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Ferris JK, Lo BP, Barisano G, Brodtmann A, Buetefisch CM, Conforto AB, Donnelly MR, Egorova-Brumley N, Hayward KS, Khlif MS, Revill KP, Zavaliangos-Petropulu A, Boyd L, Liew SL. Modulation of the Association Between Corticospinal Tract Damage and Outcome After Stroke by White Matter Hyperintensities. Neurology 2024; 102:e209387. [PMID: 38701386 PMCID: PMC11196095 DOI: 10.1212/wnl.0000000000209387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Motor outcomes after stroke relate to corticospinal tract (CST) damage. The brain leverages surviving neural pathways to compensate for CST damage and mediate motor recovery. Thus, concurrent age-related damage from white matter hyperintensities (WMHs) might affect neurologic capacity for recovery after CST injury. The role of WMHs in post-stroke motor outcomes is unclear. In this study, we evaluated whether WMHs modulate the relationship between CST damage and post-stroke motor outcomes. METHODS We used data from the multisite ENIGMA Stroke Recovery Working Group with T1 and T2/fluid-attenuated inversion recovery imaging. CST damage was indexed with weighted CST lesion load (CST-LL). WMH volumes were extracted with Freesurfer's SAMSEG. Mixed-effects beta-regression models were fit to test the impact of CST-LL, WMH volume, and their interaction on motor impairment, controlling for age, days after stroke, and stroke volume. RESULTS A total of 223 individuals were included. WMH volume related to motor impairment above and beyond CST-LL (β = 0.178, 95% CI 0.025-0.331, p = 0.022). Relationships varied by WMH severity (mild vs moderate-severe). In individuals with mild WMHs, motor impairment related to CST-LL (β = 0.888, 95% CI 0.604-1.172, p < 0.001) with a CST-LL × WMH interaction (β = -0.211, 95% CI -0.340 to -0.026, p = 0.026). In individuals with moderate-severe WMHs, motor impairment related to WMH volume (β = 0.299, 95% CI 0.008-0.590, p = 0.044), but did not significantly relate to CST-LL or a CST-LL × WMH interaction. DISCUSSION WMHs relate to motor outcomes after stroke and modify relationships between motor impairment and CST damage. WMH-related damage may be under-recognized in stroke research as a factor contributing to variability in motor outcomes. Our findings emphasize the importance of brain structural reserve in motor outcomes after brain injury.
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Affiliation(s)
- Jennifer K Ferris
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Bethany P Lo
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Giuseppe Barisano
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Amy Brodtmann
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Cathrin M Buetefisch
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Adriana B Conforto
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Miranda R Donnelly
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Natalia Egorova-Brumley
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Kathryn S Hayward
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Mohamed Salah Khlif
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Kate P Revill
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Artemis Zavaliangos-Petropulu
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Lara Boyd
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
| | - Sook-Lei Liew
- From the Gerontology Research Centre (J.K.F.), Simon Fraser University; Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health (J.K.F.), University of British Columbia, Vancouver, Canada; Chan Division of Occupational Science and Occupational Therapy (B.P.L., M.R.D., S.-L.L.), University of Southern California, Los Angeles; Department of Neurosurgery (G.B.), Stanford School of Medicine, Stanford University, CA; Central Clinical School (A.B., M.S.K.), Monash University, Melbourne, Victoria, Australia; Department of Medicine (A.B.), Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Department of Neurology (C.M.B.), Department of Rehabilitation Medicine (C.M.B.), and Department of Radiology (C.M.B.), Emory University, Atlanta, GA; Hospital das Clinicas HCFMUSP (A.B.C.), Faculdade de Medicina, Universidade de São Paulo; Hospital Israelita Albert Einstein (A.B.C.), São Paulo, Brazil; Melbourne School of Psychological Sciences (N.E.-B.), University of Melbourne; Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health (K.S.H.), University of Melbourne, Victoria, Australia; Facility for Education and Research in Neuroscience (K.P.R.), Emory University, Atlanta, GA; Brain Mapping Center (A.Z.-P.), Department of Neurology, Geffen School of Medicine, University of California Los Angeles; and Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine (L.B., S.-L.L.), University of Southern California, Los Angeles
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Zhao Z, Zhang Y, Su J, Yang L, Pang L, Gao Y, Wang H. A comprehensive review for artificial intelligence on neuroimaging in rehabilitation of ischemic stroke. Front Neurol 2024; 15:1367854. [PMID: 38606275 PMCID: PMC11007047 DOI: 10.3389/fneur.2024.1367854] [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: 01/09/2024] [Accepted: 03/08/2024] [Indexed: 04/13/2024] Open
Abstract
Stroke is the second leading cause of death worldwide, with ischemic stroke accounting for a significant proportion of morbidity and mortality among stroke patients. Ischemic stroke often causes disability and cognitive impairment in patients, which seriously affects the quality of life of patients. Therefore, how to predict the recovery of patients can provide support for clinical intervention in advance and improve the enthusiasm of patients for rehabilitation treatment. With the popularization of imaging technology, the diagnosis and treatment of ischemic stroke patients are often accompanied by a large number of imaging data. Through machine learning and Deep Learning, information from imaging data can be used more effectively. In this review, we discuss recent advances in neuroimaging, machine learning, and Deep Learning in the rehabilitation of ischemic stroke.
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Affiliation(s)
- Zijian Zhao
- Rehabilitation Center, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yuanyuan Zhang
- Rehabilitation Center, ShengJing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jiuhui Su
- Department of Orthopedics, Haicheng Bonesetting Hospital, Haicheng, Liaoning Province, China
| | - Lianbo Yang
- Department of Reparative and Reconstructive Surgery, The Second Hospital of Dalian Medical University, Dalian Liaoning Province, China
| | - Luhang Pang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yingshan Gao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hongbo Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Ferris JK, Lo BP, Barisano G, Brodtmann A, Buetefisch CM, Conforto AB, Donnelly MH, Egorova-Brumley N, Hayward KS, Khlif MS, Revill KP, Zavaliangos-Petropulu A, Boyd LA, Liew SL. White matter hyperintensities modify relationships between corticospinal tract damage and motor outcomes after stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.29.23297734. [PMID: 37961329 PMCID: PMC10635227 DOI: 10.1101/2023.10.29.23297734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Motor outcomes after stroke relate to corticospinal tract (CST) damage. Concurrent damage from white matter hyperintensities (WMHs) might impact neurological capacity for recovery after CST injury. Here, we evaluated if WMHs modulate the relationship between CST damage and post-stroke motor impairment outcome. We included 223 individuals from the ENIGMA Stroke Recovery Working Group. CST damage was indexed with weighted CST lesion load (CST-LL). Mixed effects beta-regression models were fit to test the impact of CST-LL, WMH volume, and their interaction on motor impairment. WMH volume related to motor impairment above and beyond CST-LL (β = 0.178, p = 0.022). We tested if relationships varied by WMH severity (mild vs. moderate-severe). In individuals with mild WMHs, motor impairment related to CST-LL (β = 0.888, p < 0.001) with a CST-LL x WMH interaction (β = -0.211, 0.026). In individuals with moderate-severe WMHs, motor impairment related to WMH volume (β = 0.299, p = 0.044), but did not significantly relate to CST-LL or a CST-LL x WMH interaction. WMH-related damage may be under-recognised in stroke research as a factor contributing to variability in motor outcomes. Our findings emphasize the importance of brain structural reserve in motor outcomes after brain injury.
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Affiliation(s)
- Jennifer K Ferris
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
- Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bethany P Lo
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Giuseppe Barisano
- Department of Neurosurgery, Stanford School of Medicine, Stanford University, California, USA
| | - Amy Brodtmann
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Cathrin M Buetefisch
- Department of Neurology, Emory University, Atlanta, Georgia, USA
- Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, USA
- Department of Radiology, Emory University, Atlanta, Georgia, USA
| | - Adriana B Conforto
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Miranda H Donnelly
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Natalia Egorova-Brumley
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kathryn S Hayward
- Departments of Physiotherapy, Medicine (RMH) & The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Kate P Revill
- Facility for Education and Research in Neuroscience, Emory University, Atlanta, Georgia, USA
| | - Artemis Zavaliangos-Petropulu
- Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Lara A Boyd
- Department of Physical Therapy and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sook-Lei Liew
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Mark and Mary Stevens Neuroimaging and Informatics Institute and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Stroke-Related Alterations in the Brain's Functional Connectivity Response Associated with Upper Limb Multi-Joint Linkage Movement. Brain Sci 2023; 13:brainsci13020338. [PMID: 36831881 PMCID: PMC9954203 DOI: 10.3390/brainsci13020338] [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: 12/19/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Stroke is one of the primary causes of motor disorders, which can seriously affect the patient's quality of life. However, the assessment of the upper limb affected by stroke is commonly based on scales, and the characteristics of brain reorganization induced by limb movement are not clear. Thus, this study aimed to investigate stroke-related cortical reorganization based on functional near infrared spectroscopy (fNIRS) during upper limb multi-joint linkage movement with reference to the Fugl-Meyer Assessment of the upper extremities (FMA-UE). In total, 15 stroke patients and 15 healthy subjects participated in this study. The functional connectivity (FC) between channels and the regions of interest (ROI) was calculated by Pearson's correlation coefficient. The results showed that compared with the control group, the FC between the prefrontal cortex and the motor cortex was significantly increased in the resting state and the affected upper limb's multi-joint linkage movements, while the FC between the motor cortex was significantly decreased during the unaffected upper limb's multi-joint linkage movements. Moreover, the significantly increased ROI FC in the resting state showed a significantly positive correlation with FMA-UE in stroke patients (p < 0.05). This study highlights a new biomarker for evaluating the function of movement in stroke patients and provides guidance for rehabilitation training.
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Demers M, Varghese R, Winstein C. Retrospective Analysis of Task-Specific Effects on Brain Activity After Stroke: A Pilot Study. Front Hum Neurosci 2022; 16:871239. [PMID: 35721357 PMCID: PMC9201099 DOI: 10.3389/fnhum.2022.871239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Evidence supports cortical reorganization in sensorimotor areas induced by constraint-induced movement therapy (CIMT). However, only a few studies examined the neural plastic changes as a function of task specificity. This retrospective analysis aims to evaluate the functional brain activation changes during a precision and a power grasp task in chronic stroke survivors who received 2-weeks of CIMT compared to a no-treatment control group. Methods Fourteen chronic stroke survivors, randomized to CIMT (n = 8) or non-CIMT (n = 6), underwent functional MRI (fMRI) before and after a 2-week period. Two behavioral measures, the 6-item Wolf Motor Function Test (WMFT-6) and the Motor Activity Log (MAL), and fMRI brain scans were collected before and after a 2-week period. During scan runs, participants performed two different grasp tasks (precision, power). Pre to post changes in laterality index (LI) were compared by group and task for two predetermined motor regions of interest: dorsal premotor cortex (PMd) and primary motor cortex (MI). Results In contrast to the control group, the CIMT group showed significant improvements in the WMFT-6. For the MAL, both groups showed a trend toward greater improvements from baseline. Two weeks of CIMT resulted in a relative increase in activity in a key region of the motor network, PMd of the lesioned hemisphere, under precision grasp task conditions compared to the non-treatment control group. No changes in LI were observed in MI for either task or group. Conclusion These findings provide preliminary evidence for task-specific effects of CIMT in the promotion of recovery-supportive cortical reorganization in chronic stroke survivors.
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Affiliation(s)
- Marika Demers
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Rini Varghese
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Carolee Winstein
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Cassidy JM, Mark JI, Cramer SC. Functional connectivity drives stroke recovery: shifting the paradigm from correlation to causation. Brain 2022; 145:1211-1228. [PMID: 34932786 PMCID: PMC9630718 DOI: 10.1093/brain/awab469] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 11/14/2022] Open
Abstract
Stroke is a leading cause of disability, with deficits encompassing multiple functional domains. The heterogeneity underlying stroke poses significant challenges in the prediction of post-stroke recovery, prompting the development of neuroimaging-based biomarkers. Structural neuroimaging measurements, particularly those reflecting corticospinal tract injury, are well-documented in the literature as potential biomarker candidates of post-stroke motor recovery. Consistent with the view of stroke as a 'circuitopathy', functional neuroimaging measures probing functional connectivity may also prove informative in post-stroke recovery. An important step in the development of biomarkers based on functional neural network connectivity is the establishment of causality between connectivity and post-stroke recovery. Current evidence predominantly involves statistical correlations between connectivity measures and post-stroke behavioural status, either cross-sectionally or serially over time. However, the advancement of functional connectivity application in stroke depends on devising experiments that infer causality. In 1965, Sir Austin Bradford Hill introduced nine viewpoints to consider when determining the causality of an association: (i) strength; (ii) consistency; (iii) specificity; (iv) temporality; (v) biological gradient; (vi) plausibility; (vii) coherence; (viii) experiment; and (ix) analogy. Collectively referred to as the Bradford Hill Criteria, these points have been widely adopted in epidemiology. In this review, we assert the value of implementing Bradford Hill's framework to stroke rehabilitation and neuroimaging. We focus on the role of neural network connectivity measurements acquired from task-oriented and resting-state functional MRI, EEG, magnetoencephalography and functional near-infrared spectroscopy in describing and predicting post-stroke behavioural status and recovery. We also identify research opportunities within each Bradford Hill tenet to shift the experimental paradigm from correlation to causation.
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Affiliation(s)
- Jessica M Cassidy
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jasper I Mark
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles; and California Rehabilitation Institute, Los Angeles, CA, USA
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Lee JJ, Shin JH. Predicting Clinically Significant Improvement After Robot-Assisted Upper Limb Rehabilitation in Subacute and Chronic Stroke. Front Neurol 2021; 12:668923. [PMID: 34276535 PMCID: PMC8281036 DOI: 10.3389/fneur.2021.668923] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/01/2021] [Indexed: 12/11/2022] Open
Abstract
Prior studies examining predictors of favorable clinical outcomes after upper limb robot-assisted therapy (RT) have many shortcomings. Therefore, the aim of this study was to identify meaningful predictors and a prediction model for clinically significant motor improvement in upper limb impairment after RT for each stroke phase. This retrospective, single-center study enrolled patients with stroke who received RT using InMotion2 along with conventional therapy (CT) from January 2015 to September 2019. Demographic characteristics, clinical measures, and robotic kinematic measures were evaluated. The primary outcome measure was the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and we classified patients with improvement more than the minimal clinically important difference as responders for each stroke phase. Univariable and multivariable logistic regression analyses were performed to assess the relationship between potential predictors and RT responders and determine meaningful predictors. Subsequently, meaningful predictors were included in the final prediction model. One hundred forty-four patients were enrolled. The Hand Movement Scale and time since onset were significant predictors of clinically significant improvement in upper limb impairment (P = 0.045 and 0.043, respectively), as represented by the FMA-UE score after RT along with CT, in patients with subacute stroke. These variables were also meaningful predictors with borderline statistical significance in patients with chronic stroke (P = 0.076 and 0.066, respectively). Better hand movement and a shorter time since onset can be used as realistic predictors of clinically significant motor improvement in upper limb impairment after RT with InMotion2 alongside CT in patients with subacute and chronic stroke. This information may help healthcare professionals discern optimal patients for RT and accurately inform patients and caregivers about outcomes of RT.
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Affiliation(s)
- Jae Joon Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea.,Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea
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Allegra Mascaro AL, Conti E, Lai S, Di Giovanna AP, Spalletti C, Alia C, Panarese A, Scaglione A, Sacconi L, Micera S, Caleo M, Pavone FS. Combined Rehabilitation Promotes the Recovery of Structural and Functional Features of Healthy Neuronal Networks after Stroke. Cell Rep 2020; 28:3474-3485.e6. [PMID: 31553915 DOI: 10.1016/j.celrep.2019.08.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 06/19/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022] Open
Abstract
Rehabilitation is considered the most effective treatment for promoting the recovery of motor deficits after stroke. One of the most challenging experimental goals is to unambiguously link brain rewiring to motor improvement prompted by rehabilitative therapy. Previous work showed that robotic training combined with transient inactivation of the contralesional cortex promotes a generalized recovery in a mouse model of stroke. Here, we use advanced optical imaging and manipulation tools to study cortical remodeling induced by this rehabilitation paradigm. We show that the stabilization of peri-infarct synaptic contacts accompanies increased vascular density induced by angiogenesis. Furthermore, temporal and spatial features of cortical activation recover toward pre-stroke conditions through the progressive formation of a new motor representation in the peri-infarct area. In the same animals, we observe reinforcement of inter-hemispheric connectivity. Our results provide evidence that combined rehabilitation promotes the restoration of structural and functional features distinctive of healthy neuronal networks.
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Affiliation(s)
- Anna Letizia Allegra Mascaro
- Neuroscience Institute, National Research Council, Pisa 56124, Italy; European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto Fiorentino 50019, Italy.
| | - Emilia Conti
- European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto Fiorentino 50019, Italy; Department of Physics and Astronomy, University of Florence, Sesto Fiorentino 50019, Italy
| | - Stefano Lai
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa 56127, Italy
| | | | | | - Claudia Alia
- Neuroscience Institute, National Research Council, Pisa 56124, Italy
| | - Alessandro Panarese
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa 56127, Italy
| | - Alessandro Scaglione
- European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto Fiorentino 50019, Italy
| | - Leonardo Sacconi
- European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto Fiorentino 50019, Italy; National Institute of Optics, National Research Council, Sesto Fiorentino 50019, Italy
| | - Silvestro Micera
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa 56127, Italy; Bertarelli Foundation Chair in Translational NeuroEngineering, Centre for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
| | - Matteo Caleo
- Neuroscience Institute, National Research Council, Pisa 56124, Italy; Department of Biomedical Sciences, University of Padua, Padova 35131, Italy
| | - Francesco Saverio Pavone
- European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto Fiorentino 50019, Italy; Department of Physics and Astronomy, University of Florence, Sesto Fiorentino 50019, Italy; National Institute of Optics, National Research Council, Sesto Fiorentino 50019, Italy
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Imaging Developmental and Interventional Plasticity Following Perinatal Stroke. Can J Neurol Sci 2020; 48:157-171. [DOI: 10.1017/cjn.2020.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT:Perinatal stroke occurs around the time of birth and leads to lifelong neurological disabilities including hemiparetic cerebral palsy. Magnetic resonance imaging (MRI) has revolutionized our understanding of developmental neuroplasticity following early injury, quantifying volumetric, structural, functional, and metabolic compensatory changes after perinatal stroke. Such techniques can also be used to investigate how the brain responds to treatment (interventional neuroplasticity). Here, we review the current state of knowledge of how established and emerging neuroimaging modalities are informing neuroplasticity models in children with perinatal stroke. Specifically, we review structural imaging characterizing lesion characteristics and volumetrics, diffusion tensor imaging investigating white matter tracts and networks, task-based functional MRI for localizing function, resting state functional imaging for characterizing functional connectomes, and spectroscopy examining neurometabolic changes. Key challenges and exciting avenues for future investigations are also considered.
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10
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Mann J. The medical avatar and its role in neurorehabilitation and neuroplasticity: A review. NeuroRehabilitation 2020; 46:467-482. [PMID: 32508340 DOI: 10.3233/nre-203063] [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 One of the most interesting emerging medical devices is the medical avatar - a digital representation of the patient that can be used toward myriad ends, the full potential of which remains to be explored. Medical avatars have been instantiated as telemedical tools used to establish a representation of the patient in tele-space, upon which data about the patient's health can be represented and goals and progress can be visually tracked. Manipulation of the medical avatar has also been explored as a means of increasing motivation and inducing neural plasticity. OBJECTIVE The article reviews the literature on body representation, simulation, and action-observation and explores how these components of neurorehabilitation are engaged by an avatar-based self-representation. METHODS Through a review of the literature on body representation, simulation, and action-observation and a review of how these components of neurorehabilitation can be engaged and manipulated with an avatar, the neuroplastic potential of the medical avatar is explored. Literature on the use of the medical avatar for neurorehabilitation is also reviewed. RESULTS This review demonstrates that the medical avatar has vast potentialities in neurorehabilitation and that further research on its use and effect is needed.
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Affiliation(s)
- Jessie Mann
- Virginia Tech Carilion Fralin Biomedical Research Institute, 2 Riverside Cr., Roanoke, VA 24016, USA. Tel.: + 1-201-423-3434; E-mail:
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11
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Smedes F, Giacometti da Silva L. Motor learning with the PNF-concept, an alternative to constrained induced movement therapy in a patient after a stroke; a case report. J Bodyw Mov Ther 2019; 23:622-627. [DOI: 10.1016/j.jbmt.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/12/2018] [Accepted: 05/26/2018] [Indexed: 11/28/2022]
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12
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Brown KE, Neva JL, Feldman SJ, Staines WR, Boyd LA. Sensorimotor integration in chronic stroke: Baseline differences and response to sensory training. Restor Neurol Neurosci 2018. [PMID: 29526859 DOI: 10.3233/rnn-170790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The integration of somatosensory information from the environment into the motor cortex to inform movement is essential for motor function. As motor deficits commonly persist into the chronic phase of stroke recovery, it is important to understand potential contributing factors to these deficits, as well as their relationship with motor function. To date the impact of chronic stroke on sensorimotor integration has not been thoroughly investigated. OBJECTIVES The current study aimed to comprehensively examine the influence of chronic stroke on sensorimotor integration, and determine whether sensorimotor integration can be modified with an intervention. Further, it determined the relationship between neurophysiological measures of sensorimotor integration and motor deficits post-stroke. METHODS Fourteen individuals with chronic stroke and twelve older healthy controls participated. Motor impairment and function were quantified in individuals with chronic stroke. Baseline neurophysiology was assessed using nerve-based measures (short- and long-latency afferent inhibition, afferent facilitation) and vibration-based measures of sensorimotor integration, which paired vibration with single and paired-pulse TMS techniques. Neurophysiological assessment was performed before and after a vibration-based sensory training paradigm to assess changes within these circuits. RESULTS Vibration-based, but not nerve-based measures of sensorimotor integration were different in individuals with chronic stroke, as compared to older healthy controls, suggesting that stroke differentially impacts integration of specific types of somatosensory information. Sensorimotor integration was behaviourally relevant in that it related to both motor function and impairment post-stroke. Finally, sensory training modulated sensorimotor integration in individuals with chronic stroke and controls. CONCLUSION Sensorimotor integration is differentially impacted by chronic stroke based on the type of afferent feedback. However, both nerve-based and vibration-based measures relate to motor impairment and function in individuals with chronic stroke.
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Affiliation(s)
- Katlyn E Brown
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jason L Neva
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samantha J Feldman
- Graduate Program in Neuroscience, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - W Richard Staines
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lara A Boyd
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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13
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Carvalho R, Azevedo E, Marques P, Dias N, Cerqueira JJ. Physiotherapy based on problem-solving in upper limb function and neuroplasticity in chronic stroke patients: A case series. J Eval Clin Pract 2018; 24:552-560. [PMID: 29691951 DOI: 10.1111/jep.12921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 12/13/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Upper limb recovery is one of the main concerns of stroke neurorehabilitation. Neuroplasticity might underlie such recovery, particularly in the chronic phase. The purpose of this study was to assess the effect of physiotherapy based on problem-solving in recovering arm function in chronic stroke patients and explore its neuroplastic changes. METHODS A small sample research design with a n of 3 using a pre-post test design was carried out. Neuroplasticity and function were assessed by using functional magnetic resonance imaging (during motor imagery and performance), action research arm test, motor assessment scale, and Fugl-Meyer assessment scale, at 3 sequential time periods: baseline(m0-before a 4-week period without physiotherapy), pre-treatment(m1), and post-treatment(m2). Minimal clinical important differences and a recovery score were assessed. Assessors were blinded to moment assignment. Patients1 underwent physiotherapy sessions, 50 minutes, 5 days/week for 4 weeks. Four control subjects served as a reference for functional magnetic resonance imaging changes. RESULTS All patients recovered more than 20% after intervention. Stroke patients had similar increased areas as healthy subjects during motor execution but not during imagination at baseline. Consequently, all patients increased activity in the contralateral precentral area after intervention. CONCLUSIONS This study indicates that 4 weeks of physiotherapy promoted the recovery of arm function and neuroplasticity in all chronic stroke patients. Future research is recommended to determine the efficacy of this therapy.
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Affiliation(s)
- Raquel Carvalho
- Department of Physical Therapy, CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal
| | - Elsa Azevedo
- Department of Neurology, Hospital São João and Faculty of Medicine of University of Porto, Portugal
| | - Paulo Marques
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno Dias
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,DIGARC, Polytechnic Institute of Cavado and Ave, Barcelos, Portugal
| | - João José Cerqueira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Jeffers MS, Corbett D. Synergistic Effects of Enriched Environment and Task-Specific Reach Training on Poststroke Recovery of Motor Function. Stroke 2018; 49:1496-1503. [PMID: 29752347 DOI: 10.1161/strokeaha.118.020814] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/09/2018] [Accepted: 04/17/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Reach training in concert with environmental enrichment provides functional benefits after experimental stroke in rats. The present study extended these findings by assessing whether intensive task-specific reach training or enrichment initiated alone would provide similar functional benefit. Additionally, we investigated whether the 70% recovery rule, or a combined model of initial poststroke impairment, cortical infarct volume, and rehabilitation intensity, could predict recovery in the single-pellet task, as previously found for the Montoya staircase. METHODS Rats were trained on single-pellet reaching before middle cerebral artery occlusion via intracerebral injection of ET-1 (endothelin-1). There were 4 experimental groups: stroke+enrichment, stroke+reaching, stroke+enrichment+reaching, and sham+enrichment+reaching. Reaching rehabilitation utilized a modified Whishaw box that encouraged impaired forelimb reaching for 6 hours per day, 5 days per week, for 4 weeks. All treatment paradigms began 7 days after ischemia with weekly assessment on the single-pellet task during rehabilitation and again 4 weeks after rehabilitation concluded. RESULTS Rats exposed to the combination of enrichment and reaching showed the greatest improvement in pellet retrieval and comparable performance to shams after 3 weeks of treatment, whereas those groups that received a monotherapy remained significantly impaired at all time points. Initial impairment alone did not significantly predict recovery in single-pellet as the 70% rule would suggest; however, a combined model of cortical infarct volume and rehabilitation intensity predicted change in pellet retrieval on the single-pellet task with the same accuracy as previously shown with the staircase, demonstrating the generalizability of this model across reaching tasks. CONCLUSIONS Task-specific reach training and environmental enrichment have synergistic effects in rats that persist long after rehabilitation ends, and this recovery is predicted by infarct volume and rehabilitation intensity.
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Affiliation(s)
- Matthew Strider Jeffers
- From the Department of Cellular and Molecular Medicine, University of Ottawa, Canada (M.S.J., D.C.)
| | - Dale Corbett
- From the Department of Cellular and Molecular Medicine, University of Ottawa, Canada (M.S.J., D.C.) .,Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada (D.C.)
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Biomarkers of Rehabilitation Therapy Vary according to Stroke Severity. Neural Plast 2018; 2018:9867196. [PMID: 29721009 PMCID: PMC5867600 DOI: 10.1155/2018/9867196] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 11/28/2022] Open
Abstract
Biomarkers that capture treatment effects could improve the precision of clinical decision making for restorative therapies. We examined the performance of candidate structural, functional, and angiogenesis-related MRI biomarkers before and after a 3-week course of standardized robotic therapy in 18 patients with chronic stroke and hypothesized that results vary significantly according to stroke severity. Patients were 4.1 ± 1 months poststroke, with baseline arm Fugl-Meyer scores of 20–60. When all patients were examined together, no imaging measure changed over time in a manner that correlated with treatment-induced motor gains. However, when also considering the interaction with baseline motor status, treatment-induced motor gains were significantly related to change in three functional connectivity measures: ipsilesional motor cortex connectivity with (1) contralesional motor cortex (p = 0.003), (2) contralesional dorsal premotor cortex (p = 0.005), and (3) ipsilesional dorsal premotor cortex (p = 0.004). In more impaired patients, larger treatment gains were associated with greater increases in functional connectivity, whereas in less impaired patients larger treatment gains were associated with greater decreases in functional connectivity. Functional connectivity measures performed best as biomarkers of treatment effects after stroke. The relationship between changes in functional connectivity and treatment gains varied according to baseline stroke severity. Biomarkers of restorative therapy effects are not one-size-fits-all after stroke.
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Interhemispheric Pathways Are Important for Motor Outcome in Individuals with Chronic and Severe Upper Limb Impairment Post Stroke. Neural Plast 2017; 2017:4281532. [PMID: 29348943 PMCID: PMC5733869 DOI: 10.1155/2017/4281532] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/27/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background Severity of arm impairment alone does not explain motor outcomes in people with severe impairment post stroke. Objective Define the contribution of brain biomarkers to upper limb motor outcomes in people with severe arm impairment post stroke. Methods Paretic arm impairment (Fugl-Meyer upper limb, FM-UL) and function (Wolf Motor Function Test rate, WMFT-rate) were measured in 15 individuals with severe (FM-UL ≤ 30/66) and 14 with mild–moderate (FM-UL > 40/66) impairment. Transcranial magnetic stimulation and diffusion weight imaging indexed structure and function of the corticospinal tract and corpus callosum. Separate models of the relationship between possible biomarkers and motor outcomes at a single chronic (≥6 months) time point post stroke were performed. Results Age (ΔR20.365, p = 0.017) and ipsilesional-transcallosal inhibition (ΔR20.182, p = 0.048) explained a 54.7% (p = 0.009) variance in paretic WMFT-rate. Prefrontal corpus callous fractional anisotropy (PF-CC FA) alone explained 49.3% (p = 0.007) variance in FM-UL outcome. The same models did not explain significant variance in mild–moderate stroke. In the severe group, k-means cluster analysis of PF-CC FA distinguished two subgroups, separated by a clinically meaningful and significant difference in motor impairment (p = 0.049) and function (p = 0.006) outcomes. Conclusion Corpus callosum function and structure were identified as possible biomarkers of motor outcome in people with chronic and severe arm impairment.
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Abstract
Stroke instigates a dynamic process of repair and remodelling of remaining neural circuits, and this process is shaped by behavioural experiences. The onset of motor disability simultaneously creates a powerful incentive to develop new, compensatory ways of performing daily activities. Compensatory movement strategies that are developed in response to motor impairments can be a dominant force in shaping post-stroke neural remodelling responses and can have mixed effects on functional outcome. The possibility of selectively harnessing the effects of compensatory behaviour on neural reorganization is still an insufficiently explored route for optimizing functional outcome after stroke.
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Affiliation(s)
- Theresa A Jones
- Department of Psychology and Institute for Neuroscience, University of Texas at Austin, Texas 78712, USA
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Kirton A. Advancing non-invasive neuromodulation clinical trials in children: Lessons from perinatal stroke. Eur J Paediatr Neurol 2017; 21:75-103. [PMID: 27470654 DOI: 10.1016/j.ejpn.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 12/18/2022]
Abstract
Applications of non-invasive brain stimulation including therapeutic neuromodulation are expanding at an alarming rate. Increasingly established scientific principles, including directional modulation of well-informed cortical targets, are advancing clinical trial development. However, high levels of disease burden coupled with zealous enthusiasm may be getting ahead of rational research and evidence. Experience is limited in the developing brain where additional issues must be considered. Properly designed and meticulously executed clinical trials are essential and required to advance and optimize the potential of non-invasive neuromodulation without risking the well-being of children and families. Perinatal stroke causes most hemiplegic cerebral palsy and, as a focal injury of defined timing in an otherwise healthy brain, is an ideal human model of developmental plasticity. Advanced models of how the motor systems of young brains develop following early stroke are affording novel windows of opportunity for neuromodulation clinical trials, possibly directing neuroplasticity toward better outcomes. Reviewing the principles of clinical trial design relevant to neuromodulation and using perinatal stroke as a model, this article reviews the current and future issues of advancing such trials in children.
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Affiliation(s)
- Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, 2888 Shaganappi Trail NW, Calgary, AB T3B6A8, Canada.
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Are we armed with the right data? Pooled individual data review of biomarkers in people with severe upper limb impairment after stroke. NEUROIMAGE-CLINICAL 2016; 13:310-319. [PMID: 28053857 PMCID: PMC5198729 DOI: 10.1016/j.nicl.2016.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 01/11/2023]
Abstract
To build an understanding of the neurobiology underpinning arm recovery in people with severe arm impairment due to stroke, we conducted a pooled individual data systematic review to: 1) characterize brain biomarkers; 2) determine relationship(s) between biomarkers and motor outcome; and 3) establish relationship(s) between biomarkers and motor recovery. Three electronic databases were searched up to October 2, 2015. Eligible studies included adults with severe arm impairment after stroke. Descriptive statistics were calculated to characterize brain biomarkers, and pooling of individual patient data was performed using mixed-effects linear regression to examine relationships between brain biomarkers and motor outcome and recovery. Thirty-eight articles including individual data from 372 people with severe arm impairment were analysed. The majority of individuals were in the chronic (> 6 months) phase post stroke (51%) and had a subcortical stroke (49%). The presence of a motor evoked potential (indexed by transcranial magnetic stimulation) was the only biomarker related to better motor outcome (p = 0.02). There was no relationship between motor outcome and stroke volume (cm3), location (cortical, subcortical, mixed) or side (left vs. right), and corticospinal tract asymmetry index (extracted from diffusion weighted imaging). Only one study had longitudinal data, thus no data pooling was possible to address change over time (preventing our third objective). Based on the available evidence, motor evoked potentials at rest were the only biomarker that predicted motor outcome in individuals with severe arm impairment following stroke. Given that few biomarkers emerged, this review highlights the need to move beyond currently known biomarkers and identify new indices with sufficient variability and sensitivity to guide recovery models in individuals with severe motor impairments following stroke. PROSPERO CRD42015026107.
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Mazerolle EL, Ma Y, Sinclair D, Pike GB. Impact of abnormal cerebrovascular reactivity on BOLD fMRI: a preliminary investigation of moyamoya disease. Clin Physiol Funct Imaging 2016; 38:87-92. [PMID: 27572110 PMCID: PMC5763346 DOI: 10.1111/cpf.12387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/26/2016] [Indexed: 02/02/2023]
Abstract
Blood oxygen level‐dependent (BOLD) functional magnetic resonance imaging (fMRI) studies of patients with cerebrovascular disease have largely ignored the confounds associated with abnormal cerebral blood flow, vascular reactivity and neurovascular coupling. We studied BOLD fMRI activation and cerebrovascular reactivity in moyamoya disease. To characterize the impact of remote vascular demands on BOLD fMRI measurements, we varied the vascular territories engaged by manipulating the experimental task performed by the participants. Vascular territories affected by disease were identified using BOLD cerebrovascular reactivity. Preliminary evidence from two patients pre‐ and postrevascularization surgery and four controls indicates that neurovascular coupling in affected brain regions can be modulated by the task‐related vascular demands in unaffected regions. In one patient studied, we observed that brain regions with improved cerebrovascular reactivity after surgery demonstrated normalized neurovascular coupling, that is the degree to which neurovascular coupling was modulated by task‐related vascular demands was decreased. We propose that variations in task‐dependent neurovascular coupling in patients with moyamoya disease are likely related to vascular steal. While preliminary, our findings are a proof of concept of the limitations of BOLD fMRI in cerebrovascular disease and suggest a role for assessment of cerebrovascular reactivity to improve interpretation of task‐related BOLD fMRI activation.
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Affiliation(s)
- Erin L Mazerolle
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Yuhan Ma
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - David Sinclair
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - G Bruce Pike
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Biomedical Engineering, McGill University, Montreal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Carey LM, Seitz RJ. Functional Neuroimaging in Stroke Recovery and Neurorehabilitation: Conceptual Issues and Perspectives. Int J Stroke 2016; 2:245-64. [DOI: 10.1111/j.1747-4949.2007.00164.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background In stroke, functional neuroimaging has become a potent diagnostic tool; opened new insights into the pathophysiology of ischaemic damage in the human brain; and made possible the assessment of functional–structural relationships in postlesion recovery. Summary of review Here, we give a critical account on the potential and limitation of functional neuroimaging and discuss concepts related to the use of neuroimaging for exploring the neurobiological and neuroanatomical mechanisms of poststroke recovery and neurorehabilitation. We identify and provide evidence for five hypotheses that functional neuroimaging can provide new insights into: adaptation occurs at the level of functional brain systems; the brain–behaviour relationship varies with recovery and over time; functional neuroimaging can improve our ability to predict recovery and select individuals for rehabilitation; mechanisms of recovery reflect different pathophysiological phases; and brain adaptation may be modulated by experience and specific rehabilitation. The significance and application of this new evidence is discussed, and recommendations made for investigations in the field. Conclusion Functional neuroimaging is an important tool to explore the mechanisms underlying brain plasticity and, thereby, to guide clinical research in neurorehabilitation.
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Affiliation(s)
- Leeanne M. Carey
- National Stroke Research Institute, Neurosciences Building, Heidelberg Heights, Vic., Australia
- School of Occupational Therapy, LaTrobe University, Bundoora, Vic., Australia
| | - Rüdiger J. Seitz
- National Stroke Research Institute, Neurosciences Building, Heidelberg Heights, Vic., Australia
- Institute of Advanced Study, La Trobe University, Bundoora, Vic., Australia
- Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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22
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Carey LM, Abbott DF, Lamp G, Puce A, Seitz RJ, Donnan GA. Same Intervention-Different Reorganization: The Impact of Lesion Location on Training-Facilitated Somatosensory Recovery After Stroke. Neurorehabil Neural Repair 2016; 30:988-1000. [PMID: 27325624 DOI: 10.1177/1545968316653836] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The brain may reorganize to optimize stroke recovery. Yet relatively little is known about neural correlates of training-facilitated recovery, particularly after loss of body sensations. OBJECTIVE Our aim was to characterize changes in brain activation following clinically effective touch discrimination training in stroke patients with somatosensory loss after lesions of primary/secondary somatosensory cortices or thalamic/capsular somatosensory regions using functional magnetic resonance imaging (fMRI). METHODS Eleven stroke patients with somatosensory loss, 7 with lesions involving primary (S1) and/or secondary (S2) somatosensory cortex (4 male, 58.7 ± 13.3 years) and 4 with lesions primarily involving somatosensory thalamus and/or capsular/white matter regions (2 male, 58 ± 8.6 years) were studied. Clinical and MRI testing occurred at 6 months poststroke (preintervention), and following 15 sessions of clinically effective touch discrimination training (postintervention). RESULTS Improved touch discrimination of a magnitude similar to previous clinical studies and approaching normal range was found. Patients with thalamic/capsular somatosensory lesions activated preintervention in left ipsilesional supramarginal gyrus, and postintervention in ipsilesional insula and supramarginal gyrus. In contrast, those with S1/S2 lesions did not show common activation preintervention, only deactivation in contralesional superior parietal lobe, including S1, and cingulate cortex postintervention. The S1/S2 group did, however, show significant change over time involving ipsilesional precuneus. This change was greater than for the thalamic/capsular group (P = .012; d = -2.43; CI = -0.67 to -3.76). CONCLUSION Different patterns of change in activation are evident following touch discrimination training with thalamic/capsular lesions compared with S1/S2 cortical somatosensory lesions, despite common training and similar improvement.
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Affiliation(s)
- Leeanne M Carey
- La Trobe University, Bundoora, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David F Abbott
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gemma Lamp
- La Trobe University, Bundoora, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aina Puce
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia Indiana University, Bloomington, IN, USA
| | - Rüdiger J Seitz
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia LVR-Klinikum Düsseldorf, Düsseldorf, Germany University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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Julkunen P, Määttä S, Säisänen L, Kallioniemi E, Könönen M, Jäkälä P, Vanninen R, Vaalto S. Functional and structural cortical characteristics after restricted focal motor cortical infarction evaluated at chronic stage - Indications from a preliminary study. Clin Neurophysiol 2016; 127:2775-2784. [PMID: 27417053 DOI: 10.1016/j.clinph.2016.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 05/04/2016] [Accepted: 05/10/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess the inter-hemispheric differences in neuronal function and structure of the motor cortex in a small group of chronic stroke patients having suffered a restricted ischemic lesion affecting hand motor representation. GABAergic intracortical inhibition, known to be affected by stroke lesion, was also investigated. METHODS Eight patients exhibiting little or no motor impairment were studied using transcranial magnetic stimulation (TMS) and diffusion weighted imaging (DWI) >15months from diagnosis. Resting motor threshold (MT) for 50μV and 2mV motor evoked potentials, and short-interval intracortical inhibition (SICI) were measured from hand muscles. Apparent diffusion coefficients (ADCs) were analyzed from the DWI for the primary motor cortex (M1), the supplementary motor area (SMA) and thalamus for reflecting changes in neuronal organization. RESULTS The MTs did not differ between the affected (AH) and unaffected hemisphere (UH) in 50μV responses, while the MTs for 2mV responses were higher (p=0.018) in AH. SICI was weakened in AH (p=0.008). ADCs were higher in the affected M1 compared to the unaffected M1 (p=0.018) while there were no inter-hemispheric differences in SMA or thalamus. CONCLUSIONS Inter-hemispheric asymmetry and neuronal organization demonstrated abnormalities in the M1. However, no confident inference can be made whether the observed alterations in neurophysiological and imaging measures have causal role for motor rehabilitation in these patients. SIGNIFICANCE Neurophysiological changes persist and are detectable using TMS years after stroke even though clinical symptoms have normalized.
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Affiliation(s)
- Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Sara Määttä
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Neurophysiology, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Laura Säisänen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Neurophysiology, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Elisa Kallioniemi
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Jäkälä
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland; Department of Neurology, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Radiology, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Selja Vaalto
- Department of Clinical Neurophysiology, Helsinki University Hospital, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
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Inhibitory and excitatory motor cortex dysfunction persists in the chronic poststroke recovery phase. J Clin Neurophysiol 2016; 32:251-6. [PMID: 25350636 DOI: 10.1097/wnp.0000000000000143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To establish differences in intracortical facilitation (ICF) and intracortical inhibition (ICI) between survivors of stroke and healthy individuals. METHODS Fourteen chronic stroke survivors and 19 healthy subjects were investigated using single- and paired-pulse transcranial magnetic stimulation. Transcranial magnetic stimulation was applied over the motor cortex in the lesioned (stroke survivors) or left (healthy subjects) hemisphere. Motor evoked potentials were collected from the contralateral first dorsal interosseus. Subjects received 40 pseudo-randomized trials consisting of 10 trials for each: conditioning stimulus, test stimulus, ICF, and ICI. Between the groups, we compared motor evoked potential amplitudes for test stimulus, ICF, and ICI, motor threshold, and ICF/ICI ratio. RESULTS Compared with healthy individuals, the stroke group exhibited higher motor threshold and lower ICI; the difference ICF neared significance. The ICF/ICI ratio was significantly lower in the stroke group and close to 1, indicating little difference between ICF and ICI responses. These differences demonstrate that motor cortex excitatory and inhibitory mechanisms are impaired for individuals in the chronic poststroke recovery phase. CONCLUSIONS Compared with healthy individuals, both global and intracortical transcranial magnetic stimulation measures reveal reduced motor cortex excitability in survivors of stroke. Interventions that normalize motor cortex excitability may promote better neurophysiological conditions for motor recovery to occur.
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25
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Furlan L, Conforto AB, Cohen LG, Sterr A. Upper Limb Immobilisation: A Neural Plasticity Model with Relevance to Poststroke Motor Rehabilitation. Neural Plast 2015; 2016:8176217. [PMID: 26843992 PMCID: PMC4710952 DOI: 10.1155/2016/8176217] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 11/26/2022] Open
Abstract
Advances in our understanding of the neural plasticity that occurs after hemiparetic stroke have contributed to the formulation of theories of poststroke motor recovery. These theories, in turn, have underpinned contemporary motor rehabilitation strategies for treating motor deficits after stroke, such as upper limb hemiparesis. However, a relative drawback has been that, in general, these strategies are most compatible with the recovery profiles of relatively high-functioning stroke survivors and therefore do not easily translate into benefit to those individuals sustaining low-functioning upper limb hemiparesis, who otherwise have poorer residual function. For these individuals, alternative motor rehabilitation strategies are currently needed. In this paper, we will review upper limb immobilisation studies that have been conducted with healthy adult humans and animals. Then, we will discuss how the findings from these studies could inspire the creation of a neural plasticity model that is likely to be of particular relevance to the context of motor rehabilitation after stroke. For instance, as will be elaborated, such model could contribute to the development of alternative motor rehabilitation strategies for treating poststroke upper limb hemiparesis. The implications of the findings from those immobilisation studies for contemporary motor rehabilitation strategies will also be discussed and perspectives for future research in this arena will be provided as well.
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Affiliation(s)
- Leonardo Furlan
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Adriana Bastos Conforto
- Neurology Clinical Division, Clinics Hospital, São Paulo University, Avenida Dr. Enéas C. Aguiar 255/5084, 05403-010 São Paulo, SP, Brazil
- Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, 05601-901 São Paulo, SP, Brazil
| | - Leonardo G. Cohen
- Human Cortical Physiology and Stroke Rehabilitation Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Building 10, Room 7D54, Bethesda, MD 20892, USA
| | - Annette Sterr
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
- Neurology Clinical Division, Clinics Hospital, São Paulo University, Avenida Dr. Enéas C. Aguiar 255/5084, 05403-010 São Paulo, SP, Brazil
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26
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Zhang Z, Fang Q, Gu X. Objective Assessment of Upper-Limb Mobility for Poststroke Rehabilitation. IEEE Trans Biomed Eng 2015; 63:859-68. [PMID: 26357394 DOI: 10.1109/tbme.2015.2477095] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The assessment of the limb mobility of stroke patients is an essential part of poststroke rehabilitation. Conventionally, the assessment is manually performed by clinicians using chart-based ordinal scales, which can be subjective and inefficient. By introducing quantitative evaluation measures, the sensitivity and efficiency of the assessment process can be significantly improved. In this paper, a novel single-index-based assessment approach for quantitative upper-limb mobility evaluation has been proposed for poststroke rehabilitation. Instead of the traditional human-observation-based measures, the proposed assessment system utilizes the kinematic information automatically collected during a regular rehabilitation training exercise using a wearable inertial measurement unit. By calculating a single index, the system can efficiently generate objective and consistent quantitative results that can reflect the stroke patient's upper-limb mobility. In order to verify and validate the proposed assessment system, experiments have been conducted using 145 motion samples collected from 21 stroke patients (12 males, nine females, mean age 58.7±19.3) and eight healthy participants. The results have suggested that the proposed assessment index can not only differentiate the levels of limb function impairment clearly (p < 0.001, two-tailed Welch's t-test), but also strongly correlate with the Brunnstrom stages of recovery (r = 0.86, p < 0.001). The assessment index is also proven to have great potential in automatic Brunnstrom stage classification application with an 82.1% classification accuracy, while using a K-nearest-neighbor classifier.
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27
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Comani S, Velluto L, Schinaia L, Cerroni G, Serio A, Buzzelli S, Sorbi S, Guarnieri B. Monitoring Neuro-Motor Recovery From Stroke With High-Resolution EEG, Robotics and Virtual Reality: A Proof of Concept. IEEE Trans Neural Syst Rehabil Eng 2015; 23:1106-16. [PMID: 25910194 DOI: 10.1109/tnsre.2015.2425474] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A novel system for the neuro-motor rehabilitation of upper limbs was validated in three sub-acute post-stroke patients. The system permits synchronized cortical and kinematic measures by integrating high-resolution EEG, passive robotic device and Virtual Reality. The brain functional re-organization was monitored in association with motor patterns replicating activities of daily living (ADL). Patients underwent 13 rehabilitation sessions. At sessions 1, 7 and 13, clinical tests were administered to assess the level of motor impairment, and EEG was recorded during rehabilitation task execution. For each session and rehabilitation task, four kinematic indices of motor performance were calculated and compared with the outcome of clinical tests. Functional source maps were obtained from EEG data and projected on the real patients' anatomy (MRI data). Laterality indices were calculated for hemispheric dominance assessment. All patients showed increased participation in the rehabilitation process. Cortical activation changes during recovery were detected in relation to different motor patterns, hence verifying the system's suitability to add quantitative measures of motor performance and neural recovery to classical tests. We conclude that this system seems a promising tool for novel robot-based rehabilitation paradigms tailored to individual needs and neuro-motor responses of the patients.
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Sangani S, Lamontagne A, Fung J. Cortical mechanisms underlying sensorimotor enhancement promoted by walking with haptic inputs in a virtual environment. SENSORIMOTOR REHABILITATION - AT THE CROSSROADS OF BASIC AND CLINICAL SCIENCES 2015; 218:313-30. [DOI: 10.1016/bs.pbr.2014.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Hubbard IJ, Carey LM, Budd TW, Parsons MW. Reorganizing therapy: changing the clinical approach to upper limb recovery post-stroke. Occup Ther Int 2014; 22:28-35. [PMID: 25327458 DOI: 10.1002/oti.1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/14/2014] [Accepted: 09/05/2014] [Indexed: 11/06/2022] Open
Abstract
Stroke is the leading cause of adult disability, and as a consequence, most therapists will provide health care to patients with stroke during their professional careers. An increasing number of studies are investigating the association between upper limb recovery and changes in brain activation patterns following stroke. In this review, we explore the translational implications of this research for health professionals working in stroke recovery. We argue that in light of the most recent evidence, therapists should consider how best to take full advantage of the brain's natural ability to reorganize, when prescribing and applying interventions to those with a stroke-affected upper limb. The authors propose that stroke is a brain-based problem that needs a brain-based solution. This review addresses two topics, anticipating recovery and maximizing recovery. It proposes five practice-ready recommendations that are based on the evidence reviewed. The over-riding aim of this review and discussion is to challenge therapists to reconsider the health care they prescribe and apply to people with a stroke-affected upper limb.
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Affiliation(s)
- Isobel J Hubbard
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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30
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Burke E, Dodakian L, See J, McKenzie A, Riley JD, Le V, Cramer SC. A multimodal approach to understanding motor impairment and disability after stroke. J Neurol 2014; 261:1178-86. [PMID: 24728337 DOI: 10.1007/s00415-014-7341-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 01/20/2023]
Abstract
Many different measures have been found to be related to behavioral outcome after stroke. Preclinical studies emphasize the importance of brain injury and neural function. However, the measures most important to human outcomes remain uncertain, in part because studies often examine one measure at a time or enroll only mildly impaired patients. The current study addressed this by performing multimodal evaluation in a heterogeneous population. Patients (n = 36) with stable arm paresis 3-6 months post-stroke were assessed across 6 categories of measures related to stroke outcome: demographics/medical history, cognitive/mood status, genetics, neurophysiology, brain injury, and cortical function. Multivariate modeling identified measures independently related to an impairment-based outcome (arm Fugl-Meyer motor score). Analyses were repeated (1) identifying measures related to disability (modified Rankin Scale score), describing independence in daily functions and (2) using only patients with mild deficits. Across patients, greater impairment was related to measures of injury (reduced corticospinal tract integrity) and neurophysiology (absence of motor evoked potential). In contrast, (1) greater disability was related to greater injury and poorer cognitive status (MMSE score) and (2) among patients with mild deficits, greater impairment was related to cortical function (greater contralesional motor/premotor cortex activation). Impairment after stroke is most related to injury and neurophysiology, consistent with preclinical studies. These relationships vary according to the patient subgroup or the behavioral endpoint studied. One potential implication of these results is that choice of biomarker or stratifying variable in a clinical stroke study might vary according to patient characteristics.
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Affiliation(s)
- Erin Burke
- Department of Anatomy and Neurobiology, University of California, Irvine, CA, 92697, USA,
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Abstract
Stroke is the largest single cause of severe physical disability and rehabilitation to reduce functional deficits is the most effective treatment. Occupational therapists play a central role in rehabilitation as members of a multidisciplinary team. Occupational therapy is a client-centered profession that uses meaningful activities across the spectrum of physical and mental domains to reduce limitations after stroke. Where remediation is not possible, occupational therapists implement compensatory strategies to promote independence. Rehabilitation is based on the concept of brain plasticity, which implies that it is possible to modulate or facilitate cerebral reorganization by external inputs. Occupational therapy activities are specifically geared to promote this re-education process and encourage the development of lost skills while accommodating for specific physical, cognitive or affective impairments. Principles of motor, sensory, cognitive and affective rehabilitation are incorporated into effective task-specific activities and environments are adapted to create the optimum conditions for successful rehabilitation. Several promising new rehabilitation approaches, based on neuropsychology and technological advances, have been developed to complement therapy inputs and exploit the brain's capacity to recover from stroke.
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Affiliation(s)
- Paran Govender
- Department of Occupational Therapy, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
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32
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Carey LM, Seitz RJ, Parsons M, Levi C, Farquharson S, Tournier JD, Palmer S, Connelly A. Beyond the lesion: neuroimaging foundations for post-stroke recovery. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.13.39] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A shift is emerging in the way in which we view post-stroke recovery. This shift, supported by evidence from neuroimaging studies, encourages us to look beyond the lesion and to identify viable brain networks with capacity for plasticity. In this article, the authors review current advances in neuroimaging techniques and the new insights that they have contributed. The ability to quantify salvageable tissue, evidence of changes in remote networks, changes of functional and structural connectivity, and alterations in cortical thickness are reviewed in the context of their impact on post-stroke recovery. The value of monitoring spared structural connections and functional connectivity of brain networks within and across hemispheres is highlighted.
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Affiliation(s)
- Leeanne M Carey
- Department of Occupational Therapy, La Trobe University, Bundoora, Australia
| | - Rüdiger J Seitz
- Centre of Neurology & Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany
- Department of Neurology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf; Bergische Landstrasse 2, 40629 Düsseldorf, Germany
| | - Mark Parsons
- Stroke Program, Centre for Translational Neuroscience & Mental Health Research, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, Department of Neurology, John Hunter Hospital, Lookout Road, New Lambton, NSW, 2305, Australia
| | - Christopher Levi
- Stroke Program, Centre for Translational Neuroscience & Mental Health Research, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, Department of Neurology, John Hunter Hospital, Lookout Road, New Lambton, NSW, 2305, Australia
| | - Shawna Farquharson
- Imaging Division, The Florey Institute of Neuroscience & Mental Health, Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, 3084, Australia
- Department of Medical Imaging & Radiation Science, Monash University, Melbourne, Australia
| | - Jacques-Donald Tournier
- Imaging Division, The Florey Institute of Neuroscience & Mental Health, Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, 3084, Australia
| | - Susan Palmer
- Neurorehabilitation & Recovery, Stroke Division, The Florey Institute of Neuroscience & Mental Health, University of Melbourne, Melbourne Brain Centre, Austin Campus, 245 Burgundy Street, Heidelberg, Victoria, 3084, Australia
| | - Alan Connelly
- Imaging Division, The Florey Institute of Neuroscience & Mental Health, Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, 3084, Australia
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Pinter D, Pegritz S, Pargfrieder C, Reiter G, Wurm W, Gattringer T, Linderl-Madrutter R, Neuper C, Fazekas F, Grieshofer P, Enzinger C. Exploratory study on the effects of a robotic hand rehabilitation device on changes in grip strength and brain activity after stroke. Top Stroke Rehabil 2013; 20:308-16. [PMID: 23893830 DOI: 10.1310/tsr2004-308] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The brain mechanisms underlying successful recovery of hand fuenction after stroke are still not fully understood, although functional MRI (fMRI) studies underline the importance of neuronal plasticity. METHODS We explored potential changes in brain activity in 7 patients with subacute to chronic stroke (69 ± 8 years) with moderate- to high-grade distal paresis of the upper limb (Motricity Index: 59.4) after standardized robotic finger-hand rehabilitation training, in addition to conventional rehabilitation therapy for 3 weeks. Behavioral and fMRI assessments were carried out before and after training to characterize changes in brain activity and behavior. RESULTS The Motricity Index (pre: 59.4, post: 67.2, P < .05) and grip force (pre: 7.26, post: 11.87, P < .05) of the paretic hand increased significantly after rehabilitation. On fMRI, active movement of the affected (left) hand resulted in contralesional (ie, ipsilateral) activation of the primary sensorimotor cortex prior to rehabilitation. After rehabilitation, activation appeared "normalized," including the ipsilesional primary sensorimotor cortex and supplementary motor area (SMA). No changes and no abnormalities of activation maps were seen during movement of the unaffected hand. Subsequent region-of-interest analyses showed no significant ipsilesional activation increases after rehabilitation. CONCLUSION Despite behavioral improvements, we failed to identify consistent patterns of functional reorganization in our sample. This warrants caution in the use of fMRI as a tool to explore neural plasticity in heterogeneous samples lacking sufficient statistical power.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
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Burke E, Cramer SC. Biomarkers and predictors of restorative therapy effects after stroke. Curr Neurol Neurosci Rep 2013; 13:329. [PMID: 23299824 DOI: 10.1007/s11910-012-0329-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Many restorative therapies that promote brain repair are under development. Stroke is very heterogeneous, highlighting the need to identify target populations and to understand intersubject differences in treatment response. Several neuroimaging measures have shown promise as biomarkers and predictors, including measures of structure and function, in gray matter and white matter. The choice of biomarker and predictor can differ with the content of therapy and with the population under study, for example, contralesional hemisphere measures may be of particular importance in patients with more severe injury. Studies of training effects in healthy subjects provide insights useful to brain repair. Limitations of published studies include a focus on chronic stroke, however the brain is most galvanized to respond to restorative therapies in the early days after stroke. Multimodal approaches might be the most robust approach for stratifying patients and so for optimizing prescription of restorative therapies after stroke.
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Affiliation(s)
- Erin Burke
- Department of Anatomy & Neurobiology, University of California, Irvine, CA, USA
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Woolgar A, Bor D, Duncan J. Global increase in task-related fronto-parietal activity after focal frontal lobe lesion. J Cogn Neurosci 2013; 25:1542-52. [PMID: 23767925 DOI: 10.1162/jocn_a_00432] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A critical question for neuropsychology is how complex brain networks react to damage. Here, we address this question for the well-known executive control or multiple-demand (MD) system, a fronto-parietal network showing increased activity with many different kinds of cognitive demand, including standard tests of fluid intelligence. Using fMRI, we ask how focal frontal lobe damage affects MD activity during a standard fluid intelligence task. Despite poor behavioral performance, frontal patients showed increased fronto-parietal activity relative to controls. The activation difference was not accounted for by difference in IQ. Moreover, rather than specific focus on perilesional or contralesional cortex, additional recruitment was distributed throughout the MD regions and surrounding cortex and included parietal MD regions distant from the injury. The data suggest that, following local frontal lobe damage, there is a global compensatory recruitment of an adaptive and integrated fronto-parietal network.
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Affiliation(s)
- Alexandra Woolgar
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia 2109.
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Kirton A. Modeling developmental plasticity after perinatal stroke: defining central therapeutic targets in cerebral palsy. Pediatr Neurol 2013; 48:81-94. [PMID: 23337000 DOI: 10.1016/j.pediatrneurol.2012.08.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/02/2012] [Indexed: 01/18/2023]
Abstract
Perinatal stroke is presented as the ideal human model of developmental neuroplasticity. The precise timing, mechanisms, and locations of specific perinatal stroke diseases provide common examples of well defined, focal, perinatal brain injuries. Motor disability (hemiparetic cerebral palsy) constitutes the primary adverse outcome and the focus of models explaining how motor systems develop in health and after early injury. Combining basic science animal work with human applied technology (functional magnetic resonance imaging, diffusion tensor imaging, and transcranial magnetic stimulation), a model of plastic motor development after perinatal stroke is presented. Potential central therapeutic targets are revealed. The means to measure and modulate these targets, including evidence-based rehabilitation therapies and noninvasive brain stimulation, are suggested. Implications for clinical trials and future directions are discussed.
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Affiliation(s)
- Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital Research Institute, and Section of Neurology, Department of Pediatrics and Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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Sharma N, Classen J, Cohen LG. Neural plasticity and its contribution to functional recovery. HANDBOOK OF CLINICAL NEUROLOGY 2013; 110:3-12. [PMID: 23312626 DOI: 10.1016/b978-0-444-52901-5.00001-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
In this chapter we address the phenomena of neural plasticity, operationally defined as the ability of the central nervous system to adapt in response to changes in the environment or lesions. At the cellular level, we discuss basic changes in membrane excitability, synaptic plasticity as well as structural changes in dendritic and axonal anatomy that support behavioral expressions of plasticity and functional recovery. We consider the different levels at which these changes can occur and possible links with modification of cognitive strategies, recruitment of new/different neural networks, or changes in strength of such connections or specific brain areas in charge of carrying out a particular task (i.e., movement, language, vision, hearing). The study of neuroplasticity has wide-reaching implications for understanding reorganization of action and cognition in the healthy and lesioned brain.
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Affiliation(s)
- Nikhil Sharma
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
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The Neurorehabilitation Training Toolkit (NTT): A Novel Worldwide Accessible Motor Training Approach for At-Home Rehabilitation after Stroke. Stroke Res Treat 2012; 2012:802157. [PMID: 22619741 PMCID: PMC3350995 DOI: 10.1155/2012/802157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 02/06/2012] [Accepted: 02/13/2012] [Indexed: 01/19/2023] Open
Abstract
After stroke, enduring rehabilitation is required for maximum recovery, and ideally throughout life to prevent functional deterioration. Hence we developed a new concept for at-home low-cost motor rehabilitation, the NTT, an Internet-based interactive system for upper-limb rehabilitation. In this paper we present the NTT design concepts, its implementation and a proof of concept study with 10 healthy participants. The NTT brings together concepts of optimal learning, engagement, and storytelling to deliver a personalized training to its users. In this study we evaluate the feasibility of NTT as a tool capable of automatically assessing and adapting to its user. This is achieved by means of a psychometric study where we show that the NTT is able to assess movement kinematics-movement smoothness, range of motion, arm displacement and arm coordination-in healthy users. Subsequently, a modeling approach is presented to understand how the measured movement kinematics relate to training parameters, and how these can be modified to adapt the training to meet the needs of patients. Finally, an adaptive algorithm for the personalization of training considering motivational and performance aspects is proposed. In the next phase we will deploy and evaluate the NTT with stroke patients at their homes.
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Page SJ, Schmid A, Harris JE. Optimizing terminology for stroke motor rehabilitation: recommendations from the American Congress of Rehabilitation Medicine Stroke Movement Interventions Subcommittee. Arch Phys Med Rehabil 2012; 93:1395-9. [PMID: 22446292 DOI: 10.1016/j.apmr.2012.03.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/02/2012] [Accepted: 03/09/2012] [Indexed: 11/16/2022]
Abstract
As knowledge and interest in stroke motor rehabilitation continue to increase, consistent terminologies that are specific to this discipline must be established. Such language is critical to effective rehabilitative team communication, and is important to facilitating communication among the diverse groups interested in the science and practice of stroke motor rehabilitation. The purpose of this article is to provide operational definitions for 3 concepts that are common-and commonly mislabeled-attributes of stroke motor rehabilitation interventions: intensity, duration, and frequency. In developing these guidelines, conceptual frameworks used in the pharmaceutical, exercise, and rehabilitative therapy realms were used. Implications of these definitions for research and clinical practice are also discussed.
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Affiliation(s)
- Stephen J Page
- School of Allied Medical Professions, and the Neuromotor Recovery and Rehabilitation Laboratory (the RehabLab) at the School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University Medical Center, Columbus, OH 43210, USA.
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Rosen BR, Savoy RL. fMRI at 20: has it changed the world? Neuroimage 2012; 62:1316-24. [PMID: 22433659 DOI: 10.1016/j.neuroimage.2012.03.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/28/2012] [Accepted: 03/01/2012] [Indexed: 12/15/2022] Open
Abstract
The prevalence of fMRI in cognitive neuroscience research is clear, but the overall impact of the associated research in the broader scope of our scientific community, and of society, is less obvious. The first reports of fMRI garnered huge interest in many areas, giving rise to a wide range of applications and technical developments over the past 20 years. Using five primary areas, i.e. scientific impact, clinical practice, cognitive neuroscience, mental illness, and society-this essay examines the question: Has fMRI changed the world?
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Affiliation(s)
- Bruce R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.
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Abstract
The prospects for stem cell-derived therapy in stroke look promising, with a myriad of cell therapy products developed from brain, blood, bone marrow, and adipose tissue in early clinical development. Eight clinical trials have now reported final results, and several are currently registered recruiting patients or pending to start. Products passing the safety hurdle are recruiting patients for large efficacy studies. Besides identifying the most appropriate cell type, other issues to resolve include optimal timing for intervention, optimal delivery route, cell dose, patient selection, relevant clinical endpoints, and monitoring for effectiveness, to advance cell therapy through the hurdles of clinical research. In this chapter, we present the products and strategies used in the current cell therapy trials in ischemic stroke, provide an update on relevant preclinical research, and discuss the vital developments still needed to advance their clinical application as a future therapeutic option.
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Affiliation(s)
- John D Sinden
- ReNeuron Limited, Surrey Research Park, Guildford, Surrey, UK.
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Repair-Based Therapies After Stroke. Transl Stroke Res 2012. [DOI: 10.1007/978-1-4419-9530-8_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Harnish S, Meinzer M, Trinastic J, Fitzgerald D, Page S. Language changes coincide with motor and fMRI changes following upper extremity motor therapy for hemiparesis: a brief report. Brain Imaging Behav 2011; 8:370-7. [DOI: 10.1007/s11682-011-9139-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cramer SC, Sur M, Dobkin BH, O'Brien C, Sanger TD, Trojanowski JQ, Rumsey JM, Hicks R, Cameron J, Chen D, Chen WG, Cohen LG, deCharms C, Duffy CJ, Eden GF, Fetz EE, Filart R, Freund M, Grant SJ, Haber S, Kalivas PW, Kolb B, Kramer AF, Lynch M, Mayberg HS, McQuillen PS, Nitkin R, Pascual-Leone A, Reuter-Lorenz P, Schiff N, Sharma A, Shekim L, Stryker M, Sullivan EV, Vinogradov S. Harnessing neuroplasticity for clinical applications. Brain 2011; 134:1591-609. [PMID: 21482550 PMCID: PMC3102236 DOI: 10.1093/brain/awr039] [Citation(s) in RCA: 620] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Neuroplasticity can be defined as the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections. Major advances in the understanding of neuroplasticity have to date yielded few established interventions. To advance the translation of neuroplasticity research towards clinical applications, the National Institutes of Health Blueprint for Neuroscience Research sponsored a workshop in 2009. Basic and clinical researchers in disciplines from central nervous system injury/stroke, mental/addictive disorders, paediatric/developmental disorders and neurodegeneration/ageing identified cardinal examples of neuroplasticity, underlying mechanisms, therapeutic implications and common denominators. Promising therapies that may enhance training-induced cognitive and motor learning, such as brain stimulation and neuropharmacological interventions, were identified, along with questions of how best to use this body of information to reduce human disability. Improved understanding of adaptive mechanisms at every level, from molecules to synapses, to networks, to behaviour, can be gained from iterative collaborations between basic and clinical researchers. Lessons can be gleaned from studying fields related to plasticity, such as development, critical periods, learning and response to disease. Improved means of assessing neuroplasticity in humans, including biomarkers for predicting and monitoring treatment response, are needed. Neuroplasticity occurs with many variations, in many forms, and in many contexts. However, common themes in plasticity that emerge across diverse central nervous system conditions include experience dependence, time sensitivity and the importance of motivation and attention. Integration of information across disciplines should enhance opportunities for the translation of neuroplasticity and circuit retraining research into effective clinical therapies.
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Affiliation(s)
- Steven C Cramer
- Department of Neurology, UC Irvine Medical Centre, 101 The City Drive South, Bldg 53, Rm 203, Orange, CA 92868-4280, USA.
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Harris-Love ML, Morton SM, Perez MA, Cohen LG. Mechanisms of short-term training-induced reaching improvement in severely hemiparetic stroke patients: a TMS study. Neurorehabil Neural Repair 2011; 25:398-411. [PMID: 21343522 DOI: 10.1177/1545968310395600] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The neurophysiological mechanisms underlying improved upper-extremity motor skills have been partially investigated in patients with good motor recovery but are poorly understood in more impaired individuals, the majority of stroke survivors. OBJECTIVE The authors studied changes in primary motor cortex (M1) excitability (motor evoked potentials [MEPs], contralateral and ipsilateral silent periods [CSPs and ISPs] using transcranial magnetic stimulation [TMS]) associated with training-induced reaching improvement in stroke patients with severe arm paresis (n = 11; Upper-Extremity Fugl-Meyer score (F-M) = 27 ± 6). METHODS All patients underwent a single session of reaching training focused on moving the affected hand from a resting site to a target placed at 80% of maximum forward reaching amplitude in response to a visual "GO" cue. Triceps contribute primarily as agonist and biceps primarily as antagonist to the trained forward reaching movement. Response times were recorded for each reaching movement. RESULTS Preceding training (baseline), greater interhemispheric inhibition (measured by ISP) in the affected triceps muscle, reflecting inhibition from the nonlesioned to the lesioned M1, was observed in patients with lower F-M scores (more severe motor impairment). Training-induced improvements in reaching were greater in patients with slower response times at baseline. Increased MEP amplitudes and decreased ISPs and CSPs were observed in the affected triceps but not in the biceps muscle after training. CONCLUSION These results indicate that along with training-induced motor improvements, training-specific modulation of intrahemispheric and interhemispheric mechanisms occurs after reaching practice in chronic stroke patients with substantial arm impairment.
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Molier BI, Van Asseldonk EHF, Hermens HJ, Jannink MJA. Nature, timing, frequency and type of augmented feedback; does it influence motor relearning of the hemiparetic arm after stroke? A systematic review. Disabil Rehabil 2011; 32:1799-809. [PMID: 20345249 DOI: 10.3109/09638281003734359] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the effect of different aspects and types of augmented feedback on motor functions and motor activities of the hemiparetic arm after stroke. METHOD Systematic search of the scientific literature was performed in the Pubmed and Cochrane database from 1975 to March 2009. The augmented feedback used in the intervention was classified with respect to aspects (nature, timing and frequency) and types (auditory, sensory and visual). RESULTS The systematic literature search resulted in 299 citations. On the basis of inclusion and exclusion criteria, 23 full-text articles were included for analysis. There are some trends in favour of providing augmented knowledge of performance feedback, augmented auditory and combined sensory and visual feedback. No consistent effects on motor relearning were observed for summary or faded, terminal or concurrent, solely visual or solely sensory augmented feedback. CONCLUSIONS On the basis of this study, it was not possible to determine which combinations of aspects and types of augmented feedback are most essential for a beneficial effect on motor activities and motor functions of the hemiparetic arm after stroke. This was due to the combination of multiple aspects and types of augmented feedback in the included studies. This systematic review indicates that augmented feedback in general has an added value for stroke rehabilitation.
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Affiliation(s)
- Birgit I Molier
- Roessingh Research and Development, 7500 AH Enschede, the Netherlands. b.molier @rrd.nl
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Neural Plasticity After Acquired Brain Injury: Evidence from Functional Neuroimaging. PM R 2010; 2:S306-12. [DOI: 10.1016/j.pmrj.2010.10.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 10/07/2010] [Indexed: 11/18/2022]
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Sharma N, Cohen LG. Recovery of motor function after stroke. Dev Psychobiol 2010; 54:254-62. [PMID: 22415914 DOI: 10.1002/dev.20508] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 09/22/2010] [Indexed: 01/27/2023]
Abstract
The human brain possesses a remarkable ability to adapt in response to changing anatomical (e.g., aging) or environmental modifications. This form of neuroplasticity is important at all stages of life but is critical in neurological disorders such as amblyopia and stroke. This review focuses upon our new understanding of possible mechanisms underlying functional deficits evidenced after adult-onset stroke. We review the functional interactions between different brain regions that may contribute to motor disability after stroke and, based on this information, possible interventional approaches to motor stroke disability. New information now points to the involvement of non-primary motor areas and their interaction with the primary motor cortex as areas of interest. The emergence of this new information is likely to impact new efforts to develop more effective neurorehabilitative interventions using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) that may be relevant to other neurological disorders such as amblyopia.
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Affiliation(s)
- Nikhil Sharma
- Human Cortical Physiology and Stroke Neurorehabilitation Section, NINDS, NIH, Bethesda, Maryland, USA.
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Michielsen ME, Selles RW, van der Geest JN, Eckhardt M, Yavuzer G, Stam HJ, Smits M, Ribbers GM, Bussmann JBJ. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair 2010; 25:223-33. [PMID: 21051765 DOI: 10.1177/1545968310385127] [Citation(s) in RCA: 215] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis. METHODS A total of 40 chronic stroke patients (mean time post .onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline-posttreatment and at 6 months-were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9). RESULTS Posttreatment, the FMA improved more in the mirror than in the control group (3.6 ± 1.5, P < .05), but this improvement did not persist at follow-up. No changes were found on the other outcome measures (all Ps >.05). fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (weighted laterality index difference 0.40 ± 0.39, P < .05). CONCLUSION This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization. Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains.
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Marsden D, Quinn R, Pond N, Golledge R, Neilson C, White J, McElduff P, Pollack M. A multidisciplinary group programme in rural settings for community-dwelling chronic stroke survivors and their carers: a pilot randomized controlled trial. Clin Rehabil 2010; 24:328-41. [PMID: 20176772 DOI: 10.1177/0269215509344268] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore whether a group programme for community-dwelling chronic stroke survivors and their carers is feasible in rural settings; to measure the impact of the programme on health-related quality of life and functional performance; and to determine if any benefits gained are maintained. DESIGN Randomized, assessor blind, cross-over, controlled trial. SETTING Rural outpatient. SUBJECTS Twenty-five community-dwelling, chronic stroke survivors and 17 carers of participant stroke survivors. INTERVENTION The intervention group undertook a once-a-week, seven-week group programme combining physical activity, education, self-management principles and a 'healthy options' morning tea. At completion, the control group crossed over to receive the intervention. MAIN MEASURES Stroke Impact Scale (stroke survivors), Health Impact Scale (carers), Six Minute Walk Test, Timed Up and Go, Caregiver Strain Index. RESULTS There were insufficient participants for results to reach statistical significance. However between-group trends favoured the intervention group in the majority of outcome measures for stroke survivors and carers. The majority of measures remained above baseline at 12 weeks post programme for stroke survivor participants. The programme was well attended. Of the seven sessions all participants attended four or more and 88% attended six or seven sessions. CONCLUSIONS This novel programme incorporating physical activity, education and social interaction proved feasible to undertake by a stroke-specific multidisciplinary team in three rural Australian settings. This programme may improve and maintain health-related quality of life and physical functioning for chronic stroke survivors and their carers and warrants further investigation.
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Affiliation(s)
- Dianne Marsden
- Hunter Stroke Service, Rankin Park Campus, New Lambton Heights, NSW, Australia.
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