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Shetty GB, H L N. Scalp Acupuncture on the Immediate and Prolonged Motor Recovery in Spinal Cord Injury: a Case Report. J Acupunct Meridian Stud 2023; 16:188-192. [PMID: 37885254 DOI: 10.51507/j.jams.2023.16.5.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/01/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Spinal cord injury (SCI) is one of the main causes of lifelong motor impairment and is associated with important secondary complications. Thus, multifaceted treatments are needed for early functional recovery. Currently, in cases of SCI, surgery, stem cell treatment, medication, and physical therapy are used to repair and restore neuronal activity. Additionally, encouraging results have been reported on the use of acupuncture to modulate neuronal plasticity. Here, we present an SCI case involving a burst fracture at the L3 level, which was treated for 21 days using scalp acupuncture with residential physical therapy. Activation of the motor area was observed after the 1st day of treatment, with the patient completely regaining power and range of motion in the knees, Additionally, over 21 days, the patient exhibited markedly improved motor recovery and functional outcomes, which had not been observed over the previous six months. This report highlights the importance of complementing scalp acupuncture with intensive physical therapy for better motor recovery.
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Affiliation(s)
- Geetha B Shetty
- Department of Acupuncture and Energy Medicine, S.D.M College of Naturopathy and Yogic Sciences, Ujire, India
| | - Nanjeshgowda H L
- Department of Natural Therapeutics, S.D.M College of Naturopathy and Yogic Sciences, Ujire, India
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2
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Zu Y, Luo L, Chen X, Xie H, Yang CHR, Qi Y, Niu W. Characteristics of corticomuscular coupling during wheelchair Tai Chi in patients with spinal cord injury. J Neuroeng Rehabil 2023; 20:79. [PMID: 37330516 PMCID: PMC10276494 DOI: 10.1186/s12984-023-01203-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/11/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Wheelchair Tai Chi (WCTC) has been proved to have benefits for the brain and motor system of spinal cord injury (SCI) patients. However, the characteristics of corticomuscular coupling during WCTC are scarcely known. We aimed to investigate changes following SCI on corticomuscular coupling, and further compare the coupling characteristics of WCTC with aerobic exercise in SCI patients. METHODS A total of 15 SCI patients and 25 healthy controls were recruited. The patients had to perform aerobic exercise and WCTC, while healthy controls needed to complete a set of WCTC. The participants accomplished the test following the tutorial video in a sitting position. The upper limb muscle activation was measured from upper trapezius, medial deltoid, biceps brachii and triceps brachii with surface electromyography. Cortical activity in the prefrontal cortex, premotor cortex, supplementary motor area and primary motor cortex was simultaneously collected by functional near-infrared spectroscopy. The functional connectivity, phase synchronization index and coherence values were then calculated and statistically analyzed. RESULTS Compared to healthy controls, changes in functional connectivity and higher muscle activation were observed in the SCI group. There was no significant difference in phase synchronization between groups. Among patients, significantly higher coherence values between the left biceps brachii as well as the right triceps brachii and contralateral regions of interest were found during WCTC than during aerobic exercise. CONCLUSION The patients may compensate for the lack of corticomuscular coupling by enhancing muscle activation. This study demonstrated the potential and advantages of WCTC in eliciting corticomuscular coupling, which may optimize rehabilitation following SCI.
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Affiliation(s)
- Yangmin Zu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Laboratory of Biomechanics and Rehabilitation Engineering, School of Medicine, Tongji University, Shanghai, China
| | - Lina Luo
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Laboratory of Biomechanics and Rehabilitation Engineering, School of Medicine, Tongji University, Shanghai, China
| | - Xinpeng Chen
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Haixia Xie
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Chich-Haung Richard Yang
- Department of Physical Therapy, College of Medicine, Tzu Chi University, Hualien City, Taiwan
- Sport Medicine Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien City, Taiwan
| | - Yan Qi
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Wenxin Niu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Laboratory of Biomechanics and Rehabilitation Engineering, School of Medicine, Tongji University, Shanghai, China
- Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai, China
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3
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Kumari R, Gibson H, Jarjees M, Turner C, Purcell M, Vučković A. The predictive value of cortical activity during motor imagery for subacute spinal cord injury-induced neuropathic pain. Clin Neurophysiol 2023; 148:32-43. [PMID: 36796284 DOI: 10.1016/j.clinph.2023.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/06/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study is to explore whether cortical activation and its lateralization during motor imagery (MI) in subacute spinal cord injury (SCI) are indicative of existing or upcoming central neuropathic pain (CNP). METHODS Multichannel electroencephalogram was recorded during MI of both hands in four groups of participants: able-bodied (N = 10), SCI and CNP (N = 11), SCI who developed CNP within 6 months of EEG recording (N = 10), and SCI who remained CNP-free (N = 10). Source activations and its lateralization were derived in four frequency bands in 20 regions spanning sensorimotor cortex and pain matrix. RESULTS Statistically significant differences in lateralization were found in the theta band in premotor cortex (upcoming vs existing CNP, p = 0.036), in the alpha band at the insula (healthy vs upcoming CNP, p = 0.012), and in the higher beta band at the somatosensory association cortex (no CNP vs upcoming CNP, p = 0.042). People with upcoming CNP had stronger activation compared to those with no CNP in the higher beta band for MI of both hands. CONCLUSIONS Activation intensity and lateralization during MI in pain-related areas might hold a predictive value for CNP. SIGNIFICANCE The study increases understanding of the mechanisms underlying transition from asymptomatic to symptomatic early CNP in SCI.
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Affiliation(s)
- Radha Kumari
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
| | - Hannah Gibson
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
| | - Mohammed Jarjees
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK; Medical Instrumentation Techniques Engineering Department, Northern Technical University, Mosul 41002, Iraq
| | - Christopher Turner
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
| | - Mariel Purcell
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Aleksandra Vučković
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK.
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Kumari R, Jarjees M, Susnoschi-Luca I, Purcell M, Vučković A. Effective Connectivity in Spinal Cord Injury-Induced Neuropathic Pain. SENSORS (BASEL, SWITZERLAND) 2022; 22:6337. [PMID: 36080805 PMCID: PMC9460641 DOI: 10.3390/s22176337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
AIM The aim of this study was to differentiate the effects of spinal cord injury (SCI) and central neuropathic pain (CNP) on effective connectivity during motor imagery of legs, where CNP is typically experienced. METHODS Multichannel EEG was recorded during motor imagery of the legs in 3 groups of people: able-bodied (N = 10), SCI with existing CNP (N = 10), and SCI with no CNP (N = 20). The last group was followed up for 6 months to check for the onset of CNP. Source reconstruction was performed to obtain cortical activity in 17 areas spanning sensorimotor regions and pain matrix. Effective connectivity was calculated using the directed transfer function in 4 frequency bands and compared between groups. RESULTS A total of 50% of the SCI group with no CNP developed CNP later. Statistically significant differences in effective connectivity were found between all groups. The differences between groups were not dependent on the frequency band. Outflows from the supplementary motor area were greater for the able-bodied group while the outflows from the secondary somatosensory cortex were greater for the SCI groups. The group with existing CNP showed the least differences from the able-bodied group, appearing to reverse the effects of SCI. The connectivities involving the pain matrix were different between able-bodied and SCI groups irrespective of CNP status, indicating their involvement in motor networks generally. SIGNIFICANCE The study findings might help guide therapeutic interventions targeted at the brain for CNP alleviation as well as motor recovery post SCI.
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Affiliation(s)
- Radha Kumari
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
| | - Mohammed Jarjees
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
- Medical Instrumentation Techniques Engineering Department, Northern Technical University, Mosul 41002, Iraq
| | - Ioana Susnoschi-Luca
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
| | - Mariel Purcell
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Aleksandra Vučković
- Biomedical Engineering Research Division, University of Glasgow, Glasgow G12 8QQ, UK
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5
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Leemhuis E, Giuffrida V, De Martino ML, Forte G, Pecchinenda A, De Gennaro L, Giannini AM, Pazzaglia M. Rethinking the Body in the Brain after Spinal Cord Injury. J Clin Med 2022; 11:jcm11020388. [PMID: 35054089 PMCID: PMC8780443 DOI: 10.3390/jcm11020388] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/12/2022] [Indexed: 02/05/2023] Open
Abstract
Spinal cord injuries (SCI) are disruptive neurological events that severly affect the body leading to the interruption of sensorimotor and autonomic pathways. Recent research highlighted SCI-related alterations extend beyond than the expected network, involving most of the central nervous system and goes far beyond primary sensorimotor cortices. The present perspective offers an alternative, useful way to interpret conflicting findings by focusing on the deafferented and deefferented body as the central object of interest. After an introduction to the main processes involved in reorganization according to SCI, we will focus separately on the body regions of the head, upper limbs, and lower limbs in complete, incomplete, and deafferent SCI participants. On one hand, the imprinting of the body’s spatial organization is entrenched in the brain such that its representation likely lasts for the entire lifetime of patients, independent of the severity of the SCI. However, neural activity is extremely adaptable, even over short time scales, and is modulated by changing conditions or different compensative strategies. Therefore, a better understanding of both aspects is an invaluable clinical resource for rehabilitation and the successful use of modern robotic technologies.
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Affiliation(s)
- Erik Leemhuis
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Valentina Giuffrida
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Maria Luisa De Martino
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Giuseppe Forte
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (M.P.); Tel.: +39-6-49917633 (M.P.)
| | - Anna Pecchinenda
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Anna Maria Giannini
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
| | - Mariella Pazzaglia
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (V.G.); (M.L.D.M.); (A.P.); (L.D.G.); (A.M.G.)
- Action and Body Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (M.P.); Tel.: +39-6-49917633 (M.P.)
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Prak RF, Marsman JBC, Renken R, Tepper M, Thomas CK, Zijdewind I. Increased Ipsilateral M1 Activation after Incomplete Spinal Cord Injury Facilitates Motor Performance. J Neurotrauma 2021; 38:2988-2998. [PMID: 34491111 DOI: 10.1089/neu.2021.0140] [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: 11/12/2022] Open
Abstract
Incomplete spinal cord injury (SCI) may result in muscle weakness and difficulties with force gradation. Although these impairments arise from the injury and subsequent changes at spinal levels, changes have also been demonstrated in the brain. Blood-oxygen-level dependent (BOLD) imaging was used to investigate these changes in brain activation in the context of unimanual contractions with the first dorsal interosseous muscle. BOLD- and force data were obtained in 19 individuals with SCI (AISA Impairment Scale [AIS] C/D, level C4-C8) and 24 able-bodied controls during maximal voluntary contractions (MVCs). To assess force modulation, participants performed 12 submaximal contractions with each hand (at 10, 30, 50, and 70% MVC) by matching their force level to a visual target. MVCs were weaker in the SCI group (both hands p < 0.001), but BOLD activation did not differ between SCI and control groups. For the submaximal contractions, force (as %MVC) was similar across groups. However, SCI participants showed increased activity of the ipsilateral motor cortex and contralateral cerebellum across all contractions, with no differential effect of force level. Activity of ipsilateral M1 was best explained by force of the target hand (vs. the non-target hand). In conclusion, the data suggest that after incomplete cervical SCI, individuals remain capable of producing maximal supraspinal drive and are able to modulate this drive adequately. Activity of the ipsilateral motor network appears to be task related, although it remains uncertain how this activity contributes to task performance and whether this effect could potentially be harnessed to improve motor functioning.
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Affiliation(s)
- Roeland F Prak
- Department of Biomedical Sciences of Cells and Systems and University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Bernard C Marsman
- Department of Biomedical Sciences of Cells and Systems and University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Remco Renken
- Department of Biomedical Sciences of Cells and Systems and University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marga Tepper
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christine K Thomas
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Physiology and Biophysics and University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Inge Zijdewind
- Department of Biomedical Sciences of Cells and Systems and University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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7
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Alterations of functional connectivity between thalamus and cortex before and after decompression in cervical spondylotic myelopathy patients: a resting-state functional MRI study. Neuroreport 2021; 31:365-371. [PMID: 31609830 DOI: 10.1097/wnr.0000000000001346] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cervical spondylotic myelopathy is regarded as a chronic, special incomplete spinal cord injury, so the sensory components transmitted to thalamus decreased after distal spinal cord injury, which lead the disturbance of thalamus-cortex circuits, which might explain the alterations of clinical function of cervical spondylotic myelopathy patients. However, for lack of effective methods to evaluate the disturbance circuits and how the relative mechanism adapt to the recovery of cervical spondylotic myelopathy patients after decompression. Therefore, this study aim to explore how the possible mechanism of thalamus-cortex circuits reorganization adapt to the recovery of clinical function. METHODS Regard thalamus as the interest area, we evaluate the brain functional connectivity within 43 pre-operative cervical spondylotic myelopathy patients, 21 post-operative (after 3 months) cervical spondylotic myelopathy patients and 43 healthy controls. Functional connectivity difference between pre-/post-operative cervical spondylotic myelopathy group and healthy controls group were obtained by two independent samples t-test, and difference between pre-operative cervical spondylotic myelopathy and post-operative cervical spondylotic myelopathy group were obtained by paired t-test. Clinical function was measured via Neck Disability Index and Japanese Orthopaedic Association scores. Furthermore, Pearson correlation were used to analyse the correlation between functional connectivity values and clinical scores. RESULTS Compared with healthy controls group, pre-operative cervical spondylotic myelopathy group showed increased functional connectivity between left thalamus and bilateral lingual gyrus/cuneus/right cerebellum posterior lobe (Voxel P-value <0.01, Cluster P-value <0.05, GRF corrected); post-operative cervical spondylotic myelopathy group manifested decreased functional connectivity between right thalamus and bilateral paracentral lobe/precentral gyrus but significantly increased between right thalamus and pons/superior temporal gyrus. In comparison with pre-operative cervical spondylotic myelopathy group, post-operative cervical spondylotic myelopathy group showed increased functional connectivity between bilateral thalamus and posterior cingulate lobe, angular gyrus, medial prefrontal, but significantly decreased functional connectivity between bilateral thalamus and paracentral lobe/precentral gyrus. The functional connectivity between left thalamus and bilateral lingual gyrus/cuneus/right cerebellum posterior lobe in pre-operative cervical spondylotic myelopathy group have a significantly positive correlation with sensory Japanese Orthopaedic Association scores (r = 0.568, P < 0.001). The functional connectivity between thalamus and paracentral lobe/precentral gyrus in post-operative cervical spondylotic myelopathy group have a significantly positive correlation with upper limb movement Japanese Orthopaedic Association scores (r = 0.448, P = 0.042). CONCLUSION Pre- or post-operative cervical spondylotic myelopathy patients showed functional connectivity alteration between thalamus and cortex, which suggest adaptive changes may favor the preservation of cortical sensorimotor networks before and after cervical cord decompression, and supply the improvement of clinical function.
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Shulga A, Lioumis P, Kirveskari E, Savolainen S, Mäkelä JP. A novel paired associative stimulation protocol with a high-frequency peripheral component: A review on results in spinal cord injury rehabilitation. Eur J Neurosci 2021; 53:3242-3257. [PMID: 33738876 DOI: 10.1111/ejn.15191] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
In recent decades, a multitude of therapeutic approaches has been developed for spinal cord injury (SCI), but few have progressed to regular clinical practice. Novel non-invasive, cost-effective, and feasible approaches to treat this challenging condition are needed. A novel variant of paired associative stimulation (PAS), high-PAS, consists of non-invasive high-intensity transcranial magnetic stimulation (TMS) and non-invasive high-frequency electrical peripheral nerve stimulation (PNS). We observed a therapeutic effect of high-PAS in 20 patients with incomplete SCI with wide range of injury severity, age, and time since injury. Tetraplegic and paraplegic, traumatic, and neurological SCI patients benefited from upper- or lower-limb high-PAS. We observed increases in manual motor scores (MMT) of upper and lower limbs, functional hand tests, walking tests, and measures of functional independence. We also optimized PAS settings in several studies in healthy subjects and began elucidating the mechanisms of therapeutic action. The scope of this review is to describe the clinical experience gained with this novel PAS approach. This review is focused on the summary of our results and observations and the methodological considerations for researchers and clinicians interested in adopting and further developing this new method.
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Affiliation(s)
- Anastasia Shulga
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, Finland.,Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pantelis Lioumis
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Erika Kirveskari
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, Finland.,HUS Medical Imaging Center, Clinical Neurophysiology; Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sarianna Savolainen
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, Finland.,Validia Rehabilitation Center, Helsinki, Finland
| | - Jyrki P Mäkelä
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, University of Helsinki and Aalto University School of Science, Helsinki, Finland
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9
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Melo MC, Macedo DR, Soares AB. Divergent Findings in Brain Reorganization After Spinal Cord Injury: A Review. J Neuroimaging 2020; 30:410-427. [PMID: 32418286 DOI: 10.1111/jon.12711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/02/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022] Open
Abstract
Spinal cord injury (SCI) leads to a general lack of sensory and motor functions below the level of injury and may promote deafferentation-induced brain reorganization. Functional magnetic resonance imaging (fMRI) has been established as an essential tool in neuroscience research and can precisely map the spatiotemporal distribution of brain activity. Task-based fMRI experiments associated with the tongue, upper limbs, or lower limbs have been used as the primary paradigms to study brain reorganization following SCI. A review of the current literature on the subject shows one common trait: while most articles agree that brain networks are usually preserved after SCI, and that is not the case as some articles describe possible alterations in brain activation after the lesion. There is no consensus if those alterations indeed occur. In articles that show alterations, there is no agreement if they are transient or permanent. Besides, there is no consensus on which areas are most prone to activation changes, or on the intensity and direction (increase vs. decrease) of those possible changes. In this article, we present a critical review of the literature and trace possible reasons for those contradictory findings on brain reorganization following SCI. fMRI studies based on the ankle dorsiflexion, upper-limb, and tongue paradigms are used as case studies for the analyses.
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Affiliation(s)
- Mariana Cardoso Melo
- Biomedical Engineering Lab, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Dhainner Rocha Macedo
- Biomedical Engineering Lab, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Alcimar Barbosa Soares
- Biomedical Engineering Lab, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
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10
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Cabibel V, Hordacre B, Perrey S. Implication of the ipsilateral motor network in unilateral voluntary muscle contraction: the cross-activation phenomenon. J Neurophysiol 2020; 123:2090-2098. [DOI: 10.1152/jn.00064.2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Voluntary force production requires that the brain produces and transmits a motor command to the muscles. It is widely acknowledged that motor commands are executed from the primary motor cortex (M1) located in the contralateral hemisphere. However, involvement of M1 located in the ipsilateral hemisphere during moderate to high levels of unilateral muscle contractions (>30% of the maximum) has been disclosed in recent years. This phenomenon has been termed cross-activation. The activation of the ipsilateral M1 relies on complex inhibitory and excitatory interhemispheric interactions mediated via the corpus callosum and modulated according to the contraction level. The regulatory mechanisms underlying these interhemispheric interactions, especially excitatory ones, remain vague, and contradictions exist in the literature. In addition, very little is known regarding the possibility that other pathways could also mediate the cross-activation. In the present review, we will therefore summarize the concept of cross-activation during unilateral voluntary muscle contraction and explore the associated mechanisms and other nervous system pathways underpinning this response. A broader knowledge of these mechanisms would consequently allow a better comprehension of the motor system as a whole, as distant brain networks working together to produce the motor command.
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Affiliation(s)
- Vincent Cabibel
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - Stéphane Perrey
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
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11
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Ge Y, Pan Y, Wu Q, Dou W. A Distance-Based Neurorehabilitation Evaluation Method Using Linear SVM and Resting-State fMRI. Front Neurol 2019; 10:1105. [PMID: 31736850 PMCID: PMC6838867 DOI: 10.3389/fneur.2019.01105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/02/2019] [Indexed: 11/22/2022] Open
Abstract
During neurorehabilitation, clinical measurements are widely adopted to evaluate behavioral improvements after treatment. However, it is not able to identify or monitor the change of central nervous system (CNS) of each individual patient. Resting-state functional magnetic resonance imaging (rs-fMRI) has been widely used to investigate brain functions in healthy controls (HCs) and patients with neurological diseases, which could find functional changes following neurorehabilitation. In this paper, a distance-based rehabilitation evaluation method based on rs-fMRI was proposed. Specifically, we posit that in the functional connectivity (FC) space, patients and HCs distribute separately. Linear support vector machines (SVM) were trained on the brain networks to firstly separate patients from HCs. Second, the FC similarity between patients and HCs was measured by the L2 distance of each subject's feature vector to the separating hyperplane. Finally, statistical analysis of the distance revealed rehabilitation program induced improvements in patients and predicted rehabilitation outcomes. An rs-fMRI dataset with 22 HCs and 18 spinal cord injury (SCI) patients was utilized to validate our method. We built whole-brain networks using five atlases to test the robustness of the method and search for features under different node resolutions. The classifier successfully separated patients and HCs. Significant improvements in FC after treatment were found for the patients for all five atlases using the proposed method, which was consistent with clinical measurements. Furthermore, distance obtained from individual patient's longitudinal data showed a similar trend with each one's clinical scores, implying the possibility of individual rehabilitation outcome tracking and prediction. Our method not only provides a novel perspective of applying rs-fMRI to neurorehabilitation monitoring but also proves the potential in individualized rehabilitation prediction.
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Affiliation(s)
- Yunxiang Ge
- Department of Electronic Engineering, Tsinghua University, Beijing, China.,Beijing National Research Center for Information Science and Technology (BNRist), Beijing, China
| | - Yu Pan
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Qiong Wu
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Weibei Dou
- Department of Electronic Engineering, Tsinghua University, Beijing, China.,Beijing National Research Center for Information Science and Technology (BNRist), Beijing, China
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12
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Karr JE, Iverson GL, Berghem K, Kotilainen AK, Terry DP, Luoto TM. Complicated mild traumatic brain injury in older adults: Post-concussion symptoms and functional outcome at one week post injury. Brain Inj 2019; 34:26-33. [DOI: 10.1080/02699052.2019.1669825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Justin E. Karr
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
- Spaulding Research Institute, Boston, MA, USA
| | - Ksenia Berghem
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | | | - Douglas P. Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| | - Teemu M. Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
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13
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Smirl JD, Jones KE, Copeland P, Khatra O, Taylor EH, Van Donkelaar P. Characterizing symptoms of traumatic brain injury in survivors of intimate partner violence. Brain Inj 2019; 33:1529-1538. [DOI: 10.1080/02699052.2019.1658129] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jonathan D. Smirl
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - K. Elisabeth Jones
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paige Copeland
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Omeet Khatra
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward H. Taylor
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paul Van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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14
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Paired associative stimulation improves hand function after non-traumatic spinal cord injury: A case series. Clin Neurophysiol Pract 2019; 4:178-183. [PMID: 31886442 PMCID: PMC6921158 DOI: 10.1016/j.cnp.2019.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/11/2019] [Indexed: 01/23/2023] Open
Abstract
PAS improved hand function in 5 patients with incomplete non-traumatic tetraplegia. The effect persisted for at least 6 months after the end of the 6-week stimulation. There were no adverse effects.
Objectives Long-term paired associative stimulation (PAS) is a non-invasive combination of transcranial magnetic stimulation and peripheral nerve stimulation and leads to improved hand motor function in individuals with incomplete traumatic tetraplegia. Spinal cord injuries (SCIs) can also be induced by neurological diseases. We tested a similar long-term PAS approach in patients with non-traumatic neurological SCI. Methods In this case series, five patients with non-traumatic tetraplegia received PAS to the weaker upper limb 3 to 5 times per week for 6 weeks. Patients were evaluated by manual muscle testing (MMT) before and immediately after the therapy and at the 1- and 6-month follow-ups. Patients were also evaluated for spasticity, hand mechanical and digital dynamometry, pinch test and Box and Block test. Results MMT values of all patients improved at all post-PAS evaluations. The mean ± standard error MMT increase was 1.44 ± 0.37 points (p = 0.043) immediately after PAS, 1.57 ± 0.4 points (p = 0.043) at the 1-month follow-up and 1.71 ± 0.47 points (p = 0.043) at the 6-month follow-up. The pinch test, digital dynamometry and Box and Block test results also improved in all patients. Conclusions Long-term PAS may be a safe and effective treatment for improving hand function in patients with non-traumatic tetraplegia. Significance This is the first report demonstrating the therapeutic potential of PAS for neurological SCI.
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15
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Booker J, Sinha S, Choudhari K, Dawson J, Singh R. Predicting functional recovery after mild traumatic brain injury: the SHEFBIT cohort. Brain Inj 2019; 33:1158-1164. [DOI: 10.1080/02699052.2019.1629626] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- James Booker
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Saurabh Sinha
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Kishor Choudhari
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jeremy Dawson
- Institute of Work Psychology, University of Sheffield Management School, Sheffield, UK
| | - Rajiv Singh
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
- Osborn Neurorehabilitation Unit, Department of Rehabilitation Medicine, Sheffield Teaching Hospitals, Sheffield, UK
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16
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Mäntykoski T, Iverson GL, Renko J, Kataja A, Öhman J, Luoto TM. Violence-related traumatic brain injury. Brain Inj 2019; 33:1045-1049. [PMID: 31023103 DOI: 10.1080/02699052.2019.1606442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives: The purpose of this study was to determine the unique characteristics of violence-related traumatic brain injuries (TBI). Methods: All consecutive patients who underwent head CT due to an acute head injury (n = 3023) at the Emergency Department of Tampere University Hospital (Aug 2010-Jul 2012) were included. A detailed retrospective data collection was conducted in relation to demographics, injury-related data, premorbid health, clinical characteristics, and neuroimaging findings. Results: Patients with violence-related TBIs (n = 222) were compared to patients who sustained a TBI by other mechanisms (n = 2801). Statistically significant differences were found on age, gender, prior circulatory system disease, prior mental or behavioral disorders, chronic alcohol abuse, regular substance abuse, regular medication, alcohol intoxication at the time of injury, narcotics intoxication at the time of injury, and acute traumatic lesion on head CT. The groups did not differ on clinical signs of TBI severity. Conclusions: Young adult males with premorbid mental health history and chronic alcohol abuse are most prone to sustain a TBI due to a violence-related incident. Incidents are often related to alcohol intoxication. However, violence was not consistently associated with more severe TBIs than other mechanisms of injury.
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Affiliation(s)
| | - Grant L Iverson
- b Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA.,c Spaulding Rehabilitation Hospital , Boston , MA , USA.,d Home Base , A Red Sox Foundation and Massachusetts General Hospital Program , Boston , MA , USA
| | - Juuli Renko
- a School of Medicine , University of Tampere , Tampere , Finland
| | - Anneli Kataja
- e Medical Imaging Centre, Department of Radiology , Tampere University Hospital , Tampere , Finland
| | - Juha Öhman
- f Department of Neurosurgery , Tampere University Hospital , Tampere , Finland
| | - Teemu M Luoto
- f Department of Neurosurgery , Tampere University Hospital , Tampere , Finland
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17
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Whether Visual-related Structural and Functional Changes Occur in Brain of Patients with Acute Incomplete Cervical Cord Injury: A Multimodal Based MRI Study. Neuroscience 2018; 393:284-294. [PMID: 30326291 DOI: 10.1016/j.neuroscience.2018.10.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 01/01/2023]
Abstract
Visual-related cortex plays an important role in the process of movement. It is of great importance to clarify whether traumatic spinal cord injury (SCI), which is a typical disease that results in sensorimotor dysfunction, leads to the alteration of visual-related brain structure and function area. To address this issue, multimodality MRI was applied on eleven patients with acute incomplete cervical cord injury (ICCI) and eleven healthy controls (HCs) to explore possible structural and functional changes of the brain. Voxel-based morphometry (VBM) analysis was performed to investigate the changes in brain structure of ICCI patients. The fractional amplitude of low-frequency fluctuations (fALFF) was used to characterize changes in regional neural activities, and independent component analysis (ICA) was carried out to explore alterations in the resting-state networks (RSNs) after ICCI. We also investigated correlations among brain imaging metrics and between the metrics and clinical variables. Compared with HCs, ICCI patients exhibited significant gray matter atrophy in the left hippocampus and parahippocampal gyrus, right superior frontal gyrus (SFG), and middle frontal gyrus (MFG) and also a decrease in fALFF in the left orbitofrontal cortex (OFC). Moreover, ICCI patients exhibited decreased intra-network functional connectivity (FC) in the medial vision network (mVN). The mean fALFF value was correlated with clinical motor scores of the left extremities and the total motor scores. Our findings proved that ICCI can not only cause structural changes in visual-related brain regions, but also result in visual-related brain functional alterations, revealing the possible mechanism of the effects of visual feedback training in motor function rehabilitation of SCI patients.
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18
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Hawasli AH, Rutlin J, Roland JL, Murphy RKJ, Song SK, Leuthardt EC, Shimony JS, Ray WZ. Spinal Cord Injury Disrupts Resting-State Networks in the Human Brain. J Neurotrauma 2018; 35:864-873. [PMID: 29179629 DOI: 10.1089/neu.2017.5212] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Despite 253,000 spinal cord injury (SCI) patients in the United States, little is known about how SCI affects brain networks. Spinal MRI provides only structural information with no insight into functional connectivity. Resting-state functional MRI (RS-fMRI) quantifies network connectivity through the identification of resting-state networks (RSNs) and allows detection of functionally relevant changes during disease. Given the robust network of spinal cord afferents to the brain, we hypothesized that SCI produces meaningful changes in brain RSNs. RS-fMRIs and functional assessments were performed on 10 SCI subjects. Blood oxygen-dependent RS-fMRI sequences were acquired. Seed-based correlation mapping was performed using five RSNs: default-mode (DMN), dorsal-attention (DAN), salience (SAL), control (CON), and somatomotor (SMN). RSNs were compared with normal control subjects using false-discovery rate-corrected two way t tests. SCI reduced brain network connectivity within the SAL, SMN, and DMN and disrupted anti-correlated connectivity between CON and SMN. When divided into separate cohorts, complete but not incomplete SCI disrupted connectivity within SAL, DAN, SMN and DMN and between CON and SMN. Finally, connectivity changed over time after SCI: the primary motor cortex decreased connectivity with the primary somatosensory cortex, the visual cortex decreased connectivity with the primary motor cortex, and the visual cortex decreased connectivity with the sensory parietal cortex. These unique findings demonstrate the functional network plasticity that occurs in the brain as a result of injury to the spinal cord. Connectivity changes after SCI may serve as biomarkers to predict functional recovery following an SCI and guide future therapy.
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Affiliation(s)
- Ammar H Hawasli
- 1 Department of Neurological Surgery, Washington University School of Medicine , Saint Louis, Missouri.,2 Department of Biomedical Engineering, Washington University School of Medicine , Saint Louis, Missouri.,3 Department of Orthopedic Surgery, Washington University School of Medicine , Saint Louis, Missouri
| | - Jerrel Rutlin
- 4 Department of Mallinckrodt Institute of Radiology, Washington University School of Medicine , Saint Louis, Missouri
| | - Jarod L Roland
- 1 Department of Neurological Surgery, Washington University School of Medicine , Saint Louis, Missouri
| | - Rory K J Murphy
- 5 Department of Neurosurgery, University of California San Francisco , California
| | - Sheng-Kwei Song
- 4 Department of Mallinckrodt Institute of Radiology, Washington University School of Medicine , Saint Louis, Missouri
| | - Eric C Leuthardt
- 1 Department of Neurological Surgery, Washington University School of Medicine , Saint Louis, Missouri.,2 Department of Biomedical Engineering, Washington University School of Medicine , Saint Louis, Missouri
| | - Joshua S Shimony
- 4 Department of Mallinckrodt Institute of Radiology, Washington University School of Medicine , Saint Louis, Missouri
| | - Wilson Z Ray
- 1 Department of Neurological Surgery, Washington University School of Medicine , Saint Louis, Missouri.,2 Department of Biomedical Engineering, Washington University School of Medicine , Saint Louis, Missouri
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19
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Wegrzyk J, Ranjeva JP, Fouré A, Kavounoudias A, Vilmen C, Mattei JP, Guye M, Maffiuletti NA, Place N, Bendahan D, Gondin J. Specific brain activation patterns associated with two neuromuscular electrical stimulation protocols. Sci Rep 2017; 7:2742. [PMID: 28577338 PMCID: PMC5457446 DOI: 10.1038/s41598-017-03188-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/27/2017] [Indexed: 11/24/2022] Open
Abstract
The influence of neuromuscular electrical stimulation (NMES) parameters on brain activation has been scarcely investigated. We aimed at comparing two frequently used NMES protocols - designed to vary in the extent of sensory input. Whole-brain functional magnetic resonance imaging was performed in sixteen healthy subjects during wide-pulse high-frequency (WPHF, 100 Hz–1 ms) and conventional (CONV, 25 Hz–0.05 ms) NMES applied over the triceps surae. Each protocol included 20 isometric contractions performed at 10% of maximal force. Voluntary plantar flexions (VOL) were performed as control trial. Mean force was not different among the three protocols, however, total current charge was higher for WPHF than for CONV. All protocols elicited significant activations of the sensorimotor network, cerebellum and thalamus. WPHF resulted in lower deactivation in the secondary somatosensory cortex and precuneus. Bilateral thalami and caudate nuclei were hyperactivated for CONV. The modulation of the NMES parameters resulted in differently activated/deactivated regions related to total current charge of the stimulation but not to mean force. By targeting different cerebral brain regions, the two NMES protocols might allow for individually-designed rehabilitation training in patients who can no longer execute voluntary movements.
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Affiliation(s)
- Jennifer Wegrzyk
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France
| | | | - Alexandre Fouré
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France
| | - Anne Kavounoudias
- Aix Marseille Univ, CNRS, Laboratoire Neurosciences Intégratives et Adaptatives, UMR 7260, 13385, Marseille, France
| | | | - Jean-Pierre Mattei
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France.,AP-HM, Hôpital de Sainte Marguerite, Service de Rhumatologie, Pôle Appareil Locomoteur, 13005, Marseille, France
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France.,AP-HM, Hôpital de la Timone, CEMEREM, Pôle Imagerie Médicale, 13005, Marseille, France
| | | | - Nicolas Place
- University of Lausanne, Faculty of Biology and Medicine, Institute of Sport Sciences and Department of Physiology, Lausanne, Switzerland
| | - David Bendahan
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France
| | - Julien Gondin
- Aix Marseille Univ, CNRS, CRMBM, UMR 7339, 13385, Marseille, France. .,Institut NeuroMyoGène, Université Claude Bernard Lyon 1, INSERM U1217, CNRS UMR 5310, Villeurbanne, France.
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20
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Pan Y, Dou WB, Wang YH, Luo HW, Ge YX, Yan SY, Xu Q, Tu YY, Xiao YQ, Wu Q, Zheng ZZ, Zhao HL. Non-concomitant cortical structural and functional alterations in sensorimotor areas following incomplete spinal cord injury. Neural Regen Res 2017; 12:2059-2066. [PMID: 29323046 PMCID: PMC5784355 DOI: 10.4103/1673-5374.221165] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Brain plasticity, including anatomical changes and functional reorganization, is the physiological basis of functional recovery after spinal cord injury (SCI). The correlation between brain anatomical changes and functional reorganization after SCI is unclear. This study aimed to explore whether alterations of cortical structure and network function are concomitant in sensorimotor areas after incomplete SCI. Eighteen patients with incomplete SCI (mean age 40.94 ± 14.10 years old; male:female, 7:11) and 18 healthy subjects (37.33 ± 11.79 years old; male:female, 7:11) were studied by resting state functional magnetic resonance imaging. Gray matter volume (GMV) and functional connectivity were used to evaluate cortical structure and network function, respectively. There was no significant alteration of GMV in sensorimotor areas in patients with incomplete SCI compared with healthy subjects. Intra-hemispheric functional connectivity between left primary somatosensory cortex (BA1) and left primary motor cortex (BA4), and left BA1 and left somatosensory association cortex (BA5) was decreased, as well as inter-hemispheric functional connectivity between left BA1 and right BA4, left BA1 and right BA5, and left BA4 and right BA5 in patients with SCI. Functional connectivity between both BA4 areas was also decreased. The decreased functional connectivity between the left BA1 and the right BA4 positively correlated with American Spinal Injury Association sensory score in SCI patients. The results indicate that alterations of cortical anatomical structure and network functional connectivity in sensorimotor areas were non-concomitant in patients with incomplete SCI, indicating the network functional changes in sensorimotor areas may not be dependent on anatomic structure. The strength of functional connectivity within sensorimotor areas could serve as a potential imaging biomarker for assessment and prediction of sensory function in patients with incomplete SCI. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR-ROC-17013566).
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Affiliation(s)
- Yu Pan
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei-Bei Dou
- Department of Electronic Engineering, Tsinghua University, Beijing, China
| | - Yue-Heng Wang
- Department of Electronic Engineering, Tsinghua University, Beijing, China
| | - Hui-Wen Luo
- Department of Electronic Engineering, Tsinghua University, Beijing, China
| | - Yun-Xiang Ge
- Department of Electronic Engineering, Tsinghua University, Beijing, China
| | - Shu-Yu Yan
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Quan Xu
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yuan-Yuan Tu
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yan-Qing Xiao
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Qiong Wu
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Zhuo-Zhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Hong-Liang Zhao
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Beijing, China
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