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Fernanda Silva G, Campos LF, de Aquino Miranda JM, Guirro Zuliani F, de Souza Fonseca BH, de Araújo AET, de Melo PF, Suzuki LG, Aniceto LP, Bazan R, Sande de Souza LAP, Luvizutto GJ. Repetitive peripheral sensory stimulation for motor recovery after stroke: a scoping review. Top Stroke Rehabil 2024; 31:723-737. [PMID: 38452790 DOI: 10.1080/10749357.2024.2322890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/10/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE Enhancing afferent information from the paretic limb can improve post-stroke motor recovery. However, uncertainties exist regarding varied sensory peripheral neuromodulation protocols and their specific impacts. This study outlines the use of repetitive peripheral sensory stimulation (RPSS) and repetitive magnetic stimulation (rPMS) in individuals with stroke. METHODS This scoping review was conducted according to the JBI Evidence Synthesis guidelines. We searched studies published until June 2023 on several databases using a three-step analysis and categorization of the studies: pre-analysis, exploration of the material, and data processing. RESULTS We identified 916 studies, 52 of which were included (N = 1,125 participants). Approximately 53.84% of the participants were in the chronic phase, displaying moderate-to-severe functional impairment. Thirty-two studies used RPSS often combining it with task-oriented training, while 20 used rPMS as a standalone intervention. The RPSS primarily targeted the median and ulnar nerves, stimulating for an average of 92.78 min at an intensity that induced paresthesia. RPMS targeted the upper and lower limb paretic muscles, employing a 20 Hz frequency in most studies. The mean stimulation time was 12.74 min, with an intensity of 70% of the maximal stimulator output. Among the 114 variables analyzed in the 52 studies, 88 (77.20%) were in the "s,b" domain, with 26 (22.8%) falling under the "d" domain of the ICF. DISCUSSION AND CONCLUSION Sensory peripheral neuromodulation protocols hold the potential for enhancing post-stroke motor recovery, yet optimal outcomes were obtained when integrated with intensive or task-oriented motor training.
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Affiliation(s)
| | | | | | - Flávia Guirro Zuliani
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | | | | | - Luiz Gustavo Suzuki
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, Brazil
| | - Luiz Paulo Aniceto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Botucatu, São Paulo, Brazil
| | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Brazil
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2
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Wang P, Cao W, Zhou H, Zhang HX, Zhang L, Liu L, Sui Y, Zhang Z, Yin X, Yang F, Kong L. Efficacy of median nerve electrical stimulation on the recovery of patients with consciousness disorders: a systematic review and meta-analysis. J Int Med Res 2022; 50:3000605221134467. [PMID: 36448965 PMCID: PMC9720824 DOI: 10.1177/03000605221134467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/05/2022] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE To identify whether median nerve stimulation (MNS) may be a potential candidate for the treatment of consciousness disorders via a systematic review and meta-analysis. METHODS PubMed, Cochrane Library, China National Knowledge Infrastructure, Chinese VIP Information, Wanfang, and SinoMed databases were searched. Risk of bias was assessed using the Cochrane Collaboration's tool. The Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), electroencephalogram (EEG), days in the Intensive Care Unit (ICU), and cerebral blood flow measures were compared between the median nerve stimulation and control groups. The meta-analysis was conducted using Review Manager software. RESULTS We identified 2244 studies, of which 23 (with data from 1856 patients) qualified for the analysis. MNS improved GCS scores (mean difference [MD] = 2.15), EEG scores (MD = 1.61), cerebral mean blood flow velocity (MD = 4.23), and cerebral systolic blood flow velocity (MD = 10.51). Furthermore, it decreased DRS scores (MD = -1.77) and days in the ICU (MD = -2.02). The effects of MNS on GCS scores increased with longer treatments (1 week, MD = 1.03; 1 month, MD = 2.35) and were better with right MNS (right, MD = 2.36; bilateral, MD = 1.72). CONCLUSIONS MNS may promote recovery from consciousness disorders.
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Affiliation(s)
- Peng Wang
- The First Clinical College, Shandong University of Traditional
Chinese Medicine, Jinan, China
- Department of Critical Care Unit, Shandong Provincial Hospital
Affiliated to Shandong First Medical University, Jinan, China
| | - Wei Cao
- Department of Nephrology, The First Affiliated Hospital of
Shandong First Medical University, Jinan, China
- Department of Nephrology, Jinan, Shandong Provincial Qianfoshan
Hospital, Shandong, China
| | - Hong Zhou
- Department of Neurorehabilitation, Weifang Traditional Chinese
Hospital, Weifang, China
| | - Huan Xin Zhang
- Department of Neurorehabilitation, Weifang Traditional Chinese
Hospital, Weifang, China
| | - Lunzhong Zhang
- Department of Neurorehabilitation, Weifang Traditional Chinese
Hospital, Weifang, China
| | - Li Liu
- Department of Neurorehabilitation, Weifang Traditional Chinese
Hospital, Weifang, China
| | - Yunlong Sui
- Department of Neurorehabilitation, Weifang Traditional Chinese
Hospital, Weifang, China
| | - Zhen Zhang
- Department of Neurorehabilitation, Weifang Traditional Chinese
Hospital, Weifang, China
| | - Xiaoyu Yin
- Shandong Provincial Hospital Affiliated to Shandong First
Medical University, Medical College, Jinan, China
| | - Fan Yang
- Department of Rehabilitation Medicine, Shandong Provincial
Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Li Kong
- Department of Emergency Center, Shandong University of
Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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3
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Veldman MP, Dolfen N, Gann MA, Van Roy A, Peeters R, King BR, Albouy G. Somatosensory targeted memory reactivation enhances motor performance via hippocampal-mediated plasticity. Cereb Cortex 2022; 33:3734-3749. [PMID: 35972408 DOI: 10.1093/cercor/bhac304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/14/2022] Open
Abstract
Increasing evidence suggests that reactivation of newly acquired memory traces during postlearning wakefulness plays an important role in memory consolidation. Here, we sought to boost the reactivation of a motor memory trace during postlearning wakefulness (quiet rest) immediately following learning using somatosensory targeted memory reactivation (TMR). Using functional magnetic resonance imaging, we examined the neural correlates of the reactivation process as well as the effect of the TMR intervention on brain responses elicited by task practice on 24 healthy young adults. Behavioral data of the post-TMR retest session showed a faster learning rate for the motor sequence that was reactivated as compared to the not-reactivated sequence. Brain imaging data revealed that motor, parietal, frontal, and cerebellar brain regions, which were recruited during initial motor learning, were specifically reactivated during the TMR episode and that hippocampo-frontal connectivity was modulated by the reactivation process. Importantly, the TMR-induced behavioral advantage was paralleled by dynamical changes in hippocampal activity and hippocampo-motor connectivity during task practice. Altogether, the present results suggest that somatosensory TMR during postlearning quiet rest can enhance motor performance via the modulation of hippocampo-cortical responses.
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Affiliation(s)
- Menno P Veldman
- KU Leuven, Department of Movement Sciences, Movement Control and Neuroplasticity Research Group, Leuven 3001, Belgium.,Leuven Brain Institute (LBI), KU Leuven, Leuven 3001, Belgium
| | - Nina Dolfen
- KU Leuven, Department of Movement Sciences, Movement Control and Neuroplasticity Research Group, Leuven 3001, Belgium.,Leuven Brain Institute (LBI), KU Leuven, Leuven 3001, Belgium
| | - Mareike A Gann
- KU Leuven, Department of Movement Sciences, Movement Control and Neuroplasticity Research Group, Leuven 3001, Belgium.,Leuven Brain Institute (LBI), KU Leuven, Leuven 3001, Belgium
| | - Anke Van Roy
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT 84112, United States
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, Leuven 3000, Belgium.,Department of Imaging and Pathology, Biomedical Sciences Group, Leuven 3000, Belgium
| | - Bradley R King
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT 84112, United States
| | - Geneviève Albouy
- KU Leuven, Department of Movement Sciences, Movement Control and Neuroplasticity Research Group, Leuven 3001, Belgium.,Leuven Brain Institute (LBI), KU Leuven, Leuven 3001, Belgium.,Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT 84112, United States
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4
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Depannemaecker D, Canton Santos LE, Rodrigues AM, Scorza CA, Scorza FA, Almeida ACGD. Realistic spiking neural network: Non-synaptic mechanisms improve convergence in cell assembly. Neural Netw 2019; 122:420-433. [PMID: 31841876 DOI: 10.1016/j.neunet.2019.09.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/26/2023]
Abstract
Learning in neural networks inspired by brain tissue has been studied for machine learning applications. However, existing works primarily focused on the concept of synaptic weight modulation, and other aspects of neuronal interactions, such as non-synaptic mechanisms, have been neglected. Non-synaptic interaction mechanisms have been shown to play significant roles in the brain, and four classes of these mechanisms can be highlighted: (i) electrotonic coupling; (ii) ephaptic interactions; (iii) electric field effects; and iv) extracellular ionic fluctuations. In this work, we proposed simple rules for learning inspired by recent findings in machine learning adapted to a realistic spiking neural network. We show that the inclusion of non-synaptic interaction mechanisms improves cell assembly convergence. By including extracellular ionic fluctuation represented by the extracellular electrodiffusion in the network, we showed the importance of these mechanisms to improve cell assembly convergence. Additionally, we observed a variety of electrophysiological patterns of neuronal activity, particularly bursting and synchronism when the convergence is improved.
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Affiliation(s)
- Damien Depannemaecker
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil; Disciplina de Neurociência, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Luiz Eduardo Canton Santos
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil; Disciplina de Neurociência, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Antônio Márcio Rodrigues
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil
| | - Carla Alessandra Scorza
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil
| | - Fulvio Alexandre Scorza
- Disciplina de Neurociência, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Antônio-Carlos Guimarães de Almeida
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil.
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5
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Carson RG, Buick AR. Neuromuscular electrical stimulation-promoted plasticity of the human brain. J Physiol 2019; 599:2375-2399. [PMID: 31495924 DOI: 10.1113/jp278298] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022] Open
Abstract
The application of neuromuscular electrical stimulation (NMES) to paretic limbs has demonstrated utility for motor rehabilitation following brain injury. When NMES is delivered to a mixed peripheral nerve, typically both efferent and afferent fibres are recruited. Muscle contractions brought about by the excitation of motor neurons are often used to compensate for disability by assisting actions such as the formation of hand aperture, or by preventing others including foot drop. In this context, exogenous stimulation provides a direct substitute for endogenous neural drive. The goal of the present narrative review is to describe the means through which NMES may also promote sustained adaptations within central motor pathways, leading ultimately to increases in (intrinsic) functional capacity. There is an obvious practical motivation, in that detailed knowledge concerning the mechanisms of adaptation has the potential to inform neurorehabilitation practice. In addition, responses to NMES provide a means of studying CNS plasticity at a systems level in humans. We summarize the fundamental aspects of NMES, focusing on the forms that are employed most commonly in clinical and experimental practice. Specific attention is devoted to adjuvant techniques that further promote adaptive responses to NMES thereby offering the prospect of increased therapeutic potential. The emergent theme is that an association with centrally initiated neural activity, whether this is generated in the context of NMES triggered by efferent drive or via indirect methods such as mental imagery, may in some circumstances promote the physiological changes that can be induced through peripheral electrical stimulation.
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Affiliation(s)
- Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland.,School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, UK.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Alison R Buick
- School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, UK
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6
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Delorme M, Vergotte G, Perrey S, Froger J, Laffont I. Time course of sensorimotor cortex reorganization during upper extremity task accompanying motor recovery early after stroke: An fNIRS study. Restor Neurol Neurosci 2019; 37:207-218. [PMID: 31227675 DOI: 10.3233/rnn-180877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The acute phase of stroke is accompanied by functional changes and interplay of both hemispheres. However, our understanding of how the time course of upper limb functional motor recovery is related to the progression of brain reorganization in the sensorimotor areas remains limited. This study aimed to assess the time course of hemodynamic patterns of cortical sensorimotor areas using functional near infrared spectroscopy (fNIRS) and motor recovery within three months after a stroke. METHOD Eight right-handed first ischemic/hemorrhagic stroke patients (60±8 years, 3 women) with mild to severe hemiparesis were examined with repetitive fNIRS measurements and motor recovery tests (Fugl-Meyer score) during two months. Hemodynamic changes over the ipsilesional and contralesional sensorimotor areas were collected from a multi-channel fNIRS system during intermittent isometric muscle contractions at self-selected submaximal force levels for each arm. Lateralization index was computed to evaluate the changes in the interhemispheric balance between the cortical sensorimotor areas. RESULTS Lateralization index values during non-paretic arm movements showed no significant changes over time in patients and were comparable to those observed in eight healthy controls. Paretic-arm movements were associated early with a bilateral cortical activity before shifting to ipsilesional patterns (p < 0.01). Progressive lateralization observed over the two months (p < 0.05) evolved concomitantly with an increase in the Fugl-Meyer score (p < 0.001). CONCLUSIONS Cortical reorganization monitoring using fNIRS during the first weeks after stroke may be applied for assessing progressive brain plasticity in addition to clinical measures of performance.
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Affiliation(s)
- Marion Delorme
- EuroMov, Univ. Montpellier, Montpellier, France.,Nîmes University Hospital, Department of Physical Medicine and Rehabilitation, Nîmes, France
| | | | | | - Jérôme Froger
- EuroMov, Univ. Montpellier, Montpellier, France.,Nîmes University Hospital, Department of Physical Medicine and Rehabilitation, Nîmes, France
| | - Isabelle Laffont
- EuroMov, Univ. Montpellier, Montpellier, France.,Montpellier University Hospital, Department of Physical Medicine and Rehabilitation, Montpellier, France
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7
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Huang TY, Pan LLH, Yang WW, Huang LY, Sun PC, Chen CS. Biomechanical Evaluation of Three-Dimensional Printed Dynamic Hand Device for Patients With Chronic Stroke. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1246-1252. [DOI: 10.1109/tnsre.2019.2915260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Reorganization of the somatosensory pathway after subacute incomplete cervical cord injury. NEUROIMAGE-CLINICAL 2019; 21:101674. [PMID: 30642754 PMCID: PMC6412100 DOI: 10.1016/j.nicl.2019.101674] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 12/07/2018] [Accepted: 01/08/2019] [Indexed: 12/11/2022]
Abstract
Objective The main purpose of the present study was to investigate the possible somatosensory-related brain functional reorganization after traumatic spinal cord injury (SCI). Methods Thirteen patients with subacute incomplete cervical cord injury (ICCI) and thirteen age- and sex-matched healthy controls (HCs) were recruited. Eleven patients and all the HCs underwent both sensory task-related brain functional scanning and whole brain structural scanning on a 3.0 Tesla MRI system, and two patients underwent only structural scanning; the process of structural scanning was completed on thirteen patients, while functional scanning was only applied to eleven patients. We performed sensory task-related functional MRI (fMRI) to investigate the functional changes in the brain. In addition, voxel-based morphometry (VBM) was applied to explore whether any sensory-related brain structural changes occur in the whole brain after SCI. Results Compared with HCs, ICCI patients exhibited decreased activation in the left postcentral gyrus (postCG), the brainstem (midbrain and right pons) and the right cerebellar lobules IV-VI. Moreover, a significant positive association was found between the activation in the left PostCG and the activation in both the brainstem and the right cerebellar lobules IV-VI. Additionally, the decrease in gray matter volume (GMV) was detected in the left superior parietal lobule (SPL). The decrease of white matter volume (WMV) was observed in the right temporal lobe, the right occipital lobe, and the right calcarine gyrus. No structural change in the primary sensory cortex (S1), the secondary somatosensory cortex (S2) or the thalamus was detected. Conclusion These functional and structural findings may demonstrate the existence of an alternative pathway in the impairment of somatosensory function after SCI, which consists of the ipsilateral cerebellum, the brainstem and the contralateral postCG. It provides a new theoretical basis for the mechanism of sensory-related brain alteration in SCI patients and the rehabilitation therapy based on this pathway in the future. We found that sensory-related brain reorganization may not occur in the thalamus in patients with ICCI. We found that brain structural reorganization did not occur in the S1 or the S2 in patients with ICCI. We observed that SCI can cause brain structural reorganization in non-sensory-related areas. We observed that an alternative pathway may exist in the impairment of somatosensory function after SCI.
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9
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von Bornstädt D, Gertz K, Lagumersindez Denis N, Seners P, Baron JC, Endres M. Sensory stimulation in acute stroke therapy. J Cereb Blood Flow Metab 2018; 38:1682-1689. [PMID: 30073883 PMCID: PMC6168904 DOI: 10.1177/0271678x18791073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/14/2018] [Accepted: 06/17/2018] [Indexed: 02/06/2023]
Abstract
The beneficial effects of cortical activation for functional recovery after ischemic stroke have been well described. However, little is known about the role of early sensory stimulation, i.e. stimulation during first 6 h after stroke onset even during acute treatment. In recent years, various preclinical studies reported significant effects of acute sensory stimulation that range from entire neuroprotection to increased infarct volumes by 30-50%. Systematic knowledge about the effect of acute sensory stimulation on stroke outcome is highly relevant as stroke patients are subject to uncontrolled sensory stimulation during transport, acute treatment, and critical care. This article discusses the current stage of knowledge about acute sensory stimulation and provides directions for future experimental and clinical trials.
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Affiliation(s)
- Daniel von Bornstädt
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Center for Stroke Research Berlin, Berlin, Germany
| | - Karen Gertz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
| | - Nielsen Lagumersindez Denis
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
| | - Pierre Seners
- Department of Neurology, Hôpital Sainte-Anne, University Paris Descartes, INSERM U894, France
| | - Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, University Paris Descartes, INSERM U894, France
| | - Matthias Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research) Partner Site, Berlin, Germany
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10
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Boyd LA, Hayward KS, Ward NS, Stinear CM, Rosso C, Fisher RJ, Carter AR, Leff AP, Copland DA, Carey LM, Cohen LG, Basso DM, Maguire JM, Cramer SC. Biomarkers of Stroke Recovery: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2018; 31:864-876. [PMID: 29233071 DOI: 10.1177/1545968317732680] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
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Affiliation(s)
- Lara A Boyd
- 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kathryn S Hayward
- 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nick S Ward
- 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Cathy M Stinear
- 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Charlotte Rosso
- 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, France; AP-HP, Stroke Unit, Pitié-Salpêtrière Hospital, France
| | - Rebecca J Fisher
- 6 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alexandre R Carter
- 7 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA
| | - Alex P Leff
- 8 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK
| | - David A Copland
- 9 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Leeanne M Carey
- 10 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonardo G Cohen
- 11 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - D Michele Basso
- 12 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Jane M Maguire
- 13 Faculty of Health, University of Technology Sydney, Ultimo, Sydney, Australia
| | - Steven C Cramer
- 14 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA
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11
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Ferris JK, Neva JL, Francisco BA, Boyd LA. Bilateral Motor Cortex Plasticity in Individuals With Chronic Stroke, Induced by Paired Associative Stimulation. Neurorehabil Neural Repair 2018; 32:671-681. [DOI: 10.1177/1545968318785043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In the chronic phase after stroke, cortical excitability differs between the cerebral hemispheres; the magnitude of this asymmetry depends on degree of motor impairment. It is unclear whether these asymmetries also affect capacity for plasticity in corticospinal tract excitability or whether hemispheric differences in plasticity are related to chronic sensorimotor impairment. Methods: Response to paired associative stimulation (PAS) was assessed bilaterally in 22 individuals with chronic hemiparesis. Corticospinal excitability was measured as the area under the motor-evoked potential (MEP) recruitment curve (AUC) at baseline, 5 minutes, and 30 minutes post-PAS. Percentage change in contralesional AUC was calculated and correlated with paretic motor and somatosensory impairment scores. Results: PAS induced a significant increase in AUC in the contralesional hemisphere ( P = .041); in the ipsilesional hemisphere, there was no significant effect of PAS ( P = .073). Contralesional AUC showed significantly greater change in individuals without an ipsilesional MEP ( P = .029). Percentage change in contralesional AUC between baseline and 5 m post-PAS correlated significantly with FM score ( r = −0.443; P = .039) and monofilament thresholds ( r = 0.444, P = .044). Discussion: There are differential responses to PAS within each cerebral hemisphere. Contralesional plasticity was increased in individuals with more severe hemiparesis, indicated by both the absence of an ipsilesional MEP and a greater degree of motor and somatosensory impairment. These data support a body of research showing compensatory changes in the contralesional hemisphere after stroke; new therapies for individuals with chronic stroke could exploit contralesional plasticity to help restore function.
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Affiliation(s)
| | - Jason L. Neva
- University of British Columbia, Vancouver, BC, Canada
| | | | - Lara A. Boyd
- University of British Columbia, Vancouver, BC, Canada
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12
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Boyd LA, Hayward KS, Ward NS, Stinear CM, Rosso C, Fisher RJ, Carter AR, Leff AP, Copland DA, Carey LM, Cohen LG, Basso DM, Maguire JM, Cramer SC. Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2018; 12:480-493. [PMID: 28697711 DOI: 10.1177/1747493017714176] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
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Affiliation(s)
- Lara A Boyd
- 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kathryn S Hayward
- 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nick S Ward
- 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Cathy M Stinear
- 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Charlotte Rosso
- 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,6 AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rebecca J Fisher
- 7 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alexandre R Carter
- 8 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA
| | - Alex P Leff
- 9 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK
| | - David A Copland
- 10 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Leeanne M Carey
- 11 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonardo G Cohen
- 12 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - D Michele Basso
- 13 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Jane M Maguire
- 14 Faculty of Health, University of Technology, Ultimo, Sydney, Australia
| | - Steven C Cramer
- 15 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA
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13
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Chen X, Xie P, Zhang Y, Chen Y, Cheng S, Zhang L. Abnormal functional corticomuscular coupling after stroke. NEUROIMAGE-CLINICAL 2018; 19:147-159. [PMID: 30035012 PMCID: PMC6051472 DOI: 10.1016/j.nicl.2018.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/01/2018] [Accepted: 04/01/2018] [Indexed: 10/31/2022]
Abstract
Motor dysfunction is a major consequence after stroke and it is generally believed that the loss of motor ability is caused by the impairments in neural network that controls movement. To explore the abnormal mechanisms how the brain controls shoulder abduction and elbow flexion in "flexion synergy" following stroke, we used the functional corticomuscular coupling (FCMC) between the brain and the muscles as a tool to identify the temporal evolution of corticomuscular interaction between the synkinetic and separate phases. 59-channel electroencephalogram (EEG) over brain scalp and 2-channel electromyogram (EMG) from biceps brachii (BB)/deltoid (DT) were recorded in sixteen stroke patients with motor dysfunction and eight healthy controls during a task of uplifting the arm (stage 1) and maintaining up to the chest (stage 2). As a result, compared to healthy controls, stroke patients had abnormally reduced coherence in EEG-BB combination and increased coherence in EEG-DT combination. Compared to synkinetic stroke patients, separate ones exhibited higher coupling at gamma-band during stage 1 and higher at beta-band during stage 2 in EEG-BB combination, but lower at beta-band during stage 2 in EEG-DT combination. Therefore, we infer that the disorders of efferent control and afferent proprioception in sensorimotor system for stroke patients effect on the oscillation at beta and gamma bands. Patients need integrate more information for shoulder abduction to compensate for the functional loss of elbow flexion in the recovery process, so that partial cortical cortex controlling on the elbow flexion may work on the shoulder abduction during "flexion synergy". Such researches could provide new perspective on the temporal evolution of corticomuscular interaction after stroke and add to our understanding of possible pathomechanisms how the brain abnormally controls shoulder abduction and elbow flexion in "flexion synergy".
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Affiliation(s)
- Xiaoling Chen
- Yanshan University, Key Lab of Measurement Technology and Instrumentation of Hebei Province, Qinhuangdao, Hebei 066004, China
| | - Ping Xie
- Yanshan University, Key Lab of Measurement Technology and Instrumentation of Hebei Province, Qinhuangdao, Hebei 066004, China.
| | - Yuanyuan Zhang
- Yanshan University, Key Lab of Measurement Technology and Instrumentation of Hebei Province, Qinhuangdao, Hebei 066004, China
| | - Yuling Chen
- Institute of Education Science, Tianjin Normal University, Applied Psychology of Tianjin Province, Tianjin 300384, China
| | - Shengcui Cheng
- Yanshan University, Key Lab of Measurement Technology and Instrumentation of Hebei Province, Qinhuangdao, Hebei 066004, China
| | - Litai Zhang
- Department of Rehabilitation Medicine, The NO.281 Hospital of Chinese People's Liberation Army, Qinhuangdao, Hebei 066100, China
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14
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Formaggio E, Storti SF, Boscolo Galazzo I, Bongiovanni LG, Cerini R, Fiaschi A, Manganotti P. Reproducibility of EEG-fMRI results in a patient with fixation-off sensitivity. Clin EEG Neurosci 2014; 45:212-7. [PMID: 24048241 DOI: 10.1177/1550059413497946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blood oxygenation level-dependent (BOLD) activation associated with interictal epileptiform discharges in a patient with fixation-off sensitivity (FOS) was studied using a combined electroencephalography-functional magnetic resonance imaging (EEG-fMRI) technique. An automatic approach for combined EEG-fMRI analysis and a subject-specific hemodynamic response function was used to improve general linear model analysis of the fMRI data. The EEG showed the typical features of FOS, with continuous epileptiform discharges during elimination of central vision by eye opening and closing and fixation; modification of this pattern was clearly visible and recognizable. During all 3 recording sessions EEG-fMRI activations indicated a BOLD signal decrease related to epileptiform activity in the parietal areas. This study can further our understanding of this EEG phenomenon and can provide some insight into the reliability of the EEG-fMRI technique in localizing the irritative zone.
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Affiliation(s)
- Emanuela Formaggio
- Department of Neurophysiology, Foundation IRCCS San Camillo Hospital, Venice, Italy
| | - Silvia Francesca Storti
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
| | - Ilaria Boscolo Galazzo
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
| | - Luigi Giuseppe Bongiovanni
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
| | - Roberto Cerini
- Department of Pathology and Diagnostics, Section of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Antonio Fiaschi
- Department of Neurophysiology, Foundation IRCCS San Camillo Hospital, Venice, Italy
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
| | - Paolo Manganotti
- Department of Neurophysiology, Foundation IRCCS San Camillo Hospital, Venice, Italy
- Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy
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15
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Boscolo Galazzo I, Storti SF, Formaggio E, Pizzini FB, Fiaschi A, Beltramello A, Bertoldo A, Manganotti P. Investigation of brain hemodynamic changes induced by active and passive movements: A combined arterial spin labeling-BOLD fMRI study. J Magn Reson Imaging 2013; 40:937-48. [DOI: 10.1002/jmri.24432] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 08/30/2013] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ilaria Boscolo Galazzo
- Department of Neurological and Movement Sciences, Section of Neurology; University of Verona; Italy
| | - Silvia F. Storti
- Department of Neurological and Movement Sciences, Section of Neurology; University of Verona; Italy
| | - Emanuela Formaggio
- Department of Neurophysiology Foundation IRCCS; San Camillo Hospital; Venice Italy
| | | | - Antonio Fiaschi
- Department of Neurological and Movement Sciences, Section of Neurology; University of Verona; Italy
- Department of Neurophysiology Foundation IRCCS; San Camillo Hospital; Venice Italy
- Clinical Neurophysiology and Functional Neuroimaging Unit; AOUI of Verona; Italy
| | | | | | - Paolo Manganotti
- Department of Neurological and Movement Sciences, Section of Neurology; University of Verona; Italy
- Department of Neurophysiology Foundation IRCCS; San Camillo Hospital; Venice Italy
- Clinical Neurophysiology and Functional Neuroimaging Unit; AOUI of Verona; Italy
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16
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Modelling hemodynamic response function in epilepsy. Clin Neurophysiol 2013; 124:2108-18. [DOI: 10.1016/j.clinph.2013.05.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 04/30/2013] [Accepted: 05/03/2013] [Indexed: 11/20/2022]
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17
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Effect of voluntary repetitive long-lasting muscle contraction activity on the BOLD signal as assessed by optimal hemodynamic response function. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2013; 27:171-84. [DOI: 10.1007/s10334-013-0401-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 11/27/2022]
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18
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Carrera E, Jones PS, Morris RS, Alawneh J, Hong YT, Aigbirhio FI, Fryer TD, Carpenter TA, Warburton EA, Baron JC. Is neural activation within the rescued penumbra impeded by selective neuronal loss? Brain 2013; 136:1816-29. [DOI: 10.1093/brain/awt112] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Modulation of event-related desynchronization in robot-assisted hand performance: brain oscillatory changes in active, passive and imagined movements. J Neuroeng Rehabil 2013; 10:24. [PMID: 23442349 PMCID: PMC3598512 DOI: 10.1186/1743-0003-10-24] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 02/21/2013] [Indexed: 11/10/2022] Open
Abstract
Background Robot-assisted therapy in patients with neurological disease is an attempt to improve function in a moderate to severe hemiparetic arm. A better understanding of cortical modifications after robot-assisted training could aid in refining rehabilitation therapy protocols for stroke patients. Modifications of cortical activity in healthy subjects were evaluated during voluntary active movement, passive robot-assisted motor movement, and motor imagery tasks performed under unimanual and bimanual protocols. Methods Twenty-one channel electroencephalography (EEG) was recorded with a video EEG system in 8 subjects. The subjects performed robot-assisted tasks using the Bi-Manu Track robot-assisted arm trainer. The motor paradigm was executed during one-day experimental sessions under eleven unimanual and bimanual protocols of active, passive and imaged movements. The event-related-synchronization/desynchronization (ERS/ERD) approach to the EEG data was applied to investigate where movement-related decreases in alpha and beta power were localized. Results Voluntary active unilateral hand movement was observed to significantly activate the contralateral side; however, bilateral activation was noted in all subjects on both the unilateral and bilateral active tasks, as well as desynchronization of alpha and beta brain oscillations during the passive robot-assisted motor tasks. During active-passive movement when the right hand drove the left one, there was predominant activation in the contralateral side. Conversely, when the left hand drove the right one, activation was bilateral, especially in the alpha range. Finally, significant contralateral EEG desynchronization was observed during the unilateral task and bilateral ERD during the bimanual task. Conclusions This study suggests new perspectives for the assessment of patients with neurological disease. The findings may be relevant for defining a baseline for future studies investigating the neural correlates of behavioral changes after robot-assisted training in stroke patients.
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20
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Chipchase L, Schabrun S, Cohen L, Hodges P, Ridding M, Rothwell J, Taylor J, Ziemann U. A checklist for assessing the methodological quality of studies using transcranial magnetic stimulation to study the motor system: an international consensus study. Clin Neurophysiol 2012; 123:1698-704. [PMID: 22647458 DOI: 10.1016/j.clinph.2012.05.003] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 04/30/2012] [Accepted: 05/03/2012] [Indexed: 11/16/2022]
Abstract
In the last decade transcranial magnetic stimulation (TMS) has been the subject of more than 20,000 original research articles. Despite this popularity, TMS responses are known to be highly variable and this variability can impact on interpretation of research findings. There are no guidelines regarding the factors that should be reported and/or controlled in TMS studies. This study aimed to develop a checklist to be recommended to evaluate the methodology and reporting of studies that use single or paired pulse TMS to study the motor system. A two round international web-based Delphi study was conducted. Panellists rated the importance of a number of subject, methodological and analytical factors to be reported and/or controlled in studies that use single or paired pulse TMS to study the motor system. Twenty-seven items for single pulse studies and 30 items for paired pulse studies were included in the final checklist. Eight items related to subjects (e.g. age, gender), 21 to methodology (e.g. coil type, stimulus intensity) and two to analysis (e.g. size of the unconditioned motor evoked potential). The checklist is recommended for inclusion when submitting manuscripts for publication to ensure transparency of reporting and could also be used to critically appraise previously published work. It is envisaged that factors could be added and deleted from the checklist on the basis of future research. Use of the TMS methodological checklist should improve the quality of data collection and reporting in TMS studies of the motor system.
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Affiliation(s)
- Lucy Chipchase
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, Australia.
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21
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Zanatta P, Messerotti Benvenuti S, Baldanzi F, Bendini M, Saccavini M, Tamari W, Palomba D, Bosco E. Pain-related somatosensory evoked potentials and functional brain magnetic resonance in the evaluation of neurologic recovery after cardiac arrest: a case study of three patients. Scand J Trauma Resusc Emerg Med 2012; 20:22. [PMID: 22463985 PMCID: PMC3355043 DOI: 10.1186/1757-7241-20-22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/31/2012] [Indexed: 01/17/2023] Open
Abstract
This case series investigates whether painful electrical stimulation increases the early prognostic value of both somatosensory-evoked potentials and functional magnetic resonance imaging in comatose patients after cardiac arrest. Three single cases with hypoxic-ischemic encephalopathy were considered. A neurophysiological evaluation with an electroencephalogram and somatosensory-evoked potentials during increased electrical stimulation in both median nerves was performed within five days of cardiac arrest. Each patient also underwent a functional magnetic resonance imaging evaluation with the same neurophysiological protocol one month after cardiac arrest. One patient, who completely recovered, showed a middle latency component at a high intensity of stimulation and the activation of all brain areas involved in cerebral pain processing. One patient in a minimally conscious state only showed the cortical somatosensory response and the activation of the primary somatosensory cortex. The last patient, who was in a vegetative state, did not show primary somatosensory evoked potentials; only the activation of subcortical brain areas occurred. These preliminary findings suggest that the pain-related somatosensory evoked potentials performed to increase the prognosis of comatose patients after cardiac arrest are associated with regional brain activity showed by functional magnetic resonance imaging during median nerves electrical stimulation. More importantly, this cases report also suggests that somatosensory evoked potentials and functional magnetic resonance imaging during painful electrical stimulation may be sensitive and complementary methods to predict the neurological outcome in the acute phase of coma. Thus, pain-related somatosensory-evoked potentials may be a reliable and a cost-effective tool for planning the early diagnostic evaluation of comatose patients.
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Affiliation(s)
- Paolo Zanatta
- Department of Anesthesia and Intensive Care, Neurophysiology, Treviso Regional Hospital, Piazzale Ospedale 1, Treviso, Italy.
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