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Zhang L, Wang J, Zhou H, Liao W, Wang N, Yu X. The effect of body weight-supported Tai Chi Yunshou on upper limb motor function in stroke survivors based on neurobiomechanical analysis: a four-arm, parallel-group, assessors-blind randomized controlled trial protocol. Front Neurol 2024; 15:1395164. [PMID: 39045430 PMCID: PMC11263172 DOI: 10.3389/fneur.2024.1395164] [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: 03/28/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction A series of functional disorders commonly occur after stroke, of which upper limb dysfunction is the most difficult to recover. The upper limb rehabilitation effect of Tai Chi Yunshou(TCY) in the later stage of stroke has been confirmed by research. Body weight support-Tai Chi Yunshou (BWS-TCY) is based on TCY exercise and robotic exoskeletons offers most flexibility in deweighting and control strategy. This study is aimed to explore the effect of BWS-TCY on upper limb motor function in stroke based on neurobiomechanics. Methods and analysis A single-blind randomized controlled trial will be conducted on 36 stroke survivors who will be randomly assigned to three groups: experimental group, control group A and control group B. In addition, 12 healthy elderly people will be recruited into the healthy control group. Those in the experimental group will receive 20 min of CRT and 20 min of BWS-TCY training, while participants in the control group A will receive 20 min of CRT and 20 min of Robot-assisted training. Participants in the control group B will undergo 40 min of Conventional rehabilitation training (CRT) daily. All interventions will take place 5 days a week for 12 weeks, with a 12-week follow-up period. No intervention will be carried out for the healthy control group. Upper limb function will be assessed before and after the intervention using various rating scales (Fugl-Meyer Assessment, Wolf Motor Function Test, etc.), as well as neurobiomechanical analyses (surface electromyography, functional near-infrared brain function analysis system, and Xsens maneuver Capture System). Additionally, 10 healthy elderly individuals will be recruited for neurobiomechanical analysis, and the results will be compared with those of stroke survivors. Discussion The results of this study will offer initial evidence on the effectiveness and feasibility of BWS-TCY as an early intervention for stroke rehabilitation. Positive findings from this study could contribute to the development of guidelines for the use of BWS-TCY in the early stages of stroke. Ethics and dissemination This study has been approved by the Research Ethics Committees of the seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Study ID: 2022-7th-HIRB-022). The results of the study will be published in a peer-reviewed journal and presented at scientific conferences. Clinical trial registration https://clinicaltrials.gov/, ChiCTR 2200063150.
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Affiliation(s)
- Liying Zhang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Neurology, Fujian Provincial Governmental Hospital, Fujian, China
| | - Jiening Wang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huanxia Zhou
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wangsheng Liao
- Department of Rehabilitation, Fuzhou Second General Hospital, Fujian, China
| | - Naizhen Wang
- Department of Rehabilitation, Fuzhou Second General Hospital, Fujian, China
| | - Xiaoming Yu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Zhang T, Xu G, Huo C, Li W, Li Z, Li W. Cortical hemodynamic response and networks in children with cerebral palsy during upper limb bilateral motor training. JOURNAL OF BIOPHOTONICS 2023; 16:e202200326. [PMID: 36602536 DOI: 10.1002/jbio.202200326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/05/2022] [Accepted: 12/28/2022] [Indexed: 05/17/2023]
Abstract
Understanding the characteristics of functional brain activity is important for motor rehabilitation of children with cerebral palsy (CP). Using the functional near-infrared spectroscopy (fNIRS) technology, the cortical response and networks of prefrontal (PFC) and motor cortices (MC) were analyzed for children with CP and typical development (CTD). Compared with CTD, the resting cortical response of dominant MC in children with CP increased, and the functional connectivity between cerebral areas decreased. In the motor state of children with CP, the coupling strength started from dominant MC increased compared with resting state, and the hemispherical autonomy index (HAI) of the dominant MC was higher than that in the CTD, which reflected the leading role of dominant MC in brain regulation during motor. The functional connectivity between bilateral MC was positively correlated with motor performance. This study provided effective indices for evaluating the motor function and real-time impact of motor on brain networks.
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Affiliation(s)
- Tengyu Zhang
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Gongcheng Xu
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Congcong Huo
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wenhao Li
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- School of Rehabilitation Engineering, Beijing College of Social Administration, Beijing, China
| | - Zengyong Li
- Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, China
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Hilderley AJ, Wright FV, Taylor MJ, Chen JL, Fehlings D. Functional Neuroplasticity and Motor Skill Change Following Gross Motor Interventions for Children With Diplegic Cerebral Palsy. Neurorehabil Neural Repair 2023; 37:16-26. [PMID: 36524254 PMCID: PMC9896542 DOI: 10.1177/15459683221143503] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gross motor intervention designs for children with diplegic cerebral palsy (DCP) require an improved understanding of the children's potential for neuroplasticity. OBJECTIVE To identify relations between functional neuroplasticity and motor skill changes following gross motor interventions for children with DCP. METHODS There were 17 participants with DCP (ages 8-16 years; 6 females; Gross Motor Function Classification System Level I [n = 9] and II [n = 8]). Each completed a 6-week gross motor intervention program that was directed toward achievement of individualized motor/physical activity goals. Outcomes were assessed pre/post and 4 to 6 months post-intervention (follow-up). An active ankle dorsiflexion task was completed during functional magnetic resonance imaging. The ratio of motor cortical activation volume in each hemisphere was calculated using a laterality index. The Challenge was the primary gross motor skill measure. Change over time and relations among outcomes were evaluated. RESULTS Challenge scores improved post-intervention (4.57% points [SD 4.45], P = .004) and were maintained at follow-up (0.75% [SD 6.57], P = 1.000). The laterality index for dominant ankle dorsiflexion increased (P = .033), while non-dominant change was variable (P = .534). Contralateral activation (laterality index ≥+0.75) was most common for both ankles. Challenge improvements correlated with increased ipsilateral activity (negative laterality index) during non-dominant dorsiflexion (r = -.56, P = .045). Smaller activation volume during non-dominant dorsiflexion predicted continued gross motor gains at follow-up (R2 = .30, P = .040). CONCLUSIONS Motor cortical activation during non-dominant ankle dorsiflexion is a modest indicator of the potential for gross motor skill change. Further investigation of patterns of neuroplastic change will improve our understanding of effects. CLINICALTRIALS.GOV REGISTRY NCT02584491 and NCT02754128.
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Affiliation(s)
- Alicia J. Hilderley
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Physical Therapy,
University of Toronto, Toronto, ON, Canada
| | - Margot J. Taylor
- Diagnostic Imaging, The Hospital for
Sick Children, Toronto, ON, Canada,Department of Medical Imaging,
University of Toronto, Toronto, ON, Canada,Department of Psychology, University of
Toronto, Toronto, ON, Canada
| | - Joyce L. Chen
- Faculty of Kinesiology and Physical
Education, University of Toronto, Toronto, ON, Canada,Hurvitz Brain Sciences Program,
Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto,
ON, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Paediatrics, Faculty of
Medicine, University of Toronto, Toronto, ON, Canada,Darcy Fehlings, Holland Bloorview Kids
Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada.
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Identification of Functional Cortical Plasticity in Children with Cerebral Palsy Associated to Robotic-Assisted Gait Training: An fNIRS Study. J Clin Med 2022; 11:jcm11226790. [PMID: 36431267 PMCID: PMC9692288 DOI: 10.3390/jcm11226790] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Cerebral palsy (CP) is a non-progressive neurologic condition that causes gait limitations, spasticity, and impaired balance and coordination. Robotic-assisted gait training (RAGT) has become a common rehabilitation tool employed to improve the gait pattern of people with neurological impairments. However, few studies have demonstrated the effectiveness of RAGT in children with CP and its neurological effects through portable neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS). The aim of the study is to evaluate the neurophysiological processes elicited by RAGT in children with CP through fNIRS, which was acquired during three sessions in one month. The repeated measure ANOVA was applied to the β-values delivered by the General Linear Model (GLM) analysis used for fNIRS data analysis, showing significant differences in the activation of both prefrontal cortex (F (1.652, 6.606) = 7.638; p = 0.022), and sensorimotor cortex (F (1.294, 5.175) = 11.92; p = 0.014) during the different RAGT sessions. In addition, a cross-validated Machine Learning (ML) framework was implemented to estimate the gross motor function measure (GMFM-88) from the GLM β-values, obtaining an estimation with a correlation coefficient r = 0.78. This approach can be used to tailor clinical treatment to each child, improving the effectiveness of rehabilitation for children with CP.
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Zhou G, Chen Y, Wang X, Wei H, Huang Q, Li L. The correlations between kinematic profiles and cerebral hemodynamics suggest changes of motor coordination in single and bilateral finger movement. Front Hum Neurosci 2022; 16:957364. [PMID: 36061505 PMCID: PMC9433536 DOI: 10.3389/fnhum.2022.957364] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The correlation between the performance of coordination movement and brain activity is still not fully understood. The current study aimed to identify activated brain regions and brain network connectivity changes for several coordinated finger movements with different difficulty levels and to correlate the brain hemodynamics and connectivity with kinematic performance. Methods Twenty-one right-dominant-handed subjects were recruited and asked to complete circular motions of single and bilateral fingers in the same direction (in-phase, IP) and in opposite directions (anti-phase, AP) on a plane. Kinematic data including radius and angular velocity at each task and synchronized blood oxygen concentration data using functional near-infrared spectroscopy (fNIRS) were recorded covering six brain regions including the prefrontal cortex, motor cortex, and occipital lobes. A general linear model was used to locate activated brain regions, and changes compared with baseline in blood oxygen concentration were used to evaluate the degree of brain region activation. Small-world properties, clustering coefficients, and efficiency were used to measure information interaction in brain activity during the movement. Result It was found that the radius error of the dominant hand was significantly lower than that of the non-dominant hand (p < 0.001) in both clockwise and counterclockwise movements. The fNIRS results confirmed that the contralateral brain region was activated during single finger movement and the dominant motor area was activated in IP movement, while both motor areas were activated simultaneously in AP movement. The Δhbo were weakly correlated with radius errors (p = 0.002). Brain information interaction in IP movement was significantly larger than that from AP movement in the brain network (p < 0.02) in the right prefrontal cortex. Brain activity in the right motor cortex reduces motor performance (p < 0.001), while the right prefrontal cortex region promotes it (p < 0.05). Conclusion Our results suggest there was a significant correlation between motion performance and brain activation level, as well as between motion deviation and brain functional connectivity. The findings may provide a basis for further exploration of the operation of complex brain networks.
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Affiliation(s)
- Guangquan Zhou
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Yuzhao Chen
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Xiaohan Wang
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Hao Wei
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Qinghua Huang
- School of Artificial Intelligence, OPtics and ElectroNics (iOPEN), Northwestern Polytechnical University, Xi’an, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
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Wang Y, Kang X, Jiao J, Zhou J, Chow BC, Baker JS, Zhao L, Liu S. Exercise Prescription Improve the Rehabilitation of a Child With Viral Encephalitis Sequelae: A Case Report. Front Pediatr 2022; 10:828014. [PMID: 35712631 PMCID: PMC9194085 DOI: 10.3389/fped.2022.828014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
This study conducted a personalized exercise prescription intervention on a child with viral encephalitis sequelae (VES). The purpose was to observe the rehabilitation process from the aspects of brain activation, and the curative effects on balance function and gait. A further aim was to explore the possible nerve biomechanical mechanisms between the extent of brain activation and the improvement in balance function and gait. A 12-week exercise prescription was used as the treatment method, and functional near-infrared spectroscopy (fNIRS), balance function test system, plantar pressure distribution system, and 3D gait system were used to assess the effects of the rehabilitation process pre and post the intervention. Following the exercise prescription intervention: (1) fNIRS showed that brain activation in the S1-D1, S1-D2, S1-D3, S2-D1, S3-D2, S3-D3, S4-D3, S5-D5, S5-D6, S5-D7, S7-D6, S7-D7, S8-D7, and S8-D8 increased significantly (P < 0.05). (2) The balance test showed that the area of motion ellipse and movement length of the child with eyes open decreased significantly and area of motion ellipse, back and forth swing, left and right swing and movement length of the child with eyes closed all decreased significantly (P < 0.05). (3) The static plantar pressure distribution demonstrated that the pressure center of the left and right foot decreased significantly (P < 0.05) from 5.3° dislocation in a straight line in the sagittal plane to 1°; an increment of the pressure loading was found on the forefoot of both feet compared with what was recorded in the pre-test. (4) The testing results of the 3D gait system showed that she had a shortened time of unilateral support phase and prolonged swing phase on the affected leg (P < 0.05), compared to that of the non-affected leg. Furthermore, the dual support phase had also been prolonged (P < 0.05). Conclusion: 12 weeks' individualized exercise training can enhance the activation in the motor areas and improve balance function and gait in a child with VES.
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Affiliation(s)
- Yang Wang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Xiaodong Kang
- Department of Child Rehabilitation, Sichuan Bayi Rehabilitation Center (Sichuan Province Rehabilitation Hospital), Chengdu, China
| | - Jiao Jiao
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Jihe Zhou
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
- Department of Child Rehabilitation, Sichuan Bayi Rehabilitation Center (Sichuan Province Rehabilitation Hospital), Chengdu, China
| | - Bik-Chu Chow
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Julien S. Baker
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Li Zhao
- Faculty of Table Tennis, Badminton and Tennis, Chengdu Sport University, Chengdu, China
| | - Siyu Liu
- Faculty of Table Tennis, Badminton and Tennis, Chengdu Sport University, Chengdu, China
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Hakim U, Pinti P, Noah AJ, Zhang X, Burgess P, Hamilton A, Hirsch J, Tachtsidis I. Investigation of functional near-infrared spectroscopy signal quality and development of the hemodynamic phase correlation signal. NEUROPHOTONICS 2022; 9:025001. [PMID: 35599691 PMCID: PMC9116886 DOI: 10.1117/1.nph.9.2.025001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Significance: There is a longstanding recommendation within the field of fNIRS to use oxygenated (HbO 2 ) and deoxygenated (HHb) hemoglobin when analyzing and interpreting results. Despite this, many fNIRS studies do focus onHbO 2 only. Previous work has shown thatHbO 2 on its own is susceptible to systemic interference and results may mostly reflect that rather than functional activation. Studies using bothHbO 2 and HHb to draw their conclusions do so with varying methods and can lead to discrepancies between studies. The combination ofHbO 2 and HHb has been recommended as a method to utilize both signals in analysis. Aim: We present the development of the hemodynamic phase correlation (HPC) signal to combineHbO 2 and HHb as recommended to utilize both signals in the analysis. We use synthetic and experimental data to evaluate how the HPC and current signals used for fNIRS analysis compare. Approach: About 18 synthetic datasets were formed using resting-state fNIRS data acquired from 16 channels over the frontal lobe. To simulate fNIRS data for a block-design task, we superimposed a synthetic task-related hemodynamic response to the resting state data. This data was used to develop an HPC-general linear model (GLM) framework. Experiments were conducted to investigate the performance of each signal at different SNR and to investigate the effect of false positives on the data. Performance was based on each signal's mean T -value across channels. Experimental data recorded from 128 participants across 134 channels during a finger-tapping task were used to investigate the performance of multiple signals [HbO 2 , HHb, HbT, HbD, correlation-based signal improvement (CBSI), and HPC] on real data. Signal performance was evaluated on its ability to localize activation to a specific region of interest. Results: Results from varying the SNR show that the HPC signal has the highest performance for high SNRs. The CBSI performed the best for medium-low SNR. The next analysis evaluated how false positives affect the signals. The analyses evaluating the effect of false positives showed that the HPC and CBSI signals reflect the effect of false positives onHbO 2 and HHb. The analysis of real experimental data revealed that the HPC and HHb signals provide localization to the primary motor cortex with the highest accuracy. Conclusions: We developed a new hemodynamic signal (HPC) with the potential to overcome the current limitations of usingHbO 2 and HHb separately. Our results suggest that the HPC signal provides comparable accuracy to HHb to localize functional activation while at the same time being more robust against false positives.
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Affiliation(s)
- Uzair Hakim
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Paola Pinti
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
- University of London, Birkbeck College, Centre for Brain and Cognitive Development, London, United Kingdom
| | - Adam J. Noah
- Yale University, Department of Neuroscience and Comparative Medicine, Yale School of Medicine, United States
| | - Xian Zhang
- Yale University, Department of Neuroscience and Comparative Medicine, Yale School of Medicine, United States
| | - Paul Burgess
- University College London, Institute of Cognitive Neuroscience, London, United Kingdom
| | - Antonia Hamilton
- University College London, Institute of Cognitive Neuroscience, London, United Kingdom
| | - Joy Hirsch
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
- Yale University, Department of Neuroscience and Comparative Medicine, Yale School of Medicine, United States
| | - Ilias Tachtsidis
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
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Sun N, He DM, Ye X, Bin L, Zhou Y, Deng X, Qu Y, Li Z, Cheng S, Shao S, Zhao FJ, Zhang TH, Cai J, Sun R, Liang FR. Immediate acupuncture with GB34 for biliary colic: protocol for a randomised controlled neuroimaging trial. BMJ Open 2022; 12:e050413. [PMID: 35027415 PMCID: PMC8762121 DOI: 10.1136/bmjopen-2021-050413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION As the main manifestation of gallstone disease, biliary colic (BC) is an episodic attack that brings patients severe pain in the right upper abdominal quadrant. Although acupuncture has been documented with significance to lead to pain relief, the immediate analgesia of acupuncture for BC still needs to be verified, and the underlying mechanism has yet to be covered. Therefore, this trial aims first to verify the immediate pain-alleviation characteristic of acupuncture for BC, then to explore its influence on the peripheral sensitised acupoint and central brain activity. METHODS AND ANALYSIS This is a randomised controlled, paralleled clinical trial, with patients and outcome assessors blinded. Seventy-two patients with gallbladder stone disease presenting with BC will be randomised into a verum acupuncture group and the sham acupuncture group. Both groups will receive one session of immediate acupuncture treatment. Improvements in patients' BC will be evaluated by the Numeric Rating Scale, and the pain threshold of acupoints will also be detected before and after treatment. During treatment, brain neural activity will be monitored with functional near-infrared spectroscopy (fNIRS), and the needle sensation will be rated. Clinical and fNIRS data will be analysed, respectively, to validate the acupuncture effect, and correlation analysis will be conducted to investigate the relationship between pain relief and peripheral-cerebral functional changes. ETHICS AND DISSEMINATION This trial has been approved by the institutional review boards and ethics committees of the First Teaching Hospital of Chengdu University of Traditional Chinese Medicine, with the ethical approval identifier 2019 KL-029, and the institutional review boards and ethics committees of the First People's Hospital of Longquanyi District, with the ethical approval identifier AF-KY-2020071. The results of this trial will be disseminated through peer-reviewed publications and conference abstracts or posters. TRIAL REGISTRATION NUMBER CTR2000034432.
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Affiliation(s)
- Ning Sun
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dong-Mei He
- Emergency Department, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Xiangyin Ye
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lei Bin
- Emergency Department, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Yuanfang Zhou
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaodong Deng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuzhu Qu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhengjie Li
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shirui Cheng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shuai Shao
- Emergency Department, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Feng-Juan Zhao
- Science and Education Department, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Tie-Huan Zhang
- Emergency Department, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Jing Cai
- Oncology-Blood Department, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Ruirui Sun
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fan-Rong Liang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Sukal-Moulton T, de Campos AC, Alter KE, Damiano DL. Functional near-infrared spectroscopy to assess sensorimotor cortical activity during hand squeezing and ankle dorsiflexion in individuals with and without bilateral and unilateral cerebral palsy. NEUROPHOTONICS 2020; 7:045001. [PMID: 33062800 PMCID: PMC7536541 DOI: 10.1117/1.nph.7.4.045001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/04/2020] [Indexed: 05/10/2023]
Abstract
Significance: Our study is the first comparison of brain activation patterns during motor tasks across unilateral cerebral palsy (UCP), bilateral cerebral palsy (BCP), and typical development (TD) to elucidate neural mechanisms and inform rehabilitation strategies. Aim: Cortical activation patterns were compared for distal upper and lower extremity tasks in UCP, BCP, and TD using functional near-infrared spectroscopy (fNIRS) and related to functional severity. Approach: Individuals with UCP ( n = 10 , 18.8 ± 6.8 years ), BCP ( n = 14 , 17.5 ± 9.6 years ), and TD ( n = 16 , 17.3 ± 9.1 years ) participated in this cross-sectional cohort study. The fNIRS was used to noninvasively monitor the hemodynamic response to task-related cortical activation. The block design involved repetitive nondominant hand squeezing and ankle dorsiflexion. Results: Individuals with UCP demonstrated the highest levels of activation for the squeeze task ( UCP > BCP q = 0.049 ; BCP > TD q < 0.001 ; and UCP > TD q = 0.001 ) and more activity in the ipsilateral versus contralateral hemisphere. Individuals with BCP showed the highest levels of cortical activation in the dorsiflexion task ( BCP > UCP q < 0.001 ; BCP > TD ). Conclusions: Grouping by CP subtype and manual function or mobility level demonstrated significant differences from TD, even for individuals with the mildest forms of CP. Hemispheric activation patterns showed hypothesized but nonsignificant trends.
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Affiliation(s)
- Theresa Sukal-Moulton
- Northwestern University Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Department of Pediatrics, Chicago, Illinois, United States
| | - Ana C. de Campos
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, Brazil
| | - Katharine E. Alter
- National Institutes of Health, Clinical Center, Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Bethesda, Maryland, United States
| | - Diane L. Damiano
- National Institutes of Health, Clinical Center, Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Bethesda, Maryland, United States
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10
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Longo E, Nishiyori R, Cruz T, Alter K, Damiano DL. Obstetric Brachial Plexus Palsy: Can a Unilateral Birth Onset Peripheral Injury Significantly Affect Brain Development? Dev Neurorehabil 2020; 23:375-382. [PMID: 31906763 PMCID: PMC7550966 DOI: 10.1080/17518423.2019.1689437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/02/2019] [Indexed: 01/15/2023]
Abstract
Purpose: Examine brain structure and function in OBPP and relate to clinical outcomes to better understand the effects of decreased motor activity on early brain development. Methods: 9 OBPP, 7 controls underwent structural MRI scans. OBPP group completed evaluations of upper-limb function and functional near-infrared spectroscopy (fNIRS) during motor tasks. Results: Mean primary motor area volume was lower in both OBPP hemispheres. No volume differences across sides seen within groups; however, Asymmetry Ratio in supplementary motor area differed between groups. Greater asymmetry in primary somatosensory area correlated with lower ABILHAND-Kids scores. fNIRS revealed more cortical activity in both hemispheres during affected arm reach. Conclusion: Cortical volume differences or asymmetry were found in motor and sensory regions in OBPP that related to clinical outcomes. Widespread cortical activity in fNIRS during affected arm reach suggests reorganization in both hemispheres and is relevant to rehabilitation of those with developmental peripheral and brain injuries.
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Affiliation(s)
- Egmar Longo
- Federal University of Rio Grande do Norte/Faculty of Health Sciences of Trairi - UFRN/FACISA, Health of Children, Santa Cruz, Brazil
| | - Ryota Nishiyori
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, US
| | - Theresa Cruz
- National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, US
| | - Katharine Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, US
| | - Diane L. Damiano
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, US
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DE CAMPOS ANACAROLINA, SUKAL-MOULTON THERESA, HUPPERT THEODORE, ALTER KATHARINE, DAMIANO DIANEL. Brain activation patterns underlying upper limb bilateral motor coordination in unilateral cerebral palsy: an fNIRS study. Dev Med Child Neurol 2020; 62:625-632. [PMID: 32034770 PMCID: PMC8202129 DOI: 10.1111/dmcn.14458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 01/26/2023]
Abstract
AIM To explore cortical activation during bimanual tasks and functional correlates in unilateral cerebral palsy (CP). METHOD This cross-sectional study included eight participants with unilateral CP (six females, two males; mean age [SD] 20y 10mo [5y 10mo], 13y 8mo-31y 6mo) in Manual Ability Classification System levels II to III and nine age-matched participants with typical development (seven females, two males; mean age [SD] 17y 8mo [5y 7mo], 9y 4mo-24y 2mo). They performed bimanual symmetric squeezing (BSS) and bimanual asymmetric squeezing (BAS) tasks at 1Hz, and a pouring task with dominant hand (DPour) and a pouring task with non-dominant hand (NDPour) at 0.67Hz, all while a custom array of functional near-infrared spectroscopy (fNIRS) optodes were placed over their sensorimotor area. Mixed-effects were used to contrast groups, tasks, and hemispheres (corrected p-values [q] reported). Analysis of variance and t-tests compared performance measures across groups and tasks. RESULTS Participants with unilateral CP showed greater activation in both hemispheres during BAS (non-lesioned: q<0.001; lesioned: q<0.001), and in the lesioned hemisphere during BSS (q<0.001), DPour (q=0.02), and NDPour (q=0.02) than those with typical development. The lesioned hemisphere in unilateral CP showed more activity than the non-lesioned one (BSS: q=0.01; BAS: q=0.009; NDPour: q=0.04). During BAS, higher cortical activity correlated with more synchronous arm activation (r=0.79; p=0.02); activity lateralized towards the non-lesioned hemisphere correlated with better Pediatric Evaluation of Disability Inventory computer adaptive test scores (r=0.81; p=0.03). INTERPRETATION Results suggest abnormally increased sensorimotor cortical activity in unilateral CP, with implications to be investigated. WHAT THIS PAPER ADDS Cortical activity in manual tasks is described with functional near-infrared spectroscopy in typical and atypical cohorts. Activation levels in unilateral cerebral palsy appear to escalate with task difficulty. Increased brain activity may be associated with poorer selective manual control. Specific patterns of brain activity may be related to impaired bimanual function.
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Affiliation(s)
- ANA CAROLINA DE CAMPOS
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.,Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - THERESA SUKAL-MOULTON
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA,Department of Pediatrics, Northwestern University, Chicago, IL, USA
| | - THEODORE HUPPERT
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - KATHARINE ALTER
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - DIANE L DAMIANO
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Short MR, Damiano DL, Kim Y, Bulea TC. Children With Unilateral Cerebral Palsy Utilize More Cortical Resources for Similar Motor Output During Treadmill Gait. Front Hum Neurosci 2020; 14:36. [PMID: 32153376 PMCID: PMC7047842 DOI: 10.3389/fnhum.2020.00036] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022] Open
Abstract
Children with unilateral cerebral palsy (CP) walk independently although with an asymmetrical, more poorly coordinated pattern compared to their peers. While gait biomechanics in unilateral CP and their alteration from those without CP have been well documented, cortical mechanisms underlying gait remain inadequately understood. To the best of our knowledge, this is the first study utilizing electroencephalography (EEG) during treadmill gait in older children with and without CP. Lower limb surface electromyographic (EMG) data were collected and muscle synergy analyses performed to quantify motor output. Our primary goal was to evaluate the relationships between cortical and muscle activation within and across groups and hemispheres to provide novel insights into neural control of gait and how it may be disrupted by an early unilateral brain injury. Participants included 9 children with unilateral CP, mean age 16.0 ± 2.7 years, and 12 with typical development (TD), mean age 14.8 ± 3.0 years. EEG data were collected during a standing baseline and treadmill walking at self-selected speed. EMG of 16 lower limb muscles were also collected bilaterally and synchronized with EEG. No significant group differences were found in synergy number or structure across groups. Six cortical clusters were identified as having gait-related activation and all contained participants from both CP and TD groups; however, the percent of individuals per group appearing in different clusters varied. Notably, the cluster least represented in CP was the non-dominant motor region. Both groups showed mu-band ERD in the motor clusters during gait although sustained beta-band ERD was not evident in TD. The CP group showed greater cortical activation than TD during walking as measured by mu- and beta-ERD in the dominant and non-dominant motor and parietal regions and elevated low gamma-activity in the frontal and parietal areas, a unique finding in CP. CP showed greater bilateral motor EEG-EMG coherence in the gamma-band with the hallucis longus compared to TD. In summary, individuals with CP display increased cortical activation during gait possibly relating to differences in distal motor control of the more affected side. Strategies that iteratively reduce cortical activation while improving selective motor control are needed in CP.
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Affiliation(s)
- Matthew R. Short
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States
| | - Diane L. Damiano
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States
| | - Yushin Kim
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States
- Sports Health Rehabilitation, Cheongju University, Cheongju, South Korea
| | - Thomas C. Bulea
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States
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Carcreff L, Fluss J, Allali G, Valenza N, Aminian K, Newman CJ, Armand S. The effects of dual tasks on gait in children with cerebral palsy. Gait Posture 2019; 70:148-155. [PMID: 30875601 DOI: 10.1016/j.gaitpost.2019.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/29/2019] [Accepted: 02/20/2019] [Indexed: 02/02/2023]
Abstract
AIM To assess the gait and cognitive performances of children with cerebral palsy (CP) during dual tasks (DT) in comparison to typically developing (TD) children. METHOD This prospective, observational, case-control study included 18 children with CP (7 girls, 11 boys; median age 12 [10:13] years and 19 controls (9 girls, 10 boys; median age 12 [10:13y6mo] years). Performances were recorded during a simple walking task, 5 DT (walking + cognitive tasks with increasing cognitive load), and 5 simple cognitive tasks (while sitting). Gait parameters were computed using an optoelectronic system during walking tasks. Six parameters were selected for analysis by a principal component analysis. Cognitive performance was measured for each cognitive task. The dual-task cost (DTC) was calculated for each DT. RESULTS Gait performance decreased in both groups as DT cognitive load increased (e.g., walking speed normalized by leg length, in simple task: 1.25 [1.15:1.46] s-1 for CP, 1.53 [1.38:1.62] s-1 for TD; DT with highest load: 0.64 [0.53:0.80] s-1 for CP, 0.95 [0.75:1.08] s-1 for TD). The CP group performed significantly worse than TD group in every task (including the simple task), but DTC were similar in both groups. A task effect was found for the majority of the gait parameters. INTERPRETATION The reduced gait performance induced by DT may generate underestimated difficulties for children with CP in daily-life situations, where DT are common. This should be considered in clinical assessments.
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Affiliation(s)
- Lena Carcreff
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva 1211, Switzerland; Laboratory of Movement Analysis and Measurement, EPFL, Lausanne 1015, Switzerland; Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne 1011, Switzerland.
| | - Joel Fluss
- Pediatric Neurology Unit, Children's Hospital, Geneva University Hospitals, Geneva 1211, Switzerland.
| | - Gilles Allali
- Department of Neurology, Geneva University Hospitals and University of Geneva, Geneva 1211, Switzerland; Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
| | - Nathalie Valenza
- Pediatric Neurology Unit, Children's Hospital, Geneva University Hospitals, Geneva 1211, Switzerland.
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, EPFL, Lausanne 1015, Switzerland.
| | - Christopher J Newman
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne 1011, Switzerland.
| | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva 1211, Switzerland.
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Affiliation(s)
- Marc Degelaen
- Physiotherapy, Free University Brussels, Brussels, Belgium
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