Neural investigations of a digital-game based intervention for young Learners with mathematical developmental variability

Developmental dyscalculia (DD), a significant mathematics learning difficulty, remains under-researched in terms of its neural mechanisms and effective interventions. Few studies have examined neural changes after math interventions in young children. This study investigated these changes in thirty-two dyscalculia-at-risk (DR) and non-dyscalculia-at-risk (NDR) children following a digital game-based intervention, focusing on brain activation and network changes using graph theory metrics. NDR children were randomized into intervention and control groups. Results indicated increased activation in the inferior frontal gyrus (IFG) and intraparietal sulcus (IPS) during symbolic arithmetic tasks for both DR and NDR groups post-intervention. Conversely, both groups showed decreased IFG activation during nonsymbolic tasks. Notably, IPS activation significantly increased only for the NDR intervention group in symbolic tasks, a finding that disappeared when controlling for Total Reading, suggesting the potential influence of initial reading ability on intervention outcomes. Brain network analysis showed improved integration for the NDR intervention group, demonstrated by higher clustering coefficient and local efficiency. The DR group, however, displayed reduced local efficiency, potentially reflecting shifts in network states, or insufficient intervention dosage.

Evaluation of the impacts of neuromuscular electrical stimulation based on cortico-muscular-cortical functional network

BACKGROUND AND OBJECTIVE

Neuromuscular electrical stimulation (NMES) has been extensively applied for recovery of motor functions. However, its impact on the cortical network changes related to muscle activity remains unclear, which is crucial for understanding the changes in the collaborative working patterns within the sensory-motor control system post-stroke.

METHODS

In this research, we have integrated cortico-muscular interactions, intercortical interactions, and intramuscular interactions to propose a novel closed-loop network structure, namely the cortico-muscular-cortical functional network (CMCFN). The framework is endowed with the capability to distinguish the directionality of causal interactions and local frequency band characteristics through transfer spectral entropy (TSE). Subsequently, the CMCFN is applied to stroke patients to elucidate the potential influence of NMES on cortical physiological function changes during motor induction.

RESULTS

The results indicate that short-term modulation by NMES significantly enhanced the cortico-muscular interactions of the contralateral cerebral hemisphere and the affected upper limb (p < 0.001), while coexistence of facilitatory and inhibitory effects is observed in the intermuscular coupling across different electromyography (EMG) signals. Furthermore, following NMES treatment, the connectivity of the brain functional network is significantly strengthened, particularly in the γ frequency band (30-45 Hz), with marked improvements in the clustering coefficient and shortest path length (p < 0.001).

CONCLUSIONS

As a new framework, CMCFN offers a novel perspective for studying motor cortical networks related to muscle activity.

Enhanced Brain Functional Interaction Following BCI-Guided Supernumerary Robotic Finger Training Based on Sixth-Finger Motor Imagery

Supernumerary robotic finger (SRF) has shown unique advantages in the field of motor augmentation and rehabilitation, while the development of brain computer interface (BCI) technology has provided the possibility for direct control of SRF. However, the neuroplasticity effects of BCI-actuated SRF (BCI-SRF) training based on the "six finger" motor imagery paradigm are still unclear. This study recruited 20 healthy right-handed participants and randomly assigned them to either a BCI-SRF training group or a sham SRF training group. During the testing phase before and after 4 weeks of training, all participants were tested for SRF-finger opposition sequence behavior, resting state fMRI (rs-fMRI), and task-based fMRI (tb-fMRI). The results showed that compared with the Sham group, the BCI-SRF group improved the accuracy rate of the SRF-finger opposition sequence by 132%. The activation analysis of tb-fMRI before and after training revealed a significant increase in left middle frontal gyrus only in the BCI-SRF group. In addition, the BCI-SRF group showed an increase in FC between the right primary motor cortex and left cerebellum inferior lobe, as well as between the left middle frontal gyrus and the right precuneus lobe after training, while there was no significant change in the Sham group. In addition, only the BCI-SRF group showed a significant increase in clustering coefficients after training. Moreover, the increase in the clustering coefficients of the two groups is positively correlated with the improvement of the accuracy of the SRF-finger opposition sequences. These results indicate that the integration of BCI and SRF significantly regulates the functional interaction between motor learning and cognitive imagery brain regions, enhances the integration and processing ability of brain networks for local information, and improves human-machine interaction behavioral performance.

Exploring the interrelationship of intra- and inter-network alteration in motor recovery after stroke

Brain networks demonstrate various dynamics during recovery after a stroke. Recovery of interhemispheric interaction and balance and the occurrence of network reorganization have also been reported during stroke recovery. This study aimed to investigate the dynamics of brain networks after stroke. At the large-scale brain network level, this study focuses on determining whether changes in brain networks during the functional recovery period following a stroke, along with concurrent changes in connected networks, facilitate functional recovery. Eighty-three subacute ischemic stroke patients participated. All patients underwent resting-state functional MRI and motor function assessments at two weeks and three months after stroke onset. Intra- and inter-networks from 12 resting-state networks were extracted from functional MRI data. The interrelationship between intra-network values changes and inter-network values between the corresponding network and other networks during the recovery period was investigated. The interrelationship between the good and poor recovery subgroups was compared. The interrelationship of intra- and inter-network alterations could be observed in both groups. This interrelationship was more pronounced across multiple networks in the good recovery group compared to the poor recovery group. The group differences in the interrelationship of intra- and inter-network alteration were shown in diverse sub-networks, including cognitive and sensory networks as well as motor networks. This study suggests the importance of adopting a plasticity-oriented perspective focused on changes in intra- and inter-network connectivity throughout the entire brain rather than solely emphasizing the motor function area for predicting and treating motor function recovery.

Exploring cortical excitability in children with cerebral palsy through lower limb robot training based on MI-BCI

This study aims to compare brain activity differences under the motor imagery-brain-computer interface (MI-BCI), motor imagery (MI), and resting (REST) paradigms through EEG microstate and functional connectivity (FC) analysis, providing a theoretical basis for applying MI-BCI in the rehabilitation of children with cerebral palsy (CP). This study included 30 subjects aged 4-6 years with GMFCS II-III grade, diagnosed with CP and classified as spastic diplegia. They sequentially completed EEG signal acquisition under REST, MI, and MI-BCI conditions. Clustering analysis was used to analyze EEG microstates and extract EEG microstate temporal parameters. Additionally, the strength of brain FC in different frequency bands was analyzed to compare the differences under various conditions. Four microstate classes (A-D) were identified to best explain the datasets of three groups. Compared to REST, the average duration and coverage rate of microstate D under MI and MI-BCI significantly increased (P < 0.05), while their frequency and the coverage rate and frequency of microstate A decreased. Compared to MI, the average duration of microstate C under MI-BCI significantly decreased (P < 0.05), while the frequency of microstate B significantly increased (P < 0.05). Additionally, the transition probability results showed that other microstates under REST had a higher transition probability to microstate A, while under MI and MI-BCI, other microstates had a higher transition probability to microstate D. The brain network results revealed significant differences in brain network connectivity among REST, MI, and MI-BCI across different frequency bands. No FC differences were found between REST, MI, and MI-BCI in the α2 frequency band. In the δ and γ frequency bands, MI and MI-BCI both had greater inter-electrode connectivity strength than REST. In the θ frequency band, REST had greater inter-electrode connectivity strength than MI-BCI, while MI-BCI had greater inter-electrode connectivity strength than both REST and MI. In the α1 frequency band, MI-BCI had greater inter-electrode connectivity strength than REST, and in the β frequency band, MI-BCI had greater inter-electrode connectivity strength than MI. MI-BCI can significantly alter the brain activity patterns of children with CP, particularly by enhancing the activity intensity of EEG microstates related to attention, motor planning, and execution, as well as the brain FC strength in different frequency bands. It holds high application value in the lower limb motor rehabilitation of children with CP.

Imaging the cerebral vasculature at different scales: translational tools to investigate the neurovascular interfaces

The improvements in imaging technology opened up the possibility to investigate the structure and function of cerebral vasculature and the neurovascular unit with unprecedented precision and gaining deep insights not only on the morphology of the vessels but also regarding their function and regulation related to the cerebral activity. In this review, we will dissect the different imaging capabilities regarding the cerebrovascular tree, the neurovascular unit, the haemodynamic response function, and thus, the vascular-neuronal coupling. We will discuss both clinical and preclinical setting, with a final discussion on the current scenery in cerebrovascular imaging where magnetic resonance imaging and multimodal microscopy emerge as the most potent and versatile tools, respectively, in the clinical and preclinical context.

Disruptions of resting-state functional connectivity in post-stroke motor dysfunctions: a meta-analysis

This study aims to unravel the consistent abnormalities in functional connectivity (FC) with the primary motor cortex (M1) for post-stroke motor dysfunctions and the dynamic shifts of FC across distinct phases (acute/subacute/chronic) following stroke onset. Eleven studies with 269 stroke patients and 257 healthy controls (HCs) were included after screening articles in PubMed, Web of Science, and Embase. Voxel-wise meta-analysis and subgroup analysis on three phases after stroke onset were applied using the anisotropic effect size-signed differential mapping toolbox. Additionally, a M1-seeded FC analysis from an independent dataset with 29 stroke patients and 40 HCs was applied to validate the results of the meta-analyses. The abnormal connectivity with M1 in patients with post-stroke motor dysfunctions extended beyond motor-related regions to non-motor domains. A consistent interhemispheric connectivity reduction between M1 and motor-related regions emerged as a hallmark, persisting across different phases after stroke onset. These alterations were largely replicable through validation analysis. Our findings indicated the imbalance of connectivity in patients with post-stroke motor dysfunctions.

Rehabilitation training robot using mirror therapy for the upper and lower limb after stroke: a prospective cohort study

BACKGROUND

This prospective cohort study was designed to investigate and compare the effectiveness of rehabilitation training robots versus conventional rehabilitation training on stroke survivors by monitoring alterations in brain network of stroke patients before and after robot intervention.

METHODS

Between September 2020 and November 2021, stroke patients at four grade-A tertiary hospitals underwent limb rehabilitation training. Of the total of participants, 117 patients received conventional limb rehabilitation, 93 patients participated in upper-limb robot training, and 103 patients underwent lower-limb robot training. The measured outcomes included modified Barthel Index (MBI), Fugl-Meyer assessment subscale (FMA), and manual muscle testing (MMT). Functional magnetic resonance imaging (fMRI) was conducted on 30 patients to assess changes in the brain network. Data were mainly analyzed based on the Intention-to-Treat (ITT) principle.

RESULTS

Post-interventional analysis utilizing linear mixed models in ITT analysis revealed that the robot training group had greater enhancements compared to the conventional limb rehabilitation training group. Notably, the shoulder flexor strength (P = 0.043) was significantly higher in the upper-limb group. On the other hand, hip flexor strength (P < 0.001), hip extensor strength (P < 0.001), knee extensor strength (P = 0.013), ankle dorsiflexion strength (P < 0.001) and ankle plantarflexor strength (P < 0.001) were significantly higher in the lower-limb group. In the upper-limb group, region-of-interest (ROI) -to-ROI analysis revealed enhanced functional connectivity between the left hemisphere's motor control region and the auditory network. ROI-to-ROI analysis primarily showed enhanced interhemispheric functional connectivity in the lower-limb group, specifically between right the hemisphere's motor control region (central opercular cortex) and left hemisphere's primary motor area in the precentral gyrus.

CONCLUSIONS

According to our research findings, upper- and lower-limb rehabilitation robots demonstrated great potential in promoting motor function recovery in stroke patients. Robot-assisted training offers an alternative treatment method with comparable efficacy to traditional rehabilitation. Large-scale randomized controlled trials are needed to confirm these results.

TRIAL REGISTRATION

The study was registered on the Chinese Clinical Trial Registry (ChiCTR1800019783).

Acupuncture modulates group neural activity in patients with post stroke sensory impairment: An fMRI study based on inter-subject correlation and inter-subject functional connectivity

Sensory impairment after stroke has become an important health problem that affects the health and quality of life of patients. Acupuncture is a widely accepted method for stroke rehabilitation. The development of fMRI provides a good platform for the study of neural activity patterns induced by acupuncture, and many studies have found that acupuncture can induce special activation of the brain in stroke patients. We introduced the inter-subject functional connectivity(ISFC) method into the study of acupuncture treatment for sensory impairment after stroke to explore the group effects of acupuncture treatment and the specific mode of action of acupuncture for sensory impairment. In this study, 24 stroke patients with limb numbness and 23 healthy controls were included, and three functional magnetic resonance scans were designed, including resting state, acupuncture task state, and acupuncture-retention state(LI11 and ST36 were used during the task fMRI). The main observation was the connection changes in 50 regions of interest, including the sensory-motor network, central executive network, thalamus, cingulate gyrus, and other brain regions. The findings showed that acupuncture could cause certain patterns of neural activity in the patients. These patterns included a significant rise in ISFC within the sensory-motor network and between the sensory-motor network and the thalamus and the central executive network. When different types of acupuncture were compared, it was found that the first effect of acupuncture was mostly large-scale activation of the sensory-motor network and the thalamus. The second effect, on the other hand, was low-intensity activation in a limited range. In general, this study explored the group mechanism of acupuncture for sensory function rehabilitation after stroke and provided some help for understanding neural activity patterns from a cross-subject dimension.

Corticomuscular Coupling Alterations During Elbow Isometric Contraction Correlated With Clinical Scores: An fNIRS-sEMG Study in Stroke Survivors

The study aimed to investigate changes in corticomuscular coupling during elbow flexion and extension in stroke survivors using functional near-infrared spectroscopy (fNIRS) and surface electromyography (sEMG), and to evaluate the relationship between coupling characteristics and clinical assessment scales. This study recruited 12 stroke survivors and 12 age-matched healthy subjects, and further divided the subjects into the affected side group, healthy-side group and age-matched healthy group. They performed elbow flexion and extension tasks at 30% and 70% of the maximum voluntary contraction (MVC). The cerebral blood flow dynamics of the bilateral prefrontal cortex, motor cortex, and occipital lobe, along with sEMG signals from the biceps brachii and triceps brachii, were simultaneously recorded. At matched force levels, the fuzzy approximate entropy values of both agonist and antagonistic muscles were notably lower in the affected group compared to the healthy group (P < 0.05). The effective connectivity from the ipsilateral motor cortex to the contralateral motor cortex during elbow movements in the affected group showed a meaningful positive association with the Fugl-Meyer Assessment (FMA) scale. Additionally, the transfer entropy from the contralateral motor cortex to the agonist muscle in the affected group demonstrated a significant positive correlation with the FMA scale at 70% MVC during elbow flexion. This research identified differences in intermuscular coordination, brain network connectivity, and corticomuscular coupling between stroke survivors and healthy individuals during motor tasks and our findings suggest that it can serve as a potential quantitative marker for assessing upper limb motor function post-stroke. The relationship between these characteristics and clinical scales signifies potential quantitative assessment parameters for stroke rehabilitation, underscoring the importance of exploring corticomuscular coupling in the recovery of upper limb motor function post-stroke.

Loss of white matter tracts and persistent microglial activation in the chronic phase of ischemic stroke in female rats and the effect of miR-20a-3p treatment

Our previous studies showed that intravenous injections of the small non-coding RNA mir-20a-3p is neuroprotective for stroke in the acute phase and attenuates long-term cognitive impairment in middle-aged female rats. In this study, we evaluated postmortem brain pathology at 100+d after stroke in a set of behaviorally characterized animals. This included Sham (no stroke) controls or stroke animals that received either mir20a-3p at 4h, 24h and 70d iv post stroke (MCAo+mir20a-3p) or a scrambled oligo (MCAo+Scr). Brain volumetric features were analyzed with T2 weighted and Diffusion Tensor magnetic resonance imaging (MRI) followed by histological analysis. Principal component analysis of Fractional Anisotropy (FA)-diffusion tensor MRI measures showed that MCAo+Scr and MCAo+mir20a-3p groups differed significantly in the volume of white matter but not gray matter. Weil myelin-stained sections confirmed decreased volume of the corpus callosum, internal capsule and the anterior commissure in the ischemic hemisphere of MCAo+Scr animals compared to the non-ischemic hemisphere, while sham and MCAo+Mir-20a-3p showed no hemispheric asymmetries. The MCAo+Scr group also exhibited asymmetry in hemisphere and lateral ventricle volumes, with ventricular enlargement in the ischemic hemisphere as compared to the non-ischemic hemisphere. The numbers of microglia were significantly elevated in white matter tracts in the MCAo+Scr group, with a trend towards increased myelin phagocytic microglia in these tracts. Regression analysis indicated that performance on an episodic memory test (novel object recognition test; NORT) was associated with decreased white matter volume and increased microglial numbers. These data support the hypothesis that stroke-induced cognitive impairment is accompanied by white matter attrition and persistent microglial activation and is consistent with reports that cognitive deterioration resulting from vascular diseases, such as stroke, is associated with secondary neurodegeneration in regions distal from the initial infarction.

Cerebello-Cerebral Resting-State Functional Connectivity in Poststroke Aphasia

Introduction: The influence of the cerebellum in poststroke aphasia recovery is poorly understood. Despite the right cerebellum being identified as a critical region involved in both language and cognitive functions, little is known about functional connections between the cerebellum and bilateral cortical hemispheres following stroke. This study investigated the relationship between chronic poststroke naming deficits and cerebello-cerebral resting-state functional connectivity (FC). Methods: Twenty-five cognitively normal participants and 42 participants with chronic poststroke aphasia underwent resting-state functional magnetic resonance imaging. Participants with aphasia also underwent language assessment. We conducted regions of interest (ROI)-to-ROI analyses to investigate the FC between the right cerebellar Crus I/II (seed ROI; Cereb1r/Cereb2r) and bilateral cortical language regions and compared these results to cognitively normal controls. Single-subject connectivity parameters were extracted and used as independent variables in a stepwise multiple linear regression model associating Boston Naming Test (BNT) score with FC measures. Results: FC analyses demonstrated correlations between the right cerebellar Crus I/II and both left and right cortical regions for both cognitively normal controls and stroke participants. Additionally, aphasia severity and lesion load had an effect on the cerebello-cerebral network connectivity in participants with aphasia. In a stepwise multiple linear regression, controlling for aphasia severity, time poststroke and lesion load, FC between the right Cereb2-left Cereb1 (standardized beta [std B]= -0.255, p < 0.004), right Cereb2-right anterior MTG (std B = 0.259, p < 0.004), and the right Cereb2-left anterior STG (std B = -0.208, p < 0.018) were significant predictors of BNT score. The overall model fit was R2 = 0.786 (p = 0.001). Conclusion: Functional connections between the right cerebellum and residual bilateral cerebral hemisphere regions may play a role in predicting naming ability in poststroke aphasia.

Whole-brain functional connectivity and structural network properties in stroke patients with hemiplegia

OBJECTIVE

This study explored structural and functional alterations in the whole brain of stroke patients with hemiplegia.

METHODS

We collected multimodal magnetic resonance images of 24 patients with ischaemic stroke and 16 age-matched controls. Resting-state functional connectivity (FC) for all brain regions was evaluated. Diffusion tensor imaging was used to construct white matter structural networks, and the graph properties of the structural network were analysed using graph theory to determine group differences.

RESULTS

The ipsilesional posterior parietal cortex (PPC) in the frontoparietal network accounts for more than half of the 25 brain regions with altered FC in stroke patients. The nodal efficiency of multiple ipsilesional frontal lobes and cerebellar regions, such as the ipsilateral cerebellum 8, was reduced. The contralesional cerebellum 8 showed elevated FC with the lingual gyrus and the visual network.

CONCLUSIONS

Our results suggest that the PPC and cerebellum 8 are regions worthy of in-depth study. The cerebellum 8 may supplement deficits in motor balance function by enhancing functional congruence with the visual area.

SIGNIFICANCE

This study identified key brain regions and characteristics that exhibit structural and functional changes following stroke injury.

Reorganization of cortical individualized differential structural covariance network is associated with regional morphometric changes in chronic subcortical stroke

Patients with chronic subcortical stroke undergo regional and network morphometric reorganizations beyond the lesion site, but the interplay between network and regional reorganization remains poorly understood. We aimed to clarify the reorganization patterns of the individualized differential structural covariance networks (IDSCN) in chronic subcortical stroke and investigate their associations with regional gray matter volume (GMV) changes and functional recovery. Structural MRI from four datasets enrolled 112 patients with chronic subcortical stroke (81 male, age: 55.82 ± 7.79) and 122 matched healthy controls (HC) (74 male; age: 55.28 ± 7.54). Network-based statistics were employed to identify aberrant IDSCN, Spearman correlation was conducted to assess the association between IDSCN and regional GMV alterations, and partial correlation was utilized to investigate the association between abnormal IDSCN and functional recovery. We identified 133 connections with balanced increased and decreased IDSCN. Aberrant IDSCN involved more regions than local GMV alterations, local GMV alteration exhibited intricate correlations with IDSCN, which could explain partly IDSCN reorganization (p < 0.05, corrected). Finally, abnormal IDSCN showed a weak association with long-term clinical recovery (p < 0.01). These findings reinforce the theory of adaptive network reorganization post-stroke and suggest that IDSCN may provide further insights into cortical reorganization and functional rehabilitation beyond regional morphometric measures.

Reorganization of Dynamic Network in Stroke Patients and Its Potential for Predicting Motor Recovery

Objective: The investigation of brain functional network dynamics offers a promising approach to understanding network reorganization poststroke. This study aims to explore the dynamic network configurations associated with motor recovery in stroke patients and assess their predictive potential using multilayer network analysis. Methods: Resting-state functional magnetic resonance imaging data were collected from patients with subacute stroke within 2 weeks of onset and from matched healthy controls (HCs). Group-independent component analysis and a sliding window approach were utilized to construct dynamic functional networks. A multilayer network model was applied to quantify the switching rates of individual nodes, subnetworks, and the global network across the dynamic network. Correlation analyses assessed the relationship between switching rates and motor function recovery, while linear regression models evaluated the predictive potential of global network switching rate on motor recovery outcomes. Results: Stroke patients exhibited a significant increase in the switching rates of specific brain regions, including the medial frontal gyrus, precentral gyrus, inferior parietal lobule, anterior cingulate, superior frontal gyrus, and postcentral gyrus, compared to HCs. Additionally, elevated switching rates were observed in the frontoparietal network, default mode network, cerebellar network, and in the global network. These increased switching rates were positively correlated with baseline Fugl-Meyer assessment (FMA) scores and changes in FMA scores at 90 days poststroke. Importantly, the global network's switching rate emerged as a significant predictor of motor recovery in stroke patients. Conclusions: The reorganization of dynamic network configurations in stroke patients reveals crucial insights into the mechanisms of motor recovery. These findings suggest that metrics of dynamic network reorganization, particularly global network switching rate, may offer a robust predictor of motor recovery.

Cortical neuroprosthesis-mediated functional ipsilateral control of locomotion in rats with spinal cord hemisection

Control of voluntary limb movement is predominantly attributed to the contralateral motor cortex. However, increasing evidence suggests the involvement of ipsilateral cortical networks in this process, especially in motor tasks requiring bilateral coordination, such as locomotion. In this study, we combined a unilateral thoracic spinal cord injury (SCI) with a cortical neuroprosthetic approach to investigate the functional role of the ipsilateral motor cortex in rat movement through spared contralesional pathways. Our findings reveal that in all SCI rats, stimulation of the ipsilesional motor cortex promoted a bilateral synergy. This synergy involved the elevation of the contralateral foot along with ipsilateral hindlimb extension. Additionally, in two out of seven animals, stimulation of a sub-region of the hindlimb motor cortex modulated ipsilateral hindlimb flexion. Importantly, ipsilateral cortical stimulation delivered after SCI immediately alleviated multiple locomotor and postural deficits, and this effect persisted after ablation of the homologous motor cortex. These results provide strong evidence of a causal link between cortical activation and precise ipsilateral control of hindlimb movement. This study has significant implications for the development of future neuroprosthetic technology and our understanding of motor control in the context of SCI.

Evidence that robot-assisted gait training modulates neuroplasticity after stroke: An fMRI pilot study based on graph theory analysis

OBJECTIVES

To investigate alterations of whole-brain network after stroke and therapeutic mechanisms of robot-assisted gait training (RAGT).

METHODS

21 stroke patients and 20 healthy subjects were enrolled, with the stroke patients randomized to either control group (n = 11) or robot group (n = 10), and resting-state functional magnetic resonance imaging data were collected. The global network metrics were obtained using graph theory analysis and compared between stroke patients and healthy subjects, and the effect of the RAGT on the whole-brain networks was explored.

RESULTS

Compared to healthy subjects, area under the curve (AUC) for small-worldness (σ), clustering coefficient (Cp), global efficiency (Eg) and mean local efficiency (Eloc) were significantly lower in stroke patients, whereas AUC for characteristic path length (Lp) were significantly higher. Compared with the control group, patients in robot group showed significant improvement in lower limb motor function, balance function and walking function after intervention, with a significant reduction in the AUC of Cp. Moreover, the improvement of walking function was positively correlated with the changes of AUC of σ and Eg, and negatively correlated with the changes of AUC of Cp.

CONCLUSIONS

Small-worldness and network efficiency were significantly reduced after stroke, whereas RAGT decreased characteristic path length and promoted normalization of the whole-brain network, and this change was associated with improvement in walking function. Our findings reveal the mechanism by which RAGT regulates network reorganization and neuroplasticity after stroke.

Resting-State Functional Magnetic Resonance Imaging Reveals the Effects of rTMS on Neural Activity and Brain Connectivity After Experimental Stroke

AIMS

Limited understanding of neurobiological mechanisms of repetitive transcranial magnetic stimulation (rTMS) prevents us from choosing optimal therapeutic regimen for patients to improve therapeutic efficiency. Resting-state functional magnetic resonance imaging (rs-fMRI) has been demonstrated to obtain comparable functional readouts across species.

METHODS

Intermittent and continuous theta burst stimulation were used to stimulate ipsilesional and contralesional hemisphere, respectively, during the subacute phase after stroke. We used a rat middle cerebral artery occlusion stroke model. The amplitude of low-frequency fluctuations and functional connectivity analyses of rs-fMRI were chosen to detect neuron activity and functional connectivity. The expression of neuron activation marker c-Fos and axonal plasticity marker GAP43 was examined by an immunochemistry method to corroborate the results of rs-fMRI.

RESULTS

iTBS altered the long-term neuronal activity in bilateral sensorimotor cortex, whereas cTBS influenced immediate neuronal activity of bilateral sensorimotor cortex. In addition, cTBS enhanced interhemispheric and intrahemisheric functional connectivity in contralesional hemisphere, accompanied by axonal and dendritic remodeling in the perilesional cortical areas and contralesional homologous areas after large stroke.

CONCLUSION

rTMS exerted complex effects on brain structural and functional connectivity in addition to affecting cortical excitability. cTBS promoted the compensatory effect of contralesional hemisphere after stroke with large lesions.

Frontoparietal Structural Network Disconnections Correlate With Outcome After a Severe Stroke

Structural disconnectome analyses have provided valuable insights into how a stroke lesion results in widespread network disturbances and how these relate to deficits, recovery patterns, and outcomes. Previous analyses have primarily focused on patients with relatively mild to moderate deficits. However, outcomes vary among survivors of severe strokes, and the mechanisms of recovery remain poorly understood. This study assesses the association between lesion-induced network disconnection and outcome after severe stroke. Thirty-eight ischaemic stroke patients underwent MRI brain imaging early after stroke and longitudinal clinical follow-up. Lesion information was integrated with normative connectome data to infer individual disconnectome profiles on a localized regional and region-to-region pathway level. Ordinal logistic regressions were computed to link disconnectome information to the modified Rankin Scale after 3-6 months. Disconnections of ipsilesional frontal, parietal, and temporal cortical brain areas were significantly associated with a worse motor outcome after a severe stroke, adjusted for the initial deficit, lesion volume, and age. The analysis of the underlying pathways mediating this association revealed location-specific results: For frontal, prefrontal, and temporal brain areas, the association was primarily driven by relatively sparse intrahemispheric disconnections. In contrast, the ipsilesional primary motor cortex, the dorsal premotor cortex, and various parietal brain regions showed a remarkable involvement of either frontoparietal intrahemispheric or additionally interhemispheric disconnections. These results indicate that localized disconnection of multiple regions embedded in the structural frontoparietal network correlates with worse outcomes after severe stroke. Specifically, primary motor and parietal cortices might gain particular importance as they structurally link frontoparietal networks of both hemispheres. These data shed novel light on the significance of distinct brain networks for recovery after a severe stroke.

Analysis of brain network differences in the active, motor imagery, and passive stoke rehabilitation paradigms based on the task-state EEG

Different movement paradigms have varying effects on stroke rehabilitation, and their mechanisms of action on the brain are not fully understood. This study aims to investigate disparities in brain network and functional connectivity of three movement paradigms (active, motor imagery, passive) on stroke recovery. EEG signals were recorded from 11 S patients (SP) and 13 healthy controls (HC) during fist clenching and opening tasks under the three paradigms. Brain networks were constructed to analyze alterations in brain network connectivity, node strength (NS), clustering coefficients (CC), characteristic path length (CPL), and small-world index(S). Our findings revealed increased activity in the contralateral motor area in SP and higher activity in the ipsilateral motor area in HC. In the beta band, SP exhibited significantly higher CC in motor imagery (MI) than in active and passive tasks. Furthermore, the small world index of SP during MI tasks in the beta band was significantly smaller than in the active and passive tasks. NS in the gamma band for SP during the MI paradigm was significantly higher than in the active and passive paradigms. These findings suggest reorganization within both ipsilateral and contralateral motor areas of stroke patients during MI tasks, providing evidence for neural restructuring. Collectively, these findings contribute to a deeper understanding of task-state brain network changes and the rehabilitative mechanism of MI on motor function.

Altered cerebellar-cerebral dynamic functional connectivity in patients with pontine stroke: a resting-state fMRI study

Potential changes in patterns of dynamic functional network connections at the cerebellar-cerebral level in pontine infarction (PI) patients remain unclear. The study aimed to investigate the abnormal patterns of dynamic functional connectivity (dFC) between the cerebellar subregions within networks and regions of the cerebral cortex in patients with PI. Forty-six chronic left pontine infarction (LPI), 32 chronic right pontine infarction (RPI), and 50 healthy controls (HCs) were recruited to undergo resting-state fMRI scans. Cerebellar-cerebral dFC was characterized using the sliding window method and seed-based connectivity analyses. Correlations between altered dFC values and clinical variables (The Rey Auditory Verbal Learning Test and Flanker task) in PI patients and healthy controls were investigated. Compared with HCs, the PI groups showed significantly aberrant cerebellar-cerebral dFC between cerebellar subregions within networks and supratentorial cerebral cortex, including executive, default-mode, and motor networks. Furthermore, Correlation analysis showed a decoupling between abnormal dFC and cognitive functions in PI patients. These findings indicate that PI patients are accompanied by damage to cerebellar subregions within networks and cerebellar-cerebral pathways, which may provide a potential target for treatment or an indication of therapeutic efficacy.

Brain-Hand Function Relationships Based on Level of Grasp Function in Chronic Left-Hemisphere Stroke

BACKGROUND AND OBJECTIVE

The biomarkers of hand function may differ based on level of motor impairment after stroke. The objective of this study was to determine the relationship between resting state functional connectivity (RsFC) and unimanual contralesional hand function after stroke and whether brain-behavior relationships differ based on level of grasp function.

METHODS

Sixty-two individuals with chronic, left-hemisphere stroke were separated into three functional levels based on Box and Blocks Test performance with the contralesional hand: Low (moved 0 blocks), Moderate (moved >0% but <90% of blocks relative to the ipsilesional hand), and High (moved ≥90% of blocks relative to the ipsilesional hand).

RESULTS

RsFC in the ipsilesional and interhemispheric motor networks was reduced in the Low group compared to the Moderate and High groups. While interhemispheric RsFC correlated with hand function (grip strength and Stroke Impact Scale Hand) across the sample, contralesional RsFC correlated with hand function in the Low group and no measures of connectivity correlated with hand function in the Moderate and High groups. Linear regression modeling found that contralesional RsFC significantly predicted hand function in the Low group, while no measure correlated with hand function in the High group. Corticospinal tract integrity was the only predictor of hand function for the Moderate group and in an analysis across the entire sample.

CONCLUSIONS

Differences in brain-hand function relationships based on level of motor impairment may have implications for predictive models of treatment response and the development of intervention protocols aimed at improving hand function after stroke.

Effects of high-definition tDCS targeting individual motor hotspot with EMG-driven robotic hand training on upper extremity motor function: a pilot randomized controlled trial

BACKGROUND

Delivering HD-tDCS on individual motor hotspot with optimal electric fields could overcome challenges of stroke heterogeneity, potentially facilitating neural activation and improving motor function for stroke survivors. However, the intervention effect of this personalized HD-tDCS has not been explored on post-stroke motor recovery. In this study, we aim to evaluate whether targeting individual motor hotspot with HD-tDCS followed by EMG-driven robotic hand training could further facilitate the upper extremity motor function for chronic stroke survivors.

METHODS

In this pilot randomized controlled trial, eighteen chronic stroke survivors were randomly allocated into two groups. The HDtDCS-group (n = 8) received personalized HD-tDCS using task-based fMRI to guide the stimulation on individual motor hotspot. The Sham-group (n = 10) received only sham stimulation. Both groups underwent 20 sessions of training, each session began with 20 min of HD-tDCS and was then followed by 60 min of robotic hand training. Clinical scales (Fugl-meyer Upper Extremity scale, FMAUE; Modified Ashworth Scale, MAS), and neuroimaging modalities (fMRI and EEG-EMG) were conducted before, after intervention, and at 6-month follow-up. Two-way repeated measures analysis of variance was used to compare the training effect between HDtDCS- and Sham-group.

RESULTS

HDtDCS-group demonstrated significantly better motor improvement than the Sham-group in terms of greater changes of FMAUE scores (F = 6.5, P = 0.004) and MASf (F = 3.6, P = 0.038) immediately and 6 months after the 20-session intervention. The task-based fMRI activation significantly shifted to the ipsilesional motor area in the HDtDCS-group, and this activation pattern increasingly concentrated on the motor hotspot being stimulated 6 months after training within the HDtDCS-group, whereas the increased activation is not sustainable in the Sham-group. The neuroimaging results indicate that neural plastic changes of the HDtDCS-group were guided specifically and sustained as an add-on effect of the stimulation.

CONCLUSIONS

Stimulating the individual motor hotspot before robotic hand training could further enhance brain activation in motor-related regions that promote better motor recovery for chronic stroke.

TRIAL REGISTRATION

This study was retrospectively registered in ClinicalTrials.gov (ID NCT05638464).

Disruption of Resting-State Functional Connectivity in Acute Ischemic Stroke: Comparisons Between Right and Left Hemispheric Insults

Few resting-state functional magnetic resonance imaging (RS-fMRI) studies evaluated the impact of acute ischemic changes on cerebral functional connectivity (FC) and its relationship with functional outcomes after acute ischemic stroke (AIS), considering the side of lesions. To characterize alterations of FC of patients with AIS by analyzing 12 large-scale brain networks (NWs) with RS-fMRI. Additionally, we evaluated the impact of the side (right (RH) or left (LH) hemisphere) of insult on the disruption of brain NWs. 38 patients diagnosed with AIS (17 RH and 21 LH) who performed 3T MRI scans up to 72 h after stroke were compared to 44 healthy controls. Images were processed and analyzed with the software toolbox UF2C with SPM12. For the first level, we generated individual matrices based on the time series extraction from 70 regions of interest (ROIs) from 12 functional NWs, constructing Pearson's cross-correlation; the second-level analysis included an analysis of covariance (ANCOVA) to investigate differences between groups. The statistical significance was determined with p < 0.05, after correction for multiple comparisons with false discovery rate (FDR) correction. Overall, individuals with LH insults developed poorer clinical outcomes after six months. A widespread pattern of lower FC was observed in the presence of LH insults, while a contralateral pattern of increased FC was identified in the group with RH insults. Our findings suggest that LH stroke causes a severe and widespread pattern of reduction of brain networks' FC, presumably related to the impairment in their long-term recovery.

EEG alpha band functional brain network correlates of cognitive performance in children after perinatal stroke

Mechanisms underlying cognitive impairment after perinatal stroke could be explained through brain network alterations. With aim to explore this connection, we conducted a matched test-control study to find a correlation between functional brain network properties and cognitive functions in children after perinatal stroke. First, we analyzed resting-state functional connectomes in the alpha frequency band from a 64-channel resting state EEG in 24 children with a history of perinatal stroke (12 with neonatal arterial ischemic stroke and 12 with neonatal hemorrhagic stroke) and compared them to the functional connectomes of 24 healthy controls. Next, all participants underwent cognitive evaluation. We analyzed the differences in functional brain network properties and cognitive abilities between groups and studied the correlation between network characteristics and specific cognitive functions. Functional brain networks after perinatal stroke had lower modularity, higher clustering coefficient, higher interhemispheric strength, higher characteristic path length and higher small world index. Modularity correlated positively with the IQ and processing speed, while clustering coefficient correlated negatively with IQ. Graph metrics, reflecting network segregation (clustering coefficient and small world index) correlated positively with a tendency to impulsive decision making, which also correlated positively with graph metrics, reflecting stronger functional connectivity (characteristic path length and interhemispheric strength). Our study suggests that specific cognitive functions correlate with different brain network properties and that functional network characteristics after perinatal stroke reflect poorer cognitive functioning.

Effects of the intermittent theta burst stimulation on gait, balance and lower limbs motor function in stroke: study protocol for a double-blind randomised controlled trial with multimodal neuroimaging assessments

INTRODUCTION

Approximately, 50% of stroke survivors experience impaired walking ability 6 months after conventional rehabilitation and standard care. However, compared with upper limb motor function, research on lower limbs rehabilitation through non-invasive neuromodulation like repetitive transcranial magnetic stimulation (rTMS) has received less attention. Limited evidence exists regarding the effectiveness of intermittent theta-burst stimulation (iTBS), an optimised rTMS modality, on lower limbs rehabilitation after stroke. This study aims to evaluate the effects of iTBS on gait, balance and lower limbs motor function in stroke recovery while also exploring the underlying neural mechanisms using longitudinal analysis of multimodal neuroimaging data.

METHODS AND ANALYSIS

In this double-blinded randomised controlled trial, a total of 46 patients who had a stroke will be randomly assigned in a 1:1 ratio to receive either 15 sessions of leg motor area iTBS consisting of 600 pulses or sham stimulation over the course of 3 weeks. Additionally, conventional rehabilitation therapy will be administered following the (sham) iTBS intervention. The primary outcome measure will be the 10 m walking test. Secondary outcomes include the Fugl-Meyer assessment of the lower extremity, Timed Up and Go Test, Functional Ambulation Category Scale, Berg Balance Scale, modified Barthel Index, Mini-Mental State Examination, montreal cognitive assessment, tecnobody balance assessment encompassing both static and dynamic stability evaluations, surface electromyography recording muscle activation of the lower limbs, three-dimensional gait analysis focusing on temporal and spatial parameters as well as ground reaction force measurements, corticomotor excitability tests including resting motor threshold, motor evoked potential and recruitment curves and multimodal functional MRI scanning. Outcome measures will be collected prior to and after the intervention period with follow-up at 3 weeks.

ETHICS AND DISSEMINATION

The study has received approval from the Medical Research Ethics Committee of Wuxi Mental Health Center/Wuxi Central Rehabilitation Hospital (no. WXMHCCIRB2023LLky078). Results will be disseminated through peer-reviewed journals and scientific conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2300077431.

Neuroimaging of motor recovery after ischemic stroke - functional reorganization of motor network

The long-term motor outcome of acute stroke patients may be correlated to the reorganization of brain motor network. Abundant neuroimaging studies contribute to understand the pathological changes and recovery of motor networks after stroke. In this review, we summarized how current neuroimaging studies have increased understanding of reorganization and plasticity in post stroke motor recovery. Firstly, we discussed the changes in the motor network over time during the motor-activation and resting states, as well as the overall functional integration trend of the motor network. These studies indicate that the motor network undergoes dynamic bilateral hemispheric functional reorganization, as well as a trend towards network randomization. In the second part, we summarized the current study progress in the application of neuroimaging technology to early predict the post-stroke motor outcome. In the third part, we discuss the neuroimaging techniques commonly used in the post-stroke recovery. These methods provide direct or indirect visualization patterns to understand the neural mechanisms of post-stroke motor recovery, opening up new avenues for studying spontaneous and treatment-induced recovery and plasticity after stroke.

Dynamic Reconfiguration of Brain Functional Network in Stroke

The brain continually reorganizes its functional network to adapt to post-stroke functional impairments. Previous studies using static modularity analysis have presented global-level behavior patterns of this network reorganization. However, it is far from understood how the brain reconfigures its functional network dynamically following a stroke. This study collected resting-state functional MRI data from 15 stroke patients, with mild (n = 6) and severe (n = 9) two subgroups based on their clinical symptoms. Additionally, 15 age-matched healthy subjects were considered as controls. By applying a multilayer temporal network method, a dynamic modular structure was recognized based on a time-resolved function network. The dynamic network measurements (recruitment, integration, and flexibility) were calculated to characterize the dynamic reconfiguration of post-stroke brain functional networks, hence, revealing the neural functional rebuilding process. It was found from this investigation that severe patients tended to have reduced recruitment and increased between-network integration, while mild patients exhibited low network flexibility and less network integration. It's also noted that previous studies using static methods could not reveal this severity-dependent alteration in network interaction. Clinically, the obtained knowledge of the diverse patterns of dynamic adjustment in brain functional networks observed from the brain neuronal images could help understand the underlying mechanism of the motor, speech, and cognitive functional impairments caused by stroke attacks. The present method not only could be used to evaluate patients' current brain status but also has the potential to provide insights into prognosis analysis and prediction.

Altered static and dynamic cerebellar-cerebral functional connectivity in acute pontine infarction

This study investigates abnormalities in cerebellar-cerebral static and dynamic functional connectivity among patients with acute pontine infarction, examining the relationship between these connectivity changes and behavioral dysfunction. Resting-state functional magnetic resonance imaging was utilized to collect data from 45 patients within seven days post-pontine infarction and 34 normal controls. Seed-based static and dynamic functional connectivity analyses identified divergences in cerebellar-cerebral connectivity features between pontine infarction patients and normal controls. Correlations between abnormal functional connectivity features and behavioral scores were explored. Compared to normal controls, left pontine infarction patients exhibited significantly increased static functional connectivity within the executive, affective-limbic, and motor networks. Conversely, right pontine infarction patients demonstrated decreased static functional connectivity in the executive, affective-limbic, and default mode networks, alongside an increase in the executive and motor networks. Decreased temporal variability of dynamic functional connectivity was observed in the executive and default mode networks among left pontine infarction patients. Furthermore, abnormalities in static and dynamic functional connectivity within the executive network correlated with motor and working memory performance in patients. These findings suggest that alterations in cerebellar-cerebral static and dynamic functional connectivity could underpin the behavioral dysfunctions observed in acute pontine infarction patients.

Neonatal brain dynamic functional connectivity in term and preterm infants and its association with early childhood neurodevelopment

Brain dynamic functional connectivity characterises transient connections between brain regions. Features of brain dynamics have been linked to emotion and cognition in adult individuals, and atypical patterns have been associated with neurodevelopmental conditions such as autism. Although reliable functional brain networks have been consistently identified in neonates, little is known about the early development of dynamic functional connectivity. In this study we characterise dynamic functional connectivity with functional magnetic resonance imaging (fMRI) in the first few weeks of postnatal life in term-born (n = 324) and preterm-born (n = 66) individuals. We show that a dynamic landscape of brain connectivity is already established by the time of birth in the human brain, characterised by six transient states of neonatal functional connectivity with changing dynamics through the neonatal period. The pattern of dynamic connectivity is atypical in preterm-born infants, and associated with atypical social, sensory, and repetitive behaviours measured by the Quantitative Checklist for Autism in Toddlers (Q-CHAT) scores at 18 months of age.

Effects of anodal transcranial direct current stimulation over motor cortex on resting-state brain activity in the early subacute stroke phase: A power spectral density analysis

INTRODUCTION

Despite promising results, the effects of transcranial direct current stimulation (tDCS) in the early stages of stroke and its impact on brain activity have been poorly studied. Therefore, this study aimed to investigate the effect of tDCS applied over the ipsilesional motor cortex on resting-state brain activity in the early subacute phase of stroke.

METHODS

This is a pilot, randomized, double-blind, proof-of-concept study. The patients with stroke were randomly assigned into two groups: anodal tDCS (A-tDCS) or sham tDCS (S-tDCS). For A-tDCS, the anode was placed over the ipsilesional motor cortex, while the cathode was placed over the left or right supraorbital area (Fp2 for left stroke or Fp1 for right stroke). For the real stimulation, a constant current of 1.0 mA was delivered for 20 min and then ramped down linearly for 30 s, maintaining a resistance below 10 kΩ. For the sham stimulation, the stimulator was turned on, and the current intensity was gradually increased for 30 s, tapered off over 30 s, and maintained for 30 min without stimulation. Each stimulation was performed for three consecutive sessions with an interval of 1 h between them. The primary outcome was spectral electroencephalography (EEG) analysis based on the Power Spectral Density (PSD) determined by EEG records of areas F3, F4, C3, C4, P3, and P4. Brain Vision Analyzer software processed the signals, EEG power spectral density (PSD) was calculated before and after stimulation, and alpha, beta, delta, and theta power were analyzed. The secondary outcomes included hemodynamic variables based on the difference between baseline (D0) and post-intervention session (D1) values of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), respiratory rate (RR) and peripheral oxygen saturation (SPO2). Mann-Whitney test was used to compare position measurements of two independent samples; Fisher's exact test was used to compare two proportions; paired Wilcoxon signed-rank test was used to compare the median differences in the within-group comparison, and Spearman correlations matrix among spectral power analysis between EEG bands was performed to verify consistency of occurrence of oscillations. Statistical significance was set at P < 0.05.

RESULTS

An increase in PSD in the alpha frequency in the P4 region was observed after the intervention in the A-tDCS group, as compared to the placebo group (before = 6.13; after = 10.45; p < 0.05). In the beta frequency, an increase in PSD was observed in P4 (before = 4.40; after = 6.79; p < 0.05) and C4 (before = 4.43; after = 6.94; p < 0.05) after intervention in the A-tDCS group. There was a reduction in PSD at delta frequency in C3 (before = 293.8; after = 58.6; p < 0.05) after intervention in the A-tDCS group. In addition, it was observed a strong relationship between alpha and theta power in the A-tDCS group before and after intervention. However, the sham group showed correlations between more power bands (alpha and theta, alpha and delta, and delta and theta) after intervention. There was no difference in hemodynamic variables between the intra- (before and after stimulation) and inter-groups (mean difference).

CONCLUSION

Anodal tDCS over the ipsilesional motor cortex had significant effects on the brain electrical activity in the early subacute stroke phase, increasing alpha and beta wave activities in sensorimotor regions while reducing slow delta wave activity in motor regions. These findings highlight the potential of anodal tDCS as a therapeutic intervention in the early stroke phase.

Post-stroke upper limb recovery is correlated with dynamic resting-state network connectivity

Motor recovery is still limited for people with stroke especially those with greater functional impairments. In order to improve outcome, we need to understand more about the mechanisms underpinning recovery. Task-unbiased, blood flow-independent post-stroke neural activity can be acquired from resting brain electrophysiological recordings and offers substantial promise to investigate physiological mechanisms, but behaviourally relevant features of resting-state sensorimotor network dynamics have not yet been identified. Thirty-seven people with subcortical ischaemic stroke and unilateral hand paresis of any degree were longitudinally evaluated at 3 weeks (early subacute) and 12 weeks (late subacute) after stroke. Resting-state magnetoencephalography and clinical scores of motor function were recorded and compared with matched controls. Magnetoencephalography data were decomposed using a data-driven hidden Markov model into 10 time-varying resting-state networks. People with stroke showed statistically significantly improved Action Research Arm Test and Fugl-Meyer upper extremity scores between 3 weeks and 12 weeks after stroke (both P < 0.001). Hidden Markov model analysis revealed a primarily alpha-band ipsilesional resting-state sensorimotor network which had a significantly increased life-time (the average time elapsed between entering and exiting the network) and fractional occupancy (the occupied percentage among all networks) at 3 weeks after stroke when compared with controls. The life-time of the ipsilesional resting-state sensorimotor network positively correlated with concurrent motor scores in people with stroke who had not fully recovered. Specifically, this relationship was observed only in ipsilesional rather in contralesional sensorimotor network, default mode network or visual network. The ipsilesional sensorimotor network metrics were not significantly different from controls at 12 weeks after stroke. The increased recruitment of alpha-band ipsilesional resting-state sensorimotor network at subacute stroke served as functionally correlated biomarkers exclusively in people with stroke with not fully recovered hand paresis, plausibly reflecting functional motor recovery processes.

Uncovering the Neural Mechanisms of Inter-Hemispheric Balance Restoration in Chronic Stroke Through EMG-Driven Robot Hand Training: Insights From Dynamic Causal Modeling

EMG-driven robot hand training can facilitate motor recovery in chronic stroke patients by restoring the interhemispheric balance between motor networks. However, the underlying mechanisms of reorganization between interhemispheric regions remain unclear. This study investigated the effective connectivity (EC) between the ventral premotor cortex (PMv), supplementary motor area (SMA), and primary motor cortex (M1) using Dynamic Causal Modeling (DCM) during motor tasks with the paretic hand. Nineteen chronic stroke subjects underwent 20 sessions of EMG-driven robot hand training, and their Action Reach Arm Test (ARAT) showed significant improvement ( β =3.56, [Formula: see text]). The improvement was correlated with the reduction of inhibitory coupling from the contralesional M1 to the ipsilesional M1 (r=0.58, p=0.014). An increase in the laterality index was only observed in homotopic M1, but not in the premotor area. Additionally, we identified an increase in resting-state functional connectivity (FC) between bilateral M1 ( β =0.11, p=0.01). Inter-M1 FC demonstrated marginal positive relationships with ARAT scores (r=0.402, p=0.110), but its changes did not correlate with ARAT improvements. These findings suggest that the improvement of hand functions brought about by EMG-driven robot hand training was driven explicitly by task-specific reorganization of motor networks. Particularly, the restoration of interhemispheric balance was induced by a reduction in interhemispheric inhibition from the contralesional M1 during motor tasks of the paretic hand. This finding sheds light on the mechanistic understanding of interhemispheric balance and functional recovery induced by EMG-driven robot training.

Noninvasive cerebellar stimulation and behavioral interventions: A crucial synergy for post-stroke motor rehabilitation

BACKGROUND

Improvement of functional movements after supratentorial stroke occurs through spontaneous biological recovery and training-induced reorganization of remnant neural networks. The cerebellum, through its connectivity with the cortex, brainstem and spinal cord, is actively engaged in both recovery and reorganization processes within the cognitive and sensorimotor systems. Noninvasive cerebellar stimulation (NiCBS) offers a safe, clinically feasible and potentially effective way to modulate the excitability of spared neural networks and promote movement recovery after supratentorial stroke. NiCBS modulates cerebellar connectivity to the cerebral cortex and brainstem, as well as influences the sensorimotor and frontoparietal networks.

OBJECTIVE

Our objective was twofold: (a) to conduct a scoping review of studies that employed NiCBS to influence motor recovery and learning in individuals with stroke, and (b) to present a theory-driven framework to inform the use of NiCBS to target distinct stroke-related deficits.

METHODS

A scoping review of current research up to August 2023 was conducted to determine the effect size of NiCBS effect on movement recovery of upper extremity function, balance, walking and motor learning in humans with stroke.

RESULTS

Calculated effect sizes were moderate to high, offering promise for improving upper extremity, balance and walking outcomes after stroke. We present a conceptual framework that capitalizes on cognitive-motor specialization of the cerebellum to formulate a synergy between NiCBS and behavioral interventions to target specific movement deficits.

CONCLUSION

NiCBS enhances recovery of upper extremity impairments, balance and walking after stroke. Physiologically-informed synergies between NiCBS and behavioral interventions have the potential to enhance recovery. Finally, we propose future directions in neurophysiological, behavioral, and clinical research to move NiCBS through the translational pipeline and augment motor recovery after stroke.

Network Reorganization for Neurophysiological and Behavioral Recovery Following Stroke

Stroke continues to be the main cause of motor disability worldwide. While rehabilitation has been promised to improve recovery after stroke, efficacy in clinical trials has been mixed. We need to understand the cortical recombination framework to understand how biomarkers for neurophysiological reorganized neurotechnologies alter network activity. Here, we summarize the principles of the movement network, including the current evidence of changes in the connections and function of encephalic regions, recovery from stroke and the therapeutic effects of rehabilitation. Overall, improvements or therapeutic effects in limb motor control following stroke are correlated with the effects of interhemispheric competition or compensatory models of the motor supplementary cortex. This review suggests that future research should focus on cross-regional communication and provide fundamental insights into further treatment and rehabilitation for post-stroke patients.

The clinical effects of brain-computer interface with robot on upper-limb function for post-stroke rehabilitation: a meta-analysis and systematic review

PURPOSE

Many recent clinical studies have suggested that the combination of brain-computer interfaces (BCIs) can induce neurological recovery and improvement in motor function. In this review, we performed a systematic review and meta-analysis to evaluate the clinical effects of BCI-robot systems.

METHODS

The articles published from January 2010 to December 2020 have been searched by using the databases (EMBASE, PubMed, CINAHL, EBSCO, Web of Science and manual search). The single-group studies were qualitatively described, and only the controlled-trial studies were included for the meta-analysis. The mean difference (MD) of Fugl-Meyer Assessment (FMA) scores were pooled and the random-effects model method was used to perform the meta-analysis. The PRISMA criteria were followed in current review.

RESULTS

A total of 897 records were identified, eight single-group studies and 11 controlled-trial studies were included in our review. The systematic analysis indicated that the BCI-robot systems had a significant improvement on motor function recovery. The meta-analysis showed there were no statistic differences between BCI-robot groups and robot groups, neither in the immediate effects nor long-term effects (p > 0.05).

CONCLUSION

The use of BCI-robot systems has significant improvement on the motor function recovery of hemiparetic upper-limb, and there is a sustaining effect. The meta-analysis showed no statistical difference between the experimental group (BCI-robot) and the control group (robot). However, there are a few shortcomings in the experimental design of existing studies, more clinical trials need to be conducted, and the experimental design needs to be more rigorous.Implications for RehabilitationIn this review, we evaluated the clinical effects of brain-computer interface with robot on upper-limb function for post-stroke rehabilitation. After we screened the databases, 19 articles were included in this review. These articles all clinical trial research, they all used non-invasive brain-computer interfaces and upper-limb robot.We conducted the systematic review with nine articles, the result indicated that the BCI-robot system had a significant improvement on motor function recovery. Eleven articles were included for the meta-analysis, the result showed there were no statistic differences between BCI-robot groups and robot groups, neither in the immediate effects nor long-term effects.We thought the result of meta-analysis which showed no statistic difference was probably caused by the heterogenicity of clinical trial designs of these articles.We thought the BCI-robot systems are promising strategies for post-stroke rehabilitation. And we gave several suggestions for further research: (1) The experimental design should be more rigorous, and describe the experimental designs in detail, especially the control group intervention, to make the experiment replicability. (2) New evaluation criteria need to be established, more objective assessment such as biomechanical assessment, fMRI should be utilised as the primary outcome. (3) More clinical studies with larger sample size, novel external devices, and BCI systems need to be conducted to investigate the differences between BCI-robot system and other interventions. (4) Further research could shift the focus to the patients who are in subacute stage, to explore if the early BCI training can make a positive impact on cerebral cortical recovery.

A Generalized Cortico-Muscular-Cortical Network to Evaluate the Effects of Three-Week Brain Stimulation

OBJECTIVE

Post-stroke transcranial magnetic stimulation (TMS) has gradually become a brain intervention to assist patients in the recovery of motor function. The long lasting regulatory of TMS may involve the coupling changes between cortex and muscles. However, the effects of multi-day TMS on motor recovery after stroke is unclear.

METHODS

This study proposed to quantify the effects of three-week TMS on brain activity and muscles movement performance based on a generalized cortico-muscular-cortical network (gCMCN). The gCMCN-based features were further extracted and combined with the partial least squares (PLS) method to predict the Fugl-Meyer of upper extremity (FMUE) in stroke patients, thereby establishing an objective rehabilitation method that can evaluate the positive effects of continuous TMS on motor function.

RESULTS

We found that the improvement of motor function after three-week TMS was significantly correlated with the complexity trend of information interaction between hemispheres and the intensity of corticomuscular coupling. In addition, the fitting coefficient ([Formula: see text]) for predicted and actual FMUE before and after TMS were 0.856 and 0.963, respectively, suggesting that the gCMCN-based measurement may be a promising method for evaluating the therapeutic effect of TMS.

CONCLUSION

From the perspective of a novel brain-muscles network with dynamic contraction as the entry point, this work quantified TMS-induced connectivity differences while evaluating the potential efficacy of multi-day TMS.

SIGNIFICANCE

It provides a unique insight for the further application of intervention therapy in the field of brain diseases.

Cortical effects of wrist tendon vibration during an arm tracking task in chronic stroke survivors: An EEG study

The purpose of this study was to characterize changes in cortical activity and connectivity in stroke survivors when vibration is applied to the wrist flexor tendons during a visuomotor tracking task. Data were collected from 10 chronic stroke participants and 10 neurologically-intact controls while tracking a target through a figure-8 pattern in the horizontal plane. Electroencephalography (EEG) was used to measure cortical activity (beta band desynchronization) and connectivity (beta band task-based coherence) with movement kinematics and performance error also being recorded during the task. All participants came into our lab on two separate days and performed three blocks (16 trials each, 48 total trials) of tracking, with the middle block including vibration or sham applied at the wrist flexor tendons. The order of the sessions (Vibe vs. Sham) was counterbalanced across participants to prevent ordering effects. During the Sham session, cortical activity increased as the tracking task progressed (over blocks). This effect was reduced when vibration was applied to controls. In contrast, vibration increased cortical activity during the vibration period in participants with stroke. Cortical connectivity increased during vibration, with larger effect sizes in participants with stroke. Changes in tracking performance, standard deviation of hand speed, were observed in both control and stroke groups. Overall, EEG measures of brain activity and connectivity provided insight into effects of vibration on brain control of a visuomotor task. The increases in cortical activity and connectivity with vibration improved patterns of activity in people with stroke. These findings suggest that reactivation of normal cortical networks via tendon vibration may be useful during physical rehabilitation of stroke patients.

Patient-specific modeling for guided rehabilitation of stroke patients: the BrainX3 use-case

BrainX3 is an interactive neuroinformatics platform that has been thoughtfully designed to support neuroscientists and clinicians with the visualization, analysis, and simulation of human neuroimaging, electrophysiological data, and brain models. The platform is intended to facilitate research and clinical use cases, with a focus on personalized medicine diagnostics, prognostics, and intervention decisions. BrainX3 is designed to provide an intuitive user experience and is equipped to handle different data types and 3D visualizations. To enhance patient-based analysis, and in keeping with the principles of personalized medicine, we propose a framework that can assist clinicians in identifying lesions and making patient-specific intervention decisions. To this end, we are developing an AI-based model for lesion identification, along with a mapping of tract information. By leveraging the patient's lesion information, we can gain valuable insights into the structural damage caused by the lesion. Furthermore, constraining whole-brain models with patient-specific disconnection masks can allow for the detection of mesoscale excitatory-inhibitory imbalances that cause disruptions in macroscale network properties. Finally, such information has the potential to guide neuromodulation approaches, assisting in the choice of candidate targets for stimulation techniques such as Transcranial Ultrasound Stimulation (TUS), which modulate E-I balance, potentiating cortical reorganization and the restoration of the dynamics and functionality disrupted due to the lesion.

Rehabilitation Modulates High-Order Interactions Among Large-Scale Brain Networks in Subacute Stroke

The recovery of motor functions after stroke is fostered by the functional integration of large-scale brain networks, including the motor network (MN) and high-order cognitive controls networks, such as the default mode (DMN) and executive control (ECN) networks. In this paper, electroencephalography signals are used to investigate interactions among these three resting state networks (RSNs) in subacute stroke patients after motor rehabilitation. A novel metric, the O-information rate (OIR), is used to quantify the balance between redundancy and synergy in the complex high-order interactions among RSNs, as well as its causal decomposition to identify the direction of information flow. The paper also employs conditional spectral Granger causality to assess pairwise directed functional connectivity between RSNs. After rehabilitation, a synergy increase among these RSNs is found, especially driven by MN. From the pairwise description, a reduced directed functional connectivity towards MN is enhanced after treatment. Besides, inter-network connectivity changes are associated with motor recovery, for which the mediation role of ECN seems to play a relevant role, both from pairwise and high-order interactions perspective.

Disability and persistent motor deficits are linked to structural crossed cerebellar diaschisis in chronic stroke

Brain imaging has significantly contributed to our understanding of the cerebellum being involved in recovery after non-cerebellar stroke. Due to its connections with supratentorial brain networks, acute stroke can alter the function and structure of the contralesional cerebellum, known as crossed cerebellar diaschisis (CCD). Data on the spatially precise distribution of structural CCD and their implications for persistent deficits after stroke are notably limited. In this cross-sectional study, structural MRI and clinical data were analyzed from 32 chronic stroke patients, at least 6 months after the event. We quantified lobule-specific contralesional atrophy, as a surrogate of structural CCD, in patients and healthy controls. Volumetric data were integrated with clinical scores of disability and motor deficits. Diaschisis-outcome models were adjusted for the covariables age, lesion volume, and damage to the corticospinal tract. We found that structural CCD was evident for the whole cerebellum, and particularly for lobules V and VI. Lobule VI diaschisis was significantly correlated with clinical scores, that is, volume reductions in contralesional lobule VI were associated with higher levels of disability and motor deficits. Lobule V and the whole cerebellum did not show similar diaschisis-outcome relationships across the spectrum of the clinical scores. These results provide novel insights into stroke-related cerebellar plasticity and might thereby promote lobule VI as a key area prone to structural CCD and potentially involved in recovery and residual motor functioning.

Graph analysis of cortical reorganization after virtual reality-based rehabilitation following stroke: a pilot randomized study

Introduction

Stroke is the leading cause of functional disability worldwide. With the increase of the global population, motor rehabilitation of stroke survivors is of ever-increasing importance. In the last decade, virtual reality (VR) technologies for rehabilitation have been extensively studied, to be used instead of or together with conventional treatments such as physiotherapy or occupational therapy. The aim of this work was to evaluate the GestureCollection VR-based rehabilitation tool in terms of the brain changes and clinical outcomes of the patients.

Methods

Two groups of chronic patients underwent a rehabilitation treatment with (experimental) or without (control) complementation with GestureCollection. Functional magnetic resonance imaging exams and clinical assessments were performed before and after the treatment. A functional connectivity graph-based analysis was used to assess differences between the connections and in the network parameters strength and clustering coefficient.

Results

Patients in both groups showed improvement in clinical scales, but there were more increases in functional connectivity in the experimental group than in the control group.

Discussion

The experimental group presented changes in the connections between the frontoparietal and the somatomotor networks, associative cerebellum and basal ganglia, which are regions associated with reward-based motor learning. On the other hand, the control group also had results in the somatomotor network, in its ipsilateral connections with the thalamus and with the motor cerebellum, which are regions more related to a purely mechanical activity. Thus, the use of the GestureCollection system was successfully shown to promote neuroplasticity in several motor-related areas.

Reduced Segregation of Brain Networks in Spatial Neglect After Stroke

Background/Purpose: To investigate the association between the degree of spatial neglect and the changes of brain system segregation (SyS; i.e., the ratio of the extent to which brain networks interact internally and with each other) after stroke. Methods: A cohort of 20 patients with right hemisphere lesion was submitted to neuropsychological assessment as well as to resting-state functional magnetic resonance imaging session at acute stage after stroke. The severity of spatial neglect was quantified using the Center of Cancellation (CoC) scores of the Bells cancellation test. For each patient, resting-state functional connectivity (FC) matrices were assessed by implementing a brain parcellation of nine networks that included the visual network, dorsal attention network (DAN), ventral attention network (VAN), sensorimotor network (SMN), auditory network, cingulo-opercular network, language network, frontoparietal network, and default mode network (DMN). For each patient and each network, we then computed the SyS derived by subtracting the between-network FC from the within-network FC (normalized by the within-network FC). Finally, for each network, the CoC scores were correlated with the SyS. Results: The correlational analyses indicated a negative association between CoC and SyS in the DAN, VAN, SMN, and DMN (q < 0.05 false discovery rate [FDR]-corrected). Patients with more severe spatial neglect exhibited lower SyS and vice versa. Conclusion: The loss of segregation in multiple and specific networks provides a functional framework for the deficits in spatial and nonspatial attention and motor/exploratory ability observed in neglect patients.

Brain Topological Reorganization Associated with Visual Neglect After Stroke

Background/Purpose: To identify brain hubs that are behaviorally relevant for neglect after stroke as well as to characterize their functional architecture of communication. Methods: Twenty acute right hemisphere damaged patients underwent neuropsychological and resting-state functional magnetic resonance imaging sessions. Spatial neglect was assessed by means of the Center of Cancellation on the Bells Cancellation Test. For each patient, resting-state functional connectivity matrices were derived by adopting a brain parcellation scheme consisting of 153 nodes. For every node, we extracted its betweenness centrality (BC) defined as the portion of all shortest paths in the connectome involving such node. Then, neglect hubs were identified as those regions showing a high correlation between their BC and neglect scores. Results: A first set of neglect hubs was identified in multiple systems including dorsal attention and ventral attention, default mode, and frontoparietal executive-control networks within the damaged hemisphere as well as in the posterior and anterior cingulate cortex. Such cortical regions exhibited a loss of BC and increased (i.e., less efficient) weighted shortest path length (WSPL) related to severe neglect. Conversely, a second group of neglect hubs found in visual and motor networks, in the undamaged hemisphere, exhibited a pathological increase of BC and reduction of WSPL associated with severe neglect. Conclusion: The topological reorganization of the brain in neglect patients might reflect a maladaptive shift in processing spatial information from higher level associative-control systems to lower level visual and sensory-motor processing areas after a right hemisphere lesion.

Posterior parietal cortical areas and recovery after motor stroke: a scoping review

Brain imaging and electrophysiology have significantly enhanced our current understanding of stroke-related changes in brain structure and function and their implications for recovery processes. In the motor domain, most studies have focused on key motor areas of the frontal lobe including the primary and secondary motor cortices. Time- and recovery-dependent alterations in regional anatomy, brain activity and inter-regional connectivity have been related to recovery. In contrast, the involvement of posterior parietal cortical areas in stroke recovery is poorly understood although these regions are similarly important for important aspects of motor functioning in the healthy brain. Just in recent years, the field has increasingly started to explore to what extent posterior parietal cortical areas might undergo equivalent changes in task-related activation, regional brain structure and inter-regional functional and structural connectivity after stroke. The aim of this scoping review is to give an update on available data covering these aspects and thereby providing novel insights into parieto-frontal interactions for systems neuroscience stroke recovery research in the upper limb motor domain.

Protocol for a single-blind randomized clinical trial to test the efficacy of bilateral transcranial magnetic stimulation on upper extremity motor function in patients recovering from stroke

BACKGROUND

No consensus currently exists regarding the optimal protocol for repetitive transcranial magnetic stimulation (rTMS) treatment of upper-extremity motor dysfunction after stroke. Studies have shown that combined low- and high-frequency stimulation (LF-HF-rTMS) of the bilateral cerebral hemispheres is more effective than sham stimulation or stimulation of one cerebral hemisphere alone in treating motor dysfunction in the subacute stage of stroke. The efficacy of this protocol in the convalescence phase of stroke has rarely been reported, and its mechanism of action has not been clarified. In this study, we designed a prospective, single-blind, randomized controlled trial to investigate the efficacy and safety of different stimulation regimens for the treatment of upper extremity motor disorders in patients with convalescent stage stroke and aimed to explore the underlying mechanisms based on biomarkers such as brain-derived neurotrophic factor (BDNF).

METHODS

Seventy-six subjects will be randomly divided into combined, low-frequency, high-frequency, and control groups based on the proportion of 1:1:1:1, with 19 cases in each group. All groups will have conventional rehabilitation, on top of which the combined group will receive 1 Hz rTMS in the unaffected hemisphere and 10 Hz rTMS in the affected hemisphere. The low-frequency group will be administered 1 Hz rTMS in the unaffected hemisphere and sham stimulation in the contralateral hemisphere. The high-frequency group will be administered 10 Hz rTMS in the affected hemisphere and contralateral sham stimulation. The control group will receive bilateral sham stimulation. Assessments will be performed at baseline, after 2 weeks of treatment, and at post-treatment follow-up at week 6. The primary outcomes are FMA-UE (Fugl-Meyer assessment-upper extremity), latency, and serum BDNF levels. The secondary outcomes are the National Institute of Health Stroke Scale (NIHSS), Brunnstrom staging (BS), modified Ashworth scale (MAS), Modified Barthel Index (MBI), central motor conduction time (CMCT), precursor proteins of mature BDNF (proBDNF), and matrix metalloproteinase-9 (MMP-9) levels. Adverse events, such as headaches and seizures, will be recorded throughout the study.

DISCUSSION

The findings of this study will help develop optimal stimulation protocols for motor recovery in stroke patients and identify biomarkers that respond to post-stroke motor rehabilitation, for better guidance of clinical treatment.

TRIAL REGISTRATION

The study protocol was passed by the Medical Research Ethics Committee of the General Hospital of Ningxia Medical University on January 1, 2022 (no. KYLL-2021-1082). It was registered into the Chinese Clinical Trials Registry on May 22, 2022 (no. ChiCTR2200060201). This study is currently in progress.

Structural Integrity of the Cerebellar Outflow Tract Predicts Long-Term Motor Function After Middle Cerebral Artery Ischemic Stroke

BACKGROUND

The cerebellum plays a crucial role in functional movement by influencing sensorimotor coordination and learning. However, the effects of cortico-cerebellar connectivity on the recovery of upper extremity motor function after stroke have not been investigated. We hypothesized that the integrity of the cortico-cerebellar connections would be reduced in patients with a subacute middle cerebral artery (MCA) stroke, and that this reduction may help to predict chronic upper extremity motor function.

METHODS

We retrospectively analyzed the diffusion-tensor imaging of 25 patients with a subacute MCA stroke (mean age: 62.2 ± 2.7 years; 14 females) and 25 age- and sex-matched healthy controls. We evaluated the microstructural integrity of the corticospinal tract (CST), dentatothalamocortical tract (DTCT), and corticopontocerebellar tract (CPCT). Furthermore, we created linear regression models to predict chronic upper extremity motor function based on the structural integrity of each tract.

RESULTS

In stroke patients, the affected DTCT and CST showed significantly impaired structural integrity compared to unaffected tracts and the tracts in controls. When all models were compared, the model that used the fractional anisotropy (FA) asymmetry indices of CST and DTCT as independent variables best predicted chronic upper extremity motor function (R2 = .506, P = .001). The extent of structural integrity of the CPCT did not significantly differ between hemispheres or groups and was not predictive of motor function.

CONCLUSIONS

We found evidence that microstructural integrity of the DTCT in the subacute phase of an MCA stroke helped to predict chronic upper extremity motor function, independent of CST status.

Test-retest reliability of fNIRS in resting-state cortical activity and brain network assessment in stroke patients

Resting-state functional near infrared spectroscopy (fNIRS) scanning has attracted considerable attention in stroke rehabilitation research in recent years. The aim of this study was to quantify the reliability of fNIRS in cortical activity intensity and brain network metrics among resting-state stroke patients, and to comprehensively evaluate the effects of frequency selection, scanning duration, analysis and preprocessing strategies on test-retest reliability. Nineteen patients with stroke underwent two resting fNIRS scanning sessions with an interval of 24 hours. The haemoglobin signals were preprocessed by principal component analysis, common average reference and haemodynamic modality separation (HMS) algorithm respectively. The cortical activity, functional connectivity level, local network metrics (degree, betweenness and local efficiency) and global network metrics were calculated at 25 frequency scales × 16 time windows. The test-retest reliability of each fNIRS metric was quantified by the intraclass correlation coefficient. The results show that (1) the high-frequency band has higher ICC values than the low-frequency band, and the fNIRS metric is more reliable than at the individual channel level when averaged within the brain region channel, (2) the ICC values of the low-frequency band above the 4-minute scan time are generally higher than 0.5, the local efficiency and global network metrics reach high and excellent reliability levels after 4 min (0.5 < ICC < 0.9), with moderate or even poor reliability for degree and betweenness (ICC < 0.5), (3) HMS algorithm performs best in improving the low-frequency band ICC values. The results indicate that a scanning duration of more than 4 minutes can lead to high reliability of most fNIRS metrics when assessing low-frequency resting brain function in stroke patients. It is recommended to use the global correction method of HMS, and the reporting of degree, betweenness and single channel level should be performed with caution. This paper provides the first comprehensive reference for resting-state experimental design and analysis strategies for fNIRS in stroke rehabilitation.

Brain network characteristics between subacute and chronic stroke survivors in active, imagery, passive movement task: a pilot study

Background

The activation patterns and functional network characteristics between stroke survivors and healthy individuals based on resting-or task-state neuroimaging and neurophysiological techniques have been extensively explored. However, the discrepancy between stroke patients at different recovery stages remains unclear.

Objective

To investigate the changes in brain connectivity and network topology between subacute and chronic patients, and hope to provide a basis for rehabilitation strategies at different stages after stroke.

Methods

Fifteen stroke survivors were assigned to the subacute group (SG, N = 9) and chronic group (CG, N = 6). They were asked to perform hand grasping under active, passive, and MI conditions when recording EEG. The Fugl-Meyer Assessment Upper Extremity subscale (FMA_UE), modified Ashworth Scale (MAS), Manual Muscle Test (MMT), grip and pinch strength, modified Barthel Index (MBI), and Berg Balance Scale (BBS) were measured.

Results

Functional connectivity analyses showed significant interactions on frontal, parietal and occipital lobes connections in each frequency band, particularly in the delta band. The coupling strength of premotor cortex, M1, S1 and several connections linked to frontal, parietal, and occipital lobes in subacute subjects were lower than in chronic subjects in low alpha, high alpha, low beta, and high beta bands. Nodal clustering coefficient (CC) analyses revealed that the CC in chronic subjects was higher than in subacute subjects in the ipsilesional S1 and occipital area, contralesional dorsolateral prefrontal cortex and parietal area. Characteristic path length (CPL) analyses showed that CPL in subacute subjects was lower than in chronic subjects in low beta, high beta, and gamma bands. There were no significant differences between subacute and chronic subjects for small-world property.

Conclusion

Subacute stroke survivors were characterized by higher transfer efficiency of the entire brain network and weak local nodal effects. Transfer efficiency was reduced, the local nodal role was strengthened, and more neural resources needed to be mobilized to perform motor tasks for chronic survivors. Overall, these results may help to understand the remodeling pattern of the brain network for different post-stroke stages on task conditions and the mechanism of spontaneous recovery.