 pairs of peripheral electric stimulation of the right median nerve at the wrist at a frequency of 0.25 Hz followed by transcranial magnetic stimulation of the left M1 at the midpoint between the center of gravities of the flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles. Measures of motor cortical excitability included resting motor threshold (RMT), GABAA-mediated short-interval intracortical inhibition (SICI), and GABAB-mediated long-interval intracortical inhibition (LICI). RESULTS Motor evoked potential amplitude-conditioned LICI for the FCR muscle was significantly decreased after PAS (P = 0.020), whereas that for the ECR muscle was significantly increased (P = 0.033). Changes in RMT and SICI for the FCR and ECR muscles were not significantly different before and after PAS. Corticospinal excitability for both reciprocal muscles was increased during PAS, but GABAB-mediated cortical inhibitory functions for the agonist and antagonist muscles were reciprocally altered after PAS. CONCLUSION These results implied that the cortical excitability for reciprocal muscles including GABAB-ergic inhibitory systems within human M1 could be differently altered by PAS.
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Affiliation(s)
- Makoto Suzuki
- Graduate School of Medical Sciences, Kitasato University Kanagawa, Japan ; School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Hikari Kirimoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare Niigata, Japan
| | - Kazuhiro Sugawara
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare Niigata, Japan
| | - Makoto Watanabe
- School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Shinobu Shimizu
- School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Ikuyo Ishizaka
- School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Sumio Yamada
- Department of Rehabilitation Science, Nagoya University Graduate School of Medicine Nagoya, Japan
| | - Atsuhiko Matsunaga
- Graduate School of Medical Sciences, Kitasato University Kanagawa, Japan ; School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Michinari Fukuda
- Graduate School of Medical Sciences, Kitasato University Kanagawa, Japan ; School of Allied Health Sciences, Kitasato University Kanagawa, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare Niigata, Japan
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Hoffman L, Field-Fote E. Effects of practice combined with somatosensory or motor stimulation on hand function in persons with spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 19:288-99. [PMID: 24244094 DOI: 10.1310/sci1904-288] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Individuals with chronic tetraplegia prioritize recovery of hand function as an important factor in improving their quality of life. Interventions that may improve hand function and increase corticomotor excitability are functional electrical stimulation (FES), somatosensory stimulation (SS), and task-oriented training. OBJECTIVE We compared functional and corticomotor outcomes in a control condition to changes associated with FES (triggered via electromygraphic signals) and with SS (constant trains), each combined with either unimanual or bimanual training. METHODS Using a randomized, clinical trial design, comparisons were made to a delayed intervention control group. Participants (n = 24) had chronic tetraplegia, with the ability to activate thenar muscles, and were randomly assigned to either the immediate intervention (intervention) or control/ delayed intervention groups. Primary analyses compared intervention (FES or SS) to control/delayed intervention. Secondary analyses compared subgroups of FES versus SS (regardless of uni- or bilateral training) and uni- versus bimanual training (regardless of stimulation type). Outcomes were assessed before and after the control and the intervention period. RESULTS Compared to control/delayed intervention, the intervention group had greater changes in unimanual function and corticomotor area, regardless of whether practice was combined with FES or with SS. Irrespective of stimulation type, the bimanual subgroups improved to a greater extent than the unimanual subgroups on the bimanual hand function test. CONCLUSIONS Hand training combined with either SS or FES was associated with improved hand use and corticomotor activity in persons with chronic tetraplegia. Both interventions appear to be equally effective.
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Affiliation(s)
- Larisa Hoffman
- School of Physical Therapy, Regis University , Denver, Colorado
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Au-Yeung SSY, Hui-Chan CWY. Electrical acupoint stimulation of the affected arm in acute stroke: a placebo-controlled randomized clinical trial. Clin Rehabil 2013; 28:149-58. [PMID: 23904206 DOI: 10.1177/0269215513494875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine whether adding electrical stimulation of upper limb acupoints to conventional rehabilitation during acute stroke could produce greater and longer lasting motor improvements of the arm. DESIGN Double-blind, randomized, placebo-controlled trial. SETTING Acute stroke wards, followed by rehabilitation hospitals and subjects' residences. PARTICIPANTS Seventy-three patients ≤ 46 hours post stroke onset with moderate to severe weakness in the arm contralateral to the side of stroke. INTERVENTION All subjects received conventional rehabilitation. Twenty-nine received additional electrical stimulation, 21 received additional placebo-electrical stimulation and 23 received conventional rehabilitation only, as control. Electrical stimulation or placebo-electrical stimulation was applied to acupoints GB20, LI15, LI11, LI10 and LI4, 60 minutes a day, five days a week, for four weeks. MEASUREMENTS Primary outcome measures were hand grip and pinch strength, with Action Research Arm Test (ARAT) as secondary outcome measure. These were assessed on the affected arm at recruitment, then 4 (W4), 12 (W12) and 24 weeks (W24) afterwards. RESULTS Post-hoc analysis showed that the electrical stimulation group had greater improvements than the control group in hand grip (P = 0.015) and pinch strength (P = 0.007) at W4, with the gains maintained at W12 and W24. In contrast, the placebo-electrical stimulation group did not differ from either the control or the electrical stimulation group. Between-group improvements in ARAT scores from baseline to W24 (by 16.8 in control, 27.6 in placebo-electrical stimulation group and 26.3 in electrical stimulation group) were not significant. CONCLUSIONS Adding four weeks of electrical stimulation during acute stroke appears to produce greater and longer lasting hand grip and pinch strength improvements than administering conventional rehabilitation alone.
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Affiliation(s)
- Stephanie S Y Au-Yeung
- 1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Long-term TENS treatment decreases cortical motor representation in multiple sclerosis. Neuroscience 2013; 250:1-7. [PMID: 23831423 DOI: 10.1016/j.neuroscience.2013.06.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/02/2013] [Accepted: 06/20/2013] [Indexed: 11/21/2022]
Abstract
This study investigated the effects of a long-term transcutaneous electrical nerve stimulation (TENS) treatment on cortical motor representation in patients with multiple sclerosis (MS). In this double-blind crossover design, patients received either TENS or sham stimulation for 3 weeks (1h per day) on the median nerve region of the most impaired hand, followed by the other stimulation condition after a washout period of 6 months. Cortical motor representation was mapped using transcranial magnetic stimulation (TMS) at the baseline and after the 3-week stimulation protocol. Our results revealed that 3 weeks of daily stimulation with TENS significantly decreased the cortical motor representation of the stimulated muscle in MS patients. Although the mechanisms underlying this decrease remain unclear, our findings indicate that TENS has the ability to induce long-term reorganization in the motor cortex of MS patients.
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Manipulation of and sustained effects on the human brain induced by different modalities of acupuncture: an fMRI study. PLoS One 2013; 8:e66815. [PMID: 23840533 PMCID: PMC3696086 DOI: 10.1371/journal.pone.0066815] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 05/09/2013] [Indexed: 11/21/2022] Open
Abstract
The javascript:void(0)manipulation and sustained effects of acupuncture have been investigated in multiple studies, but several findings are inconsistent with one another. One possible explanation for these discrepancies is that different modalities of acupuncture were utilized in these studies. In the present study, we investigated both the manipulation and sustained effects of acupuncture in different modalities, including manual acupuncture (MA), electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS). MA, EA, TEAS and sensory control stimulation were applied to 18 healthy subjects, and combined block-designed and resting-state fMRI scans were performed. In analyzing these data, the block-designed datasets were used to assess the manipulation effect by employing a modified general linear model. The data from the resting states, before and after stimulation, were used to explore the brain networks involved in the sustained effect. The results showed that the two 1-min stimulation periods produced similar activation patterns in the sensory control with positive activation in the sensorimotor areas and negative activation in the default mode areas. Although similar patterns could be detected in the first stimulation period in MA, EA and TEAS, no positive activation result was observed in the second stimulation period, and EA showed a more extensive deactivation compared to MA and TEAS. Additionally, all three of the modalities of acupuncture stimulation could increase the instinct brain network in rest. A more secure and spatially extended connectivity of the default mode network was observed following MA and EA, and TEAS specifically increased the functional connectivity in the sensorimotor network. The present study suggested that different brain mechanisms might be recruited in different acupuncture modalities. In addition, the findings from our work could provide methodological information for further research into the mechanism of acupuncture.
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Tyson SF, Sadeghi-Demneh E, Nester CJ. The effects of transcutaneous electrical nerve stimulation on strength, proprioception, balance and mobility in people with stroke: a randomized controlled cross-over trial. Clin Rehabil 2013; 27:785-91. [PMID: 23503739 DOI: 10.1177/0269215513478227] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the feasibility and potential efficacy of 'activeTENS' (that is transcutaneous electrical nerve stimulation (TENS) during everyday activities) by assessing the immediate effects on strength, proprioception, balance/falls risk and mobility after stroke. DESIGN A paired-sample randomized cross-over trial. SUBJECTS Twenty-nine mobile chronic stroke survivors with no pre-existing conditions limiting balance or mobility or contra-indications to TENS. SETTING University clinical research facility. INTERVENTION A single session of 'activeTENS' delivered via a 'sock electrode' (70-130 Hz, five second cycle) plus a session of control treatment (wearing the sock electrode with no stimulation), lasting approximately two hours in total. MAIN OUTCOMES Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dyanometer, balance and falls risk (Standing Forward Reach Test) and gait speed (10-m walk test). RESULTS All participants tolerated 'active TENS'. Most parameters improved during stimulation with activeTENS; balance (p = 0.009), gait speed (p = 0.002), plantarflexor strength (p = 0.008) and proprioception of plantarflexion (p = 0.029), except dorsiflexor strength (p = 0.194) and dorsiflexion proprioception (p = 0.078). CONCLUSIONS The results provide initial evidence of the potential of 'active TENS' to benefit physical function after stroke which warrants further phase II trials to develop the intervention. Concerns that stimulation could have a detrimental impact on balance and increase risk of falls were not supported.
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Affiliation(s)
- Sarah F Tyson
- Stroke and Vascular Research Centre, University of Manchester, Manchester, UK.
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Effect of repetitive afferent electrical stimulation of the lower limb on corticomotor excitability and implications for rehabilitation. J Clin Neurosci 2013; 20:435-9. [DOI: 10.1016/j.jocn.2012.02.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 02/08/2012] [Accepted: 02/14/2012] [Indexed: 11/24/2022]
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Suzuki M, Kirimoto H, Onishi H, Yamada S, Tamaki H, Maruyama A, Yamamoto JI. Reciprocal changes in input–output curves of motor evoked potentials while learning motor skills. Brain Res 2012; 1473:114-23. [DOI: 10.1016/j.brainres.2012.07.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 07/23/2012] [Indexed: 11/15/2022]
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Sullivan JE, Hurley D, Hedman LD. Afferent stimulation provided by glove electrode during task-specific arm exercise following stroke. Clin Rehabil 2012; 26:1010-20. [DOI: 10.1177/0269215512442915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Sensory amplitude electrical stimulation (SES) and repetitive task practice reduce impairments and arm dysfunction when delivered separately following stroke. Objective: To determine if home-based, task-specific arm exercise was more effective when administered concurrent with SES. Methods: Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment (FMA) score 28/66 (15–45) participated. Subjects were randomly assigned to an SES ( n = 20) or sham stimulation ( n = 18) group. Subjects engaged in task-based home exercise for 30 minutes, twice daily, for four weeks while wearing a glove electrode on the impaired hand. Experimental subjects received SES while control subjects received sham stimulation during exercise. Primary outcome measures: FMA and Arm Motor Ability Test (AMAT). Results: There were no significant between-group differences for outcome measures. There was a significant difference between the pre- and post-test scores in the SES group AMAT median time ( P = 0.003 95% confidence interval (CI): −14.304, −6.365; effect size: 0.84). Practice time was not associated with changes in outcomes. Subjects with more sensorimotor dysfunction had significantly greater improvements on AMAT median time ( P = 0.037). There was a significant relationship between baseline FMA score and FMA change score ( r = 0.402; P = 0.006). Conclusions: This study describes a unique SES delivery system via glove electrode that enabled delivery of SES during home-based arm task practice in stroke survivors. Task practice with concurrent SES did not demonstrate significantly better effects than task practice with sham stimulation, however there was a trend for greater improvement in one activity measure.
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Affiliation(s)
- Jane E Sullivan
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Donna Hurley
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lois D Hedman
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Uehara S, Nambu I, Tomatsu S, Lee J, Kakei S, Naito E. Improving human plateaued motor skill with somatic stimulation. PLoS One 2011; 6:e25670. [PMID: 21991331 PMCID: PMC3186792 DOI: 10.1371/journal.pone.0025670] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 09/09/2011] [Indexed: 11/19/2022] Open
Abstract
Procedural motor learning includes a period when no substantial gain in performance improvement is obtained even with repeated, daily practice. Prompted by the potential benefit of high-frequency transcutaneous electrical stimulation, we examined if the stimulation to the hand reduces redundant motor activity that likely exists in an acquired hand motor skill, so as to further upgrade stable motor performance. Healthy participants were trained until their motor performance of continuously rotating two balls in the palm of their right hand became stable. In the series of experiments, they repeated a trial performing this cyclic rotation as many times as possible in 15 s. In trials where we applied the stimulation to the relaxed thumb before they initiated the task, most reported that their movements became smoother and they could perform the movements at a higher cycle compared to the control trials. This was not possible when the dorsal side of the wrist was stimulated. The performance improvement was associated with reduction of amplitude of finger displacement, which was consistently observed irrespective of the task demands. Importantly, this kinematic change occurred without being noticed by the participants, and their intentional changes of motor strategies (reducing amplitude of finger displacement) never improved the performance. Moreover, the performance never spontaneously improved during one-week training without stimulation, whereas the improvement in association with stimulation was consistently observed across days during training on another week combined with the stimulation. The improved effect obtained in stimulation trials on one day partially carried over to the next day, thereby promoting daily improvement of plateaued performance, which could not be unlocked by the first-week intensive training. This study demonstrated the possibility of effectively improving a plateaued motor skill, and pre-movement somatic stimulation driving this behavioral change.
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Affiliation(s)
- Shintaro Uehara
- Brain ICT Laboratory, National Institute of Information and Communications Technology, Kyoto, Japan
- Graduate School of Human and Environmental Studies, Kyoto University, Kyoto, Japan
- The Japan Society for the Promotion of Science, Tokyo, Japan
| | - Isao Nambu
- Brain ICT Laboratory, National Institute of Information and Communications Technology, Kyoto, Japan
- Center for Information and Neural Networks, Osaka, Japan
| | - Saeka Tomatsu
- Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Jongho Lee
- Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shinji Kakei
- Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Eiichi Naito
- Brain ICT Laboratory, National Institute of Information and Communications Technology, Kyoto, Japan
- Center for Information and Neural Networks, Osaka, Japan
- Graduate School of Medicine, Osaka University, Osaka, Japan
- * E-mail:
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Laufer Y, Elboim-Gabyzon M. Does sensory transcutaneous electrical stimulation enhance motor recovery following a stroke? A systematic review. Neurorehabil Neural Repair 2011; 25:799-809. [PMID: 21746874 DOI: 10.1177/1545968310397205] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Somatosensory input may lead to long-lasting cortical plasticity enhanced by motor recovery in patients with neurological impairments. Sensory transcutaneous electrical stimulation (TENS) is a relatively risk-free and easy-to-implement modality for rehabilitation. OBJECTIVE The authors systematically examine the effects of sensory TENS on motor recovery after stroke. METHODS Eligible randomized or quasi-randomized trials were identified via searches of computerized databases. Two assessors reviewed independently the eligibility and methodological quality of the retrieved articles. RESULTS In all, 15 articles satisfied the inclusion criteria. Methodological quality was generally good, with a mean (standard deviation) PEDro score of 6.7/10 (1.2). Although the majority of studies reported significant effects on at least 1 outcome measure, effect sizes were generally small. Meta-analysis could not be performed for the majority of outcome measures because of variability between studies and insufficient data. A moderate effect was determined for force production of the ankle dorsiflexors and for the Timed Up and Go test. CONCLUSIONS Sensory stimulation via TENS may be beneficial to enhance aspects of motor recovery following a stroke, particularly when used in combination with active training. Because of the great variability between studies, particularly in terms of the timing of the intervention after the stroke, the outcome measures used, and the stimulation protocols, insufficient data are available to provide guidelines about strategies and efficacy.
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Affiliation(s)
- Yocheved Laufer
- Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel.
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Schmidt MW, Hinder MR, Summers JJ, Garry MI. Long-lasting contralateral motor cortex excitability is increased by unilateral hand movement that triggers electrical stimulation of opposite homologous muscles. Neurorehabil Neural Repair 2011; 25:521-30. [PMID: 21436392 DOI: 10.1177/1545968310397202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/OBJECTIVE Long-term changes in the motor cortex can be induced by practicing motor tasks with simultaneous application of peripheral nerve stimulation. This combination may augment motor rehabilitation after stroke but has been used primarily during contraction of the affected hand. The authors tested the effect of a right hand movement that electrically stimulated left hand contraction on right motor cortex excitability. METHODS Three tasks were used in 15 healthy subjects--a motor and stimulation task (MS(task)), stimulation only task (S(task)), and motor only task (M(task)). The MS(task) consisted of isometric thumb abduction of the right hand that triggered paired electrical stimulation of the left abductor pollicis brevis (APB) and first dorsal interosseus (FDI) motor points. The S(task) was performed 1 week later and matched the stimulation received in the MS(task). The M(task) was performed as a control. Transcranial magnetic stimulation applied to the right motor cortex assessed corticospinal excitability, short latency intracortical inhibition, and intracortical facilitation of the FDI and APB before, immediately after, and 30 minutes after task performance. RESULTS Corticospinal excitability increased in the FDI and APB following the MS(task) but not following the S(task) or M(task). The increased excitability present 30 minutes after the MS(task) also correlated with excitability measures recorded 1 week later. CONCLUSION A bilateral motor and electrical stimulation task can drive persistent adaptation within the corticospinal system. Hemiplegic subjects who have poor voluntary movement of the affected hand may be able to contract the unaffected hand to activate and train homologous movements.
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Affiliation(s)
- Matthew W Schmidt
- Motor Control Laboratory, School of Psychology, University of Tasmania, Hobart, Tasmania, Australia.
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