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Fatehi V, Salahzadeh Z, Mohammadzadeh Z. Mapping and analyzing the application of digital health for stroke rehabilitation: scientometric analysis. Disabil Rehabil Assist Technol 2024:1-10. [PMID: 39140131 DOI: 10.1080/17483107.2024.2387101] [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: 01/29/2024] [Revised: 06/11/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION A modern and accessible healthcare system requires digital innovation and connectivity. The term "Digital health" covers vide range technologies, such as mobile health and applications, electronic records, telehealth and telemedicine, wearable devices, robotics, virtual reality and artificial intelligence. METHODS Scientometrics is the method that we have done in this study by Cite Space and VOSviewer software, and the result of searching the Web of Science database in plain text format to perform analysis and scientometrics and create outputs in the form of graphs and tables in the field of digital health has been used in stroke rehabilitation. RESULT A total of 2933 documents related to digital health technologies in stroke rehabilitation were identified by searching for the terms "stroke rehabilitation" or "stroke recovery" in the title and "digital health" across all fields. The strongest citations related to cerebrovascular disease spanned from 1994 to 2007, with randomised clinical trials occurring almost simultaneously and ended by 2012. Consequently, stroke rehabilitation by virtual reality technology has obtained the most citations and clinical trials and as an important part of digital health in the future research process. CONCLUSION This scientometric study offers insights into how digital health technology can assist stroke patients in self-managing their health and well-being, in addition to supporting integrated stroke rehabilitation. The analysis revealed that three themes were present: author contributors and collaboration networks, temporal evolution, the strongest citation explosions for digital health technologies in stroke rehabilitation research, and semantic analysis.
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Affiliation(s)
- Vahid Fatehi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Salahzadeh
- Department of Physiotherapy, School of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Mohammadzadeh
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Chang JY, Chun MH, Lee A, Lee A, Lee CM. Effects of training with a rehabilitation device (Rebless®) on upper limb function in patients with chronic stroke: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e38753. [PMID: 38941364 DOI: 10.1097/md.0000000000038753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Upper limb dysfunction is one of the most common sequelae of stroke and robotic therapy is considered one of the promising methods for upper limb rehabilitation. OBJECTIVE This study aimed to explore the clinical effectiveness of upper limb training using a rehabilitation robotic device (Rebless®) for patients with stroke. METHODS In this prospective, unblinded, randomized controlled trial, patients were randomly assigned to receive robotic training (experimental group, n = 15) or conventional therapy (control group, n = 15). Both groups received upper limb training lasting for 30 minutes per session with a total of 10 training sessions within 4 weeks. Motor function, functional evaluation, and spasticity were clinically assessed before and after the training. Cortical activation was measured using functional near-infrared spectroscopy at the 1st and 10th training sessions. RESULTS The experimental group demonstrated a significant improvement in the Fugl-Meyer assessment-upper extremity score and the modified Ashworth scale grade in elbow flexors. The cortical activity of the unaffected hemisphere significantly decreased after 10 training sessions in the experimental group compared with the control group. CONCLUSIONS The experimental group showed significant improvement in the Fugl-Meyer assessment-upper extremity score and spasticity of elbow flexors and had significantly decreased cortical activity of the unaffected hemisphere. Training with Rebless® may help patients with chronic stroke in restoring upper limb function and recovering the contralateral predominance of activation in motor function.
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Affiliation(s)
- Jong Yoon Chang
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Anna Lee
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ahro Lee
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Min Lee
- Research Institute of Future City and Society, Yonsei University, Seoul, Republic of Korea
- PlayIdeaLab Incorporation, Seoul, Republic of Korea
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Brannigan JFM, Fry A, Opie NL, Campbell BCV, Mitchell PJ, Oxley TJ. Endovascular Brain-Computer Interfaces in Poststroke Paralysis. Stroke 2024; 55:474-483. [PMID: 38018832 DOI: 10.1161/strokeaha.123.037719] [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] [Indexed: 11/30/2023]
Abstract
Stroke is a leading cause of paralysis, most frequently affecting the upper limbs and vocal folds. Despite recent advances in care, stroke recovery invariably reaches a plateau, after which there are permanent neurological impairments. Implantable brain-computer interface devices offer the potential to bypass permanent neurological lesions. They function by (1) recording neural activity, (2) decoding the neural signal occurring in response to volitional motor intentions, and (3) generating digital control signals that may be used to control external devices. While brain-computer interface technology has the potential to revolutionize neurological care, clinical translation has been limited. Endovascular arrays present a novel form of minimally invasive brain-computer interface devices that have been deployed in human subjects during early feasibility studies. This article provides an overview of endovascular brain-computer interface devices and critically evaluates the patient with stroke as an implant candidate. Future opportunities are mapped, along with the challenges arising when decoding neural activity following infarction. Limitations arise when considering intracerebral hemorrhage and motor cortex lesions; however, future directions are outlined that aim to address these challenges.
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Affiliation(s)
- Jamie F M Brannigan
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (J.F.M.B.)
| | - Adam Fry
- Synchron, Inc, New York, NY (A.F., N.L.O., T.J.O.)
| | - Nicholas L Opie
- Synchron, Inc, New York, NY (A.F., N.L.O., T.J.O.)
- Vascular Bionics Laboratory, Department of Medicine, The University of Melbourne, Victoria, Australia (N.L.O., T.J.O.)
| | - Bruce C V Campbell
- Department of Neurology (B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
- Melbourne Brain Centre (B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | - Peter J Mitchell
- Department of Radiology (P.J.M.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | - Thomas J Oxley
- Synchron, Inc, New York, NY (A.F., N.L.O., T.J.O.)
- Vascular Bionics Laboratory, Department of Medicine, The University of Melbourne, Victoria, Australia (N.L.O., T.J.O.)
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Stanis N, Khateeb K, Zhou J, Wang RK, Yazdan-Shahmorad A. Protocol to study ischemic stroke by photothrombotic lesioning in the cortex of non-human primates. STAR Protoc 2023; 4:102496. [PMID: 37573501 PMCID: PMC10448414 DOI: 10.1016/j.xpro.2023.102496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Neurorehabilitation strategies for ischemic stroke have shown promise for functional recovery, yet minimal tools are available to study rehabilitation techniques in non-human primates (NHPs). Here, we present a protocol to study rehabilitation techniques in NHPs using a photothrombotic technique, a form of optical focal lesioning. We also describe steps for simultaneous neurophysiological recording and in vivo validation through vascular flow imaging. This interface can examine emerging neurorehabilitation strategies in the post-stroke environment in NHPs that are evolutionarily close to humans. For complete details on the use and execution of this protocol, please refer to Khateeb et al. (2022).6.
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Affiliation(s)
- Noah Stanis
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA; Washington National Primate Research Center, Seattle, WA 98195, USA
| | - Karam Khateeb
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA; Washington National Primate Research Center, Seattle, WA 98195, USA
| | - Jasmine Zhou
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA; Washington National Primate Research Center, Seattle, WA 98195, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA; Department of Ophthalmology, University of Washington Medicine, Seattle, WA 98195, USA
| | - Azadeh Yazdan-Shahmorad
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA; Washington National Primate Research Center, Seattle, WA 98195, USA; Department of Electrical and Computer Engineering, University of Washington, Seattle, WA 98195, USA.
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5
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Singh N, Saini M, Kumar N, Padma Srivastava MV, Mehndiratta A. Individualized closed-loop TMS synchronized with exoskeleton for modulation of cortical-excitability in patients with stroke: a proof-of-concept study. Front Neurosci 2023; 17:1116273. [PMID: 37304037 PMCID: PMC10248009 DOI: 10.3389/fnins.2023.1116273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background Repetitive TMS is used in stroke rehabilitation with predefined passive low and high-frequency stimulation. Brain State-Dependent Stimulation (BSDS)/Activity-Dependent Stimulation (ADS) using bio-signal has been observed to strengthen synaptic connections. Without the personalization of brain-stimulation protocols, we risk a one-size-fits-all approach. Methods We attempted to close the ADS loop via intrinsic-proprioceptive (via exoskeleton-movement) and extrinsic-visual-feedback to the brain. We developed a patient-specific brain stimulation platform with a two-way feedback system, to synchronize single-pulse TMS with exoskeleton along with adaptive performance visual feedback, in real-time, for a focused neurorehabilitation strategy to voluntarily engage the patient in the brain stimulation process. Results The novel TMS Synchronized Exoskeleton Feedback (TSEF) platform, controlled by the patient's residual Electromyogram, simultaneously triggered exoskeleton movement and single-pulse TMS, once in 10 s, implying 0.1 Hz frequency. The TSEF platform was tested for a demonstration on three patients (n = 3) with different spasticity on the Modified Ashworth Scale (MAS = 1, 1+, 2) for one session each. Three patients completed their session in their own timing; patients with (more) spasticity tend to take (more) inter-trial intervals. A proof-of-concept study on two groups-TSEF-group and a physiotherapy control-group was performed for 45 min/day for 20-sessions. Dose-matched Physiotherapy was given to control-group. Post 20 sessions, an increase in ipsilesional cortical-excitability was observed; Motor Evoked Potential increased by ~48.5 μV at a decreased Resting Motor Threshold by ~15.6%, with improvement in clinical scales relevant to the Fugl-Mayer Wrist/Hand joint (involved in training) by 2.6 units, an effect not found in control-group. This strategy could voluntarily engage the patient. Conclusion A brain stimulation platform with a real-time two-way feedback system was developed to voluntarily engage the patients during the brain stimulation process and a proof-of-concept study on three patients indicates clinical gains with increased cortical excitability, an effect not observed in the control-group; and the encouraging results nudge for further investigations on a larger cohort.
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Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology, New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology, New Delhi, India
- Department of Biomedical Engineering, AIIMS, New Delhi, India
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Yüksel MM, Sun S, Latchoumane C, Bloch J, Courtine G, Raffin EE, Hummel FC. Low-Intensity Focused Ultrasound Neuromodulation for Stroke Recovery: A Novel Deep Brain Stimulation Approach for Neurorehabilitation? IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:300-318. [PMID: 38196977 PMCID: PMC10776095 DOI: 10.1109/ojemb.2023.3263690] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 01/11/2024] Open
Abstract
Stroke as the leading cause of adult long-term disability and has a significant impact on patients, society and socio-economics. Non-invasive brain stimulation (NIBS) approaches such as transcranial magnetic stimulation (TMS) or transcranial electrical stimulation (tES) are considered as potential therapeutic options to enhance functional reorganization and augment the effects of neurorehabilitation. However, non-invasive electrical and magnetic stimulation paradigms are limited by their depth focality trade-off function that does not allow to target deep key brain structures critically important for recovery processes. Transcranial ultrasound stimulation (TUS) is an emerging approach for non-invasive deep brain neuromodulation. Using non-ionizing, ultrasonic waves with millimeter-accuracy spatial resolution, excellent steering capacity and long penetration depth, TUS has the potential to serve as a novel non-invasive deep brain stimulation method to establish unprecedented neuromodulation and novel neurorehabilitation protocols. The purpose of the present review is to provide an overview on the current knowledge about the neuromodulatory effects of TUS while discussing the potential of TUS in the field of stroke recovery, with respect to existing NIBS methods. We will address and discuss critically crucial open questions and remaining challenges that need to be addressed before establishing TUS as a new clinical neurorehabilitation approach for motor stroke recovery.
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Affiliation(s)
- Mahmut Martin Yüksel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1201Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
| | - Shiqi Sun
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1011Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1011Switzerland
| | - Charles Latchoumane
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1011Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1011Switzerland
| | - Jocelyne Bloch
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1015Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1015Switzerland
- Department of NeurosurgeryLausanne University HospitalLausanne1011Switzerland
| | - Gregoire Courtine
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1015Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1015Switzerland
- Department of NeurosurgeryLausanne University HospitalLausanne1011Switzerland
| | - Estelle Emeline Raffin
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1201Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
| | - Friedhelm Christoph Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1202Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
- Clinical NeuroscienceUniversity of Geneva Medical SchoolGeneva1211Switzerland
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Ahnood A, Chambers A, Gelmi A, Yong KT, Kavehei O. Semiconducting electrodes for neural interfacing: a review. Chem Soc Rev 2023; 52:1491-1518. [PMID: 36734845 DOI: 10.1039/d2cs00830k] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the past 50 years, the advent of electronic technology to directly interface with neural tissue has transformed the fields of medicine and biology. Devices that restore or even replace impaired bodily functions, such as deep brain stimulators and cochlear implants, have ushered in a new treatment era for previously intractable conditions. Meanwhile, electrodes for recording and stimulating neural activity have allowed researchers to unravel the vast complexities of the human nervous system. Recent advances in semiconducting materials have allowed effective interfaces between electrodes and neuronal tissue through novel devices and structures. Often these are unattainable using conventional metallic electrodes. These have translated into advances in research and treatment. The development of semiconducting materials opens new avenues in neural interfacing. This review considers this emerging class of electrodes and how it can facilitate electrical, optical, and chemical sensing and modulation with high spatial and temporal precision. Semiconducting electrodes have advanced electrically based neural interfacing technologies owing to their unique electrochemical and photo-electrochemical attributes. Key operation modalities, namely sensing and stimulation in electrical, biochemical, and optical domains, are discussed, highlighting their contrast to metallic electrodes from the application and characterization perspective.
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Affiliation(s)
- Arman Ahnood
- School of Engineering, RMIT University, VIC 3000, Australia
| | - Andre Chambers
- School of Physics, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Amy Gelmi
- School of Science, RMIT University, VIC 3000, Australia
| | - Ken-Tye Yong
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia.,The University of Sydney Nano Institute, Sydney, NSW 2006, Australia.
| | - Omid Kavehei
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia.,The University of Sydney Nano Institute, Sydney, NSW 2006, Australia.
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Sato Y, Schmitt O, Ip Z, Rabiller G, Omodaka S, Tominaga T, Yazdan-Shahmorad A, Liu J. Pathological changes of brain oscillations following ischemic stroke. J Cereb Blood Flow Metab 2022; 42:1753-1776. [PMID: 35754347 PMCID: PMC9536122 DOI: 10.1177/0271678x221105677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/01/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022]
Abstract
Brain oscillations recorded in the extracellular space are among the most important aspects of neurophysiology data reflecting the activity and function of neurons in a population or a network. The signal strength and patterns of brain oscillations can be powerful biomarkers used for disease detection and prediction of the recovery of function. Electrophysiological signals can also serve as an index for many cutting-edge technologies aiming to interface between the nervous system and neuroprosthetic devices and to monitor the efficacy of boosting neural activity. In this review, we provided an overview of the basic knowledge regarding local field potential, electro- or magneto- encephalography signals, and their biological relevance, followed by a summary of the findings reported in various clinical and experimental stroke studies. We reviewed evidence of stroke-induced changes in hippocampal oscillations and disruption of communication between brain networks as potential mechanisms underlying post-stroke cognitive dysfunction. We also discussed the promise of brain stimulation in promoting post stroke functional recovery via restoring neural activity and enhancing brain plasticity.
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Affiliation(s)
- Yoshimichi Sato
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- Department of Neurological Surgery, SFVAMC, San Francisco, CA, USA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Oliver Schmitt
- Department of Anatomy, Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Zachary Ip
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA
| | - Gratianne Rabiller
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- Department of Neurological Surgery, SFVAMC, San Francisco, CA, USA
| | - Shunsuke Omodaka
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- Department of Neurological Surgery, SFVAMC, San Francisco, CA, USA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Azadeh Yazdan-Shahmorad
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA
| | - Jialing Liu
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- Department of Neurological Surgery, SFVAMC, San Francisco, CA, USA
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Hermann JK, Borseth A, Pucci FG, Toth C, Hogue O, Chan HH, Machado AG, Baker KB. Changes in somatosensory evoked potentials elicited by lateral cerebellar nucleus deep brain stimulation in the naïve rodent. Neurosci Lett 2022; 786:136800. [PMID: 35842210 DOI: 10.1016/j.neulet.2022.136800] [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: 01/13/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
Deep brain stimulation (DBS) of the deep cerebellar nuclei has been shown to enhance perilesional cortical excitability and promote motor rehabilitation in preclinical models of cortical ischemia and is currently being evaluated in patients with chronic, post-stroke deficits. Understanding the effects of cerebellar DBS on contralateral sensorimotor cortex may be key to developing approaches to optimize stimulation delivery and treatment outcomes. Using the naïve rat model, we characterized the effects of DBS of the lateral cerebellar nucleus (LCN) on somatosensory evoked potentials (SSEPs) and evaluated their potential use as a surrogate index of cortical excitability. SSEPs were recorded concurrently with continuous 30 Hz or 100 Hz LCN DBS and compared to the DBS OFF condition. Ratios of SSEP peak to peak amplitude during 100 Hz LCN DBS to DBS OFF at longer latency peaks were significantly>1, suggesting that cortical excitability was enhanced as a result of LCN DBS. Although changes in SSEP peak to peak amplitudes were observed, they were modest in relation to previously reported effects on motor cortical excitability. Overall, our findings suggest that LCN output influences thalamocortical somatosensory pathways, however further work is need to better understand the potential role of SSEPs in optimizing therapy.
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Affiliation(s)
- John K Hermann
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Ashley Borseth
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Francesco G Pucci
- Center for Neurologic Restoration, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Carmen Toth
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Hugh H Chan
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Andre G Machado
- Center for Neurologic Restoration, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States
| | - Kenneth B Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States.
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Cho J, Ryu S, Lee S, Kim J, Park JY, Kwon HS, Kim HI. Clozapine-Induced Chemogenetic Neuromodulation Rescues Post-Stroke Deficits After Chronic Capsular Infarct. Transl Stroke Res 2022:10.1007/s12975-022-01059-8. [PMID: 35809218 DOI: 10.1007/s12975-022-01059-8] [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: 04/26/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022]
Abstract
Long-term disabilities induced by stroke impose a heavy burden on patients, families, caregivers, and public health systems. Extensive studies have demonstrated the therapeutic value of neuromodulation in enhancing post-stroke recovery. Among them, chemogenetic neuromodulation activated by clozapine-N-oxide (CNO) has been proposed as the potential tool of neuromodulation. However, recent evidence showed that CNO does not cross the blood - brain barrier and may in fact have low binding affinity for chemogenetic tool. Thus, clozapine (CLZ) has been suggested for use in chemogenetic neuromodulation, in place of CNO, because it readily crosses the blood-brain barrier. Previously we reported that low doses of CLZ (0.1 mg/kg) successfully induced neural responses without off-target effects. Here, we show that low-dose clozapine (0.1 mg/kg) can induce prolonged chemogenetic activation while avoiding permeability issues and minimizing off-target effects. In addition, clozapine-induced excitatory chemogenetic neuromodulation (CLZ-ChemoNM) of sensory-parietal cortex with hsyn-hM3Dq-YFP-enhanced motor recovery in a chronic capsular infarct model of stroke in rats, improving post-stroke behavioral scores to 56% of pre-infarct levels. Longitudinal 2-deoxy-2-[18F]-fluoro-D-glucose microPET (FDG-microPET) scans showed that a reduction in diaschisis volume and activation of corticostriatal circuits were both correlated with post-stroke recovery. We also found c-Fos increases in bilateral cortices and BDNF increases in the cortices and striatum after CLZ-ChemoNM, indicating an increase in neural plasticity. These findings suggest the translational feasibility of CLZ-ChemoNM for augmenting recovery in chronic stroke.
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Affiliation(s)
- Jongwook Cho
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea
| | - Seungjun Ryu
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea
| | - Sunwoo Lee
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea
| | - Junsoo Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea
| | - Ji-Young Park
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea
| | - Hyuk-Sang Kwon
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea.
| | - Hyoung-Ihl Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea.
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Bloch J, Greaves-Tunnell A, Shea-Brown E, Harchaoui Z, Shojaie A, Yazdan-Shahmorad A. Network structure mediates functional reorganization induced by optogenetic stimulation of non-human primate sensorimotor cortex. iScience 2022; 25:104285. [PMID: 35573193 PMCID: PMC9095749 DOI: 10.1016/j.isci.2022.104285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/22/2022] [Accepted: 04/19/2022] [Indexed: 11/04/2022] Open
Abstract
Because aberrant network-level functional connectivity underlies a variety of neural disorders, the ability to induce targeted functional reorganization would be a profound development toward therapies for neural disorders. Brain stimulation has been shown to induce large-scale network-wide functional connectivity changes (FCC), but the mapping from stimulation to the induced changes is unclear. Here, we develop a model which jointly considers the stimulation protocol and the cortical network structure to accurately predict network-wide FCC in response to optogenetic stimulation of non-human primate primary sensorimotor cortex. We observe that the network structure has a much stronger effect than the stimulation protocol on the resulting FCC. We also observe that the mappings from these input features to the FCC diverge over frequency bands and successive stimulations. Our framework represents a paradigm shift for targeted neural stimulation and can be used to interrogate, improve, and develop stimulation-based interventions for neural disorders.
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Affiliation(s)
- Julien Bloch
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- Center for Neurotechnology, University of Washington, Seattle, WA 98105, USA
- Computational Neuroscience Center, University of Washington, Seattle, WA 98105, USA
- Washington National Primate Research Center, University of Washington, Seattle, WA 98105, USA
| | | | - Eric Shea-Brown
- Department of Applied Mathematics, University of Washington, Seattle, WA 98105, USA
- Center for Neurotechnology, University of Washington, Seattle, WA 98105, USA
- Computational Neuroscience Center, University of Washington, Seattle, WA 98105, USA
| | - Zaid Harchaoui
- Department of Statistics, University of Washington, Seattle, WA 98105, USA
| | - Ali Shojaie
- Department of Biostatistics, University of Washington, Seattle, WA 98105, USA
| | - Azadeh Yazdan-Shahmorad
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA 98105, USA
- Center for Neurotechnology, University of Washington, Seattle, WA 98105, USA
- Computational Neuroscience Center, University of Washington, Seattle, WA 98105, USA
- Washington National Primate Research Center, University of Washington, Seattle, WA 98105, USA
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León Ruiz M, Sospedra M, Arce Arce S, Tejeiro-Martínez J, Benito-León J. Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: a systematic review of the literature. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:199-215. [PMID: 35465914 DOI: 10.1016/j.nrleng.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/29/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.
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Affiliation(s)
- M León Ruiz
- Servicio de Neurología, Clínica San Vicente, Madrid, Spain; Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - M Sospedra
- Sección de Neuroinmunología y de Investigación en Esclerosis Múltiple, Departamento de Neurología, Hospital Universitario de Zúrich, Zurich, Switzerland
| | - S Arce Arce
- Servicio de Psiquiatría, Clínica San Vicente, Madrid, Spain; Departamento de Dirección Médica, Clínica San Vicente, Madrid, Spain
| | - J Tejeiro-Martínez
- Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - J Benito-León
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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13
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León Ruiz M, Sospedra M, Arce Arce S, Tejeiro-Martínez J, Benito-León J. Current evidence on the potential therapeutic applications of transcranial magnetic stimulation in multiple sclerosis: A systematic review of the literature. Neurologia 2022; 37:199-215. [PMID: 29898858 DOI: 10.1016/j.nrl.2018.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/03/2018] [Accepted: 03/29/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS). METHODS We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS. CONCLUSIONS Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.
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Affiliation(s)
- M León Ruiz
- Servicio de Neurología, Clínica San Vicente, Madrid, España; Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - M Sospedra
- Sección de Neuroinmunología y de Investigación en Esclerosis Múltiple, Departamento de Neurología, Hospital Universitario de Zúrich, Zúrich, Suiza
| | - S Arce Arce
- Servicio de Psiquiatría, Clínica San Vicente, Madrid, España; Departamento de Dirección Médica, Clínica San Vicente, Madrid, España
| | - J Tejeiro-Martínez
- Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - J Benito-León
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
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Pipatsrisawat S, Klaphajone J, Kitisak K, Sungkarat S, Wivatvongvana P. Effects of combining two techniques of non-invasive brain stimulation in subacute stroke patients: a pilot study. BMC Neurol 2022; 22:98. [PMID: 35300622 PMCID: PMC8928603 DOI: 10.1186/s12883-022-02607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Strokes have recently become a leading cause of disability among Thai people. Non-invasive brain stimulation (NIBS) seems to give promising results in stroke recovery when combined with standard rehabilitation programs. Objective To evaluate the combined effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and cathodal transcranial direct current stimulation (tDCS) over the non-lesional primary motor cortex on upper limb motor recovery in patients with subacute stroke. No reports of a combination of these two techniques of NIBS were found in the relevant literature. Methods This pilot study was a double-blinded, randomized controlled trial of ten patients with subacute stroke admitted to the Rehabilitation Medicine Inpatient Unit, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. They were randomized into two groups: five in an active and five in a sham intervention group. Fugl-Meyer’s upper extremity motor score (FMA-UE) and Wolf Motor Function Test (WMFT) were used to assess motor recovery at baseline, immediately, and 1 week after stimulation. Results A two-way repeated ANOVA (mixed design) showed a significant improvement in FMA-UE scores in the active intervention group both immediately and 1 week after stimulation in comparison to the baseline, [time, F (2, 16) = 27.44, p < 0.001, time x group interaction, F (2, 16) = 13.29, p < 0.001]. Despite no statistical significance, a trend toward higher WMFT scores was shown in the active intervention group. Conclusions A single session of low-frequency rTMS and cathodal tDCS over the non-lesional primary motor cortex may enhance upper limb motor recovery in patients with subacute stroke. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02607-3.
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Affiliation(s)
- Sutthikit Pipatsrisawat
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Jakkrit Klaphajone
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Kittipong Kitisak
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pakorn Wivatvongvana
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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15
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Xu R, Zhu GY, Zhu J, Wang Y, Xing XX, Chen LY, Li J, Shen FQ, Chen JB, Hua XY, Xu DS. Using Hebbian-Type Stimulation to Rescue Arm Function After Stroke: Study Protocol for a Randomized Clinical Trial. Front Neural Circuits 2022; 15:789095. [PMID: 35221930 PMCID: PMC8867068 DOI: 10.3389/fncir.2021.789095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Upper-extremity hemiplegia after stroke remains a significant clinical problem. The supplementary motor area (SMA) is vital to the motor recovery outcomes of chronic stroke patients. Therefore, rebuilding the descending motor tract from the SMA to the paralyzed limb is a potential approach to restoring arm motor function after stroke. Paired associative stimulation (PAS), which is based on Hebbian theory, is a potential method for reconstructing the connections in the impaired motor neural circuits. The study described in this protocol aims to assess the effects of cortico–peripheral Hebbian-type stimulation (HTS), involving PAS, for neural circuit reconstruction to rescue the paralyzed arm after stroke. Methods The study is a 4-month double-blind randomized sham-controlled clinical trial. We will recruit 90 post-stroke individuals with mild to moderate upper limb paralysis. Based on a 1:1 ratio, the participants will be randomly assigned to the HTS and sham groups. Each participant will undergo 5-week HTS or sham stimulation. Assessments will be conducted at baseline, immediately after the 5-week treatment, and at a 3-month follow-up. The primary outcome will be the Wolf Motor Function Test (WMFT). The secondary outcomes will be Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Functional Independence Measure (FIM), and functional near-infrared spectroscopy (fNIRS) parameters. The adverse events will be recorded throughout the study. Discussion Upper-limb paralysis in stroke patients is due to neural circuit disruption, so the reconstruction of effective motor circuits is a promising treatment approach. Based on its anatomical structure and function, the SMA is thought to compensate for motor dysfunction after focal brain injury at the cortical level. Our well-designed randomized controlled trial will allow us to analyze the clinical efficacy of this novel Hebbian theory-based neuromodulation strategy regarding promoting the connection between the cortex and peripheral limb. The results may have significance for the development and implementation of effective neurorehabilitation treatments. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [ChiCTR2000039949].
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Affiliation(s)
- Rong Xu
- Shanghai Zhaxin Traditional Chinese and Western Medicine Hospital, Shanghai, China
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Guang-Yue Zhu
- Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Jun Zhu
- Shanghai Zhaxin Traditional Chinese and Western Medicine Hospital, Shanghai, China
| | - Yong Wang
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Xiang-Xin Xing
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin-Yu Chen
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Jie Li
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Fu-Qiang Shen
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Jian-Bing Chen
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Xu-Yun Hua
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xu-Yun Hua,
| | - Dong-Sheng Xu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xu-Yun Hua,
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Design and Validation of Virtual Reality Task for Neuro-Rehabilitation of Distal Upper Extremities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031442. [PMID: 35162459 PMCID: PMC8835157 DOI: 10.3390/ijerph19031442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 02/05/2023]
Abstract
Stroke, affecting approximately 15 million people worldwide, has long been a global cause of death and disability. Virtual Reality (VR) has shown its potential as an assistive tool for post-stroke rehabilitation. The objective of this pilot study was to define the task-specific performance metrics of VR tasks to assess the performance level of healthy subjects and patients quantitatively and to obtain their feedback for improving the developed framework. A pilot prospective study was designed. We tested the designed VR tasks on forty healthy right-handed subjects to evaluate its potential. Qualitative trajectory plots and three quantitative performance metrics—time taken to complete the task, percentage relative error, and trajectory smoothness—were computed from the recorded data of forty healthy subjects. Two patients with stroke were also enrolled to compare their performance with healthy subjects. Each participant received one VR session of 90 min. No adverse effects were noticed throughout the study. Performance metrics obtained from healthy subjects were used as a reference for patients. Relatively higher values of task completion time and trajectory smoothness and lower values of relative % error was observed for the affected hands w.r.t the unaffected hands of both the patients. For the unaffected hands of both the patients, the performance levels were found objectively closer to that of healthy subjects. A library of VR tasks for wrist and fingers were designed, and task-specific performance metrics were defined in this study. The evaluation of the VR exercises using these performance metrics will help the clinicians to assess the patient’s progress quantitatively and to design the rehabilitation framework for a future clinical study.
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Singh N, Saini M, Kumar N, Srivastava MVP, Kumaran SS, Mehndiratta A. A Case Report: Effect of Robotic Exoskeleton Based Therapy on Neurological and Functional Recovery of a Patient With Chronic Stroke. Front Neurol 2021; 12:680733. [PMID: 34322080 PMCID: PMC8313089 DOI: 10.3389/fneur.2021.680733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In this study, a novel electromechanical robotic exoskeleton was developed for the rehabilitation of distal joints. The objective was to explore the functional MRI and the neurophysiological changes in cortical-excitability in response to exoskeleton training for a 9-year chronic stroke patient. Case-Report: The study involved a 52-year old female patient with a 9-year chronic stroke of the right hemisphere, who underwent 20 therapy sessions of 45 min each. Cortical-excitability and clinical-scales: Fugl-Mayer (FM), Modified Ashworth Scale (MAS), Brunnstrom-Stage (BS), Barthel-Index (BI), Range of Motion (ROM), were assessed pre-and post-therapy to quantitatively assess the motor recovery. Clinical Rehabilitation Impact: Increase in FM wrist/hand by 6, BI by 10, and decrease in MAS by 1 were reported. Ipsilesional Motor Evoked Potential (MEP) (obtained using Transcranial Magnetic Stimulation) was increased by 98 μV with a decrease in RMT by 6% and contralesional MEP was increased by 43 μV with a decrease in RMT by 4%. Laterality Index of Sensorimotor Cortex (SMC) reduced in precentral- gyrus (from 0.152 to -0.707) and in postcentral-gyrus (from 0.203 to -0.632). Conclusion: The novel exoskeleton-based training showed improved motor outcomes, cortical excitability, and neuronal activation. The research encourages the further investigation of the potential of exoskeleton training.
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Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M. V. Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S. Senthil Kumaran
- Department of Nuclear Medicine and Resonance, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Yang Y, Pan H, Pan W, Liu Y, Song X, Niu CM, Feng W, Wang J, Xie Q. Repetitive Transcranial Magnetic Stimulation on the Affected Hemisphere Enhances Hand Functional Recovery in Subacute Adult Stroke Patients: A Randomized Trial. Front Aging Neurosci 2021; 13:636184. [PMID: 34093164 PMCID: PMC8171119 DOI: 10.3389/fnagi.2021.636184] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Either motor training or repetitive transcranial magnetic stimulation (rTMS) could modulate the neural plasticity after stroke. Therefore, synchronizing the two interventions may optimize the efficiency of recovery. In the present study, we aim to investigate the effect of rTMS along with hand grip training on the neurobehavioral and hand functional recovery in one cohort of subacute stroke patients. Methods: Thirty-nine stroke patients were enrolled in a single-center, single-blinded, randomized clinical trial. We tested different intervention effects of rTMS and hand grip training (group A), rTMS alone (group B), and hand grip training alone (group C). For the rTMS-treated groups, patients received 10 consecutive sessions of 5-Hz stimulation over the affected hemisphere with 750 pulses. Jebsen-Taylor Hand Function Test (JTHFT), Fugl-Meyer assessment of upper extremity (FMA-UE), grip strength, modified Barthel index (mBI), and ipsilesional motor evoked potential (iMEP) latency were assessed and compared across the groups. Results: We found that only rTMS along with hand grip training group all improved in JTHFT, FMA-UE, grip strength, and mBI (p ≤ 0.01) compared with the baseline among the three groups. Furthermore, this study demonstrated that rTMS plus hand grip training had much better results in improvement of neurobehavioral outcomes compared to the rTMS alone- and hand grip training alone-treated patients (p < 0.05). However, no significant differences were detected in neurophysiologic outcome between intra-groups and inter-groups (p > 0.05). Conclusion: These proof-of-concept results suggested that rTMS alone with hand grip training was a unique approach to promote hand functional recovery in stroke patients. It provided important information to design a large-scale multi-center clinical trial to further demonstrate the efficiency of the combination of central and peripheral stimulation. Clinical Trial Registration: http://www.chictr.org.cn (#ChiCTR1900023443).
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Affiliation(s)
- Yawen Yang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijuan Pan
- Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Wenxiu Pan
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Liu
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohui Song
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanxin M Niu
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Jixian Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
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19
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Singh N, Saini M, Kumar N, Srivastava MVP, Mehndiratta A. Evidence of neuroplasticity with robotic hand exoskeleton for post-stroke rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:76. [PMID: 33957937 PMCID: PMC8101163 DOI: 10.1186/s12984-021-00867-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/20/2021] [Indexed: 01/09/2023] Open
Abstract
Background A novel electromechanical robotic-exoskeleton was designed in-house for the rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training sessions with dose-matched conventional therapy in patients with stroke. Methods A pilot prospective parallel randomized controlled study at clinical settings was designed for patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45 min each, five days a week for four weeks, in Robotic-therapy Group (RG) (n = 12) and conventional upper-limb rehabilitation in Control-Group (CG) (n = 11). We intended to evaluate the effects of a novel exoskeleton based therapy on the functional rehabilitation outcomes of upper-limb and cortical-excitability in patients with stroke as compared to the conventional-rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunnstrom-stage and Fugl-Meyer (FM) scale and neurophysiological measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor threshold, were acquired pre- and post-therapy. Results No side effects were noticed in any of the patients. Both RG and CG showed significant (p < 0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p < 0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer scale and FM Wrist-/Hand component. An increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p < 0.05) in RG over CG, as indexed by a decrease in Resting Motor Threshold and increase in the amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p < 0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion Robotic-exoskeleton training showed improvement in motor outcomes and cortical-excitability in patients with stroke. Neurophysiological changes in RG could most likely be a consequence of plastic reorganization and use-dependent plasticity. Trial registry number: ISRCTN95291802 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00867-7.
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Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All Indian Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India. .,Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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20
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Tanioka R, Betriana F, Locsin RC. Treatise on the influence of theism, transhumanism, and posthumanism on nursing and rehabilitation healthcare practice. Nurs Philos 2021; 22:e12350. [PMID: 33735494 DOI: 10.1111/nup.12350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 12/31/2022]
Abstract
Reservations concerning the ontologies of theism, transhumanism and posthumanism compel an explicatory discourse on their influences on Nursing and rehabilitation healthcare. Key journals in Nursing and health sciences have recently devoted themed issues on intelligent machine technologies such as humanoid healthcare robots and other highly technological healthcare devices and practice initiatives. While the technological advance witnessed has been a cause for celebration, questions still remain that are focused on the epistemological concerns. The purpose of this article is to discuss theistic ontologies such as the Judeo-Christian, Shinto-Buddhist and Islamic religious belief systems on transhumanism and posthumanism in the assimilation of symbiotic technological beings in Nursing and rehabilitation healthcare practice. In view of the approaching technological singularity dominating arguments regarding the future of human beings, a treatise on Nursing and rehabilitation health care is positioned well within the realms of human care. Theism, transhumanism and posthumanism are directing discussions regarding human beings and healthcare processes. It is imperative that the beneficial effects of these discussions be acknowledged within the highly technological world of Nursing and rehabilitative healthcare.
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Affiliation(s)
- Ryuichi Tanioka
- Graduate School of Health Sciences, Tokushima University, Tokushima, Japan
| | - Feni Betriana
- Graduate School of Health Sciences, Tokushima University, Tokushima, Japan
| | - Rozzano C Locsin
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Florida Atlantic University, Christine E. Lynn College of Nursing, Boca Raton, FL, USA.,Visiting Professor, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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21
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Pundik S, Skelly M, McCabe J, Akbari H, Tatsuoka C, Plow EB. Does rTMS Targeting Contralesional S1 Enhance Upper Limb Somatosensory Function in Chronic Stroke? A Proof-of-Principle Study. Neurorehabil Neural Repair 2021; 35:233-246. [PMID: 33514270 DOI: 10.1177/1545968321989338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Somatosensory deficits are prevalent after stroke, but effective interventions are limited. Brain stimulation of the contralesional primary somatosensory cortex (S1) is a promising adjunct to peripherally administered rehabilitation therapies. OBJECTIVE To assess short-term effects of repetitive transcranial magnetic stimulation (rTMS) targeting contralesional (S1) of the upper extremity. METHODS Using a single-session randomized crossover design, stroke survivors with upper extremity somatosensory loss participated in 3 rTMS treatments targeting contralesional S1: Sham, 5 Hz, and 1 Hz. rTMS was delivered concurrently with peripheral of sensory electrical stimulation and vibration of the affected hand. Outcomes included 2-point discrimination (2PD), proprioception, vibration perception threshold, monofilament threshold (size), and somatosensory evoked potential (SEP). Measures were collected before, immediately after treatment, and 1 hour after treatment. Mixed models were fit to analyze the effects of the 3 interventions. RESULTS Subjects were 59.8 ± 8.1 years old and 45 ± 39 months poststroke. There was improvement in 2PD after 5-Hz rTMS for the stroke-affected (F(2, 76.163) = 3.5, P = .035) and unaffected arm (F(2, 192.786) = 10.6, P < .0001). Peak-to-peak SEP amplitudes were greater after 5-Hz rTMS for N33-P45 (F(2, 133.027) = 3.518, P = .032) and N45-P60 (F(2, 67.353) = 3.212, P = .047). Latencies shortened after 5-Hz rTMS for N20 (F(2, 69.64) = 3.37, P = .04), N60 (F(2, 47.343) = 4.375, P = .018), and P100 (F(2, 37.608) = 3.537, P = .039) peaks. There were no differences between changes immediately after the intervention and an hour later. CONCLUSIONS Short-term application of facilitatory high-frequency rTMS (5Hz) to contralesional S1 combined with peripheral somatosensory stimulation may promote somatosensory function. This intervention may serve as a useful adjunct in somatosensory rehabilitation after stroke.
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Affiliation(s)
- Svetlana Pundik
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Margaret Skelly
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Jessica McCabe
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Heba Akbari
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Ela B Plow
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
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22
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El-Tamawy MS, Darwish MH, Elkholy SH, Moustafa EBS, Abulkassem ST, Khalifa HA. Low frequency transcranial magnetic stimulation in subacute ischemic stroke: Number of sessions that altered cortical excitability. NeuroRehabilitation 2020; 47:427-434. [PMID: 33136077 DOI: 10.3233/nre-203156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cortical reorganization between both cerebral hemispheres plays an important role in regaining the affected upper extremity motor function post-stroke. OBJECTIVES The purpose of the current study was to investigate the recommended number of contra-lesion low frequency repetitive transcranial magnetic stimulation (LF-rTMS) sessions that could enhance cortical reorganization post-stroke. METHODS Forty patients with right hemiparetic subacute ischemic stroke with an age range between 50-65 yrs were randomly assigned into two equal groups: control (GA) and study (GB) groups. Both groups were treated with a selected physical therapy program for the upper limb. Sham and real contra-lesion LF-rTMS was conducted for both groups daily for two consecutive weeks. Sequential changes of cortical excitability were calculated by the end of each session. RESULTS The significant enhancement in the cortical excitability was observed at the fourth session in favor of the study group (GB). Sequential rate of change in cortical excitability was significant for the first eight sessions. From the ninth session onwards, no difference could be detected between groups. CONCLUSION The pattern of recovery after stroke is extensive and not all factors could be controlled. Application of LF-rTMS in conjugation with a selected physical therapy program for the upper limb from four to eight sessions seems to be efficient.
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Affiliation(s)
| | - Moshera H Darwish
- Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt
| | - Saly H Elkholy
- Department of Clinical Neurophysiology, Faculty of Medicine, Cairo University, Egypt
| | - Engy BadrEldin S Moustafa
- Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt
| | - Shimaa T Abulkassem
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Egypt
| | - Heba A Khalifa
- Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt
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23
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Krucoff MO, Miller JP, Saxena T, Bellamkonda R, Rahimpour S, Harward SC, Lad SP, Turner DA. Toward Functional Restoration of the Central Nervous System: A Review of Translational Neuroscience Principles. Neurosurgery 2020; 84:30-40. [PMID: 29800461 DOI: 10.1093/neuros/nyy128] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/15/2018] [Indexed: 01/09/2023] Open
Abstract
Injury to the central nervous system (CNS) can leave patients with devastating neurological deficits that may permanently impair independence and diminish quality of life. Recent insights into how the CNS responds to injury and reacts to critically timed interventions are being translated into clinical applications that have the capacity to drastically improve outcomes for patients suffering from permanent neurological deficits due to spinal cord injury, stroke, or other CNS disorders. The translation of such knowledge into practical and impactful treatments involves the strategic collaboration between neurosurgeons, clinicians, therapists, scientists, and industry. Therefore, a common understanding of key neuroscientific principles is crucial. Conceptually, current approaches to CNS revitalization can be divided by scale into macroscopic (systems-circuitry) and microscopic (cellular-molecular). Here we review both emerging and well-established tenets that are being utilized to enhance CNS recovery on both levels, and we explore the role of neurosurgeons in developing therapies moving forward. Key principles include plasticity-driven functional recovery, cellular signaling mechanisms in axonal sprouting, critical timing for recovery after injury, and mechanisms of action underlying cellular replacement strategies. We then discuss integrative approaches aimed at synergizing interventions across scales, and we make recommendations for the basis of future clinical trial design. Ultimately, we argue that strategic modulation of microscopic cellular behavior within a macroscopic framework of functional circuitry re-establishment should provide the foundation for most neural restoration strategies, and the early involvement of neurosurgeons in the process will be crucial to successful clinical translation.
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Affiliation(s)
- Max O Krucoff
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Jonathan P Miller
- Department of Neurosurgery, Case Western Reserve University, Cleve-land, Ohio
| | - Tarun Saxena
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Ravi Bellamkonda
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Stephen C Harward
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.,Department of Mechan-ical Engineering and Material Sciences, Pratt School of Engineering, Duke Uni-versity, Durham, North Carolina.,Duke Institute for Brain Sciences, Duke Univer-sity, Durham, North Carolina.,Research and Surgery Services, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Dennis A Turner
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.,Department of Biomedical Engineering, Duke University, Durham, North Carolina.,Depart-ment of Neurobiology, Duke University, Durham, North Carolina.,Research and Surgery Services, Durham Veterans Affairs Medical Center, Durham, North Carolina
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24
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Yang YW, Pan WX, Xie Q. Combined effect of repetitive transcranial magnetic stimulation and physical exercise on cortical plasticity. Neural Regen Res 2020; 15:1986-1994. [PMID: 32394946 PMCID: PMC7716032 DOI: 10.4103/1673-5374.282239] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Physical exercise can minimize dysfunction and optimize functional motor recovery after stroke by modulating cortical plasticity. However, the limitation of physical exercise is that large amounts of time and effort are necessary to significantly improve motor function, and even then, substantial exercise may not be sufficient to normalize the observed improvements. Thus, interventions that could be used to strengthen physical exercise-induced neuroplasticity may be valuable in treating hemiplegia after stroke. Repetitive transcranial magnetic stimulation seems to be a viable strategy for enhancing such plasticity. As a non-invasive cortical stimulation technique, repetitive transcranial magnetic stimulation is able to induce long-term plastic changes in the motor system. Recently, repetitive transcranial magnetic stimulation was found to optimize the plastic changes caused by motor training, thereby enhancing the long-term effects of physical exercise in stroke patients. Therefore, it is believed that the combination of repetitive transcranial magnetic stimulation and physical exercise may represent a superior method for restoring motor function after stroke.
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Affiliation(s)
- Ya-Wen Yang
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Xiu Pan
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
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25
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Different Therapeutic Effects of Transcranial Direct Current Stimulation on Upper and Lower Limb Recovery of Stroke Patients with Motor Dysfunction: A Meta-Analysis. Neural Plast 2019; 2019:1372138. [PMID: 31827495 PMCID: PMC6881758 DOI: 10.1155/2019/1372138] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022] Open
Abstract
Objective To explore the effects of transcranial direct current stimulation (tDCS) on the motor recovery of stroke patients and the effect differences between the upper limb and lower limb. Methods Randomized control trials published until January 2019 were searched from PubMed, Embase, ScienceDirect, and Cochrane Library databases. The standardized mean difference (SMD) with 95% confidence interval (CI) was estimated separately for upper and lower limb motor outcomes to understand the mean effect size. Results Twenty-nine studies with 664 subjects were included in this meta-analysis. The overall analyses of tDCS demonstrated significant effect size both for the upper limb (SMD = 0.26, P = 0.002) and the lower limb (SMD = 0.47, P = 0.002). Compared with acute and subacute stroke patients, chronic stroke patients obtained significant effects after tDCS (SMD = 0.25, P = 0.03) in upper limb function. Furthermore, both anode and cathode stimulations produced significant effect size for stroke patients after ≤10 sessions of tDCS (anode: SMD = 0.40, P = 0.001; cathode: SMD = 0.79, P < 0.0001) with >0.029 mA/cm2 of density (anode: SMD = 0.46, P = 0.002; cathode: SMD = 0.79, P < 0.0001). But for lower limb function, more prominent effects were found in subacute stroke patients (SMD = 0.56, P = 0.001) with bilateral tDCS (SMD = 0.59, p = 0.009). Conclusion tDCS is effective for the recovery of stroke patients with motor dysfunction. In addition, upper limb and lower limb functions obtain distinct effects from different therapeutic parameters of tDCS at different stages, respectively.
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26
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Zanos S. Closed-Loop Neuromodulation in Physiological and Translational Research. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a034314. [PMID: 30559253 DOI: 10.1101/cshperspect.a034314] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Neuromodulation, the focused delivery of energy to neural tissue to affect neural or physiological processes, is a common method to study the physiology of the nervous system. It is also successfully used as treatment for disorders in which the nervous system is affected or implicated. Typically, neurostimulation is delivered in open-loop mode (i.e., according to a predetermined schedule and independently of the state of the organ or physiological system whose function is sought to be modulated). However, the physiology of the nervous system or the modulated organ can be dynamic, and the same stimulus may have different effects depending on the underlying state. As a result, open-loop stimulation may fail to restore the desired function or cause side effects. In such cases, a neuromodulation intervention may be preferable to be administered in closed-loop mode. In a closed-loop neuromodulation (CLN) system, stimulation is delivered when certain physiological states or conditions are met (responsive neurostimulation); the stimulation parameters can also be adjusted dynamically to optimize the effect of stimulation in real time (adaptive neurostimulation). In this review, the reasons and the conditions for using CLN are discussed, the basic components of a CLN system are described, and examples of CLN systems used in physiological and translational research are presented.
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Affiliation(s)
- Stavros Zanos
- Translational Neurophysiology Laboratory, Center for Bioelectronic Medicine, Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030
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27
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Marinho V, Pinto GR, Bandeira J, Oliveira T, Carvalho V, Rocha K, Magalhães F, de Sousa VG, Bastos VH, Gupta D, Orsini M, Teixeira S. Impaired decision-making and time perception in individuals with stroke: Behavioral and neural correlates. Rev Neurol (Paris) 2019; 175:367-376. [PMID: 30922589 DOI: 10.1016/j.neurol.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 01/03/2023]
Abstract
Several studies have demonstrated that stroke subjects present impairment of functions related to decision-making and timing, involving the information processing in the neural circuits of the cerebellum in association with the prefrontal cortex. This review is aimed to identify the gaps, and demonstrate a better understanding of decision-making and timing functions in the patients with stroke. Electronic literature database was searched and the findings of relevant studies were used to explore the mechanisms of decision-making and timing in patients with stroke, as well as the circuit connections in timing mediated by prefrontal cortex and cerebellum. A literature review was conducted with 65 studies that synthesized findings on decision-making and time perception in individuals with stroke. Types of neurobiological modalities in this study included: Relationships among decision-making, time perception, related cognitive aspects (such as discrimination tasks, verbal estimation, bisection tasks, time production and motor reproduction), and motor control. We demonstrate that the timing processes are important for the performance in cognitive tasks and that the cerebellum and prefrontal cortex are involved in decision-making and time perception. In the context, the decision-making is impaired in stroke patients has a great impact on executive functions, and this seems to be important in determining neurobiological aspects relevant to the time interval interpretation.
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Affiliation(s)
- V Marinho
- Neuro-innovation Technology & Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil; Genetics and Molecular Biology Laboratory, Federal University of Piauí, Parnaíba-PI, Brazil; The Northeast Biotechnology Network, Federal University of Piauí, Teresina-PI, Brazil.
| | - G R Pinto
- Genetics and Molecular Biology Laboratory, Federal University of Piauí, Parnaíba-PI, Brazil; The Northeast Biotechnology Network, Federal University of Piauí, Teresina-PI, Brazil
| | - J Bandeira
- Teresina Unified Education Center - CEUT, Teresina-PI, Brazil
| | - T Oliveira
- Neuro-innovation Technology & Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil; Genetics and Molecular Biology Laboratory, Federal University of Piauí, Parnaíba-PI, Brazil; The Northeast Biotechnology Network, Federal University of Piauí, Teresina-PI, Brazil
| | - V Carvalho
- Neuro-innovation Technology & Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil; The Northeast Biotechnology Network, Federal University of Piauí, Teresina-PI, Brazil
| | - K Rocha
- Neuro-innovation Technology & Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil; The Northeast Biotechnology Network, Federal University of Piauí, Teresina-PI, Brazil
| | - F Magalhães
- Neuro-innovation Technology & Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil; The Northeast Biotechnology Network, Federal University of Piauí, Teresina-PI, Brazil
| | - V G de Sousa
- Genetics and Molecular Biology Laboratory, Federal University of Piauí, Parnaíba-PI, Brazil
| | - V H Bastos
- The Northeast Biotechnology Network, Federal University of Piauí, Teresina-PI, Brazil; Brain Mapping and Functionality Laboratory, Federal University of Piauí, Parnaíba-PI, Brazil
| | - D Gupta
- Department of Biology, Camden County College, Blackwood, NJ, USA
| | - M Orsini
- Master's Program in Local Development Program, University Center Augusto Motta - UNISUAM, Rio de Janeiro, Brazil
| | - S Teixeira
- Neuro-innovation Technology & Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil; The Northeast Biotechnology Network, Federal University of Piauí, Teresina-PI, Brazil
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28
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Ghosh S. Improvement of gait and balance by non-invasive brain stimulation: its use in rehabilitation. Expert Rev Neurother 2019; 19:133-144. [DOI: 10.1080/14737175.2019.1564042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Soumya Ghosh
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, Australia
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29
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Averna A, Guggenmos D, Pasquale V, Semprini M, Nudo R, Chiappalone M. Neuroengineering Tools For Studying The Effect Of Intracortical Microstimulation In Rodent Models. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3076-3079. [PMID: 30441044 DOI: 10.1109/embc.2018.8512915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intracortical microstimulation can be successfully used to manipulate neuronal activity and connectivity, thus representing a potentially powerful tool to steer neuroplasticity occurring after brain injury. Activity-dependent stimulation (ADS), in which the spikes recorded from a single neuron are used to trigger stimulation at another cortical location, is able to potentiate cortical connections between distant brain areas. Here, we developed an experimental procedure and a computational pipeline aimed at investigating the ability of ADS to induce changes in intra-cortical activity of healthy anesthetized rats.
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30
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León Ruiz M, Rodríguez Sarasa M, Sanjuán Rodríguez L, Benito-León J, García-Albea Ristol E, Arce Arce S. Evidencias actuales sobre la estimulación magnética transcraneal y su utilidad potencial en la neurorrehabilitación postictus: Ampliando horizontes en el tratamiento de la enfermedad cerebrovascular. Neurologia 2018; 33:459-472. [DOI: 10.1016/j.nrl.2016.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 12/17/2022] Open
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31
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León Ruiz M, Rodríguez Sarasa M, Sanjuán Rodríguez L, Benito-León J, García-Albea Ristol E, Arce Arce S. Current evidence on transcranial magnetic stimulation and its potential usefulness in post-stroke neurorehabilitation: Opening new doors to the treatment of cerebrovascular disease. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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32
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Harvey RL, Edwards D, Dunning K, Fregni F, Stein J, Laine J, Rogers LM, Vox F, Durand-Sanchez A, Bockbrader M, Goldstein LB, Francisco GE, Kinney CL, Liu CY, Ryan S, Morales-Quezada L, Worthen-Chaudhari L, Labar D, Schambra H, Kappy CR, Kissela B, Pratt W. Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke. Stroke 2018; 49:2138-2146. [PMID: 30354990 DOI: 10.1161/strokeaha.117.020607] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to determine whether low-frequency electric field navigated repetitive transcranial magnetic stimulation to noninjured motor cortex versus sham repetitive transcranial magnetic stimulation avoiding motor cortex could improve arm motor function in hemiplegic stroke patients when combined with motor training. Methods- Twelve outpatient US rehabilitation centers enrolled participants between May 2014 and December 2015. We delivered 1 Hz active or sham repetitive transcranial magnetic stimulation to noninjured motor cortex before each of eighteen 60-minute therapy sessions over a 6-week period, with outcomes measured at 1 week and 1, 3, and 6 months after end of treatment. The primary end point was the percentage of participants improving ≥5 points on upper extremity Fugl-Meyer score 6 months after end of treatment. Secondary analyses assessed changes on the upper extremity Fugl-Meyer and Action Research Arm Test and Wolf Motor Function Test and safety. Results- Of 199 participants, 167 completed treatment and follow-up because of early discontinuation of data collection. Upper extremity Fugl-Meyer gains were significant for experimental ( P<0.001) and sham groups ( P<0.001). Sixty-seven percent of the experimental group (95% CI, 58%-75%) and 65% of sham group (95% CI, 52%-76%) improved ≥5 points on 6-month upper extremity Fugl-Meyer ( P=0.76). There was also no difference between experimental and sham groups in the Action Research Arm Test ( P=0.80) or the Wolf Motor Function Test ( P=0.55). A total of 26 serious adverse events occurred in 18 participants, with none related to the study or device, and with no difference between groups. Conclusions- Among patients 3 to 12 months poststroke, goal-oriented motor rehabilitation improved motor function 6 months after end of treatment. There was no difference between the active and sham repetitive transcranial magnetic stimulation trial arms. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02089464.
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Affiliation(s)
- Richard L. Harvey
- The Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chiago, IL (R.L.H., L.M.R.)
| | - Dylan Edwards
- Burke Neurological Institute, Weill Cornell Neurology, White Plains, NY (D.E.)
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, OH (K.D.)
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA (F.F.)
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY (J.S.)
| | - Jarmo Laine
- Nexstim Corporation, Helsinki, Finland (J.L.)
| | - Lynn M. Rogers
- The Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chiago, IL (R.L.H., L.M.R.)
| | - Ford Vox
- Shepherd Center, Clinical Research, Atlanta, GA (F.V.)
| | - Ana Durand-Sanchez
- Baylor College of Medicine, Physical Medicine and Rehabilitation, TIRR Memorial Herrmann, Houston, TX (A.D.-S.)
| | - Marcia Bockbrader
- Physical Medicine and Rehabilitation, Ohio State University, Columbus (M.B.)
| | - Larry B. Goldstein
- Kentucky Neuroscience Institute, University of Kentucky, Lexington (L.B.G.)
| | - Gerard E. Francisco
- Physical Medicine and Rehabilitation, University of Texas Health Science Center, TIRR Memorial Herrmann, Houston (G.E.F.)
| | - Carolyn L. Kinney
- Mayo Clinic Arizona, Mayo Clinic Hospital, Physical Medicine and Rehabilitation, Phoenix (C.L.K.)
| | - Charles Y. Liu
- USC Neurorestoration Center, Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA (C.Y.L.)
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Zanos S, Rembado I, Chen D, Fetz EE. Phase-Locked Stimulation during Cortical Beta Oscillations Produces Bidirectional Synaptic Plasticity in Awake Monkeys. Curr Biol 2018; 28:2515-2526.e4. [PMID: 30100342 PMCID: PMC6108550 DOI: 10.1016/j.cub.2018.07.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 04/04/2018] [Accepted: 07/04/2018] [Indexed: 12/19/2022]
Abstract
The functional role of cortical beta oscillations, if any, remains unresolved. During oscillations, the periodic fluctuation in excitability of entrained cells modulates transmission of neural impulses and periodically enhances synaptic interactions. The extent to which oscillatory episodes affect activity-dependent synaptic plasticity remains to be determined. In nonhuman primates, we delivered single-pulse electrical cortical stimulation to a "stimulated" site in sensorimotor cortex triggered on a specific phase of ongoing beta (12-25 Hz) field potential oscillations recorded at a separate "triggering" site. Corticocortical connectivity from the stimulated to the triggering site as well as to other (non-triggering) sites was assessed by cortically evoked potentials elicited by test stimuli to the stimulated site, delivered outside of oscillatory episodes. In separate experiments, connectivity was assessed by intracellular recordings of evoked excitatory postsynaptic potentials. The conditioning paradigm produced transient (1-2 s long) changes in connectivity between the stimulated and the triggering site that outlasted the duration of the oscillatory episodes. The direction of the plasticity effect depended on the phase from which stimulation was triggered: potentiation in depolarizing phases, depression in hyperpolarizing phases. Plasticity effects were also seen at non-triggering sites that exhibited oscillations synchronized with those at the triggering site. These findings indicate that cortical beta oscillations provide a spatial and temporal substrate for short-term, activity-dependent synaptic plasticity in primate neocortex and may help explain the role of oscillations in attention, learning, and cortical reorganization.
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Affiliation(s)
- Stavros Zanos
- Center for Bioelectronic Medicine, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset NY 11030, USA; Department of Physiology & Biophysics, University of Washington, 1705 NE Pacific St, Seattle, WA 98195, USA.
| | - Irene Rembado
- Department of Physiology & Biophysics, University of Washington, 1705 NE Pacific St, Seattle, WA 98195, USA.
| | - Daofen Chen
- Division of Neuroscience, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, 6001 Executive Boulevard, Bethesda, MD 20892, USA.
| | - Eberhard E Fetz
- Department of Physiology & Biophysics, University of Washington, 1705 NE Pacific St, Seattle, WA 98195, USA.
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Wathen CA, Frizon LA, Maiti TK, Baker KB, Machado AG. Deep brain stimulation of the cerebellum for poststroke motor rehabilitation: from laboratory to clinical trial. Neurosurg Focus 2018; 45:E13. [PMID: 30064319 DOI: 10.3171/2018.5.focus18164] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ischemic stroke is a leading cause of disability worldwide, with profound economic costs. Poststroke motor impairment is the most commonly encountered deficit resulting in significant disability and is the primary driver of stroke-associated healthcare expenditures. Although many patients derive some degree of benefit from physical rehabilitation, a significant proportion continue to suffer from persistent motor impairment. Noninvasive brain stimulation, vagal nerve stimulation, epidural cortical stimulation, and deep brain stimulation (DBS) have all been studied as potential modalities to improve upon the benefits derived from physical therapy alone. These neuromodulatory therapies aim primarily to augment neuroplasticity and drive functional reorganization of the surviving perilesional cortex. The authors have proposed a novel and emerging therapeutic approach based on cerebellar DBS targeted at the dentate nucleus. Their rationale is based on the extensive reciprocal connectivity between the dentate nucleus and wide swaths of cerebral cortex via the dentatothalamocortical and corticopontocerebellar tracts, as well as the known limitations to motor rehabilitation imposed by crossed cerebellar diaschisis. Preclinical studies in rodent models of ischemic stroke have shown that cerebellar DBS promotes functional recovery in a frequency-dependent manner, with the most substantial benefits of the therapy noted at 30-Hz stimulation. The improvements in motor function are paralleled by increased expression of markers of synaptic plasticity, synaptogenesis, and neurogenesis in the perilesional cortex. Given the findings of preclinical studies, a first-in-human trial, Electrical Stimulation of the Dentate Nucleus Area (EDEN) for Improvement of Upper Extremity Hemiparesis Due to Ischemic Stroke: A Safety and Feasibility Study, commenced in 2016. Although the existing preclinical evidence is promising, the results of this Phase I trial and subsequent clinical trials will be necessary to determine the future applicability of this therapy.
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Affiliation(s)
| | - Leonardo A Frizon
- 2Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
| | - Tanmoy K Maiti
- 3Department of Neurosurgery, Neurological Institute, Cleveland Clinic; and
| | - Kenneth B Baker
- 4Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andre G Machado
- 3Department of Neurosurgery, Neurological Institute, Cleveland Clinic; and
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Yazdan-Shahmorad A, Silversmith DB, Kharazia V, Sabes PN. Targeted cortical reorganization using optogenetics in non-human primates. eLife 2018; 7:31034. [PMID: 29809133 PMCID: PMC5986269 DOI: 10.7554/elife.31034] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 05/05/2018] [Indexed: 12/20/2022] Open
Abstract
Brain stimulation modulates the excitability of neural circuits and drives neuroplasticity. While the local effects of stimulation have been an active area of investigation, the effects on large-scale networks remain largely unexplored. We studied stimulation-induced changes in network dynamics in two macaques. A large-scale optogenetic interface enabled simultaneous stimulation of excitatory neurons and electrocorticographic recording across primary somatosensory (S1) and motor (M1) cortex (Yazdan-Shahmorad et al., 2016). We tracked two measures of network connectivity, the network response to focal stimulation and the baseline coherence between pairs of electrodes; these were strongly correlated before stimulation. Within minutes, stimulation in S1 or M1 significantly strengthened the gross functional connectivity between these areas. At a finer scale, stimulation led to heterogeneous connectivity changes across the network. These changes reflected the correlations introduced by stimulation-evoked activity, consistent with Hebbian plasticity models. This work extends Hebbian plasticity models to large-scale circuits, with significant implications for stimulation-based neurorehabilitation. From riding a bike to reaching for a cup of coffee, all skilled actions rely on precise connections between the sensory and motor areas of the brain. While sensory areas receive and analyse input from the senses, motor areas plan and trigger muscle contractions. Precisely adjusting the connections between these and other areas enables us to learn new skills, and it also helps us to relearn skills lost as a result of brain injury or stroke. About 70 years ago, a psychologist named Donald Hebb came up with an idea for how this process might occur. He proposed that whenever two neurons are active at the same time, the connection between them becomes stronger. This idea, that ‘cells that fire together, wire together’, became known as Hebb’s rule. Many studies have since shown that Hebb’s rule can explain changes in the strength of connections between pairs of neurons. But can it also explain how connections between entire brain regions become stronger or weaker? New results show that it can. The data were obtained using a technique called optogenetics, in which viruses are used to introduce genes for light-sensitive proteins into neurons. Shining light onto the brain will then activate any cells within that area that contain the resulting proteins. Yazdan-Shahmorad, Silversmith et al. used this technique to activate small regions of either sensory or motor brain tissue in live macaque monkeys. Doing so strengthened the overall connectivity between the two areas. The effects were more variable at the level of smaller brain regions, with some connections becoming weaker rather than stronger. However, Yazdan-Shahmorad, Silversmith et al. show that Hebb’s rule explains most of the observed changes. Many neurological and psychiatric disorders stem from abnormal brain connectivity. Simple forms of brain stimulation are already used to treat certain neurological disorders, such as Parkinson’s disease. Stimulating the brain to induce specific changes in connectivity may ultimately enable us to leverage the brain’s natural learning mechanisms to cure, instead of just treat, these conditions.
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Affiliation(s)
- Azadeh Yazdan-Shahmorad
- Department of Physiology, University of California, San Francisco, San Francisco, United States.,Center for Integrative Neuroscience, University of California, San Francisco, San Francisco, United States.,Departments of Bioengineering and Electrical Engineering, University of Washington, Seattle, United States
| | - Daniel B Silversmith
- Center for Integrative Neuroscience, University of California, San Francisco, San Francisco, United States.,UC Berkeley - UCSF Graduate Program in Bioengineering, University of California, San Francisco, San Francisco, United States
| | - Viktor Kharazia
- Center for Integrative Neuroscience, University of California, San Francisco, San Francisco, United States
| | - Philip N Sabes
- Department of Physiology, University of California, San Francisco, San Francisco, United States.,Center for Integrative Neuroscience, University of California, San Francisco, San Francisco, United States.,UC Berkeley - UCSF Graduate Program in Bioengineering, University of California, San Francisco, San Francisco, United States
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Calancie B, Wang D, Young E, Alexeeva N. Four-pulse transcranial magnetic stimulation using multiple conditioning inputs. Normative MEP responses. Exp Brain Res 2018; 236:1205-1218. [PMID: 29473092 DOI: 10.1007/s00221-018-5212-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/19/2018] [Indexed: 12/12/2022]
Abstract
A four-pulse pattern of transcranial magnetic stimulation (TMS) was compared to traditional dual-pulse TMS for its ability to modulate motor cortical excitability. This novel pattern consisted of a three-pulse train of subthreshold conditioning pulses followed by a suprathreshold test pulse (i.e., SC-T). The intervals between these superconditioning (SC) pulses (1, 3, or 6 ms) and the follow-on test pulse (1, 3, 10, or 25 ms) were varied, and the resultant MEPs were compared to those elicited by: (1) single-pulse TMS; and (2) dual-pulse conditioning-test (C-T) TMS with either short (3 ms) or long (10 ms) intervals to elicit short-interval intracortical inhibition (SICI) or intracortical facilitation (ICF), respectively. Testing included abductor pollicis brevis (APB) and tibialis anterior (TA) in 15 neurologically normal adults. For superconditioning inputs, 10 ms test intervals caused especially strong facilitation of the test MEP, while 1 ms test intervals were particularly effective at causing inhibition of the test response. For both muscles and across all subjects, the most effective of the 12 SC-T inputs tested for causing either facilitation or inhibition was-with rare exception-superior to the dual-pulse TMS input for causing facilitation (i.e., ICF) or inhibition (i.e., SICI), while the overall magnitude of effect was more pronounced in APB compared to TA. Nevertheless, after normalization, the impact of a superconditioning input train on the test MEP was similar in APB and TA muscles, suggesting similar mechanisms of action. Limited findings from a single subject with amyotrophic lateral sclerosis (ALS) are included to further illustrate the potential advantages of using a train of conditioning pulses preceding a TMS test pulse to selectively investigate abnormal motor cortical excitatory and inhibitory circuitry.
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Affiliation(s)
- Blair Calancie
- Department of Neurosurgery, Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13104, USA.
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13104, USA
| | - Eufrosina Young
- Department of Neurology, Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13104, USA
| | - Natalia Alexeeva
- Department of Neurosurgery, Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13104, USA
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Recruitment of Additional Corticospinal Pathways in the Human Brain with State-Dependent Paired Associative Stimulation. J Neurosci 2018; 38:1396-1407. [PMID: 29335359 DOI: 10.1523/jneurosci.2893-17.2017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/20/2017] [Accepted: 12/18/2017] [Indexed: 01/14/2023] Open
Abstract
Standard brain stimulation protocols modify human motor cortex excitability by modulating the gain of the activated corticospinal pathways. However, the restoration of motor function following lesions of the corticospinal tract requires also the recruitment of additional neurons to increase the net corticospinal output. For this purpose, we investigated a novel protocol based on brain state-dependent paired associative stimulation.Motor imagery (MI)-related electroencephalography was recorded in healthy males and females for brain state-dependent control of both cortical and peripheral stimulation in a brain-machine interface environment. State-dependency was investigated with concurrent, delayed, and independent stimulation relative to the MI task. Specifically, sensorimotor event-related desynchronization (ERD) in the β-band (16-22 Hz) triggered peripheral stimulation through passive hand opening by a robotic orthosis and transcranial magnetic stimulation to the respective cortical motor representation, either synchronously or subsequently. These MI-related paradigms were compared with paired cortical and peripheral input applied independent of the brain state. Cortical stimulation resulted in a significant increase in corticospinal excitability only when applied brain state-dependently and synchronously to peripheral input. These gains were resistant to a depotentiation task, revealed a nonlinear evolution of plasticity, and were mediated via the recruitment of additional corticospinal neurons rather than via synchronization of neuronal firing. Recruitment of additional corticospinal pathways may be achieved when cortical and peripheral inputs are applied concurrently, and during β-ERD. These findings resemble a gating mechanism and are potentially important for developing closed-loop brain stimulation for the treatment of hand paralysis following lesions of the corticospinal tract.SIGNIFICANCE STATEMENT The activity state of the motor system influences the excitability of corticospinal pathways to external input. State-dependent interventions harness this property to increase the connectivity between motor cortex and muscles. These stimulation protocols modulate the gain of the activated pathways, but not the overall corticospinal recruitment. In this study, a brain-machine interface paired peripheral stimulation through passive hand opening with transcranial magnetic stimulation to the respective cortical motor representation during volitional β-band desynchronization. Cortical stimulation resulted in the recruitment of additional corticospinal pathways, but only when applied brain state-dependently and synchronously to peripheral input. These effects resemble a gating mechanism and may be important for the restoration of motor function following lesions of the corticospinal tract.
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Cramer SC. Treatments to Promote Neural Repair after Stroke. J Stroke 2018; 20:57-70. [PMID: 29402069 PMCID: PMC5836581 DOI: 10.5853/jos.2017.02796] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 12/12/2022] Open
Abstract
Stroke remains a major cause of human disability worldwide. In parallel with advances in acute stroke interventions, new therapies are under development that target restorative processes. Such therapies have a treatment time window measured in days, weeks, or longer and so have the advantage that they may be accessible by a majority of patients. Several categories of restorative therapy have been studied and are reviewed herein, including drugs, growth factors, monoclonal antibodies, activity-related therapies including telerehabilitation, and a host of devices such as those related to brain stimulation or robotics. Many patients with stroke do not receive acute stroke therapies or receive them and do not derive benefit, often surviving for years thereafter. Therapies based on neural repair hold the promise of providing additional treatment options to a majority of patients with stroke.
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Affiliation(s)
- Steven C. Cramer
- Departments of Neurology, Anatomy & Neurobiology and Physical Medicine & Rehabilitation, University of California, Irvine, CA, USA
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Sebastianelli L, Versace V, Martignago S, Brigo F, Trinka E, Saltuari L, Nardone R. Low-frequency rTMS of the unaffected hemisphere in stroke patients: A systematic review. Acta Neurol Scand 2017; 136:585-605. [PMID: 28464421 DOI: 10.1111/ane.12773] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 01/02/2023]
Abstract
The aim of this review was to summarize the evidence for the effectiveness of low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the unaffected hemisphere in promoting functional recovery after stroke. We performed a systematic search of the studies using LF-rTMS over the contralesional hemisphere in stroke patients and reviewed the 67 identified articles. The studies have been gathered together according to the time interval that had elapsed between the stroke onset and the beginning of the rTMS treatment. Inhibitory rTMS of the contralesional hemisphere can induce beneficial effects on stroke patients with motor impairment, spasticity, aphasia, hemispatial neglect and dysphagia, but the therapeutic clinical significance is unclear. We observed considerable heterogeneity across studies in the stimulation protocols. The use of different patient populations, regardless of lesion site and stroke aetiology, different stimulation parameters and outcome measures means that the studies are not readily comparable, and estimating real effectiveness or reproducibility is very difficult. It seems that careful experimental design is needed and it should consider patient selection aspects, rTMS parameters and clinical assessment tools. Consecutive sessions of rTMS, as well as the combination with conventional rehabilitation therapy, may increase the magnitude and duration of the beneficial effects. In an increasing number of studies, the patients have been enrolled early after stroke. The prolonged follow-up in these patients suggests that the effects of contralesional LF-rTMS can be long-lasting. However, physiological evidence indicating increased synaptic plasticity, and thus, a more favourable outcome, in the early enrolled patients, is still lacking. Carefully designed clinical trials designed are required to address this question. LF rTMS over unaffected hemisphere may have therapeutic utility, but the evidence is still preliminary and the findings need to be confirmed in further randomized controlled trials.
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Affiliation(s)
- L. Sebastianelli
- Department of Neurorehabilitation; Hospital of Vipiteno; Vipiteno Italy
- Research Unit for Neurorehabilitation of South Tyrol; Bolzano Italy
| | - V. Versace
- Department of Neurorehabilitation; Hospital of Vipiteno; Vipiteno Italy
- Research Unit for Neurorehabilitation of South Tyrol; Bolzano Italy
| | - S. Martignago
- Department of Neurorehabilitation; Hospital of Vipiteno; Vipiteno Italy
- Research Unit for Neurorehabilitation of South Tyrol; Bolzano Italy
| | - F. Brigo
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
- Department of Neurosciences, Biomedicine and Movement Sciences; University of Verona; Verona Italy
| | - E. Trinka
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University; Salzburg Austria
| | - L. Saltuari
- Research Unit for Neurorehabilitation of South Tyrol; Bolzano Italy
- Department of Neurology; Hochzirl Hospital; Zirl Austria
| | - R. Nardone
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
- Department of Neurology; Christian Doppler Klinik; Paracelsus Medical University; Salzburg Austria
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A multielectrode array microchannel platform reveals both transient and slow changes in axonal conduction velocity. Sci Rep 2017; 7:8558. [PMID: 28819130 PMCID: PMC5561146 DOI: 10.1038/s41598-017-09033-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/14/2017] [Indexed: 02/06/2023] Open
Abstract
Due to their small dimensions, electrophysiology on thin and intricate axonal branches in support of understanding their role in normal and diseased brain function poses experimental challenges. To reduce experimental complexity, we coupled microelectrode arrays (MEAs) to bi-level microchannel devices for the long-term in vitro tracking of axonal morphology and activity with high spatiotemporal resolution. Our model allowed the long-term multisite recording from pure axonal branches in a microscopy-compatible environment. Compartmentalizing the network structure into interconnected subpopulations simplified access to the locations of interest. Electrophysiological data over 95 days in vitro (DIV) showed an age-dependent increase of axonal conduction velocity, which was positively correlated with, but independent of evolving burst activity over time. Conduction velocity remained constant at chemically increased network activity levels. In contrast, low frequency (1 Hz, 180 repetitions) electrical stimulation of axons or network subpopulations evoked amplitude-dependent direct (5-35 ms peri-stimulus) and polysynaptic (35-1,000 ms peri-stimulus) activity with temporarily (<35 ms) elevated propagation velocities along the perisomatic branches. Furthermore, effective stimulation amplitudes were found to be significantly lower (>250 mV) in microchannels when compared with those reported for unconfined cultures (>800 mV). The experimental paradigm may lead to new insights into stimulation-induced axonal plasticity.
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Female sex hormones modulate the response to low-frequency rTMS in the human motor cortex. Brain Stimul 2017; 10:850-852. [DOI: 10.1016/j.brs.2017.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 02/26/2017] [Indexed: 11/23/2022] Open
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Lajoie G, Krouchev NI, Kalaska JF, Fairhall AL, Fetz EE. Correlation-based model of artificially induced plasticity in motor cortex by a bidirectional brain-computer interface. PLoS Comput Biol 2017; 13:e1005343. [PMID: 28151957 PMCID: PMC5313237 DOI: 10.1371/journal.pcbi.1005343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/16/2017] [Accepted: 01/03/2017] [Indexed: 12/19/2022] Open
Abstract
Experiments show that spike-triggered stimulation performed with Bidirectional Brain-Computer-Interfaces (BBCI) can artificially strengthen connections between separate neural sites in motor cortex (MC). When spikes from a neuron recorded at one MC site trigger stimuli at a second target site after a fixed delay, the connections between sites eventually strengthen. It was also found that effective spike-stimulus delays are consistent with experimentally derived spike-timing-dependent plasticity (STDP) rules, suggesting that STDP is key to drive these changes. However, the impact of STDP at the level of circuits, and the mechanisms governing its modification with neural implants remain poorly understood. The present work describes a recurrent neural network model with probabilistic spiking mechanisms and plastic synapses capable of capturing both neural and synaptic activity statistics relevant to BBCI conditioning protocols. Our model successfully reproduces key experimental results, both established and new, and offers mechanistic insights into spike-triggered conditioning. Using analytical calculations and numerical simulations, we derive optimal operational regimes for BBCIs, and formulate predictions concerning the efficacy of spike-triggered conditioning in different regimes of cortical activity.
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Affiliation(s)
- Guillaume Lajoie
- University of Washington Institute for Neuroengineering, University of Washington, Seattle, WA, USA
| | | | - John F. Kalaska
- Groupe de recherche sur le système nerveux central, Département de neurosciences, Université de Montreal, Montreal, QC, Canada
| | - Adrienne L. Fairhall
- University of Washington Institute for Neuroengineering, University of Washington, Seattle, WA, USA
- Dept. of Physiology and Biophysics, University of Washington, Seattle, WA, USA
- Dept. of Physics, University of Washington, Seattle, WA, USA
| | - Eberhard E. Fetz
- University of Washington Institute for Neuroengineering, University of Washington, Seattle, WA, USA
- Dept. of Physiology and Biophysics, University of Washington, Seattle, WA, USA
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Opsommer E, Zwissig C, Korogod N, Weiss T. Effectiveness of temporary deafferentation of the arm on somatosensory and motor functions following stroke: a systematic review. ACTA ACUST UNITED AC 2016; 14:226-257. [PMID: 28009677 DOI: 10.11124/jbisrir-2016-003231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND After stroke, regaining functional use of the upper limb can be challenging. Temporary deafferentation (TD) is a novel approach used in neurorehabilitation to voluntarily reduce the somatosensory input in a body part by temporary anesthesia; which has been shown to improve sensorimotor functions in the affected limb. OBJECTIVES The primary objective of this systematic review was to present the best available evidence related to the effects of TD of the affected arm on the recovery of motor function and activity of the upper limb (arm and hand) following stroke. Further, this review aimed to assess the effects of TD on sensory function, activities of daily living (ADL) and quality of life following stroke, the acceptability and safety of the intervention as well as adverse events. INCLUSION CRITERIA TYPES OF PARTICIPANTS Adult patients (18 years and older) with a clinical diagnosis of stroke, either hemorrhagic or ischemic. TYPES OF INTERVENTIONS Reports of rehabilitation that included the use of a pneumatic tourniquet, regional anesthesia or nerve block to achieve TD of an arm, or the use of TD as a stand-alone intervention. OUTCOMES Primary outcomes were motor function and activity of the upper limb using assessment scales, motor tests and global motor functions.Secondary outcomes included measures of sensory function, ADL, impact of stroke and quality of life and pain.Additional outcomes were neurophysiological changes as studied with functional magnetic resonance imaging, magnetoencephalography and/or transcranial magnetic stimulation.Acceptability and safety of the intervention as well as adverse events were also included. TYPES OF STUDIES We included any experimental and epidemiological studies. There were no randomized controlled trials. We included non-randomized controlled trials, quasi-experimental, before and after studies and case-control studies. SEARCH STRATEGY We searched for both published and unpublished studies in major databases and all reference lists of relevant articles in English, German or French languages. We included studies published from January 1980 to October 2015. DATA EXTRACTION Data were extracted from included studies using a standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS There was heterogeneity in the types of intervention and outcome measures, therefore statistical pooling of the findings was not appropriate. As such, the studies were grouped according to type of outcome where possible. Findings are presented in a narrative form. RESULTS Eight studies met the eligibility criteria. All outcome parameters related to the primary outcome (motor function and activity of the more affected upper extremity) showed an improvement during or after TD. The sensory functions significantly improved during or after TD when measured either by the grating orienting task or the grating orientation accuracy, and slightly improved when measured using the von Frey hair testing during TD. CONCLUSION There is evidence supporting the use of TD of the upper extremity in adults after stroke. Temporary deafferentation can be recommended (Grade B).
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Affiliation(s)
- Emmanuelle Opsommer
- 1School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland 2Biological and Clinical Psychology, Institute of Psychology, Friedrich Schiller University, Jena, Germany
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Chaudhary U, Birbaumer N, Ramos-Murguialday A. Brain-computer interfaces in the completely locked-in state and chronic stroke. PROGRESS IN BRAIN RESEARCH 2016; 228:131-61. [PMID: 27590968 DOI: 10.1016/bs.pbr.2016.04.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brain-computer interfaces (BCIs) use brain activity to control external devices, facilitating paralyzed patients to interact with the environment. In this chapter, we discuss the historical perspective of development of BCIs and the current advances of noninvasive BCIs for communication in patients with amyotrophic lateral sclerosis and for restoration of motor impairment after severe stroke. Distinct techniques have been explored to control a BCI in patient population especially electroencephalography (EEG) and more recently near-infrared spectroscopy (NIRS) because of their noninvasive nature and low cost. Previous studies demonstrated successful communication of patients with locked-in state (LIS) using EEG- and invasive electrocorticography-BCI and intracortical recordings when patients still showed residual eye control, but not with patients with complete LIS (ie, complete paralysis). Recently, a NIRS-BCI and classical conditioning procedure was introduced, allowing communication in patients in the complete locked-in state (CLIS). In severe chronic stroke without residual hand function first results indicate a possible superior motor rehabilitation to available treatment using BCI training. Here we present an overview of the available studies and recent results, which open new doors for communication, in the completely paralyzed and rehabilitation in severely affected stroke patients. We also reflect on and describe possible neuronal and learning mechanisms responsible for BCI control and perspective for future BMI research for communication in CLIS and stroke motor recovery.
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Affiliation(s)
- U Chaudhary
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.
| | - N Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany; Wyss-Center for Bio- and Neuro-Engineering, Geneva, Switzerland
| | - A Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany; TECNALIA, San Sebastian, Spain.
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Rasche D, Tronnier VM. Clinical Significance of Invasive Motor Cortex Stimulation for Trigeminal Facial Neuropathic Pain Syndromes. Neurosurgery 2016; 79:655-666. [DOI: 10.1227/neu.0000000000001353] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
BACKGROUND:
Invasive neuromodulation of the cortical surface for various chronic pain syndromes has been performed for >20 years. The significance of motor cortex stimulation (MCS) in chronic trigeminal neuropathic pain (TNP) syndromes remains unclear. Different techniques are performed worldwide in regard to operative procedure, stimulation parameters, test trials, and implanted materials.
OBJECTIVE:
To present the clinical experiences of a single center with MCS, surgical approach, complications, and follow-up as a prospective, noncontrolled clinical trial.
METHODS:
The implantation of epidural leads over the motor cortex was performed via a burr hole technique with neuronavigation and intraoperative neurostimulation. Special focus was placed on a standardized test trial with an external stimulation device and the implementation of a double-blinded or placebo test phase to identify false-positive responders.
RESULTS:
A total of 36 patients with TNP were operated on, and MCS was performed. In 26 of the 36 patients (72%), a significant pain reduction from a mean of 8.11 to 4.58 (on the visual analog scale) during the test trial was achieved (P <.05). Six patients were identified as false-positive responders (17%). At the last available follow-up of 26 patients (mean, 5.6 years), active MCS led to a significant pain reduction compared with the preoperative pain ratings (mean visual analog scale score, 5.01; P <.05).
CONCLUSION:
MCS is an additional therapeutic option for patients with refractory chronic TNP, and significant long-term pain suppression can be achieved. Placebo or double-blinded testing is mandatory.
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Affiliation(s)
- Dirk Rasche
- Department of Neurosurgery, University Hospital of Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - Volker M. Tronnier
- Department of Neurosurgery, University Hospital of Schleswig-Holstein, University of Lübeck, Lübeck, Germany
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Greenwald E, Masters MR, Thakor NV. Implantable neurotechnologies: bidirectional neural interfaces--applications and VLSI circuit implementations. Med Biol Eng Comput 2016; 54:1-17. [PMID: 26753776 PMCID: PMC4839984 DOI: 10.1007/s11517-015-1429-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 12/10/2015] [Indexed: 12/20/2022]
Abstract
A bidirectional neural interface is a device that transfers information into and out of the nervous system. This class of devices has potential to improve treatment and therapy in several patient populations. Progress in very large-scale integration has advanced the design of complex integrated circuits. System-on-chip devices are capable of recording neural electrical activity and altering natural activity with electrical stimulation. Often, these devices include wireless powering and telemetry functions. This review presents the state of the art of bidirectional circuits as applied to neuroprosthetic, neurorepair, and neurotherapeutic systems.
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Affiliation(s)
- Elliot Greenwald
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
| | - Matthew R Masters
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, Singapore, Singapore.
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Koganemaru S, Fukuyama H, Mima T. Two is More Than One: How to Combine Brain Stimulation Rehabilitative Training for Functional Recovery? Front Syst Neurosci 2015; 9:154. [PMID: 26617497 PMCID: PMC4639697 DOI: 10.3389/fnsys.2015.00154] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 10/26/2015] [Indexed: 01/24/2023] Open
Abstract
A number of studies have shown that non-invasive brain stimulation has an additional effect in combination with rehabilitative therapy to enhance functional recovery than either therapy alone. The combination enhances use-dependent plasticity induced by repetitive training. The neurophysiological mechanism of the effects of this combination is based on associative plasticity. However, these effects were not reported in all cases. We propose a list of possible strategies to achieve an effective association between rehabilitative training with brain stimulation for plasticity: (1) control of temporal aspect between stimulation and task execution; (2) the use of a shaped task for the combination; (3) the appropriate stimulation of neuronal circuits where use-dependent plastic changes occur; and (4) phase synchronization between rhythmically patterned brain stimulation and task-related patterned activities of neurons. To better utilize brain stimulation in neuro-rehabilitation, it is important to develop more effective techniques to combine them.
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Affiliation(s)
- Satoko Koganemaru
- Brain Integrative Science, Kyoto University School of Medicine Sakyo-ku, Kyoto, Japan ; Human Brain Research Center, Kyoto University School of Medicine Sakyo-ku, Kyoto, Japan
| | - Hidenao Fukuyama
- Human Brain Research Center, Kyoto University School of Medicine Sakyo-ku, Kyoto, Japan
| | - Tatsuya Mima
- Human Brain Research Center, Kyoto University School of Medicine Sakyo-ku, Kyoto, Japan
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Balossier A, Etard O, Descat C, Vivien D, Emery E. Epidural Cortical Stimulation as a Treatment for Poststroke Aphasia. Neurorehabil Neural Repair 2015; 30:120-30. [DOI: 10.1177/1545968315606989] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background. Nearly 15 million people suffer from stroke every year worldwide, with about 20% of the survivors retaining chronic aphasic symptoms. Spontaneous recovery is limited to 3 to 6 months. Cortical stimulation techniques have been proposed to enhance the recovery process. Objective. The goal of this study was to evaluate the benefit of epidural cortical stimulation for the treatment of poststroke aphasia, based on a systematic review of the literature. Methods. An extensive PubMed search was performed for English language articles published from 1990 to 2014 with the keywords (cortical OR epidural) AND stimulation AND stroke AND (aphasia OR language OR speech). The criteria analyzed included the type of study, epidemiology of patients, stroke, aphasia, stimulation protocol, concurrent rehabilitation therapies, language evaluations, results observed, and follow-up. Results. Seven cases were reported to date (3 case reports, 1 randomized controlled trial). All patients experienced nonfluent aphasia following an ischemic stroke. All four studies reported encouraging effects of the stimulation with improved lexical access and fluency for all patients. The effects were specific, independent of the motor recovery or of the pain reported by the patients, and they were linked to the stimulation parameters. Conclusions. Due to the small number of existing cases in the literature, the strength of the evidence is still low. Two main hypotheses of neurobiological mechanisms have been explored: either using continuous stimulation to modify cortical perilesional inhibition or using intermittent stimulation during the speech and language therapy sessions to explore synaptic plasticity and long-term potentiation or depression. To establish the role of epidural stimulation and the relevant stimulation protocols and parameters, large randomized controlled trials are mandatory. We suggest avenues of investigation.
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Affiliation(s)
- Anne Balossier
- Centre Hospitalier Universitaire de Caen, Caen, France
- Université de Caen Basse-Normandie, Caen, France
- INSERM U919, Caen, France
| | - Olivier Etard
- Centre Hospitalier Universitaire de Caen, Caen, France
- Université de Caen Basse-Normandie, Caen, France
| | - Chloé Descat
- Centre Hospitalier Universitaire de Caen, Caen, France
| | | | - Evelyne Emery
- Centre Hospitalier Universitaire de Caen, Caen, France
- Université de Caen Basse-Normandie, Caen, France
- INSERM U919, Caen, France
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Castel-Lacanal E. Sites of electrical stimulation used in neurology. Ann Phys Rehabil Med 2015; 58:201-207. [PMID: 26183200 DOI: 10.1016/j.rehab.2015.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
Rehabilitation aims to decrease neurological impairments, in guiding plasticity. Electrical stimulation has been used for many years in rehabilitation treatment of neurological disabilities as a tool for neuromodulation inducing plasticity, although the mechanisms of its action are not well known. The applications vary, encompassing therapeutic and rehabilitative aims. The type and site of stimulation vary depending on the objectives. Some techniques are widely used in clinical practice; others are still in the research stage. They may be invasive, epidural or in direct contact with neurons; they may be noninvasive, applied transcutaneously or indirectly by current vectors. The indications vary: mobility, functionality, pain as well as pharyngeal, respiratory, and perineal function. This paper aims to summarize current data on electrical neuromodulation techniques used in neurorehabilitation, their effects and their mechanisms of action.
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Affiliation(s)
- E Castel-Lacanal
- Inserm U 825, CHU Purpan, Pavillon Baudot, place du Dr-Baylac, 31024 Toulouse cedex 3, France; Service de Médecine Physique et Réadaptation, CHU Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
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