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White MP, Hartig T, Martin L, Pahl S, van den Berg AE, Wells NM, Costongs C, Dzhambov AM, Elliott LR, Godfrey A, Hartl A, Konijnendijk C, Litt JS, Lovell R, Lymeus F, O'Driscoll C, Pichler C, Pouso S, Razani N, Secco L, Steininger MO, Stigsdotter UK, Uyarra M, van den Bosch M. Nature-based biopsychosocial resilience: An integrative theoretical framework for research on nature and health. ENVIRONMENT INTERNATIONAL 2023; 181:108234. [PMID: 37832260 DOI: 10.1016/j.envint.2023.108234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/09/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
Nature-based solutions including urban forests and wetlands can help communities cope better with climate change and other environmental stressors by enhancing social-ecological resilience. Natural ecosystems, settings, elements and affordances can also help individuals become more personally resilient to a variety of stressors, although the mechanisms underpinning individual-level nature-based resilience, and their relations to social-ecological resilience, are not well articulated. We propose 'nature-based biopsychosocial resilience theory' (NBRT) to address these gaps. Our framework begins by suggesting that individual-level resilience can refer to both: a) a person's set of adaptive resources; and b) the processes by which these resources are deployed. Drawing on existing nature-health perspectives, we argue that nature contact can support individuals build and maintain biological, psychological, and social (i.e. biopsychosocial) resilience-related resources. Together with nature-based social-ecological resilience, these biopsychosocial resilience resources can: i) reduce the risk of various stressors (preventive resilience); ii) enhance adaptive reactions to stressful circumstances (response resilience), and/or iii) facilitate more rapid and/or complete recovery from stress (recovery resilience). Reference to these three resilience processes supports integration across more familiar pathways involving harm reduction, capacity building, and restoration. Evidence in support of the theory, potential interventions to promote nature-based biopsychosocial resilience, and issues that require further consideration are discussed.
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Affiliation(s)
- Mathew P White
- Cognitive Science HUB, University of Vienna, Austria; European Centre for Environment & Human Health, University of Exeter, UK.
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Sweden; Department of Psychology, Uppsala University, Sweden
| | - Leanne Martin
- European Centre for Environment & Human Health, University of Exeter, UK
| | - Sabine Pahl
- Urban and Environmental Psychology Group, University of Vienna, Austria
| | | | - Nancy M Wells
- Department of Human Centered Design, College of Human Ecology, Cornell University, Ithaca, NY, United States
| | | | - Angel M Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lewis R Elliott
- European Centre for Environment & Human Health, University of Exeter, UK
| | | | - Arnulf Hartl
- Institute of Ecomedicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Jill S Litt
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rebecca Lovell
- European Centre for Environment & Human Health, University of Exeter, UK
| | - Freddie Lymeus
- Institute for Housing and Urban Research, Uppsala University, Sweden; Department of Psychology, Uppsala University, Sweden
| | | | - Christina Pichler
- Institute of Ecomedicine, Paracelsus Medical University, Salzburg, Austria
| | - Sarai Pouso
- AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain
| | - Nooshin Razani
- University of California San Francisco, San Francisco, CA, United States
| | - Laura Secco
- Department of Territorio e Sistemi Agro-Forestali (TESAF), University of Padua, Padua, Italy
| | | | - Ulrika K Stigsdotter
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Denmark
| | - Maria Uyarra
- AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain
| | - Matilda van den Bosch
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Madrid, Spain
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2
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Peng X, Baker-Vogel B, Sarhan M, Short EB, Zhu W, Liu H, Kautz S, Badran BW. Left or right ear? A neuroimaging study using combined taVNS/fMRI to understand the interaction between ear stimulation target and lesion location in chronic stroke. Brain Stimul 2023; 16:1144-1153. [PMID: 37517466 DOI: 10.1016/j.brs.2023.07.050] [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: 01/14/2023] [Revised: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Implanted vagus nerve stimulation (VNS) and transcutaneous auricular VNS (taVNS) have been primarily administered clinically to the unilateral-left vagus nerve. This left-only convention has proved clinically beneficial in brain disorders. However, in stroke survivors, the presence of a lesion in the brain may complicate VNS-mediated signaling, and it is important to understand the laterality effects of VNS in stroke survivors to optimize the intervention. OBJECTIVE To understand whether taVNS delivered to different ear targets relative to the lesion (ipsilesional vs contralesional vs bilateral vs sham) impacts blood oxygenation level dependent (BOLD) signal propagation in stroke survivors. METHODS We enrolled 20 adults with a prior history of stroke. Each participant underwent a single visit, during which taVNS was delivered concurrently during functional magnetic resonance imaging (fMRI) acquisition. Each participant received three discrete active stimulation conditions (ipsilesional, contralesional, bilateral) and one sham condition in a randomized order. Stimulation-related BOLD signal changes in the active conditions were compared to sham conditions to understand the interaction taVNS and laterality effects. RESULTS All active taVNS conditions deactivated the contralesional default mode network related regions compared to sham, however only ipsilesional taVNS enhanced the activations in the ipsilesional visuomotor and secondary visual cortex. Furthermore, we reveal an interaction in task activations between taVNS and cortical visuomotor areas, where ipsilesional taVNS significantly increased ipsilesional visuomotor activity and decreased contralesional visuomotor activity compared to sham. CONCLUSION Laterality of taVNS relative to the lesion is a critical factor in optimizing taVNS in a stroke population, with ipsilesional stimulation providing largest direct brain activation and should be explored further when designing taVNS studies in neurorehabilitation.
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Affiliation(s)
- Xiaolong Peng
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Brenna Baker-Vogel
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Mutaz Sarhan
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Edward B Short
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hesheng Liu
- Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Changping Laboratory, Beijing, China
| | - Steven Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Bashar W Badran
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA.
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Prange-Lasonder GB, Kottink AIR, Nikamp CDM, Buurke JH, Bos F, Van Der Sluis CK, Van Den Broek M, Onneweer B, Stolwijk-Swuste JM, Brink SM, Voet NBM, Rietman JS. Effect on Hand Function After Six-week Use of a Wearable Soft-Robotic Glove Assisting ADL: Interim Results of an Ongoing Clinical Study. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176120 DOI: 10.1109/icorr55369.2022.9896605] [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: 06/16/2023]
Abstract
In an ongoing study, an assistive wearable soft-robotic glove is tested at home for 6 weeks by subjects with decreased handgrip strength, due to different hand injuries or diseases, to assess whether use of this assistive grip-supporting glove will result in improved hand strength/ function. An interim analysis of the available dataset of 46 participants showed that (unsupported) grip strength and hand function improved after using the soft-robotic glove as assistive aid during activities of daily living (ADLs) during 6 weeks at home. After glove use is ended, this is maintained for at least 4 weeks. Considering that in the current situation the analysis is underpowered, these interim results are promising for finding a clinical (therapeutic) effect of using a soft-robotic glove as assistance during ADLs. If this is the case, this might open up entirely new opportunities for extending rehabilitation into people's homes, while also providing them with assistance to directly support performance of daily activities. Such a combination is becoming available with the development of mature and user-friendly wearable soft-robotic devices. This would enable very high doses of training throughout the day, in the most functional, task-specific way possible, and possibly prevention of learned non-use.
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Current State of Robotics in Hand Rehabilitation after Stroke: A Systematic Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Among the methods of hand function rehabilitation after stroke, robot-assisted rehabilitation is widely used, and the use of hand rehabilitation robots can provide functional training of the hand or assist the paralyzed hand with activities of daily living. However, patients with hand disorders consistently report that the needs of some users are not being met. The purpose of this review is to understand the reasons why these user needs are not being adequately addressed, to explore research on hand rehabilitation robots, to review their current state of research in recent years, and to summarize future trends in the hope that it will be useful to researchers in this research area. This review summarizes the techniques in this paper in a systematic way. We first provide a comprehensive review of research institutions, commercial products, and literature. Thus, the state of the art and deficiencies of functional hand rehabilitation robots are sought and guide the development of subsequent hand rehabilitation robots. This review focuses specifically on the actuation and control of hand functional rehabilitation robots, as user needs are primarily focused on actuation and control strategies. We also review hand detection technologies and compare them with patient needs. The results show that the trends in recent years are more inclined to pursue new lightweight materials to improve hand adaptability, investigating intelligent control methods for human-robot interaction in hand functional rehabilitation robots to improve control robustness and accuracy, and VR virtual task positioning to improve the effectiveness of active rehabilitation training.
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Mashayekhi M, Moghaddam MM. Emg-driven Fatigue-based Self-adapting Admittance Control of a Hand Rehabilitation Robot. J Biomech 2022; 138:111104. [DOI: 10.1016/j.jbiomech.2022.111104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 01/31/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
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Forman CR, Nielsen JB, Lorentzen J. Neuroplasticity at Home: Improving Home-Based Motor Learning Through Technological Solutions. A Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:789165. [PMID: 36188793 PMCID: PMC9397835 DOI: 10.3389/fresc.2021.789165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022]
Abstract
Background: Effective science-based motor rehabilitation requires high volume of individualized, intense physical training, which can be difficult to achieve exclusively through physical 1-on-1 sessions with a therapist. Home-based training, enhanced by technological solutions, could be a tool to help facilitate the important factors for neuroplastic motor improvements. Objectives: This review aimed to discover how the inclusion of modern information and communications technology in home-based training programs can promote key neuroplastic factors associated with motor learning in neurological disabilities and identify which challenges are still needed to overcome. Methods: We conducted a thorough literature search on technological home-based training solutions and categorized the different fundamental approaches that were used. We then analyzed how these approaches can be used to promote certain key factors of neuroplasticity and which challenges still need to be solved or require external personalized input from a therapist. Conclusions: The technological approaches to home-based training were divided into three categories: sensory stimuli training, digital exchange of information training, and telerehabilitation. Generally, some technologies could be characterized as easily applicable, which gave the opportunity to promote flexible scheduling and a larger overall training volume, but limited options for individualized variation and progression. Other technologies included individualization options through personalized feedback that might increase the training effect, but also increases the workload of the therapist. Further development of easily applicable and intelligent solutions, which can return precise feedback and individualized training suggestions, is needed to fully realize the potential of home-based training in motor learning activities.
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Affiliation(s)
- Christian Riis Forman
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatric Neurology, University Hospital Rigshospitalet, Copenhagen, Denmark
- *Correspondence: Jakob Lorentzen
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Nasrallah FA, Mohamed AZ, Yap HK, Lai HS, Yeow CH, Lim JH. Effect of proprioceptive stimulation using a soft robotic glove on motor activation and brain connectivity in stroke survivors. J Neural Eng 2021; 18:066049. [PMID: 34933283 DOI: 10.1088/1741-2552/ac456c] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Soft-robotic-assisted training may improve motor function during post-stroke recovery, but the underlying physiological changes are not clearly understood. We applied a single-session of intensive proprioceptive stimulation to stroke survivors using a soft robotic glove to delineate its short-term influence on brain functional activity and connectivity. APPROACH In this study, we utilized task-based and resting-state functional magnetic resonance imaging (fMRI) to characterize the changes in different brain networks following a soft robotic intervention. Nine stroke patients with hemiplegic upper limb engaged in resting-state and motor-task fMRI. The motor tasks comprised two conditions: active movement of fingers (active task) and glove-assisted active movement using a robotic glove (glove-assisted task), both with visual instruction. Each task was performed using bilateral hands simultaneously or the affected hand only. The same set of experiments was repeated following a 30-minute treatment of continuous passive motion (CPM) using a robotic glove. MAIN RESULTS On simultaneous bimanual movement, increased activation of supplementary motor area (SMA) and primary motor area (M1) were observed after CPM treatment compared to the pre-treatment condition, both in active and glove-assisted task. However, when performing the tasks solely using the affected hand, the phenomena of increased activity were not observed either in active or glove-assisted task. The comparison of the resting-state fMRI between before and after CPM showed the connectivity of the supramarginal gyrus and SMA was increased in the somatosensory network and salience network. SIGNIFICANCE This study demonstrates how passive motion exercise activates M1 and SMA in the post-stroke brain. The effective proprioceptive motor integration seen in bimanual exercise in contrast to the unilateral affected hand exercise suggests that the unaffected hemisphere might reconfigure connectivity to supplement damaged neural networks in the affected hemisphere. The somatosensory modulation rendered by the intense proprioceptive stimulation would affect the motor learning process in stroke survivors.
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Affiliation(s)
- Fatima A Nasrallah
- The University of Queensland Queensland Brain Institute, The University of Queensland, Brisbane, Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Abdalla Z Mohamed
- The University of Queensland Queensland Brain Institute, The University of Queensland, Brisbane, Australia., Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Hong Kai Yap
- Roceso Technologies, 83 Science Park Dr #04-01, Singapore, 118258, SINGAPORE
| | - Hwa Sen Lai
- National University of Singapore, Biomedical Engineering, Singapore, 119260, SINGAPORE
| | - Chen-Hua Yeow
- National University of Singapore, Biomedical Engineering, Singapore, 119260, SINGAPORE
| | - Jeong Hoon Lim
- School of Medicine, Medicine, National University of Singapore, NUHS Tower block level 10 1E, Kent Ridge Road, Singapore, Singapore, 119228, SINGAPORE
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8
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Lee SH, Lee JH. Examining the effects of upper extremity function and arm sling type on balance, gait and fall risk in patients with hemiparesis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Previous studies have reported conflicting results on the effects of arm slings on the balance and gait of patients with hemiparesis. These previous studies did not consider the ability to control the upper extremity on the affected side as a factor that could affect the patient's balance or gait when an arm sling was applied. Hence, the aim of this study was to investigate the effect of upper extremity function in the affected side and arm position according to the sling type on balance, gait and fall. Methods A total of 31 stroke patients participated in the study and were assigned to two groups according to upper extremity function (low-score group and high-score group). Under three conditions (no sling, forearm sling and shoulder sling), a fall risk test, postural stability test and limits of stability test were performed and speed, stride duration, step length and total time were measured. Results When the high-score group wore forearm slings, the static and dynamic balance ability decreased and the fall risk increased. When the low-score group wore forearm slings and shoulder slings, the static and dynamic balance ability increased and the fall risk decreased. The high-score group had a shorter gait time when wearing shoulder slings. When the low-score group wore forearm slings, the speed and step length increased and the total time decreased, enhancing the overall gait ability. Conclusions For stroke patients with better upper extremity control ability, shoulder slings are more appropriate. For patients with poor upper extremity control ability, forearm slings are more appropriate. Using the appropriate sling according to the upper extremity function can improve balance and gait ability and fall risk can be reduced.
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Affiliation(s)
- Seung-Hyuk Lee
- Department of Physical Therapy, Rehabilitation Center, Walkrun Hospital, Daejeon City, Republic of Korea
| | - Joon-Hee Lee
- Department of Physical Therapy, Rehabilitation Center, Walkrun Hospital, Daejeon City, Republic of Korea
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9
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El-Tamawy MS, Darwish MH, Basheer MA, Reda AM, Elzanaty M, Khalifa HA. Effect of cycling exercise on motor excitability and gait abnormalities in stroke patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-020-00236-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The concepts of brain excitability are still re-wiring in response to changes in environment. Ambulation is often limited in stroke patients.
Objective
To determine the effect of cycling exercise on motor excitability and consequences on spatiotemporal gait parameters in stroke patients.
Methods
Forty male ischemic stroke patients were included; their age ranged from 45 to 60 years. The patients were assigned into two equal groups: control group (GI) and study group (GII). The GI is treated by a design physical therapy program in the form of task-oriented progressive resistance exercise for lower limb muscles, and the GII is treated by the same program in addition to cycling exercise for 30 min. Treatment was conducted three times per week for 10 weeks. The excitability over motor area (Cz) was assessed by the quantitative electroencephalogram (QEEG). The spatiotemporal gait parameters were assessed by the Biodex Gait Trainer 2TM.
Results
There was a significant increase of speed, step cycle, and step length of the affected side (P < 0.05) and a non-significant difference of step length of the non-affected side in the study group compared with that of the control group (P > 0.05). There was a significant increase of excitability over motor area (Cz) in the study group compared with that of the control group (P < 0.05).
Conclusion
Cycling exercise has a positive effect on excitability over motor area of lower limbs and can improve gait parameters in stroke patients.
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Shirazi RS, Vyssotski M, Lagutin K, Thompson D, MacDonald C, Luscombe V, Glass M, Parker K, Gowing EK, Williams DBG, Clarkson AN. Neuroprotective activity of new Δ3-N-acylethanolamines in a focal ischemia stroke model. Lipids 2021; 57:17-31. [PMID: 34751447 DOI: 10.1002/lipd.12326] [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: 08/05/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
N-acylethanolamines (NAE, also called ethanolamides) are significant lipid signaling molecules with anti-inflammatory, pain-relieving, cell-protective, and anticancer properties. Here, we present the use of a hitherto unreported group of Δ3-NAE and also some Δ4- and Δ5-NAE, in in vitro and in vivo assays to gain a better understanding of their structure-bioactivity relationships. We have developed an efficient synthetic method to rapidly produce novel unlabeled and 13 C-labeled Δ3-NAE (NAE-18:5n-3, NAE-18:4n-6) and Δ4-NAE (NAE-22:5n-6). The new NAE with shorter carbon backbone structures confers greater neuroprotection than their longer carbon backbone counterparts, including anandamide (Δ5-NAE-20:4n-6) in a focal ischemia mouse model of stroke. This study highlights structure-dependent protective effects of new NAE following focal ischemia, in which some of the new NAE, administered intranasally, lead to significantly reduced infarct volume and improved recovery of limb use. The relative affinity of the new NAE toward cannabinoid receptors was assessed against anandamide, NAE-22:6n-3 and NAE-20:5n-3, which are known cannabinoid receptor ligands with high-binding constants. Among the newly synthesized NAE, Δ4-NAE-22:5n-6 shows the greatest relative affinity to cannabinoid receptors hCB1 and hCB2 , and inhibition of cyclic adenosine monophosphate activity through hCB2 compared to anandamide.
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Affiliation(s)
| | | | | | | | - Christa MacDonald
- Department of Pharmacology, University of Auckland, Auckland, New Zealand.,Department of Pharmacology and Toxicology, University of Otago, Dunedin, New Zealand
| | - Vincent Luscombe
- Department of Pharmacology, University of Auckland, Auckland, New Zealand.,Department of Pharmacology and Toxicology, University of Otago, Dunedin, New Zealand
| | - Michelle Glass
- Department of Pharmacology, University of Auckland, Auckland, New Zealand.,Department of Pharmacology and Toxicology, University of Otago, Dunedin, New Zealand
| | - Kim Parker
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Emma K Gowing
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - D Bradley G Williams
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Andrew N Clarkson
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
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Correia P, Machado S, Meyer I, Amiguet M, Eskandari A, Michel P. Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome. Eur Stroke J 2021; 6:205-212. [PMID: 34414296 DOI: 10.1177/23969873211019586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Systemic contraceptives increase the risk of ischemic stroke but little is known about the characteristics, mechanisms and long-term outcome post stroke of patients on hormonal contraception. We sought to To assess characteristics and outcome of acute ischemic stroke (AIS) in young women using systemic hormonal contraceptives (SHC) and compare them to strokes in non-contraceptive users. Patients and methods Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed demographics, risk factors, clinical, radiological and treatment data of consecutive female patients of <50 years between 2003 to 2015. We compared groups with and without SHC in a logistic regression analysis. Results Of the 179 female patients of <50 years during the observation period, 57 (39.6%) used SHC, 71.9% of whom, a combined oral contraceptive pill. On logistic regression contraceptive users were significantly younger but had comparable stroke severity. They had less migraine with aura and tobacco use, and more hyperlipidaemia. Also, contraceptive users had significantly less intra and extracranial stenosis and occlusion on arterial imaging, but more focal hypoperfusion on CT-perfusion. Undetermined mechanism of stroke was more frequent with SHC users, whereas rare mechanisms were more frequent in non-users. The contraceptive user group had a more favourable adjusted 12-month outcome with significantly fewer ischemic recurrences after stopping systemic contraception in all. Conclusion Contraceptive users with ischemic strokes are younger and have lesser tobacco use and migraine with aura and more hyperlipidemia. Their stroke mechanism is more often undetermined using a standardised work-up, and their adjusted long-term outcome is more favourable with less stroke recurrence.
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Affiliation(s)
- P Correia
- Department of Clinical Neurosciences, Stroke Centre, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.,Stroke Unit, Neurology Service, Cantonal Hospital of Biel, Biel, Switzerland
| | - S Machado
- Department of Clinical Neurosciences, Stroke Centre, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.,Neurology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - I Meyer
- Department of Clinical Neurosciences, Stroke Centre, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.,Stroke Unit, Neurology Service, Cantonal Hospital of Biel, Biel, Switzerland
| | - M Amiguet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - A Eskandari
- Department of Clinical Neurosciences, Stroke Centre, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - P Michel
- Department of Clinical Neurosciences, Stroke Centre, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
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Qi HX, Reed JL, Wang F, Gross CL, Liu X, Chen LM, Kaas JH. Longitudinal fMRI measures of cortical reactivation and hand use with and without training after sensory loss in primates. Neuroimage 2021; 236:118026. [PMID: 33930537 PMCID: PMC8409436 DOI: 10.1016/j.neuroimage.2021.118026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022] Open
Abstract
In a series of previous studies, we demonstrated that damage to the dorsal column in the cervical spinal cord deactivates the contralateral somatosensory hand cortex and impairs hand use in a reach-to-grasp task in squirrel monkeys. Nevertheless, considerable cortical reactivation and behavioral recovery occurs over the following weeks to months after lesion. This timeframe may also be a window for targeted therapies to promote cortical reactivation and functional reorganization, aiding in the recovery process. Here we asked if and how task specific training of an impaired hand would improve behavioral recovery and cortical reorganization in predictable ways, and if recovery related cortical changes would be detectable using noninvasive functional magnetic resonance imaging (fMRI). We further asked if invasive neurophysiological mapping reflected fMRI results. A reach-to-grasp task was used to test impairment and recovery of hand use before and after dorsal column lesions (DC-lesion). The activation and organization of the affected primary somatosensory cortex (area 3b) was evaluated with two types of fMRI - either blood oxygenation level dependent (BOLD) or cerebral blood volume (CBV) with a contrast agent of monocrystalline iron oxide nanocolloid (MION) - before and after DC-lesion. At the end of the behavioral and fMRI studies, microelectrode recordings in the somatosensory areas 3a, 3b and 1 were used to characterize neuronal responses and verify the somatotopy of cortical reactivations. Our results indicate that even after nearly complete DC lesions, monkeys had both considerable post-lesion behavioral recovery, as well as cortical reactivation assessed with fMRI followed by extracellular recordings. Generalized linear regression analyses indicate that lesion extent is correlated with the behavioral outcome, as well as with the difference in the percent signal change from pre-lesion peak activation in fMRI. Monkeys showed behavioral recovery and nearly complete cortical reactivation by 9-12 weeks post-lesion (particularly when the DC-lesion was incomplete). Importantly, the specific training group revealed trends for earlier behavioral recovery and had higher magnitude of fMRI responses to digit stimulation by 5-8 weeks post-lesion. Specific kinematic measures of hand movements in the selected retrieval task predicted recovery time and related to lesion characteristics better than overall task performance success. For measures of cortical reactivation, we found that CBV scans provided stronger signals to vibrotactile digit stimulation as compared to BOLD scans, and thereby may be the preferred non-invasive way to study the cortical reactivation process after sensory deprivations from digits. When the reactivation of cortex for each of the digits was considered, the reactivation by digit 2 stimulation as measured with microelectrode maps and fMRI maps was best correlated with overall behavioral recovery.
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Affiliation(s)
- Hui-Xin Qi
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA.
| | - Jamie L. Reed
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - Feng Wang
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37240, USA,Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37240, USA
| | | | - Xin Liu
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - Li Min Chen
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37240, USA,Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37240, USA
| | - Jon H. Kaas
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA,Institute of Imaging Science, Vanderbilt University, Nashville, TN 37240, USA
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13
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Sakabe N, Altukhaim S, Hayashi Y, Sakurada T, Yano S, Kondo T. Enhanced Visual Feedback Using Immersive VR Affects Decision Making Regarding Hand Use With a Simulated Impaired Limb. Front Hum Neurosci 2021; 15:677578. [PMID: 34177496 PMCID: PMC8232051 DOI: 10.3389/fnhum.2021.677578] [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: 03/07/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
The long-term effects of impairment have a negative impact on the quality of life of stroke patients in terms of not using the affected limb even after some recovery (i.e., learned non-use). Immersive virtual reality (IVR) has been introduced as a new approach for the treatment of stroke rehabilitation. We propose an IVR-based therapeutic approach to incorporate positive reinforcement components in motor coordination as opposed to constraint-induced movement therapy (CIMT). This study aimed to investigate the effect of IVR-reinforced physical therapy that incorporates positive reinforcement components in motor coordination. To simulate affected upper limb function loss in patients, a wrist weight was attached to the dominant hand of participant. Participants were asked to choose their right or left hand to reach toward a randomly allocated target. The movement of the virtual image of the upper limb was reinforced by visual feedback to participants, that is, the participants perceived their motor coordination as if their upper limb was moving to a greater degree than what was occurring in everyday life. We found that the use of the simulated affected limb was increased after the visual feedback enhancement intervention, and importantly, the effect was maintained even after gradual withdrawal of the visual amplification. The results suggest that positive reinforcement within the IVR could induce an effect on decision making in hand usage.
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Affiliation(s)
- Naoko Sakabe
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Samirah Altukhaim
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, United Kingdom.,Physiotherapy Group in Stroke Unit, Alamiri Hospital, Kuwait City, Kuwait
| | - Yoshikatsu Hayashi
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Takeshi Sakurada
- College of Science and Engineering, Ritsumeikan University, Shiga, Japan
| | - Shiro Yano
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Toshiyuki Kondo
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
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14
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Russo C, Veronelli L, Casati C, Monti A, Perucca L, Ferraro F, Corbo M, Vallar G, Bolognini N. Explicit motor sequence learning after stroke: a neuropsychological study. Exp Brain Res 2021; 239:2303-2316. [PMID: 34091696 PMCID: PMC8282572 DOI: 10.1007/s00221-021-06141-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
Motor learning interacts with and shapes experience-dependent cerebral plasticity. In stroke patients with paresis of the upper limb, motor recovery was proposed to reflect a process of re-learning the lost/impaired skill, which interacts with rehabilitation. However, to what extent stroke patients with hemiparesis may retain the ability of learning with their affected limb remains an unsolved issue, that was addressed by this study. Nineteen patients, with a cerebrovascular lesion affecting the right or the left hemisphere, underwent an explicit motor learning task (finger tapping task, FTT), which was performed with the paretic hand. Eighteen age-matched healthy participants served as controls. Motor performance was assessed during the learning phase (i.e., online learning), as well as immediately at the end of practice, and after 90 min and 24 h (i.e., retention). Results show that overall, as compared to the control group, stroke patients, regardless of the side (left/right) of the hemispheric lesion, do not show a reliable practice-dependent improvement; consequently, no retention could be detected in the long-term (after 90 min and 24 h). The motor learning impairment was associated with subcortical damage, predominantly affecting the basal ganglia; conversely, it was not associated with age, time elapsed from stroke, severity of upper-limb motor and sensory deficits, and the general neurological condition. This evidence expands our understanding regarding the potential of post-stroke motor recovery through motor practice, suggesting a potential key role of basal ganglia, not only in implicit motor learning as previously pointed out, but also in explicit finger tapping motor tasks.
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Affiliation(s)
- Cristina Russo
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.
| | - Laura Veronelli
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Carlotta Casati
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Laura Perucca
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Francesco Ferraro
- Riabilitazione Specialistica Neuromotoria - Dipartimento di Neuroscienze, ASST "Carlo Poma" di Mantova - Presidio di Riabilitazione Multifunzionale di Bozzolo, Mantua, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Policlinico, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
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15
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Peng QC, Yin L, Cao Y. Effectiveness of Virtual Reality in the Rehabilitation of Motor Function of Patients With Subacute Stroke: A Meta-Analysis. Front Neurol 2021; 12:639535. [PMID: 34025553 PMCID: PMC8131676 DOI: 10.3389/fneur.2021.639535] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/15/2021] [Indexed: 12/22/2022] Open
Abstract
Stroke is a major cause of death and disability in adults. Conventional therapy (CT) has limited effectiveness, and therefore, various virtual reality (VR) rehabilitation programs have been designed. However, their efficacy in regaining motor function in patients with subacute stroke is questionable. Therefore, we conducted this meta-analysis to determine the efficacy of VR, compared to CT, in restoring motor function in this patient population. Up to October 10, 2020, nine electronic databases were searched for relevant articles reporting the effectiveness of VR in regaining motor function in patients with subacute stroke. This search was updated on March 7, 2021, with no additional added articles. The control group included CT, physical therapy, occupational therapy, or a combination of them. Effectiveness is defined as the positive change from baseline values to the last follow-up point. The Cochrane's revised risk-of-bias tool was used to determine the quality of included trials. A metaregression analysis was conducted to determine the effect of "time since last stroke" on reported outcomes. Publication bias and sensitivity analyses were also carried out. A total of 19 studies (17 randomized controlled trials, 1 cohort study, and 1 crossover trial) were included in the qualitative analysis, whereas 16 trials were meta-analyzed. A great improvement in motor function was noted in the VR group, when compared to preintervention values [standardized mean difference (SMD) = 1.14; 95% confidence interval (CI) = 0.77-1.52; I 2 = 82%; P < 0.001]. When compared to CT, VR resulted in mild improvement in motor function (SMD = 0.47; 95% CI = 0.22-0.72; I 2 = 75%; P < 0.001). However, upon trim-and-fill adjustment, this finding was deemed insignificant (SMD = 0.08; 95% CI = -0.16 to 0.33; I 2 = 82.6%; P < 0.001). Ten studies had low risk, five had some concerns, three had high risk, and one had a moderate risk of bias. VR programs can be used jointly with CT for the rehabilitation of the motor function of patients with subacute stroke. However, more studies are still warranted to determine the effectiveness of these interventions in retaining the cognitive function and physical performance of such patients.
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Affiliation(s)
- Quan-Cheng Peng
- Department of Rehabilitation Medicine, Hanchuan People's Hospital, Hanchuan, China
| | - Ling Yin
- Department of Pharmacy, Hanchuan People's Hospital, Hanchuan, China
| | - Yi Cao
- Department of Rehabilitation Medicine, Hanchuan People's Hospital, Hanchuan, China
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16
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Effects of a Soft Robotic Hand for Hand Rehabilitation in Chronic Stroke Survivors. J Stroke Cerebrovasc Dis 2021; 30:105812. [PMID: 33895427 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/11/2021] [Accepted: 04/02/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Soft robotic hands are proposed for stroke rehabilitation in terms of their high compliance and low inherent stiffness. We investigated the clinical efficacy of a soft robotic hand that could actively flex and extend the fingers in chronic stroke subjects with different levels of spasticity. METHODS Sixteen chronic stroke subjects were recruited into this single-group study. Subjects underwent 20 sessions of 1-hour EMG-driven soft robotic hand training. Training effect was evaluated by the pre-training and post-training assessments with the clinical scores: Action Research Arm Test(ARAT), Fugl-Meyer Assessment for Upper Extremity(FMA-UE), Box-and-Block test(BBT), Modified Ashworth Scale(MAS), and maximum voluntary grip strength. RESULTS For all the recruited subjects (n = 16), significant improvement of upper limb function was generally observed in ARAT (increased mean=2.44, P = 0.032), FMA-UE (increased mean=3.31, P = 0.003), BBT (increased mean=1.81, P = 0.024), and maximum voluntary grip strength (increased mean=2.14 kg, P < 0.001). No significant change was observed in terms of spasticity with the MAS (decreased mean=0.11, P = 0.423). Further analysis showed subjects with mild or no finger flexor spasticity (MAS<2, n = 9) at pre-training had significant improvement of upper limb function after 20 sessions of training. However, for subjects with moderate and severe finger flexor spasticity (MAS=2,3, n = 7) at pre-training, no significant change in clinical scores was shown and only maximum voluntary grip strength had significant increase. CONCLUSION EMG-driven rehabilitation training using the soft robotic hand with flexion and extension could be effective for the functional recovery of upper limb in chronic stroke subjects with mild or no spasticity.
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17
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Moslemi Haghighi F, Kordi Yoosefinejad A, Razeghi M, Shariat A, Bagheri Z, Rezaei K. The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Functional Indices of Affected Upper Limb in Patients with Subacute Stroke. J Biomed Phys Eng 2021; 11:175-184. [PMID: 33937125 PMCID: PMC8064128 DOI: 10.31661/jbpe.v0i0.879] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/28/2018] [Indexed: 01/23/2023]
Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) is a novel technique that may improve recovery in patients with stoke, but the role of rTMS as an applied and practical treatment modality for stroke rehabilitation has not been established yet. Objective: This study was conducted to determine the effects of a rehabilitation program (RP) in conjunction with rTMS on functional indices of the paretic upper limb in the subacute phase of stroke. Material and Methods: In this experimental study, twenty patients in the subacute phase of stroke were randomly assigned into two groups: The high frequency rTMS (HF-rTMS) in conjunction with RP (experimental group), and the RP group (control group). The experimental group received 10 sessions of 20 Hz rTMS on the affected primary motor cortex and the other group received 10 sessions of RP. In experimental group, RP for the paretic hand was conducted following rTMS session. Box and block test (BBT), Fugl-Meyer Motor Assessment for upper limb (FMA-UL), grip strength and pinch strength were used to assess motor function before the first session and after the last session of treatment. Results: Significant improvement in BBT, FMA-UL, grip strength and pinch strength was observed in both groups. Improvement of BBT and grip strength was significantly greater in the experimental group rather than the control group (p<0.05). FMA-UL score and the pinch strength were greater in the experimental group, although the differences were not statistically significant. Conclusion: HF-rTMS in conjunction with RP is effective to improve the function of upper limb. It seems HF-rTMS is a novel feasible and safe technique for hemiparesis patients in the subacute phase of stroke.
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Affiliation(s)
- Farzaneh Moslemi Haghighi
- PhD, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- PhD, Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- PhD, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- PhD, Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- PhD, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- PhD, Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolhamid Shariat
- MD, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- MD, Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bagheri
- PhD, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Katayoon Rezaei
- PhD, Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- PhD, Student Research Committee, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Alder G, Signal N, Vandal AC, Olsen S, Jochumsen M, Niazi IK, Taylor D. Investigating the Intervention Parameters of Endogenous Paired Associative Stimulation (ePAS). Brain Sci 2021; 11:brainsci11020224. [PMID: 33673171 PMCID: PMC7918620 DOI: 10.3390/brainsci11020224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/20/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Advances in our understanding of neural plasticity have prompted the emergence of neuromodulatory interventions, which modulate corticomotor excitability (CME) and hold potential for accelerating stroke recovery. Endogenous paired associative stimulation (ePAS) involves the repeated pairing of a single pulse of peripheral electrical stimulation (PES) with endogenous movement-related cortical potentials (MRCPs), which are derived from electroencephalography. However, little is known about the optimal parameters for its delivery. A factorial design with repeated measures delivered four different versions of ePAS, in which PES intensities and movement type were manipulated. Linear mixed models were employed to assess interaction effects between PES intensity (suprathreshold (Hi) and motor threshold (Lo)) and movement type (Voluntary and Imagined) on CME. ePAS interventions significantly increased CME compared to control interventions, except in the case of Lo-Voluntary ePAS. There was an overall main effect for the Hi-Voluntary ePAS intervention immediately post-intervention (p = 0.002), with a sub-additive interaction effect at 30 min’ post-intervention (p = 0.042). Hi-Imagined and Lo-Imagined ePAS significantly increased CME for 30 min post-intervention (p = 0.038 and p = 0.043 respectively). The effects of the two PES intensities were not significantly different. CME was significantly greater after performing imagined movements, compared to voluntary movements, with motor threshold PES (Lo) 15 min post-intervention (p = 0.012). This study supports previous research investigating Lo-Imagined ePAS and extends those findings by illustrating that ePAS interventions that deliver suprathreshold intensities during voluntary or imagined movements (Hi-Voluntary and Hi-Imagined) also increase CME. Importantly, our findings indicate that stimulation intensity and movement type interact in ePAS interventions. Factorial designs are an efficient way to explore the effects of manipulating the parameters of neuromodulatory interventions. Further research is required to ensure that these parameters are appropriately refined to maximise intervention efficacy for people with stroke and to support translation into clinical practice.
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Affiliation(s)
- Gemma Alder
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
- Correspondence:
| | - Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
| | - Alain C. Vandal
- Department of Statistics, University of Auckland, Auckland 1142, New Zealand;
- Ko Awatea, Counties Manukau Health, Auckland 2025, New Zealand
| | - Sharon Olsen
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
| | - Mads Jochumsen
- Department of Health Science and Technology, Aalborg University, 9000 Aalborg, Denmark;
| | - Imran Khan Niazi
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
- Department of Health Science and Technology, Aalborg University, 9000 Aalborg, Denmark;
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (N.S.); (S.O.); (I.K.N.); (D.T.)
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19
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Tu T, Yin S, Pang J, Zhang X, Zhang L, Zhang Y, Xie Y, Guo K, Chen L, Peng J, Jiang Y. Irisin Contributes to Neuroprotection by Promoting Mitochondrial Biogenesis After Experimental Subarachnoid Hemorrhage. Front Aging Neurosci 2021; 13:640215. [PMID: 33613273 PMCID: PMC7886674 DOI: 10.3389/fnagi.2021.640215] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/12/2021] [Indexed: 12/17/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is a devastating form of stroke, which poses a series of intractable challenges to clinical practice. Imbalance of mitochondrial homeostasis has been thought to be the crucial pathomechanism in early brain injury (EBI) cascade after SAH. Irisin, a protein related to metabolism and mitochondrial homeostasis, has been reported to play pivotal roles in post-stroke neuroprotection. However, whether this myokine can exert neuroprotection effects after SAH remains unknown. In the present study, we explored the protective effects of irisin and the underlying mechanisms related to mitochondrial biogenesis in a SAH animal model. Endovascular perforation was used to induce SAH, and recombinant irisin was administered intracerebroventricularly. Neurobehavioral assessments, TdT-UTP nick end labeling (TUNEL) staining, dihydroethidium (DHE) staining, immunofluorescence, western blot, and transmission electron microscopy (TEM) were performed for post-SAH assessments. We demonstrated that irisin treatment improved neurobehavioral scores, reduced neuronal apoptosis, and alleviated oxidative stress in EBI after SAH. More importantly, the administration of exogenous irisin conserved the mitochondrial morphology and promoted mitochondrial biogenesis. The protective effects of irisin were partially reversed by the mitochondrial uncoupling protein-2 (UCP-2) inhibitor. Taken together, irisin may have neuroprotective effects against SAH via improving the mitochondrial biogenesis, at least in part, through UCP-2 related targets.
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Affiliation(s)
- Tianqi Tu
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shigang Yin
- Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinwei Pang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xianhui Zhang
- Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lifang Zhang
- Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yuxuan Zhang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yuke Xie
- Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kecheng Guo
- Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ligang Chen
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianhua Peng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yong Jiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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20
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Xu Y, Yao Y, Lyu H, Ng S, Xu Y, Poon WS, Zheng Y, Zhang S, Hu X. Rehabilitation Effects of Fatigue-Controlled Treadmill Training After Stroke: A Rat Model Study. Front Bioeng Biotechnol 2020; 8:590013. [PMID: 33330421 PMCID: PMC7734251 DOI: 10.3389/fbioe.2020.590013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Traditional rehabilitation with uniformed intensity would ignore individual tolerance and introduce the second injury to stroke survivors due to overloaded training. However, effective control of the training intensity of different stroke survivors is still lacking. The purpose of the study was to investigate the rehabilitative effects of electromyography (EMG)-based fatigue-controlled treadmill training on rat stroke model. Methods: Sprague-Dawley rats after intracerebral hemorrhage and EMG electrode implantation surgeries were randomly distributed into three groups: the control group (CTRL, n = 11), forced training group (FOR-T, n = 11), and fatigue-controlled training group (FAT-C, n = 11). The rehabilitation interventions were delivered every day from day 2 to day 14 post-stroke. No training was delivered to the CTRL group. The rats in the FOR-T group were forced to run on the treadmill without rest. The fatigue level was monitored in the FAT-C group through the drop rate of EMG mean power frequency, and rest was applied to the rats when the fatigue level exceeded the moderate fatigue threshold. The speed and accumulated running duration were comparable in the FAT-C and the FOR-T groups. Daily evaluation of the motor functions was performed using the modified Neurological Severity Score. Running symmetry was investigated by the symmetry index of EMG bursts collected from both hind limbs during training. The expression level of neurofilament-light in the striatum was measured to evaluate the neuroplasticity. Results: The FAT-C group showed significantly lower modified Neurological Severity Score compared with the FOR-T (P ≤ 0.003) and CTRL (P ≤ 0.003) groups. The FAT-C group showed a significant increase in the symmetry of hind limbs since day 7 (P = 0.000), whereas the FOR-T group did not (P = 0.349). The FAT-C group showed a higher concentration of neurofilament-light compared to the CTRL group (P = 0.005) in the unaffected striatum and the FOR-T group (P = 0.021) in the affected striatum. Conclusion: The treadmill training with moderate fatigue level controlled was more effective in motor restoration than forced training. The fatigue-controlled physical training also demonstrated positive effects in the striatum neuroplasticity. This study indicated that protocol with individual fatigue-controlled training should be considered in both animal and clinical studies for better stroke rehabilitation.
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Affiliation(s)
- Yuchen Xu
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China.,Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Yuanfa Yao
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China.,Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Lyu
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, ShaTin, Hong Kong
| | - Stephanie Ng
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, ShaTin, Hong Kong
| | - Yingke Xu
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China.,Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, ShaTin, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Shaomin Zhang
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China.,Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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21
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Tuntevski K, Hajira A, Nichols A, Alway SE, Mohamed JS. Muscle-specific sirtuin1 gain-of-function ameliorates skeletal muscle atrophy in a pre-clinical mouse model of cerebral ischemic stroke. FASEB Bioadv 2020; 2:387-397. [PMID: 32676579 PMCID: PMC7354693 DOI: 10.1096/fba.2020-00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/03/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
Stroke causes severe long-term disability in patients due to the induction of skeletal muscle atrophy and weakness, but the molecular mechanisms remain elusive. Using a preclinical mouse model of cerebral ischemic stroke, we show that stroke robustly induced atrophy and significantly decreased SirT1 gene expression in the PTA (paralytic tibialis anterior) muscle. Muscle-specific SirT1 gain-of-function mice are resistant to stroke-induced muscle atrophy and this protective effect requires its deacetylase activity. Although SirT1 counteracts the stroke-induced up-regulation of atrogin1, MuRF1 and ZNF216 genes, we found a mechanism that regulates the ZNF216 gene transcription in post-stroke muscle. Stroke increased the expression of the ZNF216 gene in PTA muscle by activating PARP-1, which binds on the ZNF216 promoter. The SirT1 gain-of-function or SirT1 activator, resveratrol, reversed the PARP-1-mediated up-regulation of ZNF216 expression at the promoter level, suggesting a contradicted role for SirT1 and PARP-1 in the regulation of ZNF216 gene. Overall, our study for the first-time demonstrated that (a) stroke causes muscle atrophy, in part, through the SirT1/PARP-1/ZNF216 signaling mechanism; (b) SirT1 can block muscle atrophy in response to different types of atrophic signals via different signaling mechanisms; and (c) SirT1 is a critical regulator of post-stroke muscle mass.
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Affiliation(s)
- Kiril Tuntevski
- Department of Human PerformanceWest Virginia University School of MedicineMorgantownWVUSA
| | - Ameena Hajira
- Department of Human PerformanceWest Virginia University School of MedicineMorgantownWVUSA
| | - Austin Nichols
- Department of Human PerformanceWest Virginia University School of MedicineMorgantownWVUSA
| | - Stephen E. Alway
- Department of Human PerformanceWest Virginia University School of MedicineMorgantownWVUSA
- Laboratory of Muscle Biology and SarcopeniaDepartment of Physical TherapyCollege of Health ProfessionsUniversity of Tennessee Health Science CenterMemphisTNUSA
- Center for Muscle, Metabolism and NeuropathologyDivision of Rehabilitation SciencesCollege of Health ProfessionsUniversity of Tennessee Health Science CenterMemphisTNUSA
| | - Junaith S. Mohamed
- Department of Human PerformanceWest Virginia University School of MedicineMorgantownWVUSA
- Laboratory of Muscle and NerveDepartment of Diagnostic and Health SciencesCollege of Health ProfessionsUniversity of Tennessee Health Science CenterMemphisTNUSA
- Center for Muscle, Metabolism and NeuropathologyDivision of Rehabilitation SciencesCollege of Health ProfessionsUniversity of Tennessee Health Science CenterMemphisTNUSA
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22
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Ferrandi PJ, Khan MM, Paez HG, Pitzer CR, Alway SE, Mohamed JS. Transcriptome Analysis of Skeletal Muscle Reveals Altered Proteolytic and Neuromuscular Junction Associated Gene Expressions in a Mouse Model of Cerebral Ischemic Stroke. Genes (Basel) 2020; 11:genes11070726. [PMID: 32629989 PMCID: PMC7397267 DOI: 10.3390/genes11070726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022] Open
Abstract
Stroke is a leading cause of mortality and long-term disability in patients worldwide. Skeletal muscle is the primary systemic target organ of stroke that induces muscle wasting and weakness, which predominantly contribute to functional disability in stroke patients. Currently, no pharmacological drug is available to treat post-stroke muscle morbidities as the mechanisms underlying post-stroke muscle wasting remain poorly understood. To understand the stroke-mediated molecular changes occurring at the transcriptional level in skeletal muscle, the gene expression profiles and enrichment pathways were explored in a mouse model of cerebral ischemic stroke via high-throughput RNA sequencing and extensive bioinformatic analyses. RNA-seq revealed that the elevated muscle atrophy observed in response to stroke was associated with the altered expression of genes involved in proteolysis, cell cycle, extracellular matrix remodeling, and the neuromuscular junction (NMJ). These data suggest that stroke primarily targets muscle protein degradation and NMJ pathway proteins to induce muscle atrophy. Collectively, we for the first time have found a novel genome-wide transcriptome signature of post-stroke skeletal muscle in mice. Our study will provide critical information to further elucidate specific gene(s) and pathway(s) that can be targeted to mitigate accountable for post-stroke muscle atrophy and related weakness.
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Affiliation(s)
- Peter J. Ferrandi
- Laboratory of Muscle and Nerve, Department of Diagnostic and Health Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
- Center for Muscle, Metabolism and Neuropathology, Division of Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.M.K.); (H.G.P.); (C.R.P.); (S.E.A.)
| | - Mohammad Moshahid Khan
- Center for Muscle, Metabolism and Neuropathology, Division of Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.M.K.); (H.G.P.); (C.R.P.); (S.E.A.)
- Department of Neurology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Hector G. Paez
- Center for Muscle, Metabolism and Neuropathology, Division of Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.M.K.); (H.G.P.); (C.R.P.); (S.E.A.)
- Laboratory of Muscle Biology and Sarcopenia, Department of Physical Therapy, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Christopher R. Pitzer
- Center for Muscle, Metabolism and Neuropathology, Division of Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.M.K.); (H.G.P.); (C.R.P.); (S.E.A.)
- Laboratory of Muscle Biology and Sarcopenia, Department of Physical Therapy, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Stephen E. Alway
- Center for Muscle, Metabolism and Neuropathology, Division of Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.M.K.); (H.G.P.); (C.R.P.); (S.E.A.)
- Laboratory of Muscle Biology and Sarcopenia, Department of Physical Therapy, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Junaith S. Mohamed
- Laboratory of Muscle and Nerve, Department of Diagnostic and Health Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
- Center for Muscle, Metabolism and Neuropathology, Division of Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.M.K.); (H.G.P.); (C.R.P.); (S.E.A.)
- Correspondence: ; Tel.: +1-901-448-8560
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23
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Proulx CE, Beaulac M, David M, Deguire C, Haché C, Klug F, Kupnik M, Higgins J, Gagnon DH. Review of the effects of soft robotic gloves for activity-based rehabilitation in individuals with reduced hand function and manual dexterity following a neurological event. J Rehabil Assist Technol Eng 2020; 7:2055668320918130. [PMID: 32435506 PMCID: PMC7223210 DOI: 10.1177/2055668320918130] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/17/2020] [Indexed: 12/20/2022] Open
Abstract
Despite limited scientific evidence, there is an increasing interest in soft robotic gloves to optimize hand- and finger-related functional abilities following a neurological event. This review maps evidence on the effects and effectiveness of soft robotic gloves for hand rehabilitation and, whenever possible, patients' satisfaction. A systematized search of the literature was conducted using keywords structured around three areas: technology attributes, anatomy, and rehabilitation. A total of 272 titles, abstracts, and keywords were initially retrieved, and data were extracted out of 13 articles. Six articles investigated the effects of wearing a soft robotic glove and eight studied the effect or effectiveness of an intervention with it. Some statistically significant and meaningful beneficial effects were confirmed with the 29 outcome measures used. Finally, 11 articles also confirmed users' satisfaction with regard to the soft robotic glove, while some articles also noticed an increased engagement in the rehabilitation program with this technology. Despite the heterogeneity across studies, soft robotic gloves stand out as a safe and promising technology to improve hand- and finger-related dexterity and functional performance. However, strengthened evidence of the effects or effectiveness of such devices is needed before their transition from laboratory to clinical practice.
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Affiliation(s)
- Camille E Proulx
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Myrka Beaulac
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Mélissa David
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Catryne Deguire
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Catherine Haché
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Florian Klug
- Technischen Universität Darmstadt, Darmstaadt, Germany
| | - Mario Kupnik
- Technischen Universität Darmstadt, Darmstaadt, Germany
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
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24
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Tu T, Peng J, Jiang Y. FNDC5/Irisin: A New Protagonist in Acute Brain Injury. Stem Cells Dev 2020; 29:533-543. [PMID: 31914844 DOI: 10.1089/scd.2019.0232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Tianqi Tu
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianhua Peng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgical Clinical Research Center of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yong Jiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgical Clinical Research Center of Sichuan Province, Luzhou, China
- Laboratory of Neurological Diseases and Brain Functions, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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25
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Hu J, Li C, Hua Y, Liu P, Gao B, Wang Y, Bai Y. Constraint-induced movement therapy improves functional recovery after ischemic stroke and its impacts on synaptic plasticity in sensorimotor cortex and hippocampus. Brain Res Bull 2020; 160:8-23. [PMID: 32298779 DOI: 10.1016/j.brainresbull.2020.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 01/28/2023]
Abstract
Constraint-induced movement therapy (CIMT) has proven to be an effective way to restore functional deficits following stroke in human and animal studies, but its underlying neural plasticity mechanism remains unknown. Accumulating evidence indicates that rehabilitation after stroke is closely associated with synaptic plasticity. We therefore investigated the impact of CIMT on synaptic plasticity in ipsilateral and contralateral brain of rats following stroke. Rats were subjected to 90 minutes of transient middle cerebral artery occlusion (MCAO). CIMT was performed from 7 days after stroke and lasted for two weeks. Modified Neurology Severity Score (mNSS) and the ladder rung walking task tests were conducted at 7,14 and 21 days after stroke. Golgi-Cox staining was used to observe the plasticity changes of dendrites and dendritic spines. The expression of glutamate receptors (GluR1, GluR2 and NR1) were examined by western blot. Our data suggest that the dendrites and dendritic spines are damaged to varying degrees in bilateral sensorimotor cortex and hippocampus after acute stroke. CIMT treatment enhances the plasticity of dendrites and dendritic spines in the ipsilateral and contralateral sensorimotor cortex, increases the expression of synaptic GluR2 in ipsilateral sensorimotor cortex, which may be mechanisms for CIMT to improve functional recovery after ischemic stroke.
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Affiliation(s)
- Jian Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ce Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Peile Liu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Beiyao Gao
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyuan Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.
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26
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Growth Hormone Promotes Motor Function after Experimental Stroke and Enhances Recovery-Promoting Mechanisms within the Peri-Infarct Area. Int J Mol Sci 2020; 21:ijms21020606. [PMID: 31963456 PMCID: PMC7013985 DOI: 10.3390/ijms21020606] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/31/2022] Open
Abstract
Motor impairment is the most common and widely recognised clinical outcome after stroke. Current clinical practice in stroke rehabilitation focuses mainly on physical therapy, with no pharmacological intervention approved to facilitate functional recovery. Several studies have documented positive effects of growth hormone (GH) on cognitive function after stroke, but surprisingly, the effects on motor function remain unclear. In this study, photothrombotic occlusion targeting the motor and sensory cortex was induced in adult male mice. Two days post-stroke, mice were administered with recombinant human GH or saline, continuing for 28 days, followed by evaluation of motor function. Three days after initiation of the treatment, bromodeoxyuridine was administered for subsequent assessment of cell proliferation. Known neurorestorative processes within the peri-infarct area were evaluated by histological and biochemical analyses at 30 days post-stroke. This study demonstrated that GH treatment improves motor function after stroke by 50%–60%, as assessed using the cylinder and grid walk tests. Furthermore, the observed functional improvements occurred in parallel with a reduction in brain tissue loss, as well as increased cell proliferation, neurogenesis, increased synaptic plasticity and angiogenesis within the peri-infarct area. These findings provide new evidence about the potential therapeutic effects of GH in stroke recovery.
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27
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Pichiorri F, Mattia D. Brain-computer interfaces in neurologic rehabilitation practice. HANDBOOK OF CLINICAL NEUROLOGY 2020; 168:101-116. [PMID: 32164846 DOI: 10.1016/b978-0-444-63934-9.00009-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The brain-computer interfaces (BCIs) for neurologic rehabilitation are based on the assumption that by retraining the brain to specific activities, an ultimate improvement of function can be expected. In this chapter, we review the present status, key determinants, and future directions of the clinical use of BCI in neurorehabilitation. The recent advancements in noninvasive BCIs as a therapeutic tool to promote functional motor recovery by inducing neuroplasticity are described, focusing on stroke as it represents the major cause of long-term motor disability. The relevance of recent findings on BCI use in spinal cord injury beyond the control of neuroprosthetic devices to restore motor function is briefly discussed. In a dedicated section, we examine the potential role of BCI technology in the domain of cognitive function recovery by instantiating BCIs in the long history of neurofeedback and some emerging BCI paradigms to address cognitive rehabilitation are highlighted. Despite the knowledge acquired over the last decade and the growing number of studies providing evidence for clinical efficacy of BCI in motor rehabilitation, an exhaustive deployment of this technology in clinical practice is still on its way. The pipeline to translate BCI to clinical practice in neurorehabilitation is the subject of this chapter.
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Affiliation(s)
- Floriana Pichiorri
- Neuroelectrical Imaging and Brain Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Donatella Mattia
- Neuroelectrical Imaging and Brain Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy.
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28
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Abstract
Brain tissue lost after a stroke is not regenerated, although a repair response associated with neurogenesis does occur. A failure to regenerate functional brain tissue is not caused by the lack of available neural cells, but rather the absence of structural support to permit a repopulation of the lesion cavity. Inductive bioscaffolds can provide this support and promote the invasion of host cells into the tissue void. The putative mechanisms of bioscaffold degradation and its pivotal role to permit invasion of neural cells are reviewed and discussed in comparison to peripheral wound healing. Key differences between regenerating and non-regenerating tissues are contrasted in an evolutionary context, with a special focus on the neurogenic response as a conditio sine qua non for brain regeneration. The pivotal role of the immune system in biodegradation and the formation of a neovasculature are contextualized with regeneration of peripheral soft tissues. The application of rehabilitation to integrate newly forming brain tissue is suggested as necessary to develop functional tissue that can alleviate behavioral impairments. Pertinent aspects of brain tissue development are considered to provide guidance to produce a metabolically and functionally integrated de novo tissue. Although little is currently known about mechanisms involved in brain tissue regeneration, this review outlines the various components and their interplay to provide a framework for ongoing and future studies. It is envisaged that a better understanding of the mechanisms involved in brain tissue regeneration will improve the design of biomaterials and the methods used for implantation, as well as rehabilitation strategies that support the restoration of behavioral functions.
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Affiliation(s)
- Michel Modo
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States,Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States,*Correspondence: Michel Modo,
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29
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Neumann S, Boothman-Burrell L, Gowing EK, Jacobsen TA, Ahring PK, Young SL, Sandager-Nielsen K, Clarkson AN. The Delta-Subunit Selective GABA A Receptor Modulator, DS2, Improves Stroke Recovery via an Anti-inflammatory Mechanism. Front Neurosci 2019; 13:1133. [PMID: 31736685 PMCID: PMC6828610 DOI: 10.3389/fnins.2019.01133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 10/07/2019] [Indexed: 12/22/2022] Open
Abstract
Inflammatory processes are known to contribute to tissue damage in the central nervous system (CNS) across a broad range of neurological conditions, including stroke. Gamma amino butyric acid (GABA), the main inhibitory neurotransmitter in the CNS, has been implicated in modulating peripheral immune responses by acting on GABA A receptors on antigen-presenting cells and lymphocytes. Here, we investigated the effects and mechanism of action of the delta-selective compound, DS2, to improve stroke recovery and modulate inflammation. We report a decrease in nuclear factor (NF)-κB activation in innate immune cells over a concentration range in vitro. Following a photochemically induced motor cortex stroke, treatment with DS2 at 0.1 mg/kg from 1 h post-stroke significantly decreased circulating tumor necrosis factor (TNF)-α, interleukin (IL)-17, and IL-6 levels, reduced infarct size and improved motor function in mice. Free brain concentrations of DS2 were found to be lower than needed for robust modulation of central GABA A receptors and were not affected by the presence and absence of elacridar, an inhibitor of both P-glycoprotein and breast cancer resistance protein (BCRP). Finally, as DS2 appears to dampen peripheral immune activation and only shows limited brain exposure, we assessed the role of DS2 to promote functional recovery after stroke when administered from 3-days after the stroke. Treatment with DS2 from 3-days post-stroke improved motor function on the grid-walking, but not on the cylinder task. These data highlight the need to further develop subunit-selective compounds to better understand change in GABA receptor signaling pathways both centrally and peripherally. Importantly, we show that GABA compounds such as DS2 that only shows limited brain exposure can still afford significant protection and promote functional recovery most likely via modulation of peripheral immune cells and could be given as an adjunct treatment.
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Affiliation(s)
- Silke Neumann
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Anatomy, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Lily Boothman-Burrell
- Department of Anatomy, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Emma K Gowing
- Department of Anatomy, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | | | - Philip K Ahring
- School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Sarah L Young
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Andrew N Clarkson
- Department of Anatomy, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
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30
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Ögün MN, Kurul R, Yaşar MF, Turkoglu SA, Avci Ş, Yildiz N. Effect of Leap Motion-based 3D Immersive Virtual Reality Usage on Upper Extremity Function in Ischemic Stroke Patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:681-688. [PMID: 31664343 DOI: 10.1590/0004-282x20190129] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/07/2019] [Indexed: 12/31/2022]
Abstract
Immersive virtual reality (VR) is a technology that provides a more realistic environmental design and object tracking than ordinary VR. The aim of this study was to investigate the effectiveness of immersive VR on upper extremity function in patients with ischemic stroke. Sixty-five patients with ischemic stroke were included in this randomized, controlled, double-blind study. Patients were randomly divided into VR (n = 33) and control (n = 32) groups. The VR group received 60 minutes of the upper extremity immersive VR rehabilitation program and the control group received 45 minutes of conventional therapy and 15 minutes of a sham VR program. Rehabilitation consisted of 18 sessions of therapy, three days per week, for six weeks. The outcome measures were the Action Research Arm Test (ARAT), Functional Independence Measure (FIM), Fugl-Meyer Upper Extremity Scale (FMUE) and Performance Assessment of Self-Care Skills (PASS). In both the VR and control groups all parameters except the PASS improved over time. However independent t-test results showed that all of the FMUE, ARAT, FIM and PASS scores were significantly higher in the VR group compared with the control (p < 0.05). The minimal clinically important difference (MCID) scores of the FMUE and ARAT were higher than the cut-off MCID scores described in the literature in the VR group, whereas the FIM scores were below the cut-off MCID scores. All scores in the control group were below the cut-off scores. Immersive VR rehabilitation appeared to be effective in improving upper extremity function and self-care skills, but it did not improve functional independence.
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Affiliation(s)
- Muhammed Nur Ögün
- Bolu Abant Izzet Baysal Universitesi; Nöroloji Anabilim Dalı, Bolu, Türkiye
| | - Ramazan Kurul
- Bolu Abant Izzet Baysal Universitesi; Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Yüksekokulu, Bolu, Türkiye
| | - Mustafa Fatih Yaşar
- Bolu Abant Izzet Baysal Universitesi; Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, Bolu, Türkiye
| | | | - Şebnem Avci
- Bolu Abant Izzet Baysal Universitesi; Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Yüksekokulu, Bolu, Türkiye
| | - Nebil Yildiz
- Bolu Abant Izzet Baysal Universitesi; Nöroloji Anabilim Dalı, Bolu, Türkiye
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31
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Clarkson AN, Boothman-Burrell L, Dósa Z, Nagaraja RY, Jin L, Parker K, van Nieuwenhuijzen PS, Neumann S, Gowing EK, Gavande N, Ahring PK, Holm MM, Hanrahan JR, Nicolazzo JA, Jensen K, Chebib M. The flavonoid, 2'-methoxy-6-methylflavone, affords neuroprotection following focal cerebral ischaemia. J Cereb Blood Flow Metab 2019; 39:1266-1282. [PMID: 29376464 PMCID: PMC6668512 DOI: 10.1177/0271678x18755628] [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] [Indexed: 12/13/2022]
Abstract
Tonic inhibitory currents, mediated by extrasynaptic GABAA receptors, are elevated at a delay following stroke. Flavonoids minimise the extent of cellular damage following stroke, but little is known about their mode of action. We demonstrate that the flavonoid, 2'-methoxy-6-methylflavone (0.1-10 µM; 2'MeO6MF), increases GABAA receptor tonic currents presumably via δ-containing GABAA receptors. Treatment with 2'MeO6MF 1-6 h post focal ischaemia dose dependently decreases infarct volume and improves functional recovery. The effect of 2'MeO6MF was attenuated in δ-/- mice, indicating that the effects of the flavonoid were mediated via δ-containing GABAA receptors. Further, as flavonoids have been shown to have multiple modes of action, we investigated the anti-inflammatory effects of 2'MeO6MF. Using a macrophage cell line, we show that 2'MeO6MF can dampen an LPS-induced elevation in NFkB activity. Assessment of vehicle-treated stroke animals revealed a significant increase in circulating IL1β, TNFα and IFγ levels. Treatment with 2'MeO6MF dampened the stroke-induced increase in circulating cytokines, which was blocked in the presence of the pan-AKT inhibitor, GSK690693. These studies support the hypothesis that compounds that potentiate tonic inhibition via δ-containing GABAA receptors soon after stroke can afford neuroprotection.
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Affiliation(s)
- Andrew N Clarkson
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand.,2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Lily Boothman-Burrell
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Zita Dósa
- 3 Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Raghavendra Y Nagaraja
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Liang Jin
- 4 Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Kim Parker
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | | | - Silke Neumann
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand.,5 Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Emma K Gowing
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Navnath Gavande
- 2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Philip K Ahring
- 2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Mai M Holm
- 3 Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Jane R Hanrahan
- 2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Joseph A Nicolazzo
- 4 Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Kimmo Jensen
- 3 Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Mary Chebib
- 2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
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Stroke Induces a BDNF-Dependent Improvement in Cognitive Flexibility in Aged Mice. Neural Plast 2019; 2019:1460890. [PMID: 31191635 PMCID: PMC6525942 DOI: 10.1155/2019/1460890] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 11/17/2022] Open
Abstract
Stroke remains a leading cause of disability worldwide. Recently, we have established an animal model of stroke that results in delayed impairment in spatial memory, allowing us to better investigate cognitive deficits. Young and aged brains show different recovery profiles after stroke; therefore, we assessed aged-related differences in poststroke cognition. As neurotrophic support diminishes with age, we also investigated the involvement of brain-derived neurotrophic factor (BDNF) in these differences. Young (3-6 months old) and aged (16-21 months old) mice were trained in operant touchscreen chambers to complete a visual pairwise discrimination (VD) task. Stroke or sham surgery was induced using the photothrombotic model to induce a bilateral prefrontal cortex stroke. Five days poststroke, an additional cohort of aged stroke animals were treated with intracerebral hydrogels loaded with the BDNF decoy, TrkB-Fc. Following treatment, animals underwent the reversal and rereversal task to identify stroke-induced cognitive deficits at days 17 and 37 poststroke, respectively. Assessment of sham animals using Cox regression and log-rank analyses showed aged mice exhibit an increased impairment on VD reversal and rereversal learning compared to young controls. Stroke to young mice revealed no impairment on either task. In contrast, stroke to aged mice facilitated a significant improvement in reversal learning, which was dampened in the presence of the BDNF decoy, TrkB-Fc. In addition, aged stroke control animals required significantly less consecutive days and correction trials to master the reversal task, relative to aged shams, an effect dampened by TrkB-Fc. Our findings support age-related differences in recovery of cognitive function after stroke. Interestingly, aged stroke animals outperformed their sham counterparts, suggesting reopening of a critical window for recovery that is being mediated by BDNF.
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Delayed treatment of α5 GABAA receptor inverse agonist improves functional recovery by enhancing neurogenesis after cerebral ischemia-reperfusion injury in rat MCAO model. Sci Rep 2019; 9:2287. [PMID: 30783142 PMCID: PMC6381084 DOI: 10.1038/s41598-019-38750-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/18/2018] [Indexed: 11/08/2022] Open
Abstract
Development of effective therapeutics and treatment strategy to promote recovery after cerebral ischemia-reperfusion injury necessitates further understandings of the complex pathophysiology of ischemic stroke. Given that α5-GABAAR inhibition has been shown to be involved in functional recovery after stroke, the present study was designed to evaluate the effects of treatment timing of α5 GABAAR inhibition on post-middle cerebral artery occlusion (MCAO) functional recovery. To this end, we examined the effects of L655,708 (α5 GABAAR inverse agonist) treatment at 3 or 7 days post-ischemia on apoptosis and neurogenesis in the peri-infarct region, brain infarction size, as well as modified neurological severity score (mNSS) and rotarod test time in rats. Consistent with previous reports, we found that when the treatment of L655,708 was initiated at post-MCAO day 3, it did not alter the functional recovery in rats. However, when the treatment of L655,708 was initiated at post-MCAO day 7, it demonstrated beneficial effects on functional recovery in rats. Interestingly, this phenomenon was not associated with altered brain infarction size nor with changes in brain cell apoptosis. However, we found that delayed treatment of L655,708 at post-MCAO day 7 significantly increased neurogenesis in peri-infarct zone in rats. These results suggested that removing α5 GABAAR-mediated tonic inhibition after cerebral ischemia-reperfusion injury may be an effective therapeutic strategy for promoting functional recovery from stroke.
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Milot MH, Léonard G, Corriveau H, Desrosiers J. Using the Borg rating of perceived exertion scale to grade the intensity of a functional training program of the affected upper limb after a stroke: a feasibility study. Clin Interv Aging 2018; 14:9-16. [PMID: 30587949 PMCID: PMC6304074 DOI: 10.2147/cia.s179691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose Intensity of a training program is a critical variable in treatment gains poststroke, but there are no guidelines to adequately dose the intensity of functional training (FT); the recommended type of training to promote poststroke recovery. Such guidelines are made available for strength training (ST) using the 1 repetition maximum (1RM), which has been linked to individuals’ self-rated level of exertion using the Borg rating of perceived exertion (BRPE) scale. The BRPE could be a valuable tool for clinicians to dose FT intensity after a stroke, but this remains to be tested. The main objective of the study was to evaluate the feasibility of the BRPE at grading FT intensity of the affected upper limb in older adults with a chronic stroke and secondarily to explore the clinical changes between FT and ST when the intensity is regulated with BRPE. Patients and methods Twelve participants were randomized into a FT or ST group and trained their affected upper limb (3 times/week for 4 weeks) with the intensity standardized with BRPE. Feasibility was assessed by adherence, occurrence of adverse events, and comparison of BRPE ratings between groups. Clinical changes were defined as improvements on the Fugl-Meyer motor assessment (FMA) and Wolf motor function test (WMFT). Results All participants adhered to FT/ST without adverse effects, and comparable BRPE ratings were noted between groups throughout the training (P≥0.42). Both groups showed significant gains at the FMA (ST: 5±4 points/FT: 6±4 points; P=0.04) and WMFT (ST: 0.4±0.3 points/FT: 0.6±0.4 points; P=0.05), which were comparable between groups (P≥0.47). Conclusion The results suggest that it is feasible to use the BRPE scale to adjust FT intensity. Gains in motor function in both groups suggest that undergoing therapy, regardless of its type, might be a sufficient stimulus to produce gains when intensity is adequately adjusted. Further studies are needed to validate the current observations.
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Affiliation(s)
- Marie-Hélène Milot
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Research Center on Aging, Sherbrooke, Québec, Canada,
| | - Guillaume Léonard
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Research Center on Aging, Sherbrooke, Québec, Canada,
| | - Hélène Corriveau
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Research Center on Aging, Sherbrooke, Québec, Canada,
| | - Johanne Desrosiers
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Research Center on Aging, Sherbrooke, Québec, Canada,
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Mensen A, Pigorini A, Facchin L, Schöne C, D'Ambrosio S, Jendoubi J, Jaramillo V, Chiffi K, Eberhard-Moscicka AK, Sarasso S, Adamantidis A, Müri RM, Huber R, Massimini M, Bassetti C. Sleep as a model to understand neuroplasticity and recovery after stroke: Observational, perturbational and interventional approaches. J Neurosci Methods 2018; 313:37-43. [PMID: 30571989 DOI: 10.1016/j.jneumeth.2018.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/19/2018] [Accepted: 12/16/2018] [Indexed: 01/28/2023]
Abstract
Our own experiences with disturbances to sleep demonstrate its crucial role in the recovery of cognitive functions. This importance is likely enhanced in the recovery from stroke; both in terms of its physiology and cognitive abilities. Decades of experimental research have highlighted which aspects and mechanisms of sleep are likely to underlie these forms of recovery. Conversely, damage to certain areas of the brain, as well as the indirect effects of stroke, may disrupt sleep. However, only limited research has been conducted which seeks to directly explore this bidirectional link between both the macro and micro-architecture of sleep and stroke. Here we describe a series of semi-independent approaches that aim to establish this link through observational, perturbational, and interventional experiments. Our primary aim is to describe the methodology for future clinical and translational research needed to delineate competing accounts of the current data. At the observational level we suggest the use of high-density EEG recording, combined analysis of macro and micro-architecture of sleep, detailed analysis of the stroke lesion, and sensitive measures of functional recovery. The perturbational approach attempts to find the causal links between sleep and stroke. We promote the use of transcranial magnetic stimulation combined with EEG to examine the cortical dynamics of the peri-infarct stroke area. Translational research should take this a step further using optogenetic techniques targeting more specific cell populations. The interventional approach focuses on how the same clinical and translational perturbational techniques can be adapted to influence long-term recovery of function.
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Androwis GJ, Pilkar R, Ramanujam A, Nolan KJ. Electromyography Assessment During Gait in a Robotic Exoskeleton for Acute Stroke. Front Neurol 2018; 9:630. [PMID: 30131756 PMCID: PMC6090052 DOI: 10.3389/fneur.2018.00630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 07/12/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Robotic exoskeleton (RE) based gait training involves repetitive task-oriented movements and weight shifts to promote functional recovery. To effectively understand the neuromuscular alterations occurring due to hemiplegia as well as due to the utilization of RE in acute stroke, there is a need for electromyography (EMG) techniques that not only quantify the intensity of muscle activations but also quantify and compare activation timings in different gait training environments. Purpose: To examine the applicability of a novel EMG analysis technique, Burst Duration Similarity Index (BDSI) during a single session of inpatient gait training in RE and during traditional overground gait training for individuals with acute stroke. Methods: Surface EMG was collected bilaterally with and without the RE device for five participants with acute stroke during the normalized gait cycle to measure lower limb muscle activations. EMG outcomes included integrated EMG (iEMG) calculated from the root-mean-square profiles, and a novel measure, BDSI derived from activation timing comparisons. Results: EMG data demonstrated volitional although varied levels of muscle activations on the affected and unaffected limbs, during gait with and without the RE. During the stance phase mean iEMG of the soleus (p = 0.019) and rectus femoris (RF) (p = 0.017) on the affected side significantly decreased with RE, as compared to without the RE. The differences in mean BDSI scores on the affected side with RE were significantly higher than without RE for the vastus lateralis (VL) (p = 0.010) and RF (p = 0.019). Conclusions: A traditional amplitude analysis (iEMG) and a novel timing analysis (BDSI) techniques were presented to assess the neuromuscular adaptations resulting in lower extremities muscles during RE assisted hemiplegic gait post acute stroke. The RE gait training environment allowed participants with hemiplegia post acute stroke to preserve their volitional neuromuscular activations during gait iEMG and BDSI analyses showed that the neuromuscular changes occurring in the RE environment were characterized by correctly timed amplitude and temporal adaptations. As a result of these adaptations, VL and RF on the affected side closely matched the activation patterns of healthy gait. Preliminary EMG data suggests that the RE provides an effective gait training environment for in acute stroke rehabilitation.
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Affiliation(s)
- Ghaith J Androwis
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Children's Specialized Hospital, Mountainside, NJ, United States
| | - Rakesh Pilkar
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, United States
| | - Arvind Ramanujam
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Karen J Nolan
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Children's Specialized Hospital, Mountainside, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, United States
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Sun Y, Sun X, Qu H, Zhao S, Xiao T, Zhao C. Neuroplasticity and behavioral effects of fluoxetine after experimental stroke. Restor Neurol Neurosci 2018; 35:457-468. [PMID: 28854520 DOI: 10.3233/rnn-170725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The brain can undergo self-repair and has the ability to compensate for functions lost after a stroke. The plasticity of the ischemic brain is influenced by several factors including aging and pharmacotherapy. Fluoxetine is an antidepressant which enhances serotonergic neurotransmission through selective inhibition of neuronal reuptake of serotonin. In clinical practice, fluoxetine alleviates the symptoms of post-stroke depression (PSD), helps motor recovery in stroke patients. In animal experiments, chronic administration of fluoxetine induces increased excitability of mature granule cells (GCs), enhancing axonal and dendritic reorganization, as well as promoting neurogenesis or angiogenesis in the dentate gurus (DG), but the effect of fluoxetine in the subventricular zone (SVZ) remains controversial. Meanwhile, chronic treatment with fluoxetine did not reverse age-dependent suppression of proliferation cells in the DG. Interestingly, although fluoxetine has been found to enhance neurogenesis in the DG in stroke rats, this property is not consistent with the behavioral recovery. More studies into this issue will be required to reveal how to translate enhanced neuronal plasticity into behavioral benefits. This review provides an update of the current knowledge about the neurogenesis and the fate of the newly generated cells after the use of fluoxetine, as well as its ability to promote a behavioral recovery after stroke in clinical and experimental results and attempts to define the therapeutic properties of fluoxetine in regenerative neuroscience.
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Affiliation(s)
- Yefei Sun
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoyu Sun
- Department of Neurology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Huiling Qu
- Department of Neurology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Shanshan Zhao
- Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Ting Xiao
- Dermatology, The First Hospital of China Medical University, Shenyang, China.,Key Laboratory of Immunodermatology, Ministry of Health, Ministry of Education, Shenyang, China
| | - Chuansheng Zhao
- Neurology, The First Hospital of China Medical University, Shenyang, China
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Naidu A, Brown D, Roth E. A Challenge-Based Approach to Body Weight-Supported Treadmill Training Poststroke: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e118. [PMID: 29724706 PMCID: PMC5958283 DOI: 10.2196/resprot.9308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/22/2018] [Accepted: 02/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background Body weight support treadmill training protocols in conjunction with other modalities are commonly used to improve poststroke balance and walking function. However, typical body weight support paradigms tend to use consistently stable balance conditions, often with handrail support and or manual assistance. Objective In this paper, we describe our study protocol, which involved 2 unique body weight support treadmill training paradigms of similar training intensity that integrated dynamic balance challenges to help improve ambulatory function post stroke. The first paradigm emphasized walking without any handrails or manual assistance, that is, hands-free walking, and served as the control group, whereas the second paradigm incorporated practicing 9 essential challenging mobility skills, akin to environmental barriers encountered during community ambulation along with hands-free walking (ie hands-free + challenge walking). Methods We recruited individuals with chronic poststroke hemiparesis and randomized them to either group. Participants trained for 6 weeks on a self-driven, robotic treadmill interface that provided body weight support and a safe gait-training environment. We assessed participants at pre-, mid- and post 6 weeks of intervention-training, with a 6-month follow-up. We hypothesized greater walking improvements in the hands-free + challenge walking group following training because of increased practice opportunity of essential mobility skills along with hands-free walking. Results We assessed 77 individuals with chronic hemiparesis, and enrolled and randomized 30 individuals poststroke for our study (hands-free group=19 and hands-free + challenge walking group=20) from June 2012 to January 2015. Data collection along with 6-month follow-up continued until January 2016. Our primary outcome measure is change in comfortable walking speed from pre to post intervention for each group. We will also assess feasibility, adherence, postintervention efficacy, and changes in various exploratory secondary outcome measures. Additionally, we will also assess participant responses to a study survey, conducted at the end of training week, to gauge each group's training experiences. Conclusions Our treadmill training paradigms, and study protocol represent advances in standardized approaches to selecting body weight support levels without the necessity for using handrails or manual assistance, while progressively providing dynamic challenges for improving poststroke ambulatory function during rehabilitation. Trial Registration ClinicalTrials.gov NCT02787759; https://clinicaltrials.gov/ct2/show/NCT02787759 (Archived by Webcite at http://www.webcitation.org/6yJZCrIea)
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Affiliation(s)
- Avantika Naidu
- Department of Physical Therapy and Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - David Brown
- Department of Physical Therapy and Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Elliot Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
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Singh H, Unger J, Zariffa J, Pakosh M, Jaglal S, Craven BC, Musselman KE. Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review. Disabil Rehabil Assist Technol 2018; 13:704-715. [PMID: 29334467 DOI: 10.1080/17483107.2018.1425747] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstact Purpose: To provide an overview of the feasibility and outcomes of robotic-assisted upper extremity training for individuals with cervical spinal cord injury (SCI), and to identify gaps in current research and articulate future research directions. MATERIALS AND METHODS A systematic search was conducted using Medline, Embase, PsycINFO, CCTR, CDSR, CINAHL and PubMed on June 7, 2017. Search terms included 3 themes: (1) robotics; (2) SCI; (3) upper extremity. Studies using robots for upper extremity rehabilitation among individuals with cervical SCI were included. Identified articles were independently reviewed by two researchers and compared to pre-specified criteria. Disagreements regarding article inclusion were resolved through discussion. The modified Downs and Black checklist was used to assess article quality. Participant characteristics, study and intervention details, training outcomes, robot features, study limitations and recommendations for future studies were abstracted from included articles. RESULTS Twelve articles (one randomized clinical trial, six case series, five case studies) met the inclusion criteria. Five robots were exoskeletons and three were end-effectors. Sample sizes ranged from 1 to 17 subjects. Articles had variable quality, with quality scores ranging from 8 to 20. Studies had a low internal validity primarily from lack of blinding or a control group. Individuals with mild-moderate impairments showed the greatest improvements on body structure/function and performance-level measures. This review is limited by the small number of articles, low-sample sizes and the diversity of devices and their associated training protocols, and outcome measures. CONCLUSIONS Preliminary evidence suggests robot-assisted interventions are safe, feasible and can reduce active assistance provided by therapists. Implications for rehabilitation Robot-assisted upper extremity training for individuals with cervical spinal cord injury is safe, feasible and can reduce hands-on assistance provided by therapists. Future research in robotics rehabilitation with individuals with spinal cord injury is needed to determine the optimal device and training protocol as well as effectiveness.
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Affiliation(s)
- Hardeep Singh
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - Janelle Unger
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - José Zariffa
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,c Institute of Biomaterials and Biomedical Engineering , University of Toronto , Toronto , ON , Canada
| | - Maureen Pakosh
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada
| | - Susan Jaglal
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,d Department of Physical Therapy , University of Toronto , Toronto , ON , Canada.,e Department of Health Policy, Management and Evaluation , University of Toronto , Toronto , ON , Canada
| | - B Catharine Craven
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,f Division of Physical Medicine and Rehabilitation, Faculty of Medicine , University of Toronto , Toronto , ON , Canada
| | - Kristin E Musselman
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,d Department of Physical Therapy , University of Toronto , Toronto , ON , Canada
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40
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Karaahmet OZ, Umay E, Gurcay E, Serçe A, Gundogdu I, Cakci A. The effect of premorbid features on post-stroke rehabilitation outcome. IRANIAN JOURNAL OF NEUROLOGY 2018; 17:38-46. [PMID: 30186558 PMCID: PMC6121201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A wide variety of factors influence stroke prognosis, including age, stroke severity, stroke mechanism, infarct location, comorbid conditions, clinical findings, and related complications. The aim of this study was to detect the prognostic determinants in patients with acute stroke for guiding rehabilitation. Methods: Patients with ischemic acute stroke were included in the study. Patients' age, sex, education level, and marital status, premorbid personality traits, comorbidities such as current smoking status and alcohol consumption, regular exercise habits, and sleeping disorder were recorded. Motor assessment and daily activity skills were evaluated according to the Brunnstrom staging and Functional Independence Measure (FIM), respectively. Results: A total of 85 patients were studied. All patients' motor and functional stages were significantly improved with the rehabilitation. The improvements in the upper extremity motor levels were less in whom over 76 years and smokers, in patients who had 4 and more comorbidities and sleep disorders. The functional improvement was less in whom over 76 years and men, and in patients who had 4 and more comorbidities and sleep disorders. Conclusion: The significant post-stroke predictor of insufficiency in functioning was having 4 or more risk factors.
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Rashid A, Suppiah S, Hoo FK, Masiran R. Bilateral Motor Cortex Control for Left Thumb Movement: An Incidental Finding Through Functional MRI (fMRI). BMJ Case Rep 2018; 2018:bcr-2017-221129. [PMID: 29301796 DOI: 10.1136/bcr-2017-221129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a healthy, right-hand dominant young male who was a volunteer for a pilot run of a functional MRI (fMRI) study. The fMRI was performed with a 3.0 Tesla MRI scanner using a finger tapping task-based activity. The subjects were instructed to perform flexion of the right thumb and left thumb consecutively (activation task) and neuronal activation in bilateral primary motor cortex (PMC) were observed during each task. One particular subject demonstrated bilateral PMC activation during the left-thumb movement task, instead of the expected activation of the contralateral PMC alone.
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Affiliation(s)
- Aida Rashid
- Department of Imaging, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Subapriya Suppiah
- Centre for Diagnostic Nuclear Imaging, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Fan Kee Hoo
- Neurology Unit, Department of Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ruziana Masiran
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Lin YH, Liang HY, Xu K, Ni HY, Dong J, Xiao H, Chang L, Wu HY, Li F, Zhu DY, Luo CX. Dissociation of nNOS from PSD-95 promotes functional recovery after cerebral ischaemia in mice through reducing excessive tonic GABA release from reactive astrocytes. J Pathol 2017; 244:176-188. [DOI: 10.1002/path.4999] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/12/2017] [Accepted: 10/12/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Yu-Hui Lin
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
| | - Hai-Ying Liang
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
| | - Ke Xu
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
| | - Huan-Yu Ni
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
| | - Jian Dong
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
| | - Hui Xiao
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
| | - Lei Chang
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
- Laboratory of Cerebrovascular Disease; Nanjing Medical University; Nanjing PR China
| | - Hai-Yin Wu
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
- Laboratory of Cerebrovascular Disease; Nanjing Medical University; Nanjing PR China
| | - Fei Li
- Department of Medicinal Chemistry, School of Pharmacy; Nanjing Medical University; Nanjing PR China
| | - Dong-Ya Zhu
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
- Laboratory of Cerebrovascular Disease; Nanjing Medical University; Nanjing PR China
| | - Chun-Xia Luo
- Department of Pharmacology, School of Pharmacy; Nanjing Medical University; Nanjing PR China
- Laboratory of Cerebrovascular Disease; Nanjing Medical University; Nanjing PR China
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Wiersma AM, Fouad K, Winship IR. Enhancing Spinal Plasticity Amplifies the Benefits of Rehabilitative Training and Improves Recovery from Stroke. J Neurosci 2017; 37:10983-10997. [PMID: 29025926 PMCID: PMC6596489 DOI: 10.1523/jneurosci.0770-17.2017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/15/2017] [Accepted: 10/01/2017] [Indexed: 12/15/2022] Open
Abstract
The limited recovery that occurs following stroke happens almost entirely in the first weeks postinjury. Moreover, the efficacy of rehabilitative training is limited beyond this narrow time frame. Sprouting of spared corticospinal tract axons in the contralesional spinal cord makes a significant contribution to sensorimotor recovery, but this structural plasticity is also limited to the first few weeks after stroke. Here, we tested the hypothesis that inducing plasticity in the spinal cord during chronic stroke could improve recovery from persistent sensorimotor impairment. We potentiated spinal plasticity during chronic stroke, weeks after the initial ischemic injury, in male Sprague-Dawley rats via intraspinal injections of chondroitinase ABC. Our data show that chondroitinase injections into the contralesional gray matter of the cervical spinal cord administered 28 d after stroke induced significant sprouting of corticospinal axons originating in the peri-infarct cortex. Chondroitinase ABC injection during chronic stroke without additional training resulted in moderate improvements of sensorimotor deficits. Importantly, this therapy dramatically potentiated the efficacy of rehabilitative training delivered during chronic stroke in a skilled forelimb reaching task. These novel data suggest that spinal therapy during chronic stroke can amplify the benefits of delayed rehabilitative training with the potential to reduce permanent disability in stroke survivors.SIGNIFICANCE STATEMENT The brain and spinal cord undergo adaptive rewiring ("plasticity") following stroke. This plasticity allows for partial functional recovery from stroke induced sensorimotor impairments. However, the plasticity that underlies recovery occurs predominantly in the first weeks following stroke, and most stroke survivors are left with permanent disability even after rehabilitation. Using animal models, our data show that removal of plasticity-inhibiting signals in the spinal cord (via intraspinal injections of the enzyme chondroitinase ABC) augments rewiring of circuits connecting the brain to the spinal cord, even weeks after stroke. Moreover, this plasticity can be harnessed by rehabilitative training to significantly promote sensorimotor recovery. Thus, intraspinal therapy may augment rehabilitative training and improve recovery even in individuals living with chronic disability due to stroke.
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Affiliation(s)
| | - Karim Fouad
- Neuroscience and Mental Health Institute
- Faculty of Rehabilitation Medicine, and
| | - Ian R Winship
- Neuroscience and Mental Health Institute,
- Neurochemical Research Unit, Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
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Wahl AS, Büchler U, Brändli A, Brattoli B, Musall S, Kasper H, Ineichen BV, Helmchen F, Ommer B, Schwab ME. Optogenetically stimulating intact rat corticospinal tract post-stroke restores motor control through regionalized functional circuit formation. Nat Commun 2017; 8:1187. [PMID: 29084962 PMCID: PMC5662731 DOI: 10.1038/s41467-017-01090-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 08/17/2017] [Indexed: 11/18/2022] Open
Abstract
Current neuromodulatory strategies to enhance motor recovery after stroke often target large brain areas non-specifically and without sufficient understanding of their interaction with internal repair mechanisms. Here we developed a novel therapeutic approach by specifically activating corticospinal circuitry using optogenetics after large strokes in rats. Similar to a neuronal growth-promoting immunotherapy, optogenetic stimulation together with intense, scheduled rehabilitation leads to the restoration of lost movement patterns rather than induced compensatory actions, as revealed by a computer vision-based automatic behavior analysis. Optogenetically activated corticospinal neurons promote axonal sprouting from the intact to the denervated cervical hemi-cord. Conversely, optogenetically silencing subsets of corticospinal neurons in recovered animals, results in mistargeting of the restored grasping function, thus identifying the reestablishment of specific and anatomically localized cortical microcircuits. These results provide a conceptual framework to improve established clinical techniques such as transcranial magnetic or transcranial direct current stimulation in stroke patients. Existing methods to improve motor function after stroke include non-specific neuromodulatory approaches. Here the authors use an automated method of analysis of reaching behaviour in rodents to show that optogenetic stimulation of intact corticospinal tract fibres leads to restoration of prior motor functions, rather than compensatory acquisition of new movements.
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Affiliation(s)
- A S Wahl
- Brain Research Institute, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland. .,Department of Health Sciences and Technology, ETH Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland. .,Central Institute of Mental Health, University of Heidelberg, J5, 68159, Mannheim, Germany.
| | - U Büchler
- Computer Vision Group, Interdisciplinary Center for Scientific Computing (IWR), University of Heidelberg, Mathematikon (INF 205), 69120, Heidelberg, Germany
| | - A Brändli
- Brain Research Institute, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland
| | - B Brattoli
- Computer Vision Group, Interdisciplinary Center for Scientific Computing (IWR), University of Heidelberg, Mathematikon (INF 205), 69120, Heidelberg, Germany
| | - S Musall
- Brain Research Institute, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland
| | - H Kasper
- Brain Research Institute, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland
| | - B V Ineichen
- Brain Research Institute, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland
| | - F Helmchen
- Brain Research Institute, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland
| | - B Ommer
- Computer Vision Group, Interdisciplinary Center for Scientific Computing (IWR), University of Heidelberg, Mathematikon (INF 205), 69120, Heidelberg, Germany
| | - M E Schwab
- Brain Research Institute, University of Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland. .,Department of Health Sciences and Technology, ETH Zurich, Winterthurerstr. 190, 8057, Zurich, Switzerland.
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Comparison of the Effect of Lateral and Backward Walking Training on Walking Function in Patients with Poststroke Hemiplegia: A Pilot Randomized Controlled Trial. Am J Phys Med Rehabil 2017; 96:61-67. [PMID: 27323323 DOI: 10.1097/phm.0000000000000541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purposes of the present study were to compare the effects of backward and lateral walking training and to identify whether additional backward or lateral walking training would be more effective in increasing the walking function of poststroke patients. DESIGN Fifty-one subjects with hemiplegic stroke were randomly allocated to 3 groups, each containing 17 subjects: the control group, the backward walking training group, and the lateral walking training group. The walking abilities of each group were assessed using a 10-m walk test and the GAITRite system for spatiotemporal gait. RESULTS The results show that there were significantly greater posttest increases in gait velocity (F = -12.09, P = 0.02) and stride length (F = -11.50, P = 0.02), decreases in the values of the 10-m walk test (F = -7.10, P = 0.03) (P < 0.05) and double-limb support period (F = 40.15, P = 0.000), and improvements in gait asymmetry (F = 13.88, P = 0.002) (P < 0.01) in subjects in the lateral walking training group compared with those in the other 2 groups. CONCLUSIONS These findings demonstrate that asymmetric gait patterns in poststroke patients could be improved by receiving additional lateral walking training therapy rather than backward walking training. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) understand the potential benefits of backward walking (BW) and lateral walking (LW) training on improving muscle strength and gait; (2) appreciate the potential value of backward and lateral walking gait training in the treatment of hemiplegic stroke patients; and (3) appropriately incorporate backward and lateral walking gait training into the treatment plan of hemiplegic stroke patients. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Sun Y, Cheng X, Wang H, Mu X, Liang Y, Luo Y, Qu H, Zhao C. dl -3- n -butylphthalide promotes neuroplasticity and motor recovery in stroke rats. Behav Brain Res 2017; 329:67-74. [DOI: 10.1016/j.bbr.2017.04.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 01/05/2023]
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47
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Ren Y, Wu YN, Yang CY, Xu T, Harvey RL, Zhang LQ. Developing a Wearable Ankle Rehabilitation Robotic Device for in-Bed Acute Stroke Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2017; 25:589-596. [DOI: 10.1109/tnsre.2016.2584003] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Parker K, Berretta A, Saenger S, Sivaramakrishnan M, Shirley SA, Metzger F, Clarkson AN. PEGylated insulin-like growth factor-I affords protection and facilitates recovery of lost functions post-focal ischemia. Sci Rep 2017; 7:241. [PMID: 28325900 PMCID: PMC5428211 DOI: 10.1038/s41598-017-00336-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/21/2017] [Indexed: 12/04/2022] Open
Abstract
Insulin-like growth factor-I (IGF-I) is involved in the maturation and maintenance of neurons, and impaired IGF-I signaling has been shown to play a role in various neurological diseases including stroke. The aim of the present study was to investigate the efficacy of an optimized IGF-I variant by adding a 40 kDa polyethylene glycol (PEG) chain to IGF-I to form PEG-IGF-I. We show that PEG-IGF-I has a slower clearance which allows for twice-weekly dosing to maintain steady-state serum levels in mice. Using a photothrombotic model of focal stroke, dosing from 3 hrs post-stroke dose-dependently (0.3–1 mg/kg) decreases the volume of infarction and improves motor behavioural function in both young 3-month and aged 22–24 month old mice. Further, PEG-IGF-I treatment increases GFAP expression when given early (3 hrs post-stroke), increases Synaptophysin expression and increases neurogenesis in young and aged. Finally, neurons (P5–6) cultured in vitro on reactive astrocytes in the presence of PEG-IGF-I showed an increase in neurite length, indicating that PEG-IGF-I can aid in sprouting of new connections. This data suggests a modulatory role of IGF-I in both protective and regenerative processes, and indicates that therapeutic approaches using PEG-IGF-I should be given early and where the endogenous regenerative potential is still high.
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Affiliation(s)
- Kim Parker
- Department of Anatomy and Brain Health Research Center, University of Otago, Dunedin 9054, New Zealand
| | - Antonio Berretta
- Department of Anatomy and Brain Health Research Center, University of Otago, Dunedin 9054, New Zealand
| | - Stefanie Saenger
- F. Hoffmann-La Roche Ltd., pRED, Pharma Research & Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, CH-4070, Basel, Switzerland
| | - Manaswini Sivaramakrishnan
- F. Hoffmann-La Roche Ltd., pRED, Pharma Research & Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, CH-4070, Basel, Switzerland
| | - Simon A Shirley
- Department of Anatomy and Brain Health Research Center, University of Otago, Dunedin 9054, New Zealand
| | - Friedrich Metzger
- F. Hoffmann-La Roche Ltd., pRED, Pharma Research & Early Development, Roche Innovation Center Basel, Grenzacherstrasse 124, CH-4070, Basel, Switzerland
| | - Andrew N Clarkson
- Department of Anatomy and Brain Health Research Center, University of Otago, Dunedin 9054, New Zealand. .,Brain Research New Zealand, University of Otago, Dunedin 9054, New Zealand. .,Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
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Wellendorph P, Jacobsen J, Skovgaard-Petersen J, Jurik A, Vogensen SB, Ecker G, Schousboe A, Krogsgaard-Larsen P, Clausen RP. γ-Aminobutyric Acid and Glycine Neurotransmitter Transporters. METHODS AND PRINCIPLES IN MEDICINAL CHEMISTRY 2017. [DOI: 10.1002/9783527679430.ch4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Petrine Wellendorph
- University of Copenhagen; Faculty of Health and Medical Sciences, Department of Drug Design and Pharmacology; Universitetsparken 2, DK-2100 Copenhagen Denmark
| | - Julie Jacobsen
- University of Copenhagen; Faculty of Health and Medical Sciences, Department of Drug Design and Pharmacology; Universitetsparken 2, DK-2100 Copenhagen Denmark
| | - Jonas Skovgaard-Petersen
- University of Copenhagen; Faculty of Health and Medical Sciences, Department of Drug Design and Pharmacology; Universitetsparken 2, DK-2100 Copenhagen Denmark
| | - Andreas Jurik
- University of Vienna; Department of Pharmaceutical Chemistry; Althanstrasse 14, A-1090 Vienna Austria
| | - Stine B. Vogensen
- University of Copenhagen; Faculty of Health and Medical Sciences, Department of Drug Design and Pharmacology; Universitetsparken 2, DK-2100 Copenhagen Denmark
| | - Gerhard Ecker
- University of Vienna; Department of Pharmaceutical Chemistry; Althanstrasse 14, A-1090 Vienna Austria
| | - Arne Schousboe
- University of Copenhagen; Faculty of Health and Medical Sciences, Department of Drug Design and Pharmacology; Universitetsparken 2, DK-2100 Copenhagen Denmark
| | - Povl Krogsgaard-Larsen
- University of Copenhagen; Faculty of Health and Medical Sciences, Department of Drug Design and Pharmacology; Universitetsparken 2, DK-2100 Copenhagen Denmark
| | - Rasmus P. Clausen
- University of Copenhagen; Faculty of Health and Medical Sciences, Department of Drug Design and Pharmacology; Universitetsparken 2, DK-2100 Copenhagen Denmark
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Wang ZR, Wang P, Xing L, Mei LP, Zhao J, Zhang T. Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients. Neural Regen Res 2017; 12:1823-1831. [PMID: 29239328 PMCID: PMC5745836 DOI: 10.4103/1673-5374.219043] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs (arms) because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor function test (WMFT) was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action performance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-OCH-12002238).
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Affiliation(s)
- Zun-Rong Wang
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Ping Wang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Liang Xing
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Li-Ping Mei
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Jun Zhao
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Tong Zhang
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
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