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Chen T, Chen T, Zhang Y, Wu K, Zou Y. Bilateral effect of acupuncture on cerebrum and cerebellum in ischaemic stroke patients with hemiparesis: a randomised clinical and neuroimaging trial. Stroke Vasc Neurol 2024; 9:306-317. [PMID: 38336368 PMCID: PMC11221322 DOI: 10.1136/svn-2023-002785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Acupuncture involving the limb region may be effective for stroke rehabilitation clinically, but the visualised and explanatory evidence is limited. Our objectives were to assess the specific effects of acupuncture for ischaemic stroke (IS) patients with hemiparesis and investigate its therapy-driven modification in functional connectivity. METHODS IS patients were randomly assigned (2:1) to receive 10 sessions of hand-foot 12 needles acupuncture (HA, n=30) or non-acupoint (NA) acupuncture (n=16), enrolling gender-matched and age-matched healthy controls (HCs, n=34). The clinical outcomes were the improved Fugl-Meyer Assessment scores including upper and lower extremity (ΔFM, ΔFM-UE, ΔFM-LE). The neuroimaging outcome was voxel-mirrored homotopic connectivity (VMHC). Static and dynamic functional connectivity (sFC, DFC) analyses were used to study the neuroplasticity reorganisation. RESULTS 46 ISs (mean(SD) age, 59.37 (11.36) years) and 34 HCs (mean(SD) age, 52.88 (9.69) years) were included in the per-protocol analysis of clinical and neuroimaging. In clinical, ΔFM scores were 5.00 in HA group and 2.50 in NA group, with a dual correlation between ΔFM and ΔVMHC (angular: r=0.696, p=0.000; cerebellum: r=-0.716, p=0.000) fitting the linear regression model (R2=0.828). In neuroimaging, ISs demonstrated decreased VMHC in bilateral postcentral gyrus and cerebellum (Gaussian random field, GRF corrected, voxel p<0.001, cluster p<0.05), which fitted the logistic regression model (AUC=0.8413, accuracy=0.7500). Following acupuncture, VMHC in bilateral superior frontal gyrus orbital part was increased with cerebro-cerebellar changes, involving higher sFC between ipsilesional superior frontal gyrus orbital part and the contralesional orbitofrontal cortex as well as cerebellum (GRF corrected, voxel p<0.001, cluster p<0.05). The coefficient of variation of VMHC was decreased in bilateral posterior cingulate gyrus (PPC) locally (GRF corrected, voxel p<0.001, cluster p<0.05), with integration states transforming into segregation states overall (p<0.05). There was no acupuncture-related adverse event. CONCLUSIONS The randomised clinical and neuroimaging trial demonstrated acupuncture could promote the motor recovery and modified cerebro-cerebellar VMHC via bilateral static and dynamic reorganisations for IS patients with hemiparesis.
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Affiliation(s)
- Tianzhu Chen
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianyan Chen
- School of Journalism and Communication, Renmin University of China, Beijing, China
| | - Yong Zhang
- Department of Rehabilitation, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kang Wu
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yihuai Zou
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Sun J, Li C. Editorial: Advanced neurotechnology in stroke rehabilitation. Front Neurol 2024; 15:1440752. [PMID: 38966087 PMCID: PMC11222633 DOI: 10.3389/fneur.2024.1440752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024] Open
Affiliation(s)
| | - Chong Li
- School of Clinical Medicine, Tsinghua University, Beijing, China
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3
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Lowenthal-Raz J, Liebermann DG, Friedman J, Soroker N. Kinematic descriptors of arm reaching movement are sensitive to hemisphere-specific immediate neuromodulatory effects of transcranial direct current stimulation post stroke. Sci Rep 2024; 14:11971. [PMID: 38796610 PMCID: PMC11127956 DOI: 10.1038/s41598-024-62889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/22/2024] [Indexed: 05/28/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) exerts beneficial effects on motor recovery after stroke, presumably by enhancement of adaptive neural plasticity. However, patients with extensive damage may experience null or deleterious effects with the predominant application mode of anodal (excitatory) stimulation of the damaged hemisphere. In such cases, excitatory stimulation of the non-damaged hemisphere might be considered. Here we asked whether tDCS exerts a measurable effect on movement quality of the hemiparetic upper limb, following just a single treatment session. Such effect may inform on the hemisphere that should be excited. Using a single-blinded crossover experimental design, stroke patients and healthy control subjects were assessed before and after anodal, cathodal and sham tDCS, each provided during a single session of reaching training (repeated point-to-point hand movement on an electronic tablet). Group comparisons of endpoint kinematics at baseline-number of peaks in the speed profile (NoP; smoothness), hand-path deviations from the straight line (SLD; accuracy) and movement time (MT; speed)-disclosed greater NoP, larger SLD and longer MT in the stroke group. NoP and MT revealed an advantage for anodal compared to sham stimulation of the lesioned hemisphere. NoP and MT improvements under anodal stimulation of the non-lesioned hemisphere correlated positively with the severity of hemiparesis. Damage to specific cortical regions and white-matter tracts was associated with lower kinematic gains from tDCS. The study shows that simple descriptors of movement kinematics of the hemiparetic upper limb are sensitive enough to demonstrate gain from neuromodulation by tDCS, following just a single session of reaching training. Moreover, the results show that tDCS-related gain is affected by the severity of baseline motor impairment, and by lesion topography.
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Affiliation(s)
- Justine Lowenthal-Raz
- Physical Therapy Department, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
- Neurological Rehabilitation Department, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Dario G Liebermann
- Physical Therapy Department, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jason Friedman
- Physical Therapy Department, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Soroker
- Neurological Rehabilitation Department, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Sheng Y, Wang J, Tan G, Chang H, Xie Q, Liu H. Muscle Synergy Plasticity in Motor Function Recovery After Stroke. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1657-1667. [PMID: 38619941 DOI: 10.1109/tnsre.2024.3389022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
In certain neurological disorders such as stroke, the impairment of upper limb function significantly impacts daily life quality and necessitates enhanced neurological control. This poses a formidable challenge in the realm of rehabilitation due to its intricate nature. Moreover, the plasticity of muscle synergy proves advantageous in assessing the enhancement of motor function among stroke patients pre and post rehabilitation training intervention, owing to the modular control strategy of central nervous system. It also facilitates the investigation of long-term alterations in remodeling of muscle functional performance among patients undergoing clinical rehabilitation, aiming to establish correlations between changes in muscle synergies and stroke characteristics such as type, stage, and sites. In this study, a three-week rehabilitation monitoring experiment was conducted to assess the motor function of stroke patients at different stages of rehabilitation based on muscle synergy performance. Additionally, we aimed to investigate the correlation between clinical scale scores, rehabilitation stages, and synergy performance in order to provide a more comprehensive understanding of stroke patient recovery. The results of 7 healthy controls and 16 stroke patients showed that high-functioning patients were superior to low-functioning patients in terms of motor function plasticity towards healthy individuals. Moreover, there was a high positive correlation between muscle synergies and clinical scale scores in high-functioning patients, and the significance gradually emerged with treatment, highlighting the potential of muscle synergy plasticity as a valuable tool for monitoring rehabilitation progress. The potential of this study was also demonstrated for elucidating the physiological mechanisms underlying motor function reconstruction within the central nervous system, which is expected to promote the further application of muscle synergy in clinical assessment.
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5
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Wessel MJ, Draaisma LR, Durand-Ruel M, Maceira-Elvira P, Moyne M, Turlan JL, Mühl A, Chauvigné L, Koch PJ, Morishita T, Guggisberg AG, Hummel FC. Multi-focal Stimulation of the Cortico-cerebellar Loop During the Acquisition of a Novel Hand Motor Skill in Chronic Stroke Survivors. CEREBELLUM (LONDON, ENGLAND) 2024; 23:341-354. [PMID: 36802021 PMCID: PMC10951005 DOI: 10.1007/s12311-023-01526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/21/2023]
Abstract
Impairment of hand motor function is a frequent consequence after a stroke and strongly determines the ability to regain a self-determined life. An influential research strategy for improving motor deficits is the combined application of behavioral training and non-invasive brain stimulation of the motor cortex (M1). However, a convincing clinical translation of the present stimulation strategies has not been achieved yet. One alternative and innovative approach is to target the functionally relevant brain network-based architecture, e.g., the dynamic interactions within the cortico-cerebellar system during learning. Here, we tested a sequential multifocal stimulation strategy targeting the cortico-cerebellar loop. Anodal transcranial direct current stimulation (tDCS) was applied simultaneously to a hand-based motor training in N = 11 chronic stroke survivors during four training sessions on two consecutive days. The tested conditions were: sequential multifocal (M1-cerebellum (CB)-M1-CB) vs. monofocal control stimulation (M1-sham-M1-sham). Additionally, skill retention was assessed 1 and 10 days after the training phase. Paired-pulse transcranial magnetic stimulation data were recorded to characterize stimulation response determining features. The application of CB-tDCS boosted motor behavior in the early training phase in comparison to the control condition. No faciliatory effects on the late training phase or skill retention were detected. Stimulation response variability was related to the magnitude of baseline motor ability and short intracortical inhibition (SICI). The present findings suggest a learning phase-specific role of the cerebellar cortex during the acquisition of a motor skill in stroke and that personalized stimulation strategies encompassing several nodes of the underlying brain network should be considered.
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Affiliation(s)
- M J Wessel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - L R Draaisma
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - M Durand-Ruel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - P Maceira-Elvira
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - M Moyne
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - J-L Turlan
- Clinique Romande de Réadaptation (CRR Suva), Sion, Switzerland
| | - A Mühl
- Clinique Romande de Réadaptation (CRR Suva), Sion, Switzerland
| | - L Chauvigné
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - P J Koch
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - T Morishita
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - A G Guggisberg
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
- Universitäre Neurorehabilitation, Universitätsklinik für Neurologie, Inselspital, University Hospital of Berne, Berne, Switzerland
| | - F C Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland.
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland.
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland.
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6
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Carè M, Chiappalone M, Cota VR. Personalized strategies of neurostimulation: from static biomarkers to dynamic closed-loop assessment of neural function. Front Neurosci 2024; 18:1363128. [PMID: 38516316 PMCID: PMC10954825 DOI: 10.3389/fnins.2024.1363128] [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: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Despite considerable advancement of first choice treatment (pharmacological, physical therapy, etc.) over many decades, neurological disorders still represent a major portion of the worldwide disease burden. Particularly concerning, the trend is that this scenario will worsen given an ever expanding and aging population. The many different methods of brain stimulation (electrical, magnetic, etc.) are, on the other hand, one of the most promising alternatives to mitigate the suffering of patients and families when conventional treatment fall short of delivering efficacious treatment. With applications in virtually all neurological conditions, neurostimulation has seen considerable success in providing relief of symptoms. On the other hand, a large variability of therapeutic outcomes has also been observed, particularly in the usage of non-invasive brain stimulation (NIBS) modalities. Borrowing inspiration and concepts from its pharmacological counterpart and empowered by unprecedented neurotechnological advancement, the neurostimulation field has seen in recent years a widespread of methods aimed at the personalization of its parameters, based on biomarkers of the individuals being treated. The rationale is that, by taking into account important factors influencing the outcome, personalized stimulation can yield a much-improved therapy. Here, we review the literature to delineate the state-of-the-art of personalized stimulation, while also considering the important aspects of the type of informing parameter (anatomy, function, hybrid), invasiveness, and level of development (pre-clinical experimentation versus clinical trials). Moreover, by reviewing relevant literature on closed loop neuroengineering solutions in general and on activity dependent stimulation method in particular, we put forward the idea that improved personalization may be achieved when the method is able to track in real time brain dynamics and adjust its stimulation parameters accordingly. We conclude that such approaches have great potential of promoting the recovery of lost functions and enhance the quality of life for patients.
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Affiliation(s)
- Marta Carè
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Michela Chiappalone
- Department of Informatics, Bioengineering, Robotics System Engineering (DIBRIS), University of Genova, Genova, Italy
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genova, Italy
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7
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Akhuj A, Deodhe NP, Jachak S. Gait Training With Motor Relearning Program in Conjunction With Functional Electrical Stimulation in Quadriparesis Secondary to Cervical and Lumbar Myelopathy. Cureus 2024; 16:e54449. [PMID: 38510883 PMCID: PMC10951938 DOI: 10.7759/cureus.54449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Degenerative cervical myelopathy is a frequently encountered age-related pathology following compression of the spinal cord. This case report delineates the clinical manifestation of cervical and lumbar myelopathy in a 78-year-old male patient, characterised by chief complaints of difficulty in moving bilateral upper and lower extremities and difficulty in bed mobility. Motor impairment can manifest in three different presentations, which are paraparesis, hemiparesis, or quadriparesis. The motor relearning program incorporating functional electrical stimulation constitutes a rehabilitative approach used for the restoration of motor function. This study outlines the protocol for the physiotherapy intervention protocol, mainly focusing on gait training. Along with it, balance training, proprioceptive neuromuscular facilitation, etc., were also included. The goal of physiotherapy rehabilitation was to improve the patient's ability to do tasks related to daily living. The outcome measures used were the dynamic gait index, functional independence measure, and Modified Japanese Orthopaedic Association score. We document significant increases in muscular tone and power, improved active range of motion, enhancements in gait parameters, and notable advancements in the individual's functional independence through the implementation of a physiotherapeutic regimen.
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Affiliation(s)
- Aditi Akhuj
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishigandha P Deodhe
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shrushti Jachak
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Morone G, Iosa M, Calabrò RS, Cerasa A, Paolucci S, Antonucci G, Ciancarelli I. Robot- and Technology-Boosting Neuroplasticity-Dependent Motor-Cognitive Functional Recovery: Looking towards the Future of Neurorehabilitation. Brain Sci 2023; 13:1687. [PMID: 38137137 PMCID: PMC10741672 DOI: 10.3390/brainsci13121687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 12/24/2023] Open
Abstract
The sequelae of neurological disorders are the leading causes of disability in all industrialized countries [...].
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Affiliation(s)
- Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (G.M.); (I.C.)
- San Raffaele Institute of Sulmona, Viale dell’Agricoltura, 67039 Sulmona, Italy
| | - Marco Iosa
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy;
- Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy;
| | | | - Antonio Cerasa
- S’Anna Institute, 88900 Crotone, Italy;
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - Stefano Paolucci
- Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy;
| | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (G.M.); (I.C.)
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9
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Wang P, Liu J, Wang L, Ma H, Mei X, Zhang A. Effects of brain-Computer interface combined with mindfulness therapy on rehabilitation of hemiplegic patients with stroke: a randomized controlled trial. Front Psychol 2023; 14:1241081. [PMID: 37876845 PMCID: PMC10590922 DOI: 10.3389/fpsyg.2023.1241081] [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: 06/16/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Aim To explore the effects of brain-computer interface training combined with mindfulness therapy on Hemiplegic Patients with Stroke. Background The prevention and treatment of stroke still faces great challenges. Maximizing the improvement of patients' ability to perform activities of daily living, limb motor function, and reducing anxiety, depression, and other social and psychological problems to improve patients' overall quality of life is the focus and difficulty of clinical rehabilitation work. Methods Patients were recruited from December 2021 to November 2022, and assigned to either the intervention or control group following a simple randomization procedure (computer-generated random numbers). Both groups received conventional rehabilitation treatment, while patients in the intervention group additionally received brain-computer interface training and mindfulness therapy. The continuous treatment duration was 5 days per week for 8 weeks. Limb motor function, activities of daily living, mindfulness attention awareness level, sleep quality, and quality of life of the patients were measured (in T0, T1, and T2). Generalized estimated equation (GEE) were used to evaluate the effects. The trial was registered with the Chinese Clinical Trial Registry (ChiCTR2300070382). Results A total of 128 participants were randomized and 64 each were assigned to the intervention and control groups (of these, eight patients were lost to follow-up). At 6 months, compared with the control group, intervention group showed statistically significant improvements in limb motor function, mindful attention awareness, activities of daily living, sleep quality, and quality of life. Conclusion Brain-computer interface combined with mindfulness therapy training can improve limb motor function, activities of daily living, mindful attention awareness, sleep quality, and quality of life in hemiplegic patients with stroke. Impact This study provides valuable insights into post-stroke care. It may help improve the effect of rehabilitation nursing to improve the comprehensive ability and quality of life of patients after stroke. Clinical review registration https://www.chictr.org.cn/, identifier ChiCTR2300070382.
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Affiliation(s)
- Pei Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji’nan, Shandong, China
| | - Jinyu Liu
- School of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Lili Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji’nan, Shandong, China
| | - Huifang Ma
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji’nan, Shandong, China
| | - Xingyan Mei
- Linyi People’s Hospital, Linyi, Shandong, China
| | - Aihua Zhang
- School of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, Shandong, China
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Lin Y, Jiang Z, Zhan G, Su H, Kang X, Jia J. Brain network characteristics between subacute and chronic stroke survivors in active, imagery, passive movement task: a pilot study. Front Neurol 2023; 14:1143955. [PMID: 37538258 PMCID: PMC10395333 DOI: 10.3389/fneur.2023.1143955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023] Open
Abstract
Background The activation patterns and functional network characteristics between stroke survivors and healthy individuals based on resting-or task-state neuroimaging and neurophysiological techniques have been extensively explored. However, the discrepancy between stroke patients at different recovery stages remains unclear. Objective To investigate the changes in brain connectivity and network topology between subacute and chronic patients, and hope to provide a basis for rehabilitation strategies at different stages after stroke. Methods Fifteen stroke survivors were assigned to the subacute group (SG, N = 9) and chronic group (CG, N = 6). They were asked to perform hand grasping under active, passive, and MI conditions when recording EEG. The Fugl-Meyer Assessment Upper Extremity subscale (FMA_UE), modified Ashworth Scale (MAS), Manual Muscle Test (MMT), grip and pinch strength, modified Barthel Index (MBI), and Berg Balance Scale (BBS) were measured. Results Functional connectivity analyses showed significant interactions on frontal, parietal and occipital lobes connections in each frequency band, particularly in the delta band. The coupling strength of premotor cortex, M1, S1 and several connections linked to frontal, parietal, and occipital lobes in subacute subjects were lower than in chronic subjects in low alpha, high alpha, low beta, and high beta bands. Nodal clustering coefficient (CC) analyses revealed that the CC in chronic subjects was higher than in subacute subjects in the ipsilesional S1 and occipital area, contralesional dorsolateral prefrontal cortex and parietal area. Characteristic path length (CPL) analyses showed that CPL in subacute subjects was lower than in chronic subjects in low beta, high beta, and gamma bands. There were no significant differences between subacute and chronic subjects for small-world property. Conclusion Subacute stroke survivors were characterized by higher transfer efficiency of the entire brain network and weak local nodal effects. Transfer efficiency was reduced, the local nodal role was strengthened, and more neural resources needed to be mobilized to perform motor tasks for chronic survivors. Overall, these results may help to understand the remodeling pattern of the brain network for different post-stroke stages on task conditions and the mechanism of spontaneous recovery.
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Affiliation(s)
- Yifang Lin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Jing’an District Central Hospital, Shanghai, China
| | - Zewu Jiang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Gege Zhan
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Haolong Su
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - XiaoYang Kang
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Jing’an District Central Hospital, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
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11
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Bonilla D, Bravo M, Bonilla SP, Iragorri AM, Mendez D, Mondragon IF, Alvarado-Rojas C, Colorado JD. Progressive Rehabilitation Based on EMG Gesture Classification and an MPC-Driven Exoskeleton. Bioengineering (Basel) 2023; 10:770. [PMID: 37508798 PMCID: PMC10376571 DOI: 10.3390/bioengineering10070770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
Stroke is a leading cause of disability and death worldwide, with a prevalence of 200 millions of cases worldwide. Motor disability is presented in 80% of patients. In this context, physical rehabilitation plays a fundamental role for gradually recovery of mobility. In this work, we designed a robotic hand exoskeleton to support rehabilitation of patients after a stroke episode. The system acquires electromyographic (EMG) signals in the forearm, and automatically estimates the movement intention for five gestures. Subsequently, we developed a predictive adaptive control of the exoskeleton to compensate for three different levels of muscle fatigue during the rehabilitation therapy exercises. The proposed system could be used to assist the rehabilitation therapy of the patients by providing a repetitive, intense, and adaptive assistance.
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Affiliation(s)
- Daniel Bonilla
- School of Engineering, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Manuela Bravo
- School of Engineering, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Stephany P Bonilla
- School of Engineering, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Angela M Iragorri
- Neurology, School of Medicine, Hospital Universitario San Ignacio, Bogota 110231, Colombia
| | - Diego Mendez
- School of Engineering, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Ivan F Mondragon
- School of Engineering, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | | | - Julian D Colorado
- School of Engineering, Pontificia Universidad Javeriana, Bogota 110231, Colombia
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12
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Cheng S, Xin R, Zhao Y, Wang P, Feng W, Liu P. Evaluation of fMRI activation in post-stroke patients with movement disorders after repetitive transcranial magnetic stimulation: a scoping review. Front Neurol 2023; 14:1192545. [PMID: 37404941 PMCID: PMC10315664 DOI: 10.3389/fneur.2023.1192545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
Background Movement disorders are one of the most common stroke residual effects, which cause a major stress on their families and society. Repetitive transcranial magnetic stimulation (rTMS) could change neuroplasticity, which has been suggested as an alternative rehabilitative treatment for enhancing stroke recovery. Functional magnetic resonance imaging (fMRI) is a promising tool to explore neural mechanisms underlying rTMS intervention. Object Our primary goal is to better understand the neuroplastic mechanisms of rTMS in stroke rehabilitation, this paper provides a scoping review of recent studies, which investigate the alteration of brain activity using fMRI after the application of rTMS over the primary motor area (M1) in movement disorders patients after stroke. Method The database PubMed, Embase, Web of Science, WanFang Chinese database, ZhiWang Chinese database from establishment of each database until December 2022 were included. Two researchers reviewed the study, collected the information and the relevant characteristic extracted to a summary table. Two researchers also assessed the quality of literature with the Downs and Black criteria. When the two researchers unable to reach an agreement, a third researcher would have been consulted. Results Seven hundred and eleven studies in all were discovered in the databases, and nine were finally enrolled. They were of good quality or fair quality. The literature mainly involved the therapeutic effect and imaging mechanisms of rTMS on improving movement disorders after stroke. In all of them, there was improvement of the motor function post-rTMS treatment. Both high-frequency rTMS (HF-rTMS) and low-frequency rTMS (LF-rTMS) can induce increased functional connectivity, which may not directly correspond to the impact of rTMS on the activation of the stimulated brain areas. Comparing real rTMS with sham group, the neuroplastic effect of real rTMS can lead to better functional connectivity in the brain network in assisting stroke recovery. Conclusion rTMS allows the excitation and synchronization of neural activity, promotes the reorganization of brain function, and achieves the motor function recovery. fMRI can observe the influence of rTMS on brain networks and reveal the neuroplasticity mechanism of post-stroke rehabilitation. The scoping review helps us to put forward a series of recommendations that might guide future researchers exploring the effect of motor stroke treatments on brain connectivity.
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Affiliation(s)
- Siman Cheng
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Rong Xin
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yan Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Peng Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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13
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Liu Y, Dong X, Huo H, Feng L, Tong D, Liu J, Zhang H, Zheng Y, Wang S, Wang D. Effects of programmed flexor-extensor alternating electrical acupoint stimulation on upper limb motor functional reconstruction after stroke: study protocol for a double-blind, randomized controlled trial. Trials 2023; 24:324. [PMID: 37170159 PMCID: PMC10174617 DOI: 10.1186/s13063-023-07283-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/29/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Stroke's prevalence and morbidity are increasing (Guano, et al. Neuro 89:53-61, 2017), and limb motor dysfunction is left in most patients (Gittler, et al. JAMA 319:820-821, 2018). Particularly, the rehabilitation of upper limbs is more difficult and time-consuming (Borges, et al. The Cochrane database of systematic reviews 10:CD011887, 2018). METHODS A double-blind randomized controlled trial (RCT) will be conducted to investigate whether a new functional electrical stimulation (FES) combined with acupoint therapy is more effective in the rehabilitation of upper limb motor dysfunction after stroke. Patients who meet the inclusion criteria will be randomly divided into two groups: programmed flexor-extensor alternating electrical acupoint stimulation group (PES group) and conventional flexor-extensor alternating electrical acupoint stimulation group (CES group), which will be treated for 3 weeks. The primary outcome measures are electroencephalogram (EEG) and surface electromyogram (sEMG). The secondary outcome variables include MBI (modified Barthel index), China Stroke Scale (CSS), FMA-U (Fugl-Meyer assessment upper limb), MMT (manual muscle testing), and Brunnstrom. DISCUSSION The results of this study are expected to verify the efficacy of PES therapy in the rehabilitation of upper limb motor function after stroke. This may promote the widespread use of the therapy in hospitals, communities, and homes for early and continuous treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT05333497. Registered on April 11, 2022.
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Affiliation(s)
- Yang Liu
- Heilongjiang University of Chinese Medicine, No. 24 Heping Road, Xiangfang District, Harbin, People's Republic of China
| | - Xu Dong
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Nangang District, No. 105 AshiheRoad, Harbin, People's Republic of China
| | - Hong Huo
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Nangang District, No. 105 AshiheRoad, Harbin, People's Republic of China
| | - Liyuan Feng
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Nangang District, No. 105 AshiheRoad, Harbin, People's Republic of China
| | - Dan Tong
- Heilongjiang University of Chinese Medicine, No. 24 Heping Road, Xiangfang District, Harbin, People's Republic of China
| | - Jiahui Liu
- Heilongjiang University of Chinese Medicine, No. 24 Heping Road, Xiangfang District, Harbin, People's Republic of China
| | - Hongyan Zhang
- Heilongjiang University of Chinese Medicine, No. 24 Heping Road, Xiangfang District, Harbin, People's Republic of China
| | - Yingkang Zheng
- Heilongjiang University of Chinese Medicine, No. 24 Heping Road, Xiangfang District, Harbin, People's Republic of China
| | - Shuai Wang
- Heilongjiang University of Chinese Medicine, No. 24 Heping Road, Xiangfang District, Harbin, People's Republic of China
| | - Dongyan Wang
- Heilongjiang University of Chinese Medicine, No. 24 Heping Road, Xiangfang District, Harbin, People's Republic of China.
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Nangang District, No. 105 AshiheRoad, Harbin, People's Republic of China.
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14
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Huo Y, Wang X, Zhao W, Hu H, Li L. Effects of EMG-based robot for upper extremity rehabilitation on post-stroke patients: a systematic review and meta-analysis. Front Physiol 2023; 14:1172958. [PMID: 37256069 PMCID: PMC10226272 DOI: 10.3389/fphys.2023.1172958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/20/2023] [Indexed: 06/01/2023] Open
Abstract
Objective: A growing body of research shows the promise and efficacy of EMG-based robot interventions in improving the motor function in stroke survivors. However, it is still controversial whether the effect of EMG-based robot is more effective than conventional therapies. This study focused on the effects of EMG-based robot on upper limb motor control, spasticity and activity limitation in stroke survivors compared with conventional rehabilitation techniques. Methods: We searched electronic databases for relevant randomized controlled trials. Outcomes included Fugl-Meyer assessment scale (FMA), Modified Ashworth Scale (MAS), and activity level. Result: Thirteen studies with 330 subjects were included. The results showed that the outcomes post intervention was significantly improved in the EMG-based robot group. Results from subgroup analyses further revealed that the efficacy of the treatment was better in patients in the subacute stage, those who received a total treatment time of less than 1000 min, and those who received EMG-based robotic therapy combined with electrical stimulation (ES). Conclusion: The effect of EMG-based robot is superior to conventional therapies in terms of improving upper extremity motor control, spasticity and activity limitation. Further research should explore optimal parameters of EMG-based robot therapy and its long-term effects on upper limb function in post-stroke patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/; Identifier: 387070.
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Affiliation(s)
- Yunxia Huo
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
| | - Xiaohan Wang
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
| | - Weihua Zhao
- Northwestern Polytechnical University Hospital, Xi’an, China
| | - Huijing Hu
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
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15
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Ciceri T, Malerba G, Gatti A, Diella E, Peruzzo D, Biffi E, Casartelli L. Context expectation influences the gait pattern biomechanics. Sci Rep 2023; 13:5644. [PMID: 37024572 PMCID: PMC10079826 DOI: 10.1038/s41598-023-32665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
Beyond classical aspects related to locomotion (biomechanics), it has been hypothesized that walking pattern is influenced by a combination of distinct computations including online sensory/perceptual sampling and the processing of expectations (neuromechanics). Here, we aimed to explore the potential impact of contrasting scenarios ("risky and potentially dangerous" scenario; "safe and comfortable" scenario) on walking pattern in a group of healthy young adults. Firstly, and consistently with previous literature, we confirmed that the scenario influences gait pattern when it is recalled concurrently to participants' walking activity (motor interference). More intriguingly, our main result showed that participants' gait pattern is also influenced by the contextual scenario when it is evoked only before the start of walking activity (motor expectation). This condition was designed to test the impact of expectations (risky scenario vs. safe scenario) on gait pattern, and the stimulation that preceded walking activity served as prior. Noteworthy, we combined statistical and machine learning (Support-Vector Machine classifier) approaches to stratify distinct levels of analyses that explored the multi-facets architecture of walking. In a nutshell, our combined statistical and machine learning analyses converge in suggesting that walking before steps is not just a paradox.
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Affiliation(s)
- Tommaso Ciceri
- Department of Information Engineering, University of Padova, Padua, PD, Italy
- Neuroimaging Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, LC, Italy
| | - Giorgia Malerba
- Bioengineering Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, LC, Italy
| | - Alice Gatti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, MI, Italy
| | - Eleonora Diella
- Bioengineering Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, LC, Italy
| | - Denis Peruzzo
- Neuroimaging Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, LC, Italy
| | - Emilia Biffi
- Bioengineering Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, LC, Italy.
| | - Luca Casartelli
- Theoretical and Cognitive Neuroscience Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, LC, Italy
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16
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Trejo JL. Artificial anatomy. Anat Rec (Hoboken) 2023; 306:703-705. [PMID: 36576413 DOI: 10.1002/ar.25141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/29/2022]
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17
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Farina D, Vujaklija I, Brånemark R, Bull AMJ, Dietl H, Graimann B, Hargrove LJ, Hoffmann KP, Huang HH, Ingvarsson T, Janusson HB, Kristjánsson K, Kuiken T, Micera S, Stieglitz T, Sturma A, Tyler D, Weir RFF, Aszmann OC. Toward higher-performance bionic limbs for wider clinical use. Nat Biomed Eng 2023; 7:473-485. [PMID: 34059810 DOI: 10.1038/s41551-021-00732-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/01/2021] [Indexed: 12/19/2022]
Abstract
Most prosthetic limbs can autonomously move with dexterity, yet they are not perceived by the user as belonging to their own body. Robotic limbs can convey information about the environment with higher precision than biological limbs, but their actual performance is substantially limited by current technologies for the interfacing of the robotic devices with the body and for transferring motor and sensory information bidirectionally between the prosthesis and the user. In this Perspective, we argue that direct skeletal attachment of bionic devices via osseointegration, the amplification of neural signals by targeted muscle innervation, improved prosthesis control via implanted muscle sensors and advanced algorithms, and the provision of sensory feedback by means of electrodes implanted in peripheral nerves, should all be leveraged towards the creation of a new generation of high-performance bionic limbs. These technologies have been clinically tested in humans, and alongside mechanical redesigns and adequate rehabilitation training should facilitate the wider clinical use of bionic limbs.
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Affiliation(s)
- Dario Farina
- Department of Bioengineering, Imperial College London, London, UK.
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Rickard Brånemark
- Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| | - Hans Dietl
- Ottobock Products SE & Co. KGaA, Vienna, Austria
| | | | - Levi J Hargrove
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Klaus-Peter Hoffmann
- Department of Medical Engineering & Neuroprosthetics, Fraunhofer-Institut für Biomedizinische Technik, Sulzbach, Germany
| | - He Helen Huang
- NCSU/UNC Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thorvaldur Ingvarsson
- Department of Research and Development, Össur Iceland, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hilmar Bragi Janusson
- School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Todd Kuiken
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Bertarelli Foundation Chair in Translational NeuroEngineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, BrainLinks-BrainTools Center and Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Agnes Sturma
- Department of Bioengineering, Imperial College London, London, UK
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Dustin Tyler
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Veterans Affairs Medical Centre, Cleveland, OH, USA
| | - Richard F Ff Weir
- Biomechatronics Development Laboratory, Bioengineering Department, University of Colorado Denver and VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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18
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Jia T, Li C, Mo L, Qian C, Li W, Xu Q, Pan Y, Liu A, Ji L. Tailoring brain-machine interface rehabilitation training based on neural reorganization: towards personalized treatment for stroke patients. Cereb Cortex 2023; 33:3043-3052. [PMID: 35788284 PMCID: PMC10016036 DOI: 10.1093/cercor/bhac259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/14/2022] Open
Abstract
Electroencephalogram (EEG)-based brain-machine interface (BMI) has the potential to enhance rehabilitation training efficiency, but it still remains elusive regarding how to design BMI training for heterogeneous stroke patients with varied neural reorganization. Here, we hypothesize that tailoring BMI training according to different patterns of neural reorganization can contribute to a personalized rehabilitation trajectory. Thirteen stroke patients were recruited in a 2-week personalized BMI training experiment. Clinical and behavioral measurements, as well as cortical and muscular activities, were assessed before and after training. Following treatment, significant improvements were found in motor function assessment. Three types of brain activation patterns were identified during BMI tasks, namely, bilateral widespread activation, ipsilesional focusing activation, and contralesional recruitment activation. Patients with either ipsilesional dominance or contralesional dominance can achieve recovery through personalized BMI training. Results indicate that personalized BMI training tends to connect the potentially reorganized brain areas with event-contingent proprioceptive feedback. It can also be inferred that personalization plays an important role in establishing the sensorimotor loop in BMI training. With further understanding of neural rehabilitation mechanisms, personalized treatment strategy is a promising way to improve the rehabilitation efficacy and promote the clinical use of rehabilitation robots and other neurotechnologies.
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Affiliation(s)
| | - Chong Li
- Corresponding authors: Division of Intelligent and Bio-mimetic Machinery, The State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China. ; Beijing Rehabilitation Hospital of Capital Medical University, Capital Medical University, Beijing 100144, China. ; Division of Intelligent and Bio-mimetic Machinery, The State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China.
| | - Linhong Mo
- Beijing Rehabilitation Hospital of Capital Medical University, Capital Medical University, Beijing 100144, China
| | - Chao Qian
- Division of Intelligent and Bio-mimetic Machinery, The State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China
| | - Wei Li
- Division of Intelligent and Bio-mimetic Machinery, The State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China
| | - Quan Xu
- Division of Intelligent and Bio-mimetic Machinery, The State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China
- Department of Physical Medicine and Rehabilitation, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
| | - Yu Pan
- Department of Physical Medicine and Rehabilitation, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
| | - Aixian Liu
- Corresponding authors: Division of Intelligent and Bio-mimetic Machinery, The State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China. ; Beijing Rehabilitation Hospital of Capital Medical University, Capital Medical University, Beijing 100144, China. ; Division of Intelligent and Bio-mimetic Machinery, The State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China.
| | - Linhong Ji
- Corresponding authors: Division of Intelligent and Bio-mimetic Machinery, The State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China. ; Beijing Rehabilitation Hospital of Capital Medical University, Capital Medical University, Beijing 100144, China. ; Division of Intelligent and Bio-mimetic Machinery, The State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China.
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19
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Wu X, Wang R, Wu Q, Liao C, Zhang J, Jiao H, Chen B, Wang S, Liu R. The effects of combined high-frequency repetitive transcranial magnetic stimulation and cervical nerve root magnetic stimulation on upper extremity motor recovery following stroke. Front Neurosci 2023; 17:1100464. [PMID: 36845428 PMCID: PMC9951778 DOI: 10.3389/fnins.2023.1100464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Upper limb motor impairments after stroke cause patients partial or total loss of the capability of performing daily living, working, and social activities, which significantly affects the quality of life (QoL) of patients and brings a heavy burden to their families and society. As a non-invasive neuromodulation technique, transcranial magnetic stimulation (TMS) can act not only on the cerebral cortex, but also on peripheral nerves, nerve roots, and muscle tissues. Previous studies have shown that magnetic stimulation on the cerebral cortex and peripheral tissues has a positive effect on the recovery of upper limb motor function after stroke, however, few studies have reported the combination of the two. Objective This study was to investigate whether high frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with cervical nerve root magnetic stimulation more effectively ameliorates upper limb motor function in stroke patients. We hypothesized that the combination of the two can achieve a synergistic effect and further promotes functional recovery. Methods Sixty patients with stroke were randomly divided into four groups and received real or sham rTMS stimulation and cervical nerve root magnetic stimulation consecutively before other therapies, once daily over five fractions per week for a total of 15 times. We evaluated the upper limb motor function and activities of daily living of the patients at the time of pre-treatment, post-treatment, and 3-month follow up. Results All patients completed study procedures without any adverse effects. The upper limb motor function and activities of daily living improved in patients of each group were improved after treatment (post 1) and 3 months after treatment (post 2). Combination treatment was significantly better than single treatments alone or sham. Conclusion Both rTMS and cervical nerve root magnetic stimulation effectively promoted upper limb motor recovery in patients with stroke. The protocol combining the two is more beneficial for motor improvement and patients can easily tolerate it. Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2100048558.
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Affiliation(s)
- Xiaofang Wu
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China,Graduate School of Xi’an Medical College, Xi’an, China
| | - Rui Wang
- Medical Department of Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Qunqiang Wu
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Chunhua Liao
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Jianshe Zhang
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Huiduo Jiao
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Baolin Chen
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Shuyan Wang
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Rui Liu
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China,*Correspondence: Rui Liu,
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20
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Wessel MJ, Draaisma LR, Hummel FC. Mini-review: Transcranial Alternating Current Stimulation and the Cerebellum. CEREBELLUM (LONDON, ENGLAND) 2023; 22:120-128. [PMID: 35060078 DOI: 10.1007/s12311-021-01362-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 02/01/2023]
Abstract
Oscillatory activity in the cerebellum and linked networks is an important aspect of neuronal processing and functional implementation of behavior. So far, it was challenging to quantify and study cerebellar oscillatory signatures in human neuroscience due to the constraints of non-invasive cerebellar electrophysiological recording and interventional techniques. The emerging cerebellar transcranial alternating current stimulation technique (CB-tACS) is a promising tool, which may partially overcome this challenge and provides an exciting non-invasive opportunity to better understand cerebellar physiology.Several studies have successfully demonstrated that CB-tACS can modulate the cerebellar outflow and cerebellum-linked behavior. In the present narrative review, we summarize current studies employing the CB-tACS approach and discuss open research questions. Hereby, we aim to provide an overview on this emerging electrophysiological technique and strive to promote future research in the field. CB-tACS will contribute in the further deciphering of cerebellar oscillatory signatures and its role for motor, cognitive, or affective functions. In long term, CB-tACS could develop into a therapeutic tool for retuning disturbed oscillatory activity in cerebellar networks underlying brain disorders.
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Affiliation(s)
- Maximilian J Wessel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École polytechnique fédérale de Lausanne (EPFL), Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland. .,Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École polytechnique fédérale de Lausanne (EPFL Valais), Sion, Switzerland. .,Department of Neurology, Julius-Maximilians-University Würzburg, Würzburg, Germany.
| | - Laurijn R Draaisma
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École polytechnique fédérale de Lausanne (EPFL), Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland.,Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École polytechnique fédérale de Lausanne (EPFL Valais), Sion, Switzerland
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École polytechnique fédérale de Lausanne (EPFL), Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland.,Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École polytechnique fédérale de Lausanne (EPFL Valais), Sion, Switzerland.,Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
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21
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Post-Stroke Rehabilitation: Challenges and New Perspectives. J Clin Med 2023; 12:jcm12020550. [PMID: 36675486 PMCID: PMC9867345 DOI: 10.3390/jcm12020550] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
A stroke is determined by insufficient blood supply to the brain due to vessel occlusion (ischemic stroke) or rupture (hemorrhagic stroke), resulting in immediate neurological impairment to differing degrees [...].
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22
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Siviy C, Baker LM, Quinlivan BT, Porciuncula F, Swaminathan K, Awad LN, Walsh CJ. Opportunities and challenges in the development of exoskeletons for locomotor assistance. Nat Biomed Eng 2022; 7:456-472. [PMID: 36550303 DOI: 10.1038/s41551-022-00984-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
Exoskeletons can augment the performance of unimpaired users and restore movement in individuals with gait impairments. Knowledge of how users interact with wearable devices and of the physiology of locomotion have informed the design of rigid and soft exoskeletons that can specifically target a single joint or a single activity. In this Review, we highlight the main advances of the past two decades in exoskeleton technology and in the development of lower-extremity exoskeletons for locomotor assistance, discuss research needs for such wearable robots and the clinical requirements for exoskeleton-assisted gait rehabilitation, and outline the main clinical challenges and opportunities for exoskeleton technology.
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Affiliation(s)
- Christopher Siviy
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Lauren M Baker
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Brendan T Quinlivan
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Franchino Porciuncula
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.,Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA, USA
| | - Krithika Swaminathan
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Louis N Awad
- Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA, USA
| | - Conor J Walsh
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
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Morone G, Capone F, Iosa M, Cruciani A, Paolucci M, Martino Cinnera A, Musumeci G, Brunelli N, Costa C, Paolucci S, Di Lazzaro V. May Dual Transcranial Direct Current Stimulation Enhance the Efficacy of Robot-Assisted Therapy for Promoting Upper Limb Recovery in Chronic Stroke? Neurorehabil Neural Repair 2022; 36:800-809. [PMID: 36458455 PMCID: PMC9720706 DOI: 10.1177/15459683221138743] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To assess whether dual transcranial direct current stimulation (tDCS) may enhance the efficacy of exoskeleton robotic training on upper limb motor functions in patients with chronic stroke. METHODS A prospective, bi-center, double-blind, randomized clinical trial study was performed. Patients with moderate-to-severe stroke (according to The National Institute of Health Stroke Scale) were randomly assigned to receive dual or sham tDCS immediately before robotic therapy (10 sessions, 2 weeks). The primary outcome was the Fugl-Meyer for Upper Extremity, assessed before, after, and at the 12-week follow-up. Neurophysiological evaluation of corticospinal projections to upper limb muscles was performed by recording motor evoked potentials (MEPs). ClinicalTrials.gov-NCT03026712. RESULTS Two hundred and sixty individuals were tested for eligibility, of which 80 were enrolled and agreed to participate. Excluding 14 dropouts, 66 patients were randomly assigned into the 2 groups. Results showed that chronic patients were stable before treatment and significantly improved after that. The records within subject improvements were not significantly different between the 2 groups. However, a post-hoc analysis subdividing patients in 2 subgroups based on the presence or absence of MEPs at the baseline showed a significantly higher effect of real tDCS in patients without MEPs when compared to patients with MEPs (F = 4.6, P = .007). CONCLUSION The adjunction of dual tDCS to robotic arm training did not further enhance recovery in the treated sample of patients with chronic stroke. However, a significant improvement in the subgroup of patients with a severe corticospinal dysfunction (as suggested by the absence of MEPs) suggests that they could benefit from such a treatment combination.
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Affiliation(s)
- Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Giovanni Morone, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, 67100, Italy.
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marco Iosa
- IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Alessandro Cruciani
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Matteo Paolucci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
- Neurology Unit, “M. Bufalini” Hospital, Cesena, AUSL Romagna, Italy
| | - Alex Martino Cinnera
- IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico,” Rome, Italy
| | - Gabriella Musumeci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Nicoletta Brunelli
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Carmelina Costa
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
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24
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Restoring After Central Nervous System Injuries: Neural Mechanisms and Translational Applications of Motor Recovery. Neurosci Bull 2022; 38:1569-1587. [DOI: 10.1007/s12264-022-00959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022] Open
Abstract
AbstractCentral nervous system (CNS) injuries, including stroke, traumatic brain injury, and spinal cord injury, are leading causes of long-term disability. It is estimated that more than half of the survivors of severe unilateral injury are unable to use the denervated limb. Previous studies have focused on neuroprotective interventions in the affected hemisphere to limit brain lesions and neurorepair measures to promote recovery. However, the ability to increase plasticity in the injured brain is restricted and difficult to improve. Therefore, over several decades, researchers have been prompted to enhance the compensation by the unaffected hemisphere. Animal experiments have revealed that regrowth of ipsilateral descending fibers from the unaffected hemisphere to denervated motor neurons plays a significant role in the restoration of motor function. In addition, several clinical treatments have been designed to restore ipsilateral motor control, including brain stimulation, nerve transfer surgery, and brain–computer interface systems. Here, we comprehensively review the neural mechanisms as well as translational applications of ipsilateral motor control upon rehabilitation after CNS injuries.
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25
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Ozgur AG, Wessel MJ, Olsen JK, Cadic-Melchior AG, Zufferey V, Johal W, Dominijanni G, Turlan JL, Mühl A, Bruno B, Vuadens P, Dillenbourg P, Hummel FC. The effect of gamified robot-enhanced training on motor performance in chronic stroke survivors. Heliyon 2022; 8:e11764. [DOI: 10.1016/j.heliyon.2022.e11764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/22/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
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26
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Hajihosseinali M, Behzadipour S, Taghizadeh G, Farahmand F. Direction-dependency of the kinematic indices in upper extremities motor assessment of stroke patients. Med Eng Phys 2022; 108:103880. [DOI: 10.1016/j.medengphy.2022.103880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 10/15/2022]
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27
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Cometa A, Falasconi A, Biasizzo M, Carpaneto J, Horn A, Mazzoni A, Micera S. Clinical neuroscience and neurotechnology: An amazing symbiosis. iScience 2022; 25:105124. [PMID: 36193050 PMCID: PMC9526189 DOI: 10.1016/j.isci.2022.105124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the last decades, clinical neuroscience found a novel ally in neurotechnologies, devices able to record and stimulate electrical activity in the nervous system. These technologies improved the ability to diagnose and treat neural disorders. Neurotechnologies are concurrently enabling a deeper understanding of healthy and pathological dynamics of the nervous system through stimulation and recordings during brain implants. On the other hand, clinical neurosciences are not only driving neuroengineering toward the most relevant clinical issues, but are also shaping the neurotechnologies thanks to clinical advancements. For instance, understanding the etiology of a disease informs the location of a therapeutic stimulation, but also the way stimulation patterns should be designed to be more effective/naturalistic. Here, we describe cases of fruitful integration such as Deep Brain Stimulation and cortical interfaces to highlight how this symbiosis between clinical neuroscience and neurotechnology is closer to a novel integrated framework than to a simple interdisciplinary interaction.
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28
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Fleury L, Koch PJ, Wessel MJ, Bonvin C, San Millan D, Constantin C, Vuadens P, Adolphsen J, Cadic Melchior A, Brügger J, Beanato E, Ceroni M, Menoud P, De Leon Rodriguez D, Zufferey V, Meyer NH, Egger P, Harquel S, Popa T, Raffin E, Girard G, Thiran JP, Vaney C, Alvarez V, Turlan JL, Mühl A, Léger B, Morishita T, Micera S, Blanke O, Van De Ville D, Hummel FC. Toward individualized medicine in stroke—The TiMeS project: Protocol of longitudinal, multi-modal, multi-domain study in stroke. Front Neurol 2022; 13:939640. [PMID: 36226086 PMCID: PMC9549862 DOI: 10.3389/fneur.2022.939640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Despite recent improvements, complete motor recovery occurs in <15% of stroke patients. To improve the therapeutic outcomes, there is a strong need to tailor treatments to each individual patient. However, there is a lack of knowledge concerning the precise neuronal mechanisms underlying the degree and course of motor recovery and its individual differences, especially in the view of brain network properties despite the fact that it became more and more clear that stroke is a network disorder. The TiMeS project is a longitudinal exploratory study aiming at characterizing stroke phenotypes of a large, representative stroke cohort through an extensive, multi-modal and multi-domain evaluation. The ultimate goal of the study is to identify prognostic biomarkers allowing to predict the individual degree and course of motor recovery and its underlying neuronal mechanisms paving the way for novel interventions and treatment stratification for the individual patients. A total of up to 100 patients will be assessed at 4 timepoints over the first year after the stroke: during the first (T1) and third (T2) week, then three (T3) and twelve (T4) months after stroke onset. To assess underlying mechanisms of recovery with a focus on network analyses and brain connectivity, we will apply synergistic state-of-the-art systems neuroscience methods including functional, diffusion, and structural magnetic resonance imaging (MRI), and electrophysiological evaluation based on transcranial magnetic stimulation (TMS) coupled with electroencephalography (EEG) and electromyography (EMG). In addition, an extensive, multi-domain neuropsychological evaluation will be performed at each timepoint, covering all sensorimotor and cognitive domains. This project will significantly add to the understanding of underlying mechanisms of motor recovery with a strong focus on the interactions between the motor and other cognitive domains and multimodal network analyses. The population-based, multi-dimensional dataset will serve as a basis to develop biomarkers to predict outcome and promote personalized stratification toward individually tailored treatment concepts using neuro-technologies, thus paving the way toward personalized precision medicine approaches in stroke rehabilitation.
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Affiliation(s)
- Lisa Fleury
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Philipp J. Koch
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Neurology, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | | | | | | | | | | | - Andéol Cadic Melchior
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Julia Brügger
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Martino Ceroni
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Pauline Menoud
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Diego De Leon Rodriguez
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Valérie Zufferey
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Nathalie H. Meyer
- Laboratory of Cognitive Neuroscience, INX and BMI, EPFL, Campus Biotech, Geneva, Switzerland
| | - Philip Egger
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Sylvain Harquel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Traian Popa
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Estelle Raffin
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Gabriel Girard
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), EPFL, Lausanne, Switzerland
| | - Jean-Philippe Thiran
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), EPFL, Lausanne, Switzerland
| | | | | | | | - Andreas Mühl
- Clinique Romande de Réadaptation, Sion, Switzerland
| | | | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, INX and BMI, EPFL, Campus Biotech, Geneva, Switzerland
- Department of Clinical Neurosciences, University of Geneva (UNIGE), Geneva, Switzerland
| | - Dimitri Van De Ville
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Medical Image Processing Lab, Center for Neuroprosthetics, Institute of Bioengineering, EPFL, Lausanne, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), EPFL, Campus Biotech, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, INX and BMI, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
- Clinical Neuroscience, Geneva University Hospital, Geneva, Switzerland
- *Correspondence: Friedhelm C. Hummel
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Rodocker HI, Bordbar A, Larson MJE, Biltz RG, Wangler L, Fadda P, Godbout JP, Tedeschi A. Breaking Mental Barriers Promotes Recovery After Spinal Cord Injury. Front Mol Neurosci 2022; 15:868563. [PMID: 35875670 PMCID: PMC9301320 DOI: 10.3389/fnmol.2022.868563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022] Open
Abstract
Functional recovery after spinal cord injury (SCI) often proves difficult as physical and mental barriers bar survivors from enacting their designated rehabilitation programs. We recently demonstrated that adult mice administered gabapentinoids, clinically approved drugs prescribed to mitigate chronic neuropathic pain, recovered upper extremity function following cervical SCI. Given that rehabilitative training enhances neuronal plasticity and promotes motor recovery, we hypothesized that the combination of an aerobic-based rehabilitation regimen like treadmill training with gabapentin (GBP) administration will maximize recovery in SCI mice by strengthening synaptic connections along the sensorimotor axis. Whereas mice administered GBP recovered forelimb functions over the course of weeks and months following SCI, no additive forelimb recovery as the result of voluntary treadmill training was noted in these mice. To our surprise, we also failed to find an additive effect in mice administered vehicle. As motivation is crucial in rehabilitation interventions, we scored active engagement toward the rehabilitation protocol and found that mice administered GBP were consistently participating in the rehabilitation program. In contrast, mice administered vehicle exhibited a steep decline in participation, especially at chronic time points. Whereas neuroinflammatory gene expression profiles were comparable between experimental conditions, we discovered that mice administered GBP had increased hippocampal neurogenesis and exhibited less anxiety-like behavior after SCI. We also found that an external, social motivator effectively rescues participation in mice administered vehicle and promotes forelimb recovery after chronic SCI. Thus, not only does a clinically relevant treatment strategy preclude the deterioration of mental health after chronic SCI, but group intervention strategies may prove to be physically and emotionally beneficial for SCI individuals.
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Affiliation(s)
- Haven I. Rodocker
- Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Arman Bordbar
- Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Molly J. E. Larson
- Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Rebecca G. Biltz
- Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, United States
| | - Lynde Wangler
- Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, United States
| | - Paolo Fadda
- Department of Cancer Biology, The Ohio State University, Columbus, OH, United States
| | - Jonathan P. Godbout
- Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, United States
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, United States
| | - Andrea Tedeschi
- Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, United States
- *Correspondence: Andrea Tedeschi
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30
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Bigoni C, Zandvliet SB, Beanato E, Crema A, Coscia M, Espinosa A, Henneken T, Hervé J, Oflar M, Evangelista GG, Morishita T, Wessel MJ, Bonvin C, Turlan JL, Birbaumer N, Hummel FC. A Novel Patient-Tailored, Cumulative Neurotechnology-Based Therapy for Upper-Limb Rehabilitation in Severely Impaired Chronic Stroke Patients: The AVANCER Study Protocol. Front Neurol 2022; 13:919511. [PMID: 35873764 PMCID: PMC9301337 DOI: 10.3389/fneur.2022.919511] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Effective, patient-tailored rehabilitation to restore upper-limb motor function in severely impaired stroke patients is still missing. If suitably combined and administered in a personalized fashion, neurotechnologies offer a large potential to assist rehabilitative therapies to enhance individual treatment effects. AVANCER (clinicaltrials.gov NCT04448483) is a two-center proof-of-concept trial with an individual based cumulative longitudinal intervention design aiming at reducing upper-limb motor impairment in severely affected stroke patients with the help of multiple neurotechnologies. AVANCER will determine feasibility, safety, and effectivity of this innovative intervention. Thirty chronic stroke patients with a Fugl-Meyer assessment of the upper limb (FM-UE) <20 will be recruited at two centers. All patients will undergo the cumulative personalized intervention within two phases: the first uses an EEG-based brain-computer interface to trigger a variety of patient-tailored movements supported by multi-channel functional electrical stimulation in combination with a hand exoskeleton. This phase will be continued until patients do not improve anymore according to a quantitative threshold based on the FM-UE. The second interventional phase will add non-invasive brain stimulation by means of anodal transcranial direct current stimulation to the motor cortex to the initial approach. Each phase will last for a minimum of 11 sessions. Clinical and multimodal assessments are longitudinally acquired, before the first interventional phase, at the switch to the second interventional phase and at the end of the second interventional phase. The primary outcome measure is the 66-point FM-UE, a significant improvement of at least four points is hypothesized and considered clinically relevant. Several clinical and system neuroscience secondary outcome measures are additionally evaluated. AVANCER aims to provide evidence for a safe, effective, personalized, adjuvant treatment for patients with severe upper-extremity impairment for whom to date there is no efficient treatment available.
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Affiliation(s)
- Claudia Bigoni
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Sarah B. Zandvliet
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Andrea Crema
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Martina Coscia
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
- confinis AG, Sursee, Switzerland
| | - Arnau Espinosa
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Tina Henneken
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Julie Hervé
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Meltem Oflar
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Giorgia G. Evangelista
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | | | - Jean-Luc Turlan
- Department of Neurological Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Niels Birbaumer
- Department of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
- *Correspondence: Friedhelm C. Hummel
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Gasperina SD, Longatelli V, Panzenbeck M, Luciani B, Morosini A, Piantoni A, Tropea P, Braghin F, Pedrocchi A, Gandolla M. AGREE: an upper-limb robotic platform for personalized rehabilitation, concept and clinical study design. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176092 DOI: 10.1109/icorr55369.2022.9896569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Rehabilitation exoskeletons can supplement therapist-based training allowing post-stroke patients to perform functional, high-dosage, repetitive exercises. The use of robotic devices allows providing intense rehabilitation sessions and permits clinicians to personalize the therapy according to the patient's need. In this work, we propose an upper-limb rehabilitation system developed within the AGREE project. The platform relies on a four degrees-of-freedom arm exoskeleton, capable of assisting state-of-the-art rehabilitation exercises under different training modalities while behaving transparently to user-generated and therapist-applied forces. The system is provided with a LEDs-matrix mat to guide patients during reaching tasks with visual feedback, an EMG reader to evaluate the patient's involvement during the therapy, and several software tools to help clinicians customize the treatment and monitor the patient's progress. A randomized controlled pilot study aimed at evaluating the usability and the effectiveness of the AGREE rehabilitation platform to improve arm impairment after stroke is currently ongoing.
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Tang Z, Han K, Wang R, Zhang Y, Zhang H. Excitatory Repetitive Transcranial Magnetic Stimulation Over the Ipsilesional Hemisphere for Upper Limb Motor Function After Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:918597. [PMID: 35795793 PMCID: PMC9251503 DOI: 10.3389/fneur.2022.918597] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a promising therapy to promote recovery of the upper limb after stroke. According to the regulation of cortical excitability, rTMS can be divided into excitatory rTMS and inhibitory rTMS, and excitatory rTMS includes high-frequency rTMS (HF-rTMS) or intermittent theta-burst stimulation (iTBS). We aimed to evaluate the effects of excitatory rTMS over the ipsilesional hemisphere on upper limb motor recovery after stroke. Methods Databases of PubMed, Embase, ISI Web of Science, and the Cochrane Library were searched for randomized controlled trials published before 31 December 2021. RCTs on the effects of HF-rTMS or iTBS on upper limb function in patients diagnosed with stroke were included. Two researchers independently screened the literature, extracted the data, and assessed quality. The meta-analysis was performed by using Review Manager Version 5.4 software. Results Fifteen studies with 449 participants were included in this meta-analysis. This meta-analysis found that excitatory rTMS had significant efficacy on upper limb motor function (MD = 5.88, 95% CI, 3.32–8.43, P < 0.001), hand strength (SMD = 0.53, 95% CI, 0.04–1.01, P = 0.03), and hand dexterity (SMD = 0.76, 95% CI, 0.39–1.14, P < 0.001). Subgroup analyses based on different types of rTMS showed that both iTBS and HF-rTMS significantly promoted upper limb motor function (iTBS, P < 0.001; HF-rTMS, P < 0.001) and hand dexterity (iTBS, P = 0.01; HF-rTMS, P < 0.001) but not hand strength (iTBS, P = 0.07; HF-rTMS, P = 0.12). Further subgroup analysis based on the duration of illness demonstrated that applying excitatory rTMS during the first 3 months (<1 month, P = 0.01; 1–3 months, P = 0.001) after stroke brought significant improvement in upper limb motor function but not in the patients with a duration longer than 3 months (P = 0.06). We found that HF-rTMS significantly enhanced the motor evoked potential (MEP) amplitude of affected hemisphere (SMD = 0.82, 95% CI, 0.32–1.33, P = 0.001). Conclusion Our study demonstrated that excitatory rTMS over the ipsilesional hemisphere could significantly improve upper limb motor function, hand strength, and hand dexterity in patients diagnosed with stroke. Both iTBS and HF-rTMS which could significantly promote upper limb motor function and hand dexterity, and excitatory rTMS were beneficial to upper limb motor function recovery only when applied in the first 3 months after stroke. HF-rTMS could significantly enhance the MEP amplitude of the affected hemisphere. High-quality and large-scale randomized controlled trials in the future are required to confirm our conclusions. Clinical Trial Registration www.crd.york.ac.uk/prospero/, identifier: CRD42022312288.
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Affiliation(s)
- Zhiqing Tang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Kaiyue Han
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Rongrong Wang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Yue Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- *Correspondence: Hao Zhang
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Wang Y, Wang L, Wang Y, Lu M, Xu L, Liu R, Wei J, Wan J, Zhang H, Zou Y. Sensorimotor Responses in Post-Stroke Hemiplegic Patients Modulated by Acupuncture at Yanglingquan (GB34): A fMRI Study Using Intersubject Functional Correlation (ISFC) Analysis. Front Neurol 2022; 13:900520. [PMID: 35734477 PMCID: PMC9208550 DOI: 10.3389/fneur.2022.900520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
Abstract
Motor dysfunction is common in patients with stroke. Acupuncture has become an acceptable alternative method for stroke rehabilitation. Previous studies have shown various functional connectivity changes activated by acupuncture. We introduced intersubject correlation (ISC) and intersubject functional correlation (ISFC) analyses into the functional magnetic resonance imaging (fMRI) for ischemic stroke to seek a common activation and suppression pattern triggered by acupuncture. In this study, 63 ischemic stroke patients with motor dysfunction and 42 normal controls were analyzed. Three functional scans were conducted during the resting state, motor task, and acupuncture at Yanglingquan (GB34) task. Twenty-two sensory, motor, and movement-imagination cortices in the bilateral hemispheres were selected as the region of interest (ROI). We performed ISC and ISFC analyses among these ROIs in three fMRI runs on patients and controls. Subgroup analyses by course or severity were also conducted. The results showed that acupuncture at GB34 triggered ISFC among upper limb motor, upper limb/hand/face, lower limb, tongue/larynx sensory, and movement imagination regions in the patient group. Subgroup ISC and ISFC analyses showed that patients tended to have increasing responses in the early stage of stroke (within 1 month) and decreasing responses afterward (1–3 months). Patients with mild clinical functional damage (NIHSS 2–4) tended to generate more responses via acupuncture than those with moderate damage (NIHSS 5–15). Our findings may help understand the clinical effects and modulatory features of acupuncture based on the group-level post-stroke neuroplasticity.
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Redolfi Riva E, D’Alessio A, Micera S. Polysaccharide Layer-by-Layer Coating for Polyimide-Based Neural Interfaces. MICROMACHINES 2022; 13:mi13050692. [PMID: 35630159 PMCID: PMC9146946 DOI: 10.3390/mi13050692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023]
Abstract
Implantable flexible neural interfaces (IfNIs) are capable of directly modulating signals of the central and peripheral nervous system by stimulating or recording the action potential. Despite outstanding results in acute experiments on animals and humans, their long-term biocompatibility is hampered by the effects of foreign body reactions that worsen electrical performance and cause tissue damage. We report on the fabrication of a polysaccharide nanostructured thin film as a coating of polyimide (PI)-based IfNIs. The layer-by-layer technique was used to coat the PI surface due to its versatility and ease of manufacturing. Two different LbL deposition techniques were tested and compared: dip coating and spin coating. Morphological and physiochemical characterization showed the presence of a very smooth and nanostructured thin film coating on the PI surface that remarkably enhanced surface hydrophilicity with respect to the bare PI surface for both the deposition techniques. However, spin coating offered more control over the fabrication properties, with the possibility to tune the coating’s physiochemical and morphological properties. Overall, the proposed coating strategies allowed the deposition of a biocompatible nanostructured film onto the PI surface and could represent a valid tool to enhance long-term IfNI biocompatibility by improving tissue/electrode integration.
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Affiliation(s)
- Eugenio Redolfi Riva
- The BioRobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (A.D.); (S.M.)
- Correspondence:
| | - Angela D’Alessio
- The BioRobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (A.D.); (S.M.)
| | - Silvestro Micera
- The BioRobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (A.D.); (S.M.)
- Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), 1000 Lausanne, Switzerland
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Pasquini M, James ND, Dewany I, Coen FV, Cho N, Lai S, Anil S, Carpaneto J, Barraud Q, Lacour SP, Micera S, Courtine G. Preclinical upper limb neurorobotic platform to assess, rehabilitate, and develop therapies. Sci Robot 2022; 7:eabk2378. [PMID: 35353601 DOI: 10.1126/scirobotics.abk2378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Numerous neurorehabilitative, neuroprosthetic, and repair interventions aim to address the consequences of upper limb impairments after neurological disorders. Although these therapies target widely different mechanisms, they share the common need for a preclinical platform that supports the development, assessment, and understanding of the therapy. Here, we introduce a neurorobotic platform for rats that meets these requirements. A four-degree-of-freedom end effector is interfaced with the rat's wrist, enabling unassisted to fully assisted execution of natural reaching and retrieval movements covering the entire body workspace. Multimodal recording capabilities permit precise quantification of upper limb movement recovery after spinal cord injury (SCI), which allowed us to uncover adaptations in corticospinal tract neuron dynamics underlying this recovery. Personalized movement assistance supported early neurorehabilitation that improved recovery after SCI. Last, the platform provided a well-controlled and practical environment to develop an implantable spinal cord neuroprosthesis that improved upper limb function after SCI.
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Affiliation(s)
- Maria Pasquini
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Nicholas D James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Inssia Dewany
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Florent-Valéry Coen
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Center for Neuroprosthetics, Institute of Electrical and MicroEngineering and Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Newton Cho
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Stefano Lai
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'anna, Pisa, Italy
| | - Selin Anil
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Jacopo Carpaneto
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'anna, Pisa, Italy
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Center for Neuroprosthetics, Institute of Electrical and MicroEngineering and Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Silvestro Micera
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
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Villamil V, Wolbring G. Influencing discussions and use of neuroadvancements as professionals and citizens: Perspectives of Canadian speech-language pathologists and audiologists. Work 2022; 71:565-584. [DOI: 10.3233/wor-205104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Early involvement of stakeholders in neuroethics and neurogovernance discourses of neuroscientific and neurotechnological advancements is seen as essential to curtail negative consequences. Speech-language pathologists (SLPs) and audiologists (AUs) make use of neuroadvancements including cochlear implants, brain-computer interfaces, and deep-brain stimulation. Although they have a stake in neuroethics and neurogovernance discussions, they are rarely mentioned in having a role, whether as professionals or as citizens. OBJECTIVE: The objective of the study was to explore the role of SLPs and AUs as professionals and citizens in neuroethics and neurogovernance discussions and examine the utility of lifelong learning mechanisms to learn about the implications of neuroadvancements to contribute in a meaningful way to these discussions. METHODS: Semi-structured interviews conducted with 7 SLPs and 3 AUs were analyzed using thematic analysis. RESULTS: Participants stated that their roles expected from them as professionals and as citizens indicate the importance to be knowledgeable on ethical, legal, and social implications of neuroadvancements and that lifelong learning is not used to learn about these implications. CONCLUSION: More must be done to facilitate the participation of SLPs and AUs in neuroethics and neurogovernance discussions, which would enrich the neuroethics and neurogovernance discourses benefitting patients, professionals, and the public.
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Affiliation(s)
- Valentina Villamil
- Speech-Language Pathology, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gregor Wolbring
- Community Rehabilitation and Disability Studies, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Gerardin E, Bontemps D, Babuin NT, Herman B, Denis A, Bihin B, Regnier M, Leeuwerck M, Deltombe T, Riga A, Vandermeeren Y. Bimanual motor skill learning with robotics in chronic stroke: comparison between minimally impaired and moderately impaired patients, and healthy individuals. J Neuroeng Rehabil 2022; 19:28. [PMID: 35300709 PMCID: PMC8928664 DOI: 10.1186/s12984-022-01009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
Background Most activities of daily life (ADL) require cooperative bimanual movements. A unilateral stroke may severely impair bimanual ADL. How patients with stroke (re)learn to coordinate their upper limbs (ULs) is largely unknown. The objectives are to determine whether patients with chronic supratentorial stroke could achieve bimanual motor skill learning (bim-MSkL) and to compare bim-MSkL between patients and healthy individuals (HIs). Methods Twenty-four patients and ten HIs trained over 3 consecutive days on an asymmetrical bimanual coordination task (CIRCUIT) implemented as a serious game in the REAplan® robot. With a common cursor controlled by coordinated movements of the ULs through robotic handles, they performed as many laps as possible (speed constraint) on the CIRCUIT while keeping the cursor within the track (accuracy constraint). The primary outcome was a bimanual speed/accuracy trade-off (biSAT), we used a bimanual coordination factor (biCO) and bimanual forces (biFOP) for the secondary outcomes. Several clinical scales were used to evaluate motor and cognitive functions. Results Overall, the patients showed improvements on biSAT and biCO. Based on biSAT progression, the HI achieved a larger bim-MSkL than the patients with mild to moderate impairment (Fugl-Meyer Assessment Upper Extremity (FMA-UE): 28–55, n = 15) but not significantly different from those with minimal motor impairment (FMA-UE: 66, n = 9). There was a significant positive correlation between biSAT evolution and the FMA-UE and Stroke Impact Scale. Conclusions Both HI and patients with chronic stroke training on a robotic device achieved bim-MSkL, although the more impaired patients were less efficient. Bim-MSkL with REAplan® may be interesting for neurorehabilitation after stroke. Trial registration: ClinicalTrial.gov identifier: NCT03974750. Registered 05 June 2019. https://clinicaltrials.gov/ct2/show/NCT03974750?cond=NCT03974750&draw=2&rank=1 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01009-3.
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Affiliation(s)
- Eloïse Gerardin
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium. .,Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium. .,Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium.
| | - Damien Bontemps
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Faculty of Motor Sciences, UCLouvain, Louvain-La-Neuve, Belgium
| | - Nicolas-Thomas Babuin
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Faculty of Motor Sciences, UCLouvain, Louvain-La-Neuve, Belgium
| | - Benoît Herman
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
| | - Adrien Denis
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
| | - Benoît Bihin
- Scientific Support Unit (USS), UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Maxime Regnier
- Scientific Support Unit (USS), UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Maria Leeuwerck
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Audrey Riga
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium
| | - Yves Vandermeeren
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium
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Undergraduate Disabled Students as Knowledge Producers Including Researchers: Perspectives of Disabled Students. EDUCATION SCIENCES 2022. [DOI: 10.3390/educsci12020077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Knowledge influences policy development and policies impact disabled people. Scientific and technological advancements, including neuro-advancements and their governance, have social implications for disabled people. However, knowledge is missing on this topic. Although efforts are underway to increase the number of disabled academics, the numbers remain low. Engaging undergraduate disabled students in knowledge production, especially research, could decrease the knowledge deficit and increase the pool of disabled students considering an academic career. We performed 10 semi-structured interviews of disabled students to understand the reality of undergraduate disabled students as knowledge producers, including researchers. Using a directed thematic content analysis, we found that participants felt that undergraduate disabled students were insufficiently exposed to and supported in the identity of being knowledge producers including researchers. Participants identified ethical, legal, and social implications of science and technology and argued that undergraduate disabled students and disabled people have a role to play in the discussions of these. Exposing disabled students at the undergraduate and high school level to knowledge production including researcher identity could increase the numbers of undergraduate disabled researchers, disabled academics, and disabled students doing research in the community after graduation and decrease the knowledge gaps around the social situation of disabled people.
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Papadopoulos S, Bonaiuto J, Mattout J. An Impending Paradigm Shift in Motor Imagery Based Brain-Computer Interfaces. Front Neurosci 2022; 15:824759. [PMID: 35095410 PMCID: PMC8789741 DOI: 10.3389/fnins.2021.824759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 01/11/2023] Open
Abstract
The development of reliable assistive devices for patients that suffer from motor impairments following central nervous system lesions remains a major challenge in the field of non-invasive Brain-Computer Interfaces (BCIs). These approaches are predominated by electroencephalography and rely on advanced signal processing and machine learning methods to extract neural correlates of motor activity. However, despite tremendous and still ongoing efforts, their value as effective clinical tools remains limited. We advocate that a rather overlooked research avenue lies in efforts to question neurophysiological markers traditionally targeted in non-invasive motor BCIs. We propose an alternative approach grounded by recent fundamental advances in non-invasive neurophysiology, specifically subject-specific feature extraction of sensorimotor bursts of activity recorded via (possibly magnetoencephalography-optimized) electroencephalography. This path holds promise in overcoming a significant proportion of existing limitations, and could foster the wider adoption of online BCIs in rehabilitation protocols.
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Affiliation(s)
- Sotirios Papadopoulos
- University Lyon 1, Lyon, France
- Lyon Neuroscience Research Center, CRNL, INSERM, U1028, CNRS, UMR 5292, Lyon, France
- Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France
- *Correspondence: Sotirios Papadopoulos,
| | - James Bonaiuto
- University Lyon 1, Lyon, France
- Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France
| | - Jérémie Mattout
- University Lyon 1, Lyon, France
- Lyon Neuroscience Research Center, CRNL, INSERM, U1028, CNRS, UMR 5292, Lyon, France
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Goffredo M, Pournajaf S, Proietti S, Gison A, Posteraro F, Franceschini M. Retrospective Robot-Measured Upper Limb Kinematic Data From Stroke Patients Are Novel Biomarkers. Front Neurol 2022; 12:803901. [PMID: 34992576 PMCID: PMC8725786 DOI: 10.3389/fneur.2021.803901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background: The efficacy of upper-limb Robot-assisted Therapy (ulRT) in stroke subjects is well-established. The robot-measured kinematic data can assess the biomechanical changes induced by ulRT and the progress of patient over time. However, literature on the analysis of pre-treatment kinematic parameters as predictive biomarkers of upper limb recovery is limited. Objective: The aim of this study was to calculate pre-treatment kinematic parameters from point-to-point reaching movements in different directions and to identify biomarkers of upper-limb motor recovery in subacute stroke subjects after ulRT. Methods: An observational retrospective study was conducted on 66 subacute stroke subjects who underwent ulRT with an end-effector robot. Kinematic parameters were calculated from the robot-measured trajectories during movements in different directions. A Generalized Linear Model (GLM) was applied considering the post-treatment Upper Limb Motricity Index and the kinematic parameters (from demanding directions of movement) as dependent variables, and the pre-treatment kinematic parameters as independent variables. Results: A subset of kinematic parameters significantly predicted the motor impairment after ulRT: the accuracy in adduction and internal rotation movements of the shoulder was the major predictor of post-treatment Upper Limb Motricity Index. The post-treatment kinematic parameters of the most demanding directions of movement significantly depended on the ability to execute elbow flexion-extension and abduction and external rotation movements of the shoulder at baseline. Conclusions: The multidirectional analysis of robot-measured kinematic data predicts motor recovery in subacute stroke survivors and paves the way in identifying subjects who may benefit more from ulRT.
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Affiliation(s)
- Michela Goffredo
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Sanaz Pournajaf
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Stefania Proietti
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Annalisa Gison
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Federico Posteraro
- Rehabilitation Department, Versilia Hospital, Azienda Unità Sanitaria Locale (AUSL) Northwest Tuscany, Camaiore, Italy
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
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Luo Q, Niu CM, Chou CH, Liang W, Deng X, Hao M, Lan N. Biorealistic Control of Hand Prosthesis Augments Functional Performance of Individuals With Amputation. Front Neurosci 2021; 15:783505. [PMID: 34970115 PMCID: PMC8712573 DOI: 10.3389/fnins.2021.783505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
The human hand has compliant properties arising from muscle biomechanics and neural reflexes, which are absent in conventional prosthetic hands. We recently proved the feasibility to restore neuromuscular reflex control (NRC) to prosthetic hands using real-time computing neuromorphic chips. Here we show that restored NRC augments the ability of individuals with forearm amputation to complete grasping tasks, including standard Box and Blocks Test (BBT), Golf Balls Test (GBT), and Potato Chips Test (PCT). The latter two were more challenging, but novel to prosthesis tests. Performance of a biorealistic controller (BC) with restored NRC was compared to that of a proportional linear feedback (PLF) controller. Eleven individuals with forearm amputation were divided into two groups: one with experience of myocontrol of a prosthetic hand and another without any. Controller performances were evaluated by success rate, failure (drop/break) rate in each grasping task. In controller property tests, biorealistic control achieved a better compliant property with a 23.2% wider range of stiffness adjustment than that of PLF control. In functional grasping tests, participants could control prosthetic hands more rapidly and steadily with neuromuscular reflex. For participants with myocontrol experience, biorealistic control yielded 20.4, 39.4, and 195.2% improvements in BBT, GBT, and PCT, respectively, compared to PLF control. Interestingly, greater improvements were achieved by participants without any myocontrol experience for BBT, GBT, and PCT at 27.4, 48.9, and 344.3%, respectively. The functional gain of biorealistic control over conventional control was more dramatic in more difficult grasp tasks of GBT and PCT, demonstrating the advantage of NRC. Results support the hypothesis that restoring neuromuscular reflex in hand prosthesis can improve neural motor compatibility to human sensorimotor system, hence enabling individuals with amputation to perform delicate grasps that are not tested with conventional prosthetic hands.
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Affiliation(s)
- Qi Luo
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chuanxin M. Niu
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chih-Hong Chou
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Wenyuan Liang
- National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Xiaoqian Deng
- Guangdong Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Manzhao Hao
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Ning Lan
- Laboratory of Neurorehabilitation Engineering, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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42
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Gradišnik L, Bošnjak R, Bunc G, Ravnik J, Maver T, Velnar T. Neurosurgical Approaches to Brain Tissue Harvesting for the Establishment of Cell Cultures in Neural Experimental Cell Models. MATERIALS (BASEL, SWITZERLAND) 2021; 14:6857. [PMID: 34832259 PMCID: PMC8624371 DOI: 10.3390/ma14226857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/30/2022]
Abstract
In recent decades, cell biology has made rapid progress. Cell isolation and cultivation techniques, supported by modern laboratory procedures and experimental capabilities, provide a wide range of opportunities for in vitro research to study physiological and pathophysiological processes in health and disease. They can also be used very efficiently for the analysis of biomaterials. Before a new biomaterial is ready for implantation into tissues and widespread use in clinical practice, it must be extensively tested. Experimental cell models, which are a suitable testing ground and the first line of empirical exploration of new biomaterials, must contain suitable cells that form the basis of biomaterial testing. To isolate a stable and suitable cell culture, many steps are required. The first and one of the most important steps is the collection of donor tissue, usually during a surgical procedure. Thus, the collection is the foundation for the success of cell isolation. This article explains the sources and neurosurgical procedures for obtaining brain tissue samples for cell isolation techniques, which are essential for biomaterial testing procedures.
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Affiliation(s)
- Lidija Gradišnik
- Faculty of Medicine, Institute of Biomedical Sciences, University of Maribor, Taborska 8, 2000 Maribor, Slovenia;
- Alma Mater Europaea ECM, Slovenska 17, 2000 Maribor, Slovenia
| | - Roman Bošnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia;
| | - Gorazd Bunc
- Department of Neurosurgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (G.B.); (J.R.)
| | - Janez Ravnik
- Department of Neurosurgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (G.B.); (J.R.)
| | - Tina Maver
- Faculty of Medicine, Institute of Biomedical Sciences, University of Maribor, Taborska 8, 2000 Maribor, Slovenia;
- Department of Pharmacology, Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia
| | - Tomaž Velnar
- Alma Mater Europaea ECM, Slovenska 17, 2000 Maribor, Slovenia
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia;
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Viganò L, Howells H, Rossi M, Rabuffetti M, Puglisi G, Leonetti A, Bellacicca A, Conti Nibali M, Gay L, Sciortino T, Cerri G, Bello L, Fornia L. Stimulation of frontal pathways disrupts hand muscle control during object manipulation. Brain 2021; 145:1535-1550. [PMID: 34623420 PMCID: PMC9128819 DOI: 10.1093/brain/awab379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
The activity of frontal motor areas during hand-object interaction is coordinated by dense communication along specific white matter pathways. This architecture allows the continuous shaping of voluntary motor output and, despite extensively investigated in non-human primate studies, remains poorly understood in humans. Disclosure of this system is crucial for predicting and treatment of motor deficits after brain lesions. For this purpose, we investigated the effect of direct electrical stimulation on white matter pathways within the frontal lobe on hand-object manipulation. This was tested in thirty-four patients (15 left hemisphere, mean age 42 years, 17 male, 15 with tractography) undergoing awake neurosurgery for frontal lobe tumour removal with the aid of the brain mapping technique. The stimulation outcome was quantified based on hand-muscle activity required by task execution. The white matter pathways responsive to stimulation with an interference on muscles were identified by means of probabilistic density estimation of stimulated sites, tract-based lesion-symptom (disconnectome) analysis and diffusion tractography on the single patient level. Finally, we assessed the effect of permanent tracts disconnection on motor outcome in the immediate postoperative period using a multivariate lesion-symptom mapping approach. The analysis showed that stimulation disrupted hand-muscle activity during task execution in 66 sites within the white matter below dorsal and ventral premotor regions. Two different EMG interference patterns associated with different structural architectures emerged: 1) an arrest pattern, characterised by complete impairment of muscle activity associated with an abrupt task interruption, occurred when stimulating a white matter area below the dorsal premotor region. Local mid-U-shaped fibres, superior fronto-striatal, corticospinal and dorsal fronto-parietal fibres intersected with this region. 2) a clumsy pattern, characterised by partial disruption of muscle activity associated with movement slowdown and/or uncoordinated finger movements, occurred when stimulating a white matter area below the ventral premotor region. Ventral fronto-parietal and inferior fronto-striatal tracts intersected with this region. Finally, only resections partially including the dorsal white matter region surrounding the supplementary motor area were associated with transient upper-limb deficit (p = 0.05; 5000 permutations). Overall, the results identify two distinct frontal white matter regions possibly mediating different aspects of hand-object interaction via distinct sets of structural connectivity. We suggest the dorsal region, associated with arrest pattern and post-operative immediate motor deficits, to be functionally proximal to motor output implementation, while the ventral region may be involved in sensorimotor integration required for task execution.
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Affiliation(s)
- Luca Viganò
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Henrietta Howells
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Marco Rossi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Marco Rabuffetti
- Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milano, Italy
| | - Guglielmo Puglisi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano.,MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Antonella Leonetti
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Andrea Bellacicca
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Marco Conti Nibali
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Lorenzo Gay
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Tommaso Sciortino
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Gabriella Cerri
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano
| | - Luca Fornia
- MoCA Laboratory, Department of Medical Biotechnology and Translational Medicine, Universita`degli Studi di Milano
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Rose CG, Deshpande AD, Carducci J, Brown JD. The road forward for upper-extremity rehabilitation robotics. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2021. [DOI: 10.1016/j.cobme.2021.100291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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45
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Bianchi L, Antonietti A, Bajwa G, Ferrante R, Mahmud M, Balachandran P. A functional BCI model by the IEEE P2731 working group: data storage and sharing. BRAIN-COMPUTER INTERFACES 2021. [DOI: 10.1080/2326263x.2021.1968632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Luigi Bianchi
- Civil Engineering and Computer Science Engineering Dept, Tor Vergata University of Rome, Rome, Italy
| | - Alberto Antonietti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Garima Bajwa
- Computer Science & Electrical Engineering, Capitol Technology University 11301 Springfield Road, Laurel, MD, USA
| | - Raffaele Ferrante
- Civil Engineering and Computer Science Engineering Dept, Tor Vergata University of Rome, Rome, Italy
| | - Mufti Mahmud
- Nottingham Trent University Clifton, Nottingham, UK
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Koch PJ, Park CH, Girard G, Beanato E, Egger P, Evangelista GG, Lee J, Wessel MJ, Morishita T, Koch G, Thiran JP, Guggisberg AG, Rosso C, Kim YH, Hummel FC. The structural connectome and motor recovery after stroke: predicting natural recovery. Brain 2021; 144:2107-2119. [PMID: 34237143 PMCID: PMC8370413 DOI: 10.1093/brain/awab082] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/11/2020] [Accepted: 12/14/2020] [Indexed: 11/20/2022] Open
Abstract
Stroke patients vary considerably in terms of outcomes: some patients present 'natural' recovery proportional to their initial impairment (fitters), while others do not (non-fitters). Thus, a key challenge in stroke rehabilitation is to identify individual recovery potential to make personalized decisions for neuro-rehabilitation, obviating the 'one-size-fits-all' approach. This goal requires (i) the prediction of individual courses of recovery in the acute stage; and (ii) an understanding of underlying neuronal network mechanisms. 'Natural' recovery is especially variable in severely impaired patients, underscoring the special clinical importance of prediction for this subgroup. Fractional anisotropy connectomes based on individual tractography of 92 patients were analysed 2 weeks after stroke (TA) and their changes to 3 months after stroke (TC - TA). Motor impairment was assessed using the Fugl-Meyer Upper Extremity (FMUE) scale. Support vector machine classifiers were trained to separate patients with natural recovery from patients without natural recovery based on their whole-brain structural connectomes and to define their respective underlying network patterns, focusing on severely impaired patients (FMUE < 20). Prediction accuracies were cross-validated internally, in one independent dataset and generalized in two independent datasets. The initial connectome 2 weeks after stroke was capable of segregating fitters from non-fitters, most importantly among severely impaired patients (TA: accuracy = 0.92, precision = 0.93). Secondary analyses studying recovery-relevant network characteristics based on the selected features revealed (i) relevant differences between networks contributing to recovery at 2 weeks and network changes over time (TC - TA); and (ii) network properties specific to severely impaired patients. Important features included the parietofrontal motor network including the intraparietal sulcus, premotor and primary motor cortices and beyond them also attentional, somatosensory or multimodal areas (e.g. the insula), strongly underscoring the importance of whole-brain connectome analyses for better predicting and understanding recovery from stroke. Computational approaches based on structural connectomes allowed the individual prediction of natural recovery 2 weeks after stroke onset, especially in the difficult to predict group of severely impaired patients, and identified the relevant underlying neuronal networks. This information will permit patients to be stratified into different recovery groups in clinical settings and will pave the way towards personalized precision neurorehabilitative treatment.
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Affiliation(s)
- Philipp J Koch
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
- Department of Neurology, University of Lübeck, 23562 Lübeck, Germany
| | - Chang-Hyun Park
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Gabriel Girard
- Signal Processing Laboratory (LTS5), School of Engineering, École Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, Switzerland
- Radiology Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, CH-1011, Lausanne, Switzerland
- CIBM Center for BioMedical Imaging, CH-1015, Lausanne, Switzerland
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Philip Egger
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Giorgia Giulia Evangelista
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Jungsoo Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351 Seoul, Republic of Korea
| | - Maximilian J Wessel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, 00179 Rome, Italy
| | - Jean-Philippe Thiran
- Signal Processing Laboratory (LTS5), School of Engineering, École Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, Switzerland
- Radiology Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, CH-1011, Lausanne, Switzerland
- CIBM Center for BioMedical Imaging, CH-1015, Lausanne, Switzerland
| | - Adrian G Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Charlotte Rosso
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 10 27, Institut du Cerveau et de la Moelle épinière, ICM, France; AP-HP, Stroke Unit, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351 Seoul, Republic of Korea
- Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
- Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland
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Qu Q, Lin Y, He Z, Fu J, Zou F, Jiang Z, Guo F, Jia J. The Effect of Applying Robot-Assisted Task-Oriented Training Using Human-Robot Collaborative Interaction Force Control Technology on Upper Limb Function in Stroke Patients: Preliminary Findings. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9916492. [PMID: 34368358 PMCID: PMC8342143 DOI: 10.1155/2021/9916492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/13/2021] [Accepted: 07/11/2021] [Indexed: 02/08/2023]
Abstract
Stroke is one of the leading causes of death and the primary cause of acquired disability worldwide. Many stroke survivors have difficulty using their upper limbs, which have important functional roles in the performance of daily life activities. Consequently, the independence and quality of life of most stroke patients are reduced. Robot-assisted therapy is an effective intervention for improving the upper limb function of individuals with stroke. Human-robot collaborative interaction force control technology is critical for improving the flexibility and followability of the robot's motion, thereby improving rehabilitation training outcomes. However, there are few reports on the effect of robot-assisted rehabilitative training on upper limb function. We applied this technology using a robot to assist patients with task-oriented training. Posttreatment changes in Fugl-Meyer and modified Barthel index (MBI) scores were assessed to determine whether this technology could improve the upper limb function of stroke patients. One healthy adult and five stroke patients, respectively, participated in functional and clinical experiments. The MBI and Fugl-Meyer scores of the five patients in the clinical experiments showed significant improvements after the intervention. The experimental results indicate that human-robot collaborative interaction force control technology is valuable for improving robots' properties and patients' recovery. This trial was registered in the Chinese clinical trial registry (ChiCTR2000038676).
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Affiliation(s)
- Qingming Qu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Yingnan Lin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Zhijie He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Jianghong Fu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Fei Zou
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Zewu Jiang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
| | - Fengxian Guo
- Shanghai Electric GeniKIT Medical Science and Technology Co. Ltd., Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, China
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48
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Conti S, Spalletti C, Pasquini M, Giordano N, Barsotti N, Mainardi M, Lai S, Giorgi A, Pasqualetti M, Micera S, Caleo M. Combining robotics with enhanced serotonin-driven cortical plasticity improves post-stroke motor recovery. Prog Neurobiol 2021; 203:102073. [PMID: 33984455 DOI: 10.1016/j.pneurobio.2021.102073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
Despite recent progresses in robotic rehabilitation technologies, their efficacy for post-stroke motor recovery is still limited. Such limitations might stem from the insufficient enhancement of plasticity mechanisms, crucial for functional recovery. Here, we designed a clinically relevant strategy that combines robotic rehabilitation with chemogenetic stimulation of serotonin release to boost plasticity. These two approaches acted synergistically to enhance post-stroke motor performance. Indeed, mice treated with our combined therapy showed substantial functional gains that persisted beyond the treatment period and generalized to non-trained tasks. Motor recovery was associated with a reduction in electrophysiological and neuroanatomical markers of GABAergic neurotransmission, suggesting disinhibition in perilesional areas. To unveil the translational potentialities of our approach, we specifically targeted the serotonin 1A receptor by delivering Buspirone, a clinically approved drug, in stroke mice undergoing robotic rehabilitation. Administration of Buspirone restored motor impairments similarly to what observed with chemogenetic stimulation, showing the immediate translational potential of this combined approach to significantly improve motor recovery after stroke.
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Affiliation(s)
- S Conti
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - C Spalletti
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - M Pasquini
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - N Giordano
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - N Barsotti
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy
| | - M Mainardi
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - S Lai
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - A Giorgi
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy
| | - M Pasqualetti
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy; Center for Neuroscience and Cognitive Systems, Istituto Italiano di Tecnologia, Rovereto, Italy
| | - S Micera
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational NeuroEngineering Laboratory, École Polytechnique Fédérale de Lausanne (EPFL), Centre for Neuroprosthetics and Institute of Bioengineering, Lausanne, Switzerland.
| | - M Caleo
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy; Department of Biomedical Sciences, University of Padova, Italy.
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Macaulay TR, Peters BT, Wood SJ, Clément GR, Oddsson L, Bloomberg JJ. Developing Proprioceptive Countermeasures to Mitigate Postural and Locomotor Control Deficits After Long-Duration Spaceflight. Front Syst Neurosci 2021; 15:658985. [PMID: 33986648 PMCID: PMC8111171 DOI: 10.3389/fnsys.2021.658985] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022] Open
Abstract
Astronauts experience post-flight disturbances in postural and locomotor control due to sensorimotor adaptations during spaceflight. These alterations may have adverse consequences if a rapid egress is required after landing. Although current exercise protocols can effectively mitigate cardiovascular and muscular deconditioning, the benefits to post-flight sensorimotor dysfunction are limited. Furthermore, some exercise capabilities like treadmill running are currently not feasible on exploration spaceflight vehicles. Thus, new in-flight operational countermeasures are needed to mitigate postural and locomotor control deficits after exploration missions. Data from spaceflight and from analog studies collectively suggest that body unloading decreases the utilization of proprioceptive input, and this adaptation strongly contributes to balance dysfunction after spaceflight. For example, on return to Earth, an astronaut's vestibular input may be compromised by adaptation to microgravity, but their proprioceptive input is compromised by body unloading. Since proprioceptive and tactile input are important for maintaining postural control, keeping these systems tuned to respond to upright balance challenges during flight may improve functional task performance after flight through dynamic reweighting of sensory input. Novel approaches are needed to compensate for the challenges of balance training in microgravity and must be tested in a body unloading environment such as head down bed rest. Here, we review insights from the literature and provide observations from our laboratory that could inform the development of an in-flight proprioceptive countermeasure.
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Affiliation(s)
| | | | - Scott J. Wood
- NASA Johnson Space Center, Houston, TX, United States
| | | | - Lars Oddsson
- RxFunction Inc., Eden Prairie, MN, United States
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
- Recaniti School for Community Health Professions, Ben Gurion University of the Negev, Beersheba, Israel
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50
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Wu J, Cheng H, Zhang J, Yang S, Cai S. Robot-Assisted Therapy for Upper Extremity Motor Impairment After Stroke: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6103015. [PMID: 33454787 DOI: 10.1093/ptj/pzab010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment. METHODS The PubMed, Embase, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer assessment for upper extremity scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies. RESULTS Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the Fugl-Meyer assessment for upper extremity scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI, 0.11-0.38; I2 = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, were superior to conventional rehabilitation (Hedges g = 0.32; 95% CI, 0.15-0.50; I2 = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI, 0.09-0.36; I2 = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI, 0.16-0.50; I2 = 34.2%). CONCLUSION RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.
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Affiliation(s)
- Jingyi Wu
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Hao Cheng
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shanli Yang
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Sufang Cai
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
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